Let’s face it, most of us don’t get ourselves into therapy until we are so broken and desperate we can barely get ourselves to the office. We are in a state of extreme need and vulnerability (usually), and the last thing on our minds is interviewing our own therapist. We want answers, and we want help, and we want it now!!!
I understand; I have been there. That is why I am giving you a list you can bring with you to your first two or three sessions so that you can really make an informed decision about how well you and your therapist are a fit. If the first session, you are in total crisis, don’t worry! You can ask these questions any time. But the sooner, the better. It is awful to get into a therapy and then realize you don’t like this therapist, don’t find them helpful, or, even worse, that they don’t like or ‘get’ you.
Remember that your therapist is YOUR hire. You are paying them to render a service, and you are in charge. If you like or don’t like what they are doing, talk to them about it! Just like with hairdressers or massage therapists, monogamy is not required. It’s therapy, not marriage.
OK, then. Here are some excellent questions to ask:
1) What professional organization(s) do you belong to? A mature and successful professional will always want to be part of a professional group larger than themselves. Professional groups provide leadership, advocacy and ongoing education to their members. Really invested professional trauma therapists should belong to at least one professional trauma organization such as the International Society for the Study of Stress and Dissociation (ISSTD); the International Society for Traumatic Stress Studies (ISTSS); the American Professional Psychology Division 56 (Division of Trauma Psychology) or one of many others. Hopefully they also belong to their local professional chapter: for social workers NASW, for psychologists, APA, the AMA if they are a psychiatrist, and so on. If they rattle off a bunch of names and letters you do not understand that is probably a good sign. They all have websites. Feel free to check them out. Many of these organizations have their own lists of providers. If they are expert presenters for these organizations, even better!
2) Do you have any special certification or training in Trauma therapy? Good answers:
Specialized supervision (regular meetings to review cases and learn from them) provided by an experienced trauma therapist or internships in trauma treatment centers. ISSTD and other organizations offer specialized courses and certifications. Also, the American Academy of Experts in Traumatic Stress certify practitioners in a number of traumatic specialty areas including crisis response, child, etc. based on their accomplishments and years of work in the field.
No. Or I understand trauma because I had a lot of it. Or I’m a good therapist and good therapists can treat anything (run away).
Trauma therapy is an advanced practice specialty area that always requires special training to be good at. You wouldn’t go to a general family doctor for a heart attack, so don’t think that any therapist can do this work. They can’t and may do you more harm than good.
3) Do you understand and treat dissociative disorders?
A surprising number of therapists have never been taught to work with dissociative disorders, don’t recognize them when they see them, and can waste years of patients’ time (not to mention money) by this lack of understanding. Dissociative disorders and traumas go hand in hand. There is even a dissociative subtype for PTSD in the latest diagnostic manual (DSM 5). If you know you have lots of trauma, or lack a significant portion of childhood memories (dissociative amnesia) you have a higher likelihood of a false and unhelpful diagnosis if your therapist does not specialize in trauma and dissociation. Common misdiagnoses are bipolar disorder, borderline personality disorder and schizophrenia.
4) Have you completed your own course of therapy?
This is an awkward but TOTALLY FAIR question, one, quite frankly, that I wish more people would ask. In the good old days, in the heyday of amazing long term therapy, it was considered on the verge of malpractice and utter ignorance not to complete one’s own therapy before embarking on treating other people. Now it is rather the norm. Very few therapists I supervise have had much of their own treatment.
There is a misconception out there that therapists are sicker than the general population and become therapists to cure themselves. After 40 years in the field, I do not subscribe to this idea. Almost everyone in society has been exposed to trauma and mental illness in their families. Very few of those people want to understand it and go on to help others – those special few are therapists.
But being a psychotherapist working with traumatized people is an incredibly challenging calling. It’s easy to make mistakes, mostly unconscious or ignorant ones. So it is important that the therapist has had enough of their own therapy to understand how their own mind defends itself and operates unconsciously so that they can work well with other minds. This is a long and arduous task requiring many hours of training and work over a period of years.
So don’t be put off by a therapist who had a lengthy therapy themselves. Chances are good that somebody in therapy for 10 years will be a much better therapist than someone who went to treatment for six months and called it ‘good’.
5) Do you believe that people can have repressed memories of trauma that they recall later in their life?
There has been a big debate in the media about this, but in the world of professional trauma therapy the debate has been over for a while. The answer is “yes, of course”. Jennifer Freyd, cognitive psychologist at the University of Oregon, and editor of the ISSTD journal, did a great deal of work in the area of what she calls “betrayal trauma”, the trauma inflicted by a caregiver. She has showed in numerous studies that the closer the relationship of the abuser to the abused, the more likely the victim will have traumatic amnesia for the event.
If memories start to surface in your therapy, you will want to make sure that you will be believed and helped. It is extremely poor therapy to answer ‘no’ to this question, because that indicates the presence of dogma and a closed mind. You may have some very challenging and unusual things to tell your therapist, and you need to trust that they can hear those things and continue to work with you in a safe and containing way.
If you don’t feel like you can ask these questions in person, there is always email! Or go to your therapist’s website and investigate them deeply. You will save yourself some emotional distress and money by being proactive in your search for a truly helpful trauma therapist. Good luck!
Susan answers all of these questions in the affirmative and would be happy to answer more here!
“It is very tempting to take the side of the perpetrator…All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain. The victim demands action, engagement, and remembering.”
~ Judith Herman
From 1989-1993 I worked in Massachusetts for the Child-At-Risk Hotline at Judge Baker Children’s Center, in the Longwood Medical Area. We covered the entire state after hours for reports of suspected child abuse and neglect when the departments of investigation were closed for the day and on weekends. I was a supervisor, which meant that every single suspected case of abuse or neglect was “run by” me. With the screener’s help I determined whether it was a case that was false, probably true or so emergently true that we had to take action that very shift.
Children’s lives and well-being hung in the balance so we were very highly trained and conscientious in our work. Over that period I estimate that I heard somewhere around 15,000 stories of child abuse. I developed a very good BS detector.
Like many I had heard vague allegations about Dylan Farrow when she was a child, but it was hard to know what to think and why the case had not been prosecuted.
This week’s publication of her letter to the New York Times has changed all that for me.
