Health Care Providers: How to Welcome and Respond to Trauma Disclosure

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TMIMy husband, a cardiologist, and I recently spoke to a group of physicians about how heart disease is caused by traumatic stress and also causes it. Afterwards, one family practice doc asked me, “I never know what to say when patients tell me their traumas.”

I realized that many doctors and therapists, for that matter, were trained in an era before abuse was acknowledged, before trauma and PTSD were common household words (in some places they still are not).

So I’ve compiled a short list of do’s and don’t’s when answering a client that discloses a disturbing history of trauma or a traumatic event.

Do:

~ Routinely administer a screening questionnaire for abuse in your intake forms. You can use the ACE questionnaire or website or come up with your own boxes to check off (e.g. history of physical abuse, sexual abuse, domestic violence, neglect, veteran etc.) Clients with a very high ACEs score will have more health problems as they age.

~ Answer with a sympathetic and simple affirming response such as:

“I’m sorry that happened to you.”
“ That is a terrible thing to have to go through.”
“You must really be suffering a lot (if the event is currently affecting the client).”

If your client’s disclosure is met with a stony or panicked silence they will leave feeling very guilty, damaged, enraged or all three. Abuse has a lot of shame associated with it. Please do not reinforce this by failing to respond appropriately.

~ Maintain eye contact with a soft gaze. Our clients often do not feel seen or like others really want to see them and their suffering. Eyes are “the windows of the soul” and the client really needs to see that you are with them in taking this great risk of disclosure. We know that people are present to us and with us when they look into our eyes.

~ Get yourself grounded in that moment. Take a deep breath and take a moment to really absorb what your client just said to you.

Some of us providers have our own trauma histories and the older we are the more likely that is. If we dissociate or ‘check out’ our client will definitely notice and probably assign the worst possible meaning to our behavior such as: “they don’t really care about me”; “they are just collecting their paycheck”; “they think I’m crazy”. Our traumatized clients already have those feelings, and they respond to any perceived confirmation of those thoughts with panic and/or rage. This panic/rage can be expressed outwardly in your office as difficult behavior or as self-harm when they go home.

~ Ask for more details – especially about how this is affecting the patient in their body right now. It is a universal truth that our clients will only tell us what we are ready to hear. They do not want to ‘injure’ us with sordid details and will often leave out important aspects of their traumas. Occasionally a client will disclose too much in a kind of verbal diarrhea manner; in those cases it is OK to gently contain the discussion and take the necessary action for that client to get help.

~ Assess for current safety and contact the correct agencies as a mandated reporter. You can never overreport elder abuse or child abuse. As a medical social work supervisor I am always surprised about how conflicted medical staff are about filing reports and how little the laws are understood and followed. The state is responsible for determining whether abuse is happening or not. Most medical providers are not trained to make those screening decisions. Hence the law that says you are a mandated reporter to file if abuse is suspected. And, yes, that means everyone on your team who has a contact with the patient. It is extremely common for abuse victims to divide up what they tell to different people. There is no way for agencies to file as a single entity. If a doctor, a nurse and a social worker talk to this person and get any kind of disclosure they ALL are legally obligated to file a report. Our clients almost never call disclosure hotlines themselves. Sometimes they don’t understand that what is happening is reportable. Child and adult lives depend on us doing our jobs. The states do a very good job of maintaining confidentiality about who said what.

~ Refer! to the appropriate provider. Have a list of trusted mental health providers in your office. Steer your client towards the Psychology Today referral website which is excellent and widely used by practitioners.

Do Not:

~ Panic. Forewarned is forearmed. Educate yourself about the types of abuse in your community and the populations you serve. If you are expecting to hear these types of disclosures (and why shouldn’t you?) your clients will have an easier time telling and you will have an easier time hearing. I have heard about some truly horrendous and damaging responses from both therapists and doctors who were not ready to hear an abuse disclosure. One damaging response can put off a patient’s healing for years or forever.

~ Promise to keep a dangerous secret. A lot of patients will ask us to keep what they tell us confidential before they want to disclose anything. Don’t paint yourself into a corner. When my patients ask me to keep their secrets, I always reply that it depends on what kind of secret they have and explain my role as a mandated reporter. That gives them more control on what they want to disclose.

~ Ignore a disclosure. Yes, I know you have less time to do more work than at any other time in your career. Working correctly with a disclosure does not have to take a great deal of time. Our patients are pretty savvy. They know we have busy schedules and lives, and they do too. The vast majority of people who disclose will not abuse the privilege. If they do, you can still be kind and containing at the same time. Or you can ask them to schedule a longer appointment soon for a full trauma assessment (something I hope to be coming soon to a medical and psychiatric clinic near you). Being busy is no excuse for being uncaring. It’s not business; it’s personal.

