The real reason my blog is not organised…

Okay… so truth be told, I was suicidal. I get that way in greater or lesser measures almost every day! Some days it’s a fleeting thought; other days it is so very intense that I dare not move out of my bed for fear I will act on those urges like I used to!

I was having a particularly bad time with the suicidal urges and so I deleted all the personal posts, believing that I was shutting my life down …even Facebook had a major overhaul with settings put in place to close it down the moment the Facebook hierarchy became aware of my demise.

I hate feeling that way… and when I act in what I believe is in the best interests of the world and later go to write a post… I feel like a right numbskull having deleted all those memories for now I need to write them again!

🙄

1st March 2015

Complex PTSD, is not a personality disorder…

The following is by Prof. Judith L Herman

From this document; HERE

Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma

Judith Lewis Herman

Observers who have never experienced prolonged terror, and who have no understanding of coercive methods of control, often presume that they would show greater psychological resistance than the victim in similar circumstances.

The survivor’s difficulties are all too easily attributed to underlying character problems, even when the trauma is known.

When the trauma is kept secret, as is frequently the case in sexual and domestic violence, the survivor’s symptoms and behavior may appear quite baffling, not only to lay people but also to mental health professionals.

The clinical picture of a person who has been reduced to elemental concerns of survival is still frequently mistaken for a portrait of the survivors underlying character.

Concepts of personality developed in ordinary circumstances are frequently applied to survivors, without an understanding of the deformations of personality which occur under conditions of coercive control.

Thus, patients who suffer from the complex sequelae of chronic trauma commonly risk being misdiagnosed as having personality disorders.

Earlier concepts of masochism or repetition compulsion might be more use fully supplanted by the concept of a complex traumatic syndrome.

Prof. Judith Lewis Herman

Joumal of Traumatic Stress, VoL 5, No. 3, 1992

More of Judith L Herman’s expert knowledge on complex trauma, can be found in her ground breaking book, which I strongly recommend.

10th November 2015

Accept what is, let go of what was, and have faith in your journey.

It’s always necessary to accept when some part of your life has reached its inevitable end. Closing the door, completing the chapter, turning the page, etc. – it doesn’t matter what you title it; what matters is that you find the strength to leave in the past those parts of your life that are over.

It’s all about embracing the truth: What has happened is uncontrollable; what you do now changes everything!

Of course, knowing this and actually living a lifestyle that reinforces this truth are two very different things. Letting go is NOT easy – it’s a journey that is traveled one day at a time. If you stick with it, here’s what your journey will ultimately teach you:

1. The most powerful changes happen in your life when you decide to take control of what you do have power over instead of craving control over everything you don’t.

2. Most people make themselves unhappy simply by finding it impossible to accept life just as it is presenting itself right now.

3. If you worry too much about what might be, and wonder too long about what might have been, you will ignore and completely miss what is.

4. When you are lost in worry, it is easy to mistake your worries for reality, instead of recognizing that they are just thoughts. Mindfulness is the remedy.

5. The biggest obstacle to growth you’ll ever have to overcome is your mind. Once you can overcome that, you can overcome anything.

6. Almost everything will work again if you unplug it for a little while, and that includes

7. YOU. (Read Wherever You Go, There You Are.)

8. You won’t always have it easy, but there is always a reason to be grateful. And the greatest gift of your gratitude is that the more grateful you are, the more present you become.

9. The secret to getting ahead is to focus all of your energy not on fixing and fighting the old, but on building and growing something new.

10. Letting go doesn’t mean you don’t care about something or someone anymore. It’s just realizing that the only thing you really have control over is yourself in this moment.

11. In most cases, you can’t calm the storm – it’s not worth trying. What you can do is calm yourself, and the storm will pass.

12. You can always control the way you respond to what happens, and in your response is your power.

13. Oftentimes letting go is simply changing the labels you place on a situation – it’s looking at the same situation with fresh eyes and an open mind.

14. There is absolutely nothing about your present circumstances that prevents you from making progress, one tiny step at a time.

15. The day you “understood” everything, was the day you stopped trying to figure everything out. The day you find peace and freedom again will be the day you let everything go.