Since it was published last week there has been a firestorm of responses and conversations popping up all over social media, some helpful and others not so much.
As a child abuse prevention professional and a treater of many adult victims of childhood trauma I would like to add my perspective. I believe Dylan. Her story is coherent, believable and internally consistent.
Let’s look at the list of secondary gains that each side gets from lying. For Woody and Dylan there are reasons to lie and reasons to tell the truth. There are also many reasons not to.
She gets attention in the press. She and her family is vilified in the media.
She gets people to feel sorry for her Her credibility is forever tarnished
in the eyes of friends, employers, etc.
She’s going for a book or movie deal? Her accused is a Hollywood insider.
She could be sued for defamation.
Maybe I lack imagination but I’m already out of reasons for her to lie about this. Usually when people tell big lies there is a big positive payoff. I don’t see it here. Do you? The Cons are overwhelmingly negative and threaten to ruin her life. Just to be a somebody in the press? There are easier ways. OK, let’s look at the other side.
He keeps making movies He gets a clean conscience (if he’s not
He keeps all his money He may need to pay a lot of money in a
People keep loving him and his work People will be revulsed by him and his work
He keeps his relationships He loses friends and business contacts
The Romans used to ask an important question, Qui Bono? Who benefits here? Dylan suffers more by lying than she gains. Woody suffers more by telling the truth by far. Lying is in his best interest as it is in the case of most perpetrators. Even if we look at just dollars and profit motive, Dylan stands to lose more than she gains by lying where the opposite is true with Woody. It is incredibly hard to win lawsuits against perpetrators, especially when there was no original conviction.
But what about the argument her mother made her do it by “implanting” memories. Oh please! Maybe (maybe!!! although I’ve never seen it in decades of practice) a seven year old could be persuaded. But an adult knows better. Mind control is possible, but it requires years of skilled training to do and the only experts in the world are black ops top secret level psy military people who do not publish manuals. Occam’s razor suggests that this argument is full of giant holes. Like smoke and fire, reports of abuse almost always coincide with actual abuse!
As for Woody, well we already know him as a man with exceedingly poor boundaries and someone who acts without considering the consequences for those around him by marrying his long-term partner, Mia’s teenaged daughter. Everyone who “testified” for him at the awards show (wasn’t that strange) talked about all the roles he had written for women, not anything about his character. I had the sense that the women supposedly speaking on his behalf were really speaking on their own interests. But having said that perps are exceedingly good at getting people to believe them. And the longer the friendship, the harder to see the perp inside the man.
If you look at the Herman quote above you will see why. I have written in The Trauma Tool Kit how the mind wants to avoid material it sees as threatening to its own sense of security and comfort. Contemplating that your best loved films were created by a monster creates a level of cognitive dissonance that most people cannot handle.
But, you see, we must. Because this is one story among millions. Every day there are victims who tell the truth and are shut out of their families because the perpetrator is believed. Because the people they tell will not or cannot tolerate a change in perspective and a re-ordering of their own lives and view of reality.
Our culture is sick. I agree with the neo-feminists who talk of the ‘rape culture’ in which we live. All over the world from time out of mind women and children have been raped, dominated and treated like property. Men have relied on each other to maintain power, to satisfy their lusts and desires and do what they want. Just because they can. For humanity to evolve, this has to end. That means TELLING THE TRUTH, no matter how unpleasant or personally uncomfortable that makes us. After all, it could be your daughter or son, neighbor, friend or cousin who is the next victim.
Only then will the real healing begin for individuals and society as whole.
As for me, I’m breaking up with Woody and all his films. I wish Dylan a sense of wholeness, peace and healing for her future. She has suffered enough.
Wow. What a week we have had. Shutdowns, debt ceilings, the PSATs if you are a Junior in high school. Tempers are flaring. There is a lot of doomsday rhetoric. A lot of DRAMA.
In The Trauma Tool Kit, I talk about how drama is not drama, it’s trauma. People are traumatized in this country. We are collectively traumatized by an unstable economy, by escalating natural disasters, by regular but unpredictable mass shootings, by increasingly mean spirited exchanges on the internet and in the media, by our own unresolved issues of sexual abuse, physical abuse, emotional violence and neglect.
Unfortunately, most people have not matured much past their early 20s in terms of their emotional self-management. If we do not do our work, heal our own wounds, those wounds get projected out into the world and onto other people and groups. As long as we think someone else is causing our suffering, we can legitimately be involved in blame, shame and finger-pointing. DRAMA.
This self-work, the work of enlightening our own minds, healing ourselves and becoming mature human beings is HARD. It is so much easier to be sarcastic, cynical and fearful, to hug our guns both metaphorical and literal. Maturity means having empathy for others, even when their point of view is different than ours. Maturity means restraint, tolerating difficult feelings without acting them out. Maturity means mutual respect even if you loathe what the other person is saying to you.
We need to grow a lot more maturity in this country or the rhetoric will continue to devolve. At some point that hateful rhetoric could spill into violence. Do we really want the bloodshed, mayhem and trauma that comes with acting out, with our continuing lack of maturity as human beings?
How do we do this? How do we grow up? The answer is simple, but not easy.
First we have to become disillusioned with fighting and realize that peace and justice come from within first, not from our side winning.
Second, we have to go inside and acknowledge that hateful feelings lurk within our own minds. We need to tame the raging beast of our traumas through meditation, restraint, insight and all of the healing methods outlined in my book The Trauma Tool Kit.
Third, we need to implement what we have learned and act in the world from that peaceful and centered place. Even after all my years of therapy, meditation, yoga, and healing, I still have to do my daily work of remembering what I know.
I have to choose peace, each and every single day.
Won’t you join me? Please. We could use some more mature adults around here.
This summer I lost my friend, teacher and mentor, Shannon Kelly. Many who knew him called him Shannon the Shaman. But Shannon was many things. He identified as a “Bubba”, a regular guy who grew up in the South hunting, drinking and loving the outdoors. As a single father to three children, he was deeply committed to parenting as best he could. For me, he was one of the best therapists and supervisors I had the pleasure to work with (he was the first therapist in Portland I met who knew what reaction formation was, and he was an accomplished Ericksonian therapist). Prior to his “coming out” as shaman, he worked 25 years as a mental health professional.