~ Forget to take care of yourself. Know your community population. If you are in low income, high crime area, your entire population may be filled with trauma. Taking a trauma informed approach to your practice could be the best thing you ever do for you and can avoid needless complaints and confrontations. Get therapy if you need it (and who doesn’t?). Do your own sympathetic downregulating exercises: yoga, tai chi, meditation, exercise, breathwork. The less you care for yourself and your own suffering, the less you will want to help anyone else.

There, that wasn’t so hard was it?! If you need more in-depth assistance I offer trauma-informed consultations for health care professionals, and I travel!

Be well!




Reiki and PTSD

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I have been told by many people over many years including intuitive clients that I should be using my hands in my healing work. Up until this past year I politely and firmly declined. Therapists consider touch to be taboo and risky. Most agencies make it clear that touch is not to happen between client and therapist – ever.

What happened to change my mind was Reiki. I started to do some research and found that many therapists (as well as nurses and doctors) across the United States use Reiki in their practice, including in the hallowed hospitals of the Harvard Medical system. Over 800 hospitals use Reiki, and it is an evidence-based practice for stress and chronic pain, two symptoms clearly related to PTSD.

As it turns out, one does not need to even touch a client in order to provide Reiki healing energy in a session. So last April I received my Reiki I and II attunements and started offering Reiki to my clients.

The results were astonishing:

– I’ve had several clients report a full night’s sleep after several months or years of sleep disruption, a common side effect of PTSD

– Clients are able to release emotions and cry on the treatment table in a way they usually do not in session. The beauty of Reiki is that they may not know why they are crying; they don’t have to have a reason or specific memory, but they always feel better afterwards and move forward in resolving previous traumas.

– Many report a feeling of a loving, warm and compassionate energy that they have not felt before or in a very long time.

– People report improved digestion and bowel function. On the table I hear people’s gut making bowel sounds, a sign of parasympathetic function being restored to the autonomic nervous system.

– Although I talk about grounding in sessions as do many trauma therapists I have found that Reiki helps clients inhabit their body more fully, and they can really notice the lack of grounding or energy in their lower body. This improves greatly over 2-3 sessions and instigates a firmer resolve to practice grounding exercises such as walking barefoot outside.

– Clients become deeply relaxed and often report the deepest states of peace in their body than they have felt in many months or weeks. Too often therapy is a very stressful experience; Reiki provides a corrective emotional experience for treatment!

– Sometimes people experience physical symptoms resolving. One patient who’d had a persistent red rash for many days reported the rash clearing up within hours of the session. Another experienced her feet becoming stronger and less prone to injury.

Often there is validation between what I as the Reiki practitioner am feeling and what the client is feeling in their body. I had one client that when I held my hands in the position around her face and temple I felt intense heat between the jaw and temple, almost as if my hands were held up next to a flame. My client felt this heat as well, and became very emotional. Later she connected that very spot to where she received electroshock therapy years before which, for her, was both validating and healing.

Although I had the intention that I would probably not touch my therapy clients, I found that people were more offended if I would not touch them. So now before sessions I get their permission and usually only touch around the head, neck and lower legs.

This past December I went back to become a Reiki Master, and have signed up for my next level of training in August. I hope very soon to be offering Reiki attunements, trainings and certifications for therapists. Stay tuned!

If you have received Reiki, I would love to hear about your experiences in the comments section!




The Trauma Therapist Podcast Interview

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Recently I had the pleasure of being interviewed for The Trauma Therapist podcast by Guy McPherson, Ph.D.  Enjoy!




School Shootings: An Open Letter to Parents

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Dear Parents,

  I feel your pain and horror.  I, too, am a parent and have two Juniors this year whose finals week was interrupted by the school shooting at Reynolds high school.  They have been so busy just trying to get through finals week that they haven’t even had time or energy to integrate what is happening in their own community.

 Nothing makes us more anxious than a threat to our children’s safety. Nothing makes us feel more powerless, saddened and enraged then when our schools safe walls are breached by murderous rage and terror.

 Some of us are vulnerable to traumatic stress and anxiety already. Events like this can feel overwhelming to cope with, and even moreso to help our kids to cope.  So what can we do?

