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Archive for the ‘Psychotherapy’ Category


Timelines and Trigger Mapping in Healing PTSD

Posted on: by Susan

In the “old” days of psychotherapy, when I began in the 80s, abreaction or emotional release of traumatic memories was considered a goal of therapy. This idea of therapy was also made popular in powerful movies such as Goodwill Hunting.

Abreaction will happen when it happens, and it will facilitate healing. But it is not enough.

We have to live with the day-to-day realities of our history as they manifest in the present moment. With that in mind, I wanted to share two of the most helpful activities in or out of therapy for people who suffer PTSD.

The first activity is to create a timeline of events. When our PTSD results in dissociation our sense of time can get distorted. In fact, many would say that PTSD itself distorts the part of the brain responsible for the sense of time passing.

In any case, most people I see have a very poor sense of the timeline of what happened to them. Also most people I see have had more than one type of trauma. Some peoples’ lives have been one traumatic event after another. Creating a visual timeline can help us understand and digest what we have actually been through.

 Chances are, when you begin, you will not put down every event. Our brains are associative, so if you are looking at, say, accidents, you will put down accidents. But, you may forget about abuse, or you may remember one type of abuse but not another. I consider the timeline a working document in therapy, whether on paper, or just as an understanding between my client and myself.

When you record an event, you have an opportunity to look at your age at the time. A good timeline should include: event, type of event, age and any other relevant details (such as physical injury).   The timeline provides a chance to re-associate the aspects of yourself connected to your own history and is a valuable tool for your therapist. (P.S. therapists can and do become dissociative too, so this tool can help ground both of you.)

The second important activity that will really start to empower you is trigger mapping. Everyone with PTSD has triggers! They may or may not be known to you. Knowing triggers can help you and your loved ones anticipate PTSD storms and head them off.

Here is how I describe trigger mapping in my book The Trauma Tool Kit:

I recommend writing down or drawing your triggers, getting them down on paper in some form or fashion. Some triggers you will know right away; some you will have to ferret out. Triggers fall into six categories: the five senses of taste, touch, smell, sight, and hearing, plus feeling states. Let’s start with the senses, because they are the easiest. You can divide your paper into different sections reflecting each of these senses. It will help jog your memory to go through each sense modality individually. Let’s say you are working in the smell category. Ask yourself what smells really bother you. All of us have smells we do and don’t like. Generally we all like floral scents and dislike the smell of feces, but I am not talking about ordinary aversions here; I am talking about radical reactions. Nobody likes the smell of poop, but if that smell sends you into a panic or frozen numbness and dissociation, it’s a trigger. Or maybe the scent of lavender makes you want to rip someone’s head off. That’s a little unusual; write it down. Take your time working through each category. Do not attempt to do all of this work in one day! If you are in therapy, it can feel safe and reassuring to do it with your therapist. Or it may not depending again on your triggers, but find some way to do it anyway. p. 184-185

The great thing about timelines and trigger mapping is that they create a bridge of healing between the present and the past. They empower and they inform, and they are tangible.  You can also add to them and edit them as you go. It is a great joy to be able to remove a trigger off the list!

One last thing, when you do them, do them with care and beauty. Take your time. Use beautiful colors and paper. Or if you just do them in your own head give yourself the benefit of a peaceful space and time to contemplate your own history and healing.

Blessings on your journey, Sue PB



Five Questions You Should Ask Your New Trauma Therapist

Posted on: by Susan

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!



Lessons From Shannon

Posted on: by Susan

          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

 



Defending Dr. Drew

Posted on: by Susan

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

Posted on: by Susan

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

Posted on: by Susan

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!



The Power of Persistence (or What you Resist, Persists)

Posted on: by Susan

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:

 Pros                                                                 Cons

 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

 

 

 

 

 



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