Our first session together was bodywork, held up in the tiny little room down the hall from his kids’ bedrooms (to make ends meet he always worked in his house those first years). Bodywork from a therapist? Actually, he had dropped the mantle of therapist long before, but not the knowledge, as his work expanded into broader and deeper realms. He had fully embraced the knowledge of himself as shaman after calling a Northwest Native American tribe. The woman who had answered the phone had not picked up a phone in ten years. She was the medicine woman and he asked to meet with her. Fresh from the Southwest, guided to work in the Northwest and pursue shamanism by a vision of red-tailed hawks, Shannon asked her who the best teacher for him might be. As the story goes, she laughed and laughed and then told him to look in the mirror.
As I was lying on the table, feeling his large hands elongate into even larger hairy bear claws (yes, he validated chuckling, bear medicine was his main access) I had a very strange sensation.
Shannon, I’m feeling weird. I feel all this sadness leaving my body, but somehow it doesn’t feel connected to me.
That’s because it’s not yours.
Lesson #1: Many of the emotions we carry around with us aren’t even ours.
Wow. That first session was a mind blower. I had been told before that I tend to carry other people’s “stuff” around with me, but until I could actually feel it leaving I really didn’t understand the power and detriment of it. At that point I had been in human services for over 20 years, not to mention my own family’s “stuff” so there was a lot to let go of. I felt immediately lighter after that and subsequent sessions, and the feelings of release persisted. Once we feel what is not ours and let go of it, it becomes easier to stay clear and to know and work with what is really our stuff and what isn’t.
During that first bodywork session I started feeling light and fluttery like I would just float away off the table. This was a familiar feeling, but because Shannon’s energy was so powerful, it became even more pronounced. I had started to feel a familiar dizziness when Shannon placed large river rocks under my hands and feet. The feelings immediately subsided and I felt a really wonderful sense of being calmly present throughout the rest of my session. I loved the sensation of solid rock underneath me and began to breathe more deeply as I relaxed.
Lesson #2: Get and stay grounded
My gymnastics teacher in middle school used to call me Pixie Fairy because I ran on my toes, and no matter what she said, she just couldn’t get me to muster a proper run to the vault. Maybe it’s a result of some of my earlier trauma, maybe it’s my celtic fairy blood, maybe it’s all the air signs in my astrological chart, but for whatever reason being grounded was always tremendously challenging for me, when I even knew what that meant! As I have said in my book, The Trauma Tool Kit: Healing PTSD From the Inside Out, being ungrounded is necessary at times for visionaries, high creative and healers, but we cannot live there. If we are not grounded we are not in touch with our bodies, our emotions and our earthly selves. As long as we are living on Earth, we need a grounded, functioning ego. We need to fully inhabit our body and all of our senses. When we don’t, anxiety fills up the void.
Shannon was very insistent on this point and wasn’t afraid to use tools like big honkin’ river rocks to get me there.
I had been taught by earlier therapists and supervisors to talk about anything and everything that came into my head. This technique came directly from Freud, who discovered the say anything approach of free association was a “royal road” to unconsciously repressed material in the psyche that caused neurosis and mood disorders. So, of course, I wanted to excitedly process all my experiences and thoughts. Shannon listened patiently for a while, and then in a booming mountain man voice said, GET OUT OF YOUR HEAD.
Lesson #3: Your thoughts aren’t as important as you think they are, and they may not even be your thoughts.
Shannon explained. We cannot solve our feelings at the level of our thoughts, and our thoughts distract us and get in the way of getting grounded and releasing. This can result in headaches, malaise, exhaustion and anxiety. If this pattern persists, it can lead to profound depression.
It turns out that he was exactly right from a neuroscience perspective. The cortex, the thinking part of the brain that is all wrinkly and sits on top, has only a few pathways that work themselves down deeper into the emotional brain, the mammalian part called the limbic brain. The limbic brain, on the other hand, has a bazillion ways to communicate its urgent messages to the cortex. This arrangement helps the organism to survive in the environment. For example, if you see a rattlesnake moving towards you on the path do you debate what kind it is, or just jump out of the way with your heart beating hard? I rest my case. (There may be those genetic anomalies that would debate the snake, but they may not survive to have offspring.)
This is why we cannot talk nor affirm ourselves out of our feelings. You can try and try to think of reasons to be happy when you are sad, but does it really work? If it works at all, it only works for a brief period of time. Until the fundamental conflict that is affecting the limbic brain is resolved or released, there will be no peace in our thoughts. The limbic brain is hardwired to the senses and body. Even our sense of smell, our olfactory bulb, is actually part of the limbic brain!
Unless thoughts and words are grounded in the reality of the body and awareness through all the senses, we are just spinning out meaningless stories that can distract us from the work at hand. Actually, I realized later, I was trained to look for overthinking as a therapist. In psychodynamic therapy this phenomenon is called “intellectualizing” and it is classified as an ego defense that affects those who like to experience the world through thoughts and the intellect.
But the important thing I gradually came to understand was that, just as many of the feelings in my body weren’t actually mine, neither were the thoughts.
~ to be continued
Children can be particularly vulnerable to distressing weather and events. Even children that were not directly affected will be deeply disturbed by these community wide disasters. Most parents have not been taught to look for signs that children are under stress, or even intense stress. This blog, by request, will give you some tips on helping your children recover from the devastating tornadoes in the midwest.
First know that your child is stressed. Some signs that children are stressed include:
- repetitive talk about the event
- repetitive drawing of the event
- unusually irritable
- unusually withdrawn
- needy and clingy
- more forgetful than usual
- having trouble regulating emotions: laughing silly “highs” crash into sullen “lows”
- hair-pulling (trichotillomania)
- disturbed eating
- disturbed sleep
We forget what it is like to be a child. Under 14 years of age, children have some awareness that they cannot survive without adult assistance; this is especially true for very young children. Children watch their parents very carefully and take their cues from them about whether they should be upset or not. In addition children have losses in the storm that adults may trivialize or not realize the depth of the loss. For instance, a parent may not know that a stuffed animal was more like a best friend, or that a destroyed work of their art has taken away a precious sense of self. Because parents are suffering their own losses and in survival mode they may not feel like children are dealing with anything significant, but, of course, they are.