As a professional and as a parent, I recommend that you put on the metaphorical oxygen mask first.  Please take the time to do whatever you can to take care of yourself in the coming weeks.  If you feel your own anxiety spiraling out of control, please get some help from a qualified trauma therapist or perhaps some other provider that you feel comfortable with such as an acupuncturist, Reiki practitioner or yoga therapist.  If you feel that you need psychiatric medication, now would be a good time to get a consultation. Practicing mindfulness meditation could be helpful or whatever really helps you calm down and integrate.

 If you are like most Americans you are probably going to want to think your way out of this problem and come up with a snappy and satisfying solution (gun control, armed school guards,  mental health interventions etc).  I would encourage you NOT to jump to this just yet.  First we need to calm ourselves down and become really, REALLY present to ourselves and our families.

 Trauma, like grief, has its own pace and rhythm, and some of us are dealing with both.  Our kids may have known the victim(s) or even been the victim. We need to give healing its full due. If our kids see us stopping, processing and restoring ourselves from trauma, that gives them permission to do so as well.  There are many resources for healing out there, including my book, The Trauma Tool Kit: Healing PTSD From the Inside Out, which has a whole chapter on first-aid for trauma shock, the first stage of trauma.  Reading it will help you cope with the immediate aftermath of trauma. (You can find it in your local library and in all bookstores.)

 Your children are in shock and grief, too.  Like my kids, they may be in the middle of finishing up testing and not really be available for processing their feelings, or they may have a lot of time on their hands and be inwardly stewing over what has happened.  Lately the world seems to have exploded in violence.  Even if they are quiet, they have definitely noticed.

 Make yourself extra available to them.  Depending on age, gender and temperament our children will have varying needs and ways of moving through their own horror, anger and sadness.  Allow them to find their own mode of expression, which may be very different than yours.  But they do need to express in order to integrate.

 As a child and teen therapist, I know that there are very few children who can just sit down and talk about their feelings to their parents in an adult way.  It is best to find activities to do with your kids and let the conversation steer its way naturally to what is troubling them.  You can ask open ended questions and make positive statements such as, “I’m really interested in what you think/feel about this event.” “What are other people saying about what happened on Facebook?” etc.  Good activities can be throwing a ball, shooting hoops (I got really good at this doing inpatient work with boys), going for a walk together, driving somewhere, listening to music together (their choice),  playing a card or board or video game (not too intense so there is room for conversation).  You need to initiate these activities, especially for kids who tend to isolate when they are upset. 

 Allow your children, and especially teens, an uncensored discussion.  If you have rules about swearing or intensity (such as loudness or sarcastic tone), tell your child that you have suspended these rules, so they can say, freely, whatever is on their mind.  Our kids talk very differently to each other than they do in front of us.  If they need to blow off steam but feel inhibited in front of us, they will blow off steam elsewhere. 

 Sometimes stressful events like this show areas of relationships that are in need of work.  If you have been having trouble connecting with your child, this trauma will not automatically draw you closer. It may, in fact, do the opposite.  If so, consider seeking out professional help for yourself and/or the family.

 Put down your cell phone when you are home.  Stay home and make it clear that you are available when they need to talk, even if that need comes up around 10 or 11 pm as they are going to bed (as if often will). Monitor your own need to engage in avoidance activities and choose engagement.

  If you do not already have a self-care routine, now would be an excellent time to start one.  I am a big fan of progressive relaxation exercises and often prescribe them.  You could find some online or buy a CD and practice relaxing your whole body a couple of times a day, to reset your own nervous system.  Allow yourself more downtime than usual.

  Know these signs of acute stress and monitor them in your children.  If they persist past 2-4 weeks they may be cause for concern:

 

-       repetitive talk about the event

-       
repetitive drawing of the event

-       irritable

-       withdrawn


-       needy and clingy


-       more forgetful than usual


-       having trouble regulating emotions: laughing silly “highs” crash into sullen “lows

-       hair-pulling (trichotillomania)


-       disturbed eating

-       insomnia or frequent awakening in fear or tantrums

-       age-inappropriate behavior such as bed-wetting

-       rigid and perseverative play behavior (in younger children)

 

Lastly, know that no matter how upsetting this event is to your family and child, healing is possible. Human beings are incredibly resilient.  In the process of healing you and your family may wish to take some action in the world.  If this feels right to you, do it.  The wound of trauma often demands some response from us – when the time is right.