16. You must let go of certainty. And you must remember that the opposite of certainty is not uncertainty, it’s openness, curiosity and a willingness to embrace life as it is, rather than resisting it. The ultimate challenge is to accept yourself exactly as you are, and accept life just as it is, but never stop trying to learn and grow to the best of your abilities.

17. Underneath it all, the hardest part is not really letting go, but rather learning to start over.

18. Stepping onto a brand new path is difficult, but not more difficult than remaining in a situation that no longer fits, or no longer exists.

19. Sometimes it takes a little heartbreak to shake you awake, help you let go, and show you that you are worth so much more than you were settling for.

20. When it comes to social drama, letting go of other people’s rude remarks is the best step forward. Most haters don’t really hate you; they just hate where they are in life, and you’re a reflection of what they wish to become. (Angel and I discuss this in detail in the “Relationships” chapter of 1,000 Little Things Happy, Successful People Do Differently.)

21. Your heart might be bruised, but it will gradually heal and become capable of feeling the beauty of life once again. It’s happened to you before, and it will happen again – life is always changing. When something ends or someone leaves, it’s because something else or someone else is about to arrive – you will feel alive and whole again soon.

22. Afterthoughts
It can be difficult to leave a long-term life situation behind, even when your inner-wisdom tells you that things aren’t right and it’s time to let go. At this point, you can choose to let go and endure the sudden pain of leaving behind the familiar to make way for a new chapter in your life, or you can stay and suffer a constant, aching pain that gradually eats away at your heart and mind, like a cancer… until you wake up one day and find yourself buried so deep in the dysfunction of the situation that you barely remember who you are and what you desire.
Don’t do this you yourself!
Things will happen that are unexpected, undesirable, and uncontrollable. But you can always choose to take the next tiniest step. Be brave and take it…
Be willing to make mistakes, learn from them, let go of them, and move along.

27th May 2014

Perhaps the biggest tragedy of our lives is that freedom is possible, yet we can pass our years trapped in the same old patterns…We may want to love other people without holding back, to feel authentic, to breathe in the beauty around us, to dance and sing. Yet each day we listen to inner voices that keep our life small.

27th May 2014

We tend to be particularly unaware that we are thinking virtually all the time. The incessant stream of thoughts flowing through our minds leaves us very little respite for inner quiet. And we leave precious little room for ourselves anyway just to be, without having to run around doing things all the time. Our actions are all too frequently driven rather than undertaken in awareness, driven by those perfectly ordinary thoughts and impulses that run through the mind like a coursing river, if not a waterfall. We get caught up in the torrent and it winds up submerging our lives as it carries us to places we may not wish to go and may not even realize we are headed for. Meditation means learning how to get out of this current, sit by its bank and listen to it, learn from it, and then use its energies to guide us rather than to tyrannize us.

Why losing someone to suicide complicates grief

Why Losing a Loved One to Suicide Complicates Grief

Suicide is unfortunately so common that everyone knows someone who has committed suicide. From the classmate who hung himself just six weeks before high school graduation to the widow who found her husband in their bedroom to the man who’s father shot himself and left him the head of the family when he was a teenager, there are so many ways that suicide leaves a trail of chaos and pain in its wake.

The sudden death of any loved one is difficult but there are several reasons why losing someone to suicide is especially hard. Studies confirm that a close relationship with a victim of suicide can lead to complicated grief and post-traumatic stress disorder.

An article in Harvard Women’s Health Watch does a nice job of outlining several of the particular dimensions that challenge survivors of suicide:

Complicated aftermath

Not to be indelicate, but the death scene can be messy. And sometimes it’s in the survivor’s home. And sometimes there are legal and financial ramifications to deal with.

Stigma

Historically, suicide was something people didn’t talk about. And it’s really hard to get support for something you can’t tell anyone. Shame festers in secret. Also, when members of our community, which could be work or church or school or neighborhood respond badly to the suicide, it can impede the survivor’s recovery.

Mixed emotions toward the victim

It’s completely normal to have complicated feelings toward the victim. When we lose someone to cancer or illness, we grieve, but we also feel pretty confident that, given the choice, they’d still want to be with us. If we are close to someone who is murdered or killed by someone else’s negligence, we know the above, and we also have someone we can be angry with. Losing someone to suicide is a double blow. This person chose to leave us and the world behind and it’s natural to feel angry with that person. There is also the loss and grief of losing a loved one.

What if’s and guilt

It