Here are some ways to help your child heal in the aftermath:
1) Limit media exposure of the event. Adults tend to watch traumatic events obsessively but we know from 9/11 that this can create traumas in kids who may not understand that they are seeing the same event repeated rather than several different events. TV may make them think the world is ending
2) Set some “processing” time aside every day for your kids where they can express their feelings. Young children (3yrs-8yrs) might be encouraged to color, draw a picture, or engage in puppet play. 8-12 years olds might want more information about storms, or just to spend time playing games. (Experienced child therapists know that most kids need to be occupied with a game or activity in order to talk about their feelings.) Teenagers may be able to sit and talk if they are mature, and are invited to participate in a judgment free zone. Also, ball throwing and basketball hoop shooting are excellent ways to get kids to open up. During this time turn off your phone and your own agendas and create a lot of space to just listen or answer questions.
3) Try to keep a normal rhythm to the day, even if you are in a shelter. Have regular mealtimes, structured activities and a bed time.
4) Speaking of bedtime, be aware that sleep may be difficult at first. Kids may be having unpleasant dreams processing the storm. Be patient and non-judgmental about this, while helping maintain a schedule.
5) Monitor your own reactions. Calm yourself down as much as possible. Do not share horrible new stories with your kids or in earshot of them. They will be alarmed but will not tell you.
6) Understand that quiet kids may not be OK. Invite them to play with you or help you with simple chores. Reinforce any sharing with your attention and love.
7) Provide lots of hugs and affection. Take time for yourself and for them. You both need the contact!
8) If your child has a pronounced behavioral change reach out for professional help ASAP. Red Cross will have referrals for free and low-income therapy professionals.
9) Be active in reassuring your children that life will get better. Hold the optimism for them, even if you are feeling discouraged. This is kind and wise parenting.
10) Lastly, cultivate patience! Be patient with your kids and be patient with the city and be patient with yourself. Stop and breathe as needed. Practice self-care and stay aware of your own needs! Then you won’t resist the children’s needs when they are up.
Know that there are so many of us pulling for all of you and your kids. Our hearts go out to yours. Be well and be safe!
I wrote this post so that those without PTSD can begin to understand and so that those with PTSD know that someone else has been there before. I do not have PTSD any longer. WARNING: MAY BE TRIGGERING.
I wake up groggy, with remnants of a bad night’s sleep still clinging to me. I don’t want to go back to sleep, but I’m not sure I can face the day either. I cannot remember my dreams, but I know they weren’t good. Last night I didn’t yell in a nightmare and disrupt my husband’s badly needed sleep. That, at least is good. I cannot remember the last time sleep felt refreshing. Now it feels like another form of deprivation, another instrument of suffering, another of the myriad losses of PTSD. I wonder if I will ever have a good night’s sleep again.
My joints and gut ache as they do every day now as I push myself up to sit on the side of my bed. If I don’t move slowly I risk dizziness. Lately my body doesn’t seem to know where it is in space. I have bruises that I don’t remember getting from bumping into doorways, edges of tables and chairs. It’s like having the PMS clumsies all the time. The bruises don’t hurt though. On the contrary, I hardly feel them. It’s the pain inside that absorbs all my attention. I breathe, attempting, without success to ground myself before beginning my day.
My kids are waiting for breakfast and a ride to school so I need to get a move on. Every day my prayer is the same. Please let me be a good mother. Help me protect them from what I am going through. Give me the strength to do what I need to and I will deal with my PTSD later. It doesn’t always help, and guilt over bad mommy moments is a constant companion these days.
Mornings are particularly bad with PTSD. It is as if someone has gone through my sensory system and turned up all the knobs to high. Light stabs my eyeballs making me squint with pain. Sounds are amplified as if I am in an echo chamber. Internal feelings and emotions can rev to highs and lows with no warning. I keep a very zen environment. The kids know not to talk too loud, bang their plates or scrape their forks. My husband is encouraged to leave the kitchen without cleaning it because the running water sounds like white noise in my head. We keep the lights low. I never know how bad it is going to be and they don’t either. Fortunately, my kids are not morning people either. They move slowly and quietly. I worry that I’ve become too controlling, but the stakes are too high to do anything different.
I’ve tried to explain what it is like to live in this body now to my very calm, stoic Lutheran raised midwestern husband. If there is a superpower for nerves of steel, he has it. My husband deals with life and death in his cath lab on a daily basis. He works in the space of millimeters for hours on end to open blocked hearts when his patients’ only alternative is life threatening surgery or certain death. He has not experienced PTSD or any mental affliction. His mental health and stability is both an asset and a hazard in our relationship. Sometimes I just need him to lose it on my behalf, to show that he really, really gets it.
I explain to him that on bad days I feel like I have ground glass running throughout my nervous system with sharp jaggedy edges. I explain how triggers make me want to jump out of my skin and how that jump is always accompanied by intense emotion, either a tornado of disintegrating rage, or fear or both. I explain how I know what some of my triggers are, but that every day, as I work through my healing in therapy, new ones are popping out and that we can both be caught off guard. I want him to understand that the constant flow of adrenaline makes me look alert and energized on the outside but that inside I feel exhausted. Wired and tired is how I put it. The foot is full throttle on the gas pedal, but the car is stuck in neutral. (I look for good manly analogies.) I explain that I need him to not react to my irritation and anger, to not take it personally, that it is only the PTSD rearing its ugly head. He nods his head with understanding, but the next time he does take it personally. And why wouldn’t he? Another source of guilt and rage for me. And a source of fragility for our marriage, a marriage that has always been strong. Is PTSD going to take this away from me too?
Normally couples can make up with physical intimacy. But even the least little bit of this comfort is now denied me. When the PTSD first hit, even hugging through two layers of flannel pajamas made me nauseous and dizzy. That initial shock has settled into a distant sort of numbness. I hug out of habit, but I can’t really feel it. I can’t feel my connection to myself or to him. The only connection that is safe for me is the kids. Thank goodness I can still feel my love for them. I realize that it is possible that my husband has become a trigger. But I’m not sure. Is it him? Or is it the trigger? Is our marriage viable? I have no idea, and I have to live with that uncertainty for months, and so does he. I decide not to decide until I have progressed in my healing.