Blessings on your journey of healing, Sue




Flashbacks, PTSD and You

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Of all the PTSD symptoms, flashbacks are some of the worst. They interrupt our sleep and our waking hours without warning. They chew us up and spit us out leaving us spent, exhausted and retraumatized. Flashbacks can really hurt us as they activate our amygdala, the crisis response center in the brain, and throw our entire nervous system into high gear. In the worst cases, we can momentarily lose touch with reality and become totally engulfed in a full body replay of traumatic events. As we heal from PTSD, it becomes essential to get a grasp on flashbacks and slowly eliminate them.

What are flashbacks?

Flashbacks are an involuntary and intrusive experience of a memory. Flashbacks can involve any combination of the senses: visual, auditory, kinesthetic (or feeling state), taste and smell. I have found that many people with traumatic pasts enter flashbacks regularly without knowing they are having one. Movie type flashbacks are obvious; for example a soldier experiencing himself back on the battle field. But flashbacks can also be, for example, an overpowering feeling of helplessness and abandonment in the present that is not in proportion to a current event.

I have come to see flashbacks as part of the body/mind’s attempt to heal. Persistent flashbacks are like a telephone ringing, or someone knocking at your door. They are your unconscious mind demanding that traumatic events in your past be dealt with and healed. Like a persistent visitor, the knocking will only get louder and more in your face if you don’t answer the door.

How can I get rid of flashbacks?

There is only one way to really get rid of flashbacks for good, and that is to dive deep into your mind and heal your PTSD by dealing with the traumatic events that caused your injury. I realize that this is not the answer that many want to hear. It is a bit like saying the only way out of your burning house is to walk straight through the fire. In the meantime there are things you can do to lessen the severity of flashbacks and help those around you cope with them:

- Learn your triggers and inform those closest to you. The more you know what causes flashbacks, the more control you have over them. Keep a log or map them, either mentally or on paper.

- Develop a twice-daily practice of invoking the relaxation response and by that I mean something like yoga, tai chi, progressive relaxation or centering prayer. Not drugs, TV or other escapist types of activities. These techniques have been shown to improve recovery time from flashbacks and decrease their intensity and frequency.

- Strengthen your mind! Flashbacks are a time disorder. Your mind gets sucked back to the time and place of injury. Don’t let that happen! Learn to stay in the present moment through meditation and grounding exercises. That way, when a flashback hits you can stay present and not get swept away in the memory.

- Talk about it. Ever since Freud discovered the “talking cure” we have known there is something magical about telling others about our difficulties. The more we process verbally, the less grip these events and memories have over us. If your memories are too intense to share with loved ones find a good trauma therapist (see my blog on finding a good trauma therapist!).

- Do not blame your self. Shame and flashbacks go hand in hand, and are often a part of the trauma being re-experienced. Be gentle with yourself and realize that this is a process that will take time to resolve.

I’ve said it before and I’ll say it again. PTSD can be healed. That means you will reach a point where flashbacks are no longer a part of your life, at least not in such a pernicious form. We may always have unpleasant memories but when trauma is resolved, they no longer have the power to hurt us.

Blessings on your journey of healing.




Don’t Let Anyone Tell You That PTSD is Permanent

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matphotoviatka

I hear from a lot of clients and friends that they have been told by their therapists that they have to learn to live with PTSD.  “Walk beside it like a friend” is how one therapist put it.

 PTSD is not your friend.  You do not want its companionship for life.

 In the yogic model of the human being, there are multiple layers. We have a physical body, an energetic body made of prana or qi/ki, two layers of mind: one cognitive and one intuitive and a bliss body.  We cannot hope to heal PTSD unless we understand this important concept:

 All layers of our being are wounded by the injuries and abuse that result in PTSD.  PTSD is the manifestation of those wounds.

 In the Western model of medicine we treat only two of the five layers.  We treat the body and we treat the cognitive mind.  In other words we address less than half of the system that has been injured.  In many cases we don’t even treat both.

 Usually people with mental disorders are remanded to some variety of psychiatric care with little attention paid to the rest of the body.  Or the reverse. If the person expresses symptoms mostly through the body, it can take years for a physician to ask simple questions about a history of trauma. 

 Most therapists and counselors pay little to no attention to anything but the latest “evidence-based” treatment, even though “evidence-based” most often means showing an effect for only 3-6 months.  Mental health treatment has become highly politicized and regulated, and essentially a casualty of the free market capitalist system here in the USA. 

 But I digress.

 As a therapist and a survivor, I am here to tell you that  you can heal fully from PTSD. In order to do this you will have to assemble your own treatment team and techniques to heal each of the layers of your being that were injured by trauma. That is essentially the thesis of my book, The Trauma Tool Kit: Healing PTSD From the Inside Out.