After everyone leaves for the day, I face hours alone, just me and my PTSD. I am both relieved and terrified. Some days are better than others. Some days I have therapy with the shaman therapist. He is helpful and powerful, and there is no state he cannot bring me out of. I am very, very lucky to have him as a resource. Still, there are many hours to fill.
With PTSD I am never really happy. I miss simple happiness. I miss joy. I take my dogs on a walk and watch them run with abandon, big wild dog joy grins on their faces. On a good day, my insides feel like a grey, shadowless Portland winter day, flat and featureless. On a bad day, a howling storm is raging that threatens to obliterate me. Unless I am in the bleakest place I will myself to do my job as mother and housemaker: cook something, clean something, pay something. Self-care and hygiene is no longer a natural act, but something that must be chosen and willed every day. When I am in the darkest states, I curl up for hours on the sofa waiting for my next therapy appointment.
Fortunately, I did not just fall off the turnip truck. I have had a lot of training and life experience. I can meditate. I can do breathing exercises. I can walk (until I have a very bad skiing accident, but that is another story). I know by virtue of my age and therapy that this too shall pass, that there is no way I can stay in this state forever, that I am working actively on my healing. Sometimes this helps, and sometimes it really doesn’t.
PTSD taunts me with loneliness. If I had cancer, or some other major medical illness, if I were a victim of a current crime or in a car accident or had something visibly wrong with me, people would know. People would sympathize, maybe bring over a casserole, send a card, check in with me or take me to lunch. But nobody knows. I cannot talk about my disability because to talk about it makes me feel much, much worse. Talking about it makes my head spin and my stomach want to retch. Even if I could stand to see the look on people’s face when I tried to talk about my condition, most of them, like my good husband, would not really understand. They might nod their heads politely and say that time heals all wounds, or that I should be grateful for what I have now. I might have to kill them for that. Or myself. So I remain silent and withdraw unnoticed. I go to school events, put on a brave face and then crawl into bed exhausted.
If I am lucky I make it through the day without any major triggers. But it feels like walking daily through a mine field. At the end of the day I lose myself briefly in spending time with my happy amazing kids. I manage to stay focused on them and their needs until their bedtime. But then I am used up and collapse on the sofa exhausted. I have nothing left for my spouse. I try to look back over my day and find one thing to feel good about. Sometimes I succeed. Sometimes I just want to hurt myself. I watch these moods come and go with the experienced eye of a therapist and meditator. It doesn’t mean it’s easy though.
I have no idea how people make it through without the level of support that I have, and then I realize that many of them don’t make it.
Bedtime comes, and with it, intense dread. I used to love bedtime. I couldn’t wait to snuggle down into flannel sheets, cozy up to my hubbie and drift off feeling our warm connection. Now we sleep on the edges of the bed. I tell him I love him, but please don’t touch me. Trained doctor that he is, he falls asleep instantly. I am left with the final battle of the day.
Sometimes I can fall asleep easily sometimes I can’t. But I never stay asleep. Every 90 minutes like clockwork, my mind and body pop out of sleep. It is exhausting. REM sleep is where our bodies process intense emotion and memories. I think about how waking people up before REM sleep is a torture that can result in psychosis. As I slip into the dream state the nightmares come. They are bad. Sometimes they are screaming and striking out in my sleep bad. But more often I wake up before I can even have them, a new conditioned response that is out of my control. I meditate. I do yoga to relax and start over. I read. Sometimes these things help and sometimes they do not.
I don’t know if tomorrow will be any better, but I hope it will. And when I can’t hope I endure.
When I was in high school and the world’s population was at about 4 billion, I saw a video about an experiment in rat overcrowding. The researchers showed very clearly that up until a certain population the rats were civil, harmonious and happy. When they became overcrowded, the rats turned on each other and a cycle of violence began. I remembered wondering where that tipping point was for humanity.
Today the world’s population stands at about 7 billion, ready to top 8 billion in the next decade. I cannot help but wonder if the world is getting too crowded to maintain civil societies. At least in the old models.
Fortunately, we are not rats. We are human beings with a plethora of ingenious human tools at our disposal, the foremost being a thinking, self-reflective brain. We can not only reshape our environment, we can also reshape our bodies, personalities and even our own brains.
Clearly, it is time to evolve.
What would it take to stop the violence?
Currently it is popular to blame religion for violence. But I don’t buy it. Historically, nationalism was blamed for wars. But we didn’t abolish nations, nor could we. Anymore than we can abolish religion. The search for God and religion seems to be hardwired into the very fabric of humanity. And that’s potentially a good thing. Innumerable hospitals, orphanages, and other charitable endeavors have been supported by large religious bodies.
Look, I’m a therapist. I’ve spent a lifetime peering into the hidden mechanisms of human consciousness. I’ve worked with victims and perpetrators of violence, religious, atheist, you name it.
And the root of violence is pretty simple. The recipe is this: take a human ego, prone to intense biological impulses like sex and aggression, add a dose of rejection, violence, or trauma and withhold empathy, attachment and kindness. Don’t forget to add the testosterone, or all that violence will turn inwards. This is the basic formula; there are of course endless ways to “spice” things up. Anything that disinhibits a human helps: drugs, a charismatic leader, any kind of reward real or imagined, spiritual or material. You get the picture.
When the world becomes an overall less kinder place to be, when governments exist to punish and control rather than support, when adults are too busy trying to survive than to connect, when children are subjected to all manner of abuse growing up, when basic needs are withheld (food, shelter, education), then we can be sure the rise of violence is around the corner.
My little piece of contribution centers around psychological trauma. Like the tipping point for rat populations, I believe that there is a tipping point for the number of citizens with untreated abuse and trauma issues that starts to unravel societies and the fabric of civilization gets weak, gauzy and prone to tears.
That is why I wrote The Trauma Tool Kit: Healing PTSD From the Inside Out. But one book is not enough to stem the tide.
If we want to turn this around we need the biggest investment in our humanity the world has ever seen.
Our healthcare system is broke.
Out educational system is broke.
Our national aggression is disproportionately funded.
PTSD is a national (and global) epidemic.
Our TV and media is a wasteland of violence, sex and empty, puerile stories aimed at the basest nature of humans.
Adults can’t find meaningful work or time to connect.
Children can’t get their emotional needs met so they are turning to early sex, drugs, computers and violent videogames.
Like the global climate crisis we are in, we are in a crisis of our own humanity.
We need to ask ourselves: what does it mean to be human? Are we living lifestyles that are in alignment with our values and ideals, or have we given up?
The answers are simple. Accomplishing them requires insight, wisdom and the will of the people.
1) Convert from a permanent wartime economy to a peace economy. Stop trying to control the world and get back to taking care of American citizens.
2) Reinstate the important status of mothers in the world by funding them to stay home with their children as needed. Working mothers is a redundant, and obnoxious term. We need to recognize that all mothers are, by definition, working.
3) Stop projecting our own internal demons onto other groups: immigrants, “terrorists”, “dirty hippies”, whatever. And affirm the dignity of all human beings, the vast majority of whom merely seek to be happy.
4) Reign in the vast greed industries and interests in Washington.
5) Recognize that only people are people. Corporations are sociopathic entities.
6) Fund a single payer healthcare system and come into the 21st century.
7) Throw out the educational dictates of the last 20 years and create sound educational ideas that really engage students and teachers in learning in the new millennium.
8) Turn off your TV. Or at least have enforced rules about usage .
9) Heal your traumas. Help yourself.
10) Recognize that your children, friends and neighbors may be struggling quietly and desperately in need of help. Help them.
11) Spend more time with your kids. Quality is not enough. Quantity is also required for healthy kids. Don’t let computers and TV parent.
12) Create community events for connection. Host a potluck once/month. Get involved. Talk to your neighbors. Get over your fear of the ‘other’.
13) MEDITATE. Rats can’t meditate, we can. If we all just calmed down and healed our own brains, it would be enough.
OK, then. We do have choices. It’s either us or no one. We can cower in fear waiting for the next attack, the next screw gone loose, or we can start changing our communities here and now.
I vote for now. I’ll go meditate on it, and then I will act.
My husband is an interventional cardiologist. Most of the people he sees are in manageable stages of cardiac disease. Some of his patients are quite sick and come in with advanced stages of illness. A few are dead and dying when they reach his cath lab. Miraculously, he can bring a few back to life, or ease their suffering greatly with stents and medications, saving them the trauma of open heart surgery.
Nobody is surprised when some of these people die. Sad. But not surprised. And certainly not outraged.
I’m a mental health professional, as is Dr. Drew Pinsky. In the media Dr. Drew has been blamed for the recent death of country singer Mindy McCready, who appeared on his show Rehab a few seasons ago. Like my husband, we both see people in various stages of illness. We’ve held people’s lives in our hands in our offices as surely as my husband has in his cath lab.
Dr. Drew, on his show Rehab, treats the sickest of the sick. He admits people to his hospital who have a terrible prognosis, many of whom have been told they are going to die if they don’t get treatment. They are in the end stages of addiction, a disease just as surely fatal as heart disease.
Yet, for some reason, when these patients die, the good doctor is blamed. Why? He is treating those who need intensive intervention and treatment in a psychiatric facility, just as my husband treats people in his hospital. These patients can get well with interventions for a period of time and then fail, just as cardiac patients can.
I can only chalk this reaction up to the ignorance and wishful thinking of the American people. Here is what I, as a lifelong mental health practitioner, would like the general public to know:
1) Addiction is a deadly disease, no less of a threat than cancer, heart disease, or a terrible accident.
2) It takes a highly skilled practitioner, one with hundreds if not thousands of hours of training, practice and supervision to help these people get better, and, yet, like other physicians, we still may lose our patients.
3) When we do lose our patients, we feel terrible. We work so much more intimately with our patients than, say, my husband does with his. We know their secrets, their character. We have laughed with them and possibly cried with them. It is impossible to be a good therapist without attaching to our clients and they to us.
4) Clinicians don’t just ever treat addictions. Addictions are always a symptom of a much bigger problem, and, frankly, that problem almost always involves boatloads of psychological trauma.
5) Working with traumatic stress is incredibly taxing for patient and practitioner. Frankly, not that many people want to do it. If you don’t believe me ask yourself when the last time is that you asked someone to tell you about their history of abuse and neglect and then listened all the way to the end of their story. Never? I rest my case.
6) Mental health clinicians are the pariahs of the medical community in the same way our patients are pariahs in the public’s eye. We treat “losers” so we must be losers is how so many of us are seen (if you wish you can substitute the word “crazy” for “loser”). Most of us are undervalued, underpaid and disempowered, but we soldier on because we believe in our work and enjoy helping people end their suffering.
7) My husband never lacks for the tools to do his work. His patients have the best equipment, the best care, and only leave the hospital when they are well enough to go home. Often they go home with assistance of some kind or another. This is rarely true in mental health work. Our patients do not have long enough stays to get better, have trouble accessing clinicians who know how to treat them, and are often discharged without enough support at home.
Even with the best support money can buy, some patients, like the country singer Mindy McCready, fail. Some people do well until they are put under undo stress and then they collapse. This was the case, as far as I can tell, with Ms. McCready. She’d already had several suicide attempts until the completed suicide of her boyfriend. She snapped.
How is this Dr. Drew’s fault? Now, I know there is some controversy about publicly airing shows on mental health treatment, and the questions are valid. Yet, as a professional whose work is always done in complete opacity, I’m happy that the general public gets to see some of what I and thousands of my colleagues give to our clients on a daily basis. I can’t participate in Take Your Daughter to Work Day, but we can sit down and watch an episode of Rehab.
I am sorry that Mindy lost her battle with depression and addiction. I am sad that Dr. Drew is getting blamed for losing a patient in the end stages of a terrible disease process. I hope we can all use this event to deepen our understanding of the terrible costs and demands of mental health and addictions instead of using it as a way to take a cheap shot at a profession that works in areas that no one else will touch.
I just returned from my favorite conference of the year, the Healing Together Conference put on by Infinite Mind. Infinite Mind is a group of people with DID, which is Dissociative Identity Disorder. You might know it better as Multiple Personality Disorder.