 Please don’t give up.  There is an end to suffering.  The “peace that passeth all understanding” is real.  It may take a while, years perhaps, but life these days is long. Keep going. You can heal fully from PTSD. 




Trauma and Psychic Ability

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This past week I presented workshops at the European Society for Trauma and Dissociation in Copenhagen, Denmark. Twice during the conference highly regarded researchers and treaters of trauma, psychologist Andrew Moskowitz and the parapsychologist Etzel Cardena wondered about the connection of PTSD and psychic experiences. In The Trauma Tool Kit (Quest, 2012) I have also noted the preponderance of unusual experiences that those with trauma report. The questions that came up was why. Why do people with high levels of trauma tend to report experiences in nonordinary reality?
Here are some of my thoughts on the matter.

1) Extraordinary Empathy. A person subjected to much trauma, especially growing up can develop certain survival skills. One of the skills of surviving an abusive home is to be able to anticipate caregiver’s moods and “manipulate” one’s caregivers into doing their job i.e. not being abusive but helping the child to grow and thrive. The child in this case has to develop preternatural attunement to the caregiver. Out of necessity the child may begin to develop telepathic capacity, exquisite sensitivity to mirror neurons in the brain and a sensitivity to electromagnetic energies emanating from the person.

2) Natural Psychic Giftedness is Aligned with Intergenerational Trauma. Many of the most sensitive and psychic cultures in the world are indigenous. Conquering cultures have gone out of their way to disable the extraordinary abilities of those cultures. Examples include the witch trials of the Inquisition, the British cutting off the fingers of Marma practitioners in India, etc. These conquered cultures store a great deal of intergenerational trauma that may predispose them to perpetuating the trauma through intergenerational abuse. We have seen examples of this repetition in Irish, Native American and African American families. In other words, the indigenous cultures already had these gifts and also manifest traumas recapitulating the original traumas of domination and assimilation so that the relationship is not causal but related to colonization.

3) Chakra Disruption. Shamanic healer Barbara Brennan has written extensively about the human energy body, which she can see clearly. She has noted that certain kinds of abuse, such as sexual abuse, can “tear” open the chakras of the body. This artificial opening then allows the energy body to be more permeable than someone who has not had chakric damage, leading to many kinds of phenomena in nonordinary reality.

4) Dissociation is a Condition of Psychism. All manner of psychic practitioners and shamanic healers need to learn to “unground” their consciousness in order to access information from other realms than the physical. If one has had early training in this from necessity caused by trauma, then one is already well on the way to developing these abilities by definition. This may be the reason that so many shamanic initiations include controlled traumas to open up the mind and supersensory perceptions (teen circumcision, fear trials such as being buried in the earth for several days, scarification, hallucinatory drugs and experiences, etc.)

5) Survival Techniques Facilitate Psychic Ability. Increasingly, trauma survivors are turning to techniques such as meditation, work with spiritual teachers and shamans to heal from extreme traumas. In India it is well known that intense yoga and meditation practices lead to the unfolding of psychic and occult abilities. When trauma survivors pursue these practices for healing, they naturally unlock thoses abilities, too.

It is good to see some of these avenues of thought being pursued in realms of academia and psychology. These pursuits are still fairly controversial in certain states and countries, but overall the public is becoming more friendly to these ideas. My next book Connected: How Reclaiming Your Indigenous Ancestry Can Heal You, Your Community and the World will be exploring these ideas in more depth. It is my strong belief that additional connection and perception may be the qualities needed by modern humanity to change the paradigm on planet Earth, heal the world’s traumas and brighten the future for us all.







Five Questions You Should Ask Your New Trauma Therapist

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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?beautiful 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.

Bad answers:
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!




Why Dylan Farrow’s Disclosure Matters

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“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.

Dylan Lies:

 Pros:                                                                          Cons:

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.

 Woody Lies:

 Pros                                                                           Cons

He keeps making movies                                     He gets a clean conscience (if he’s not

                                                                                    a sociopath)

He keeps all his money                                         He may need to pay a lot of money in a

                                                                                    lawsuit

 

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.

 

 

 







Managing the Madness: Mature Adults Wanted

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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.




Lessons From Shannon

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          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

 







Helping Kids Deal With The Moore Tornado and other Disasters

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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!




24 Hours With PTSD

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 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.




The Root of Violence: Solutions for a Beleaguered World

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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.




Defending Dr. Drew

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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.




Healing Together With An Infinite Mind

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HT_logo_HPI 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.

 




Jung on Freud, War, Death

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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!




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