Why is this my favorite conference? Many reasons. This group of people who suffer from DID and those who support and/or treat them are the most dedicated, open and knowledgeable group I have been involved with. There is no lying, no minimization, no disinformation. Pain is acknowledged but not dwelt on. Jaime Pollock, the main organizer, is known for her organizational skills, her comedic timing and her immense sensitivity to the suffering of others. She is completely open about her own journey, but never triggering. There is an art room and a quiet grounding room with lots of pillows and blankets with student psychology interns available to help as needed.
Remember the movie Sybil? Well, the real Sybil, Shirley Mason painted her way through her treatment. There was a beautiful and moving exhibit of some of her paintings during the conference. Despite the recent book questioning her diagnosis, most people who knew her, and most specialists believe, she was, in fact, DID. The pictures in this article are some of hers. Some facts about them: she often painted telephone poles, sail boats (to sail away from her pain?) and yellow, she said, was the color of her mother’s screaming.
Another famous multiple, Truddi Chase, wrote the runaway best seller When Rabbit Howls. Her daughter, Kari, gave a very moving account of what it was to be the daughter of a multiple growing up. It was very clear that a distant, mean father was much more of a liability to a growing child than a mother with DID. Another interesting presentation was a mother-daughter pair from England discussing the same topic. Carol, who only “discovered” her DID later in life brought some remarkable videos of herself in other personality states (called ‘alters’ or ‘parts’). Her daughter with much patience and humor described a mother who often could not remember what she had said five minutes ago, but she was fun to play with! They shared a very dramatic and, at times, journey of healing which continues today.
On a more serious note, the mental health system in England and other places is severely lacking and there is much international work to be done on educating practitioners not only about the reality of DID, but how to work effectively on integrating painful memories.
Here are a few important facts to know about people with DID:
1) DID begins at an early age, usually before 7 but is often not diagnosed until later in life.
2) DID is always the result of severe and prolonged trauma. There has to be immense force involved to shatter a mind.
3) Most people with DID are law-abiding and peaceful people who suffer from extreme internal torment.
4) Many people with DID grow up to be loving (if somewhat dysfunctional) parents.
5) Children of parents with DID can thrive, especially with support from the community.
6) People with DID hold jobs in all sectors of society. They are preschool teachers, lawyers, police officers, writers, hospice workers, etc.
7) You cannot tell if someone has DID by looking at them.
8) With appropriate treatment people can integrate fully and heal from DID and their traumatic histories that were the cause of their problems.
9) People with DID almost always have problems with losing time. Often people think they are pathological liars because different alters give different information. Over time they learn how to compensate for these difficulties.
10) DID is fairly prevalent. It is estimated that 1 out of 100 people in the USA suffer from DID, and it is found in every country.
I had the privilege of giving trauma informed yoga classes in the morning and presenting two workshops: one on Yogic Modalities For Healing From PTSD and one on The Effects of Abuse and Trauma on Developing Children. The audiences were engaged, and responsive.
If you are a therapist, a physician, someone suffering from DID or you know someone with DID I would highly recommend this yearly conference as a place to learn, to laugh and to commiserate with a group of compassionate and knowledgeable people. It is held in Orlando, Florida every year in late winter. I feel very grateful to be involved with this amazing group.
Too many people have forgotten the wisdom of psychotherapy’s Western fathers: Freud and Jung. This interviews reveals the spirituality, the genius, the humanity and humility of Carl Jung towards the end of his life. He advocates greater awareness and psychology to avoid war. “We know nothing of man. Far too little. We are the origin of all coming evil.” Highly recommended viewing!
Last year I posted about the largest study you’ve never heard of : the Adverse Childhood Events Study. ACE has shown by using over 17000 participants data over several years that the more adverse childhood event categories you’ve been exposed to, the higher your chance of illness, obesity, mental problems, and socioeconomic ills. You do not have to have full blown PTSD to be exposed to these risks. People with the highest scores died, on average, 20 years sooner than people with the lowest scores. The good news is that getting treatment and adopting healthy lifestyle behaviors can mitigate your risk.
What is your risk? Take the questionnaire below:
Finding Your ACE Score While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you?
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1
2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you?
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1
4. Did you often or very often feel that …
No one in your family loved you or thought you were important or special?
Your family didn’t look out for each other, feel close to each other, or support each other? Yes No If yes enter 1 ________
5. Did you often or very often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Yes No If yes enter 1 ________
6. Were your parents ever separated or divorced?
Yes No If yes enter 1 ________
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her?
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
Yes No If yes enter 1 ________
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No If yes enter 1 ________
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
Yes No If yes enter 1 _______
10. Did a household member go to prison? Yes No If yes enter 1 _______
Now add up your Yes scores: ___________
For more information go to www.acestudy.org.
I don’t know how to say this to you any other way so I’m just going to say it: There is no easy way to heal from psychological trauma.
There is no pill, no elixir, no magic wand, no therapist, no book, no workshop, no yoga class, no blogger that will give you a quick fix from your suffering. I’m sorry; I truly am.
If you want to heal from PTSD you are going to have to work very hard for a long time. You are going to have to spend money (probably a lot of money relative to your income) to get help to overcome what you feel should have never happened to you. And then you will have to work some more.
In my book I compare the journey of healing PTSD to the journey that Frodo takes in The Lord of the Rings trilogy to cast the evil, all powerful ring back into it’s source: a dangerous volcano hidden inside of an even more dangerous enemy territory governed by an all seeing magical evil sorcerer. Frodo has two choices. He can either stay in his comfort zone in the bucolic shire of his childhood and live in denial until his land is ultimately overrun with evil mutant elves and destroyed while the ring has corrupted him (or someone else) completely. Or, he can man up and take the journey, one that is most perilous and with no guarantee of success and try to destroy the thing forever.
This is basically our choice as well. Is the journey so easy? If it were, everyone would make it.
Yes, I know it sucks. But suck it up folks. That is the way it is. I can only say this to you, not because I am cruel and heartless, but because this is a journey that I’ve taken. I’ve done the dirt time, so to speak, in spades.
It is totally worth it. The sooner you get over resistance to healing and begin, the better. Healing PTSD takes a chunk of your life. Not healing from PTSD takes your entire life (and possibly future lifetimes if you believe in that sort of thing).
Take a moment and review the pros and cons of healing:
Peace of mind Nightmares and flashbacks for the rest of your life, chronic anxiety
The ability to love and be loved Failed relationships; people who are afraid of you; persistent loneliness
Bodily health Heart disease, migraines, joint pain, digestive issues, diseases
Wisdom Ignorance, bitterness, confusion
Compassion for self and others Self-pity, entitlement, self-loathing, shame
Money well spent in healing Money ill spent in addictions, diversions and distractions
Well, you get the picture.
So which will it be? Healing PTSD does have an endpoint. It brings gifts beyond compare but only if you finish the job. You have no more time to lose. Put this at the top of your New Year’s Resolutions and you will ring in a much brighter 2014.
Blessings on your journey of healing!
Endurance is the most difficult of all the disciplines but it is to the one who endures that the final victory comes. ~ Buddha
At least one of the recent spate of murderous shooting rampages show evidence of high level mind control of the perpetrator. The Aurora shooter, James Holmes is reported to have told another inmate that he thought he was in a video game at the time of the shooting and that he had been programmed and rehearsed to complete the shooting at the movie theater.
Crazy, you say?
Well many therapists, many of my colleagues have treated patients with credible stories of mind control perpetrated by factions within the US and other governments. These techniques were developed and honed in the Nazi death camps. Those “technologies” were then imported along with clandestine Nazi scientists into the USA through the infamous Project Paperclip program. Scientists have been perfecting these techniques for decades beginning with the famous MKUltra program and others such as Projects Monarch and Bluebird. These programs are well documented by releases under the Freedom of Information Act (FOIA). Unfortunately under the Bush administration many previously released documents were reclassified or redacted to the point of illegibility. Nevertheless copies remain in the hands of a few.These programs were publicly discontinued several decades ago, but the research and the programming has continued clandestinely under ultra secret black ops programs.
I have heard disclosures from prominent therapists and psychiatrists, one of whom revealed in a public workshop that some of his clients could trace their programming back to “scientist and program” and that he had shared a hallway with Martin K. Orne who used to brag about his ability to make people do anything he wanted. (Orne has sat on the famous and fraudulent False Memory Foundation and is implicated in the MKUltra programs of the 1970s).
Any time therapists and their clients have tried to step forward with this information we have been threatened, attacked and sometimes had our licenses revoked. Therapists have also been harassed with reports of mutilated animals being left at their houses and even break-ins. There has been a profound media silence in the United States about such matters even while Canada publicized a national case of successfully suing and winning a settlement with the CIA over the mind control practices executed in that country.
Today a colleague whom I respect highly sent out a release about this article on her blog about why therapists have not been credible in the media and the attacks to which we have been regularly subjected on behalf of our clients.
I hope you will take a moment to read it, but I must warn you that if this information is new to you or if you have been a victim of these programs, you will find it highly disturbing.
If you want answers and want things to really change you must educate yourself on the unthinkable. These programs must be exposed and disbanded and the thousands of citizens subjected to them require healing apace.
You can find the article here:
If you have property destruction from Sandy, please read this very important article. You don’t have to be a business owner or to have insurance to apply for a low interest loan from the Small Business Administration. You might also be able to apply even if you live in a Coastal Barrier Zone. Most loans are made at four percent! The remainder are at six percent. Read the article for complete details.
Here’s the sad truth. PTSD often worsens during the holiday season. One would hope it was different, that holiday cheer, food, friends and good spirit would pop up like champagne on one of those commercials we see on TV where people are toasting each other, smiling and all looking fit, young and strong. But alas, it is not and here are some reasons why:
1) Holidays come with lots of triggers. We can be around too many people or too few. Even if we want to be with people, loneliness can be enhanced by the inability to connect in the midst of deep emotions such as fear, grief, or rage. There is no lonely like the lonely that comes in the midst of a group of friends or family.
2) We tend to eat foods that aggravate our nervous system. PTSD causes an inflammatory reaction in the body (see my HPA Axis posts). When we pile on the sugar, alcohol, fatty foods and just plain junk that pervades holiday fare our delicate and taxed nervous system can come under a lot of strain. Eating aggravates our anxiety, and anxiety aggravates our eating, repeating until New Year’s Resolutions come.
3) Feelings of self-loathing tend to emerge more strongly in holiday season. Perhaps we are trying to live up to an unattainable ideal of our religious faith or maybe proximity to family reminds us of our (and their) shortcomings. Whatever the reason, the phenomenon is real.
4) There is a lot of stimuli in the environment! Bright lights, flashing lights, loud music, smells, endless holiday music, crowded shopping environments all add to the load on the nervous system. Not to mention traveling on overcrowded airplanes and roads in dangerous weather. Not exactly a good environment for the hypervigilant and stressed.
If you think avoiding the holidays is easy, just watch the hilarious movie, Christmas with the Kranks. A lucky few might escape to Hawaii or a cruise but even then the holidays follow and are on our mind (if not our neighbors).
So, what to do? If you see a therapist and can afford it, scheduling extra sessions can be helpful. For those of us not lucky enough to have that resource, protection from the holiday barrage starts with our own awareness.
Pace yourself. Take some time every day to see what it is you do and don’t want to do. Say ‘no’ as often as you must. Stop worrying about hurting other people’s feelings, and focus on healing your own. Remind yourself that this, too, shall pass. For it will.
Better yet, dig down in yourself to find your own meaning of the holiday – whether it is about religion, vacation, or promoting your business, find the meaning that will be best for you.
Move into alignment with the season. In Chinese philosophy, winter is a time to move inside, to become dormant like the plants outside, resting so that our roots will be nourished and the plant flourish in the Spring. This is my favorite meaning of the winter holidays: renewal, self-nourishment, quiet companionship with those you love, sleep. Lots of sleep.
So here is my wish for you in the holiday and end of year time: Know when you are triggered and move to take care of yourself as needed. Cultivate compassion in your heart for yourself and others. Rest. Eat well. (And read The Trauma Tool Kit as needed.)
The good folks at Mass General Hospital (MGH), Boston University and other research institutions have shown conclusively in a research setting, for the first time, that an 8-week meditation program affected brain function in a positive way even when the subjects were not meditating. The amygdala (our crisis response center) was positively affected by their modest practice. Highly recommended reading!(Click on the title to go right to the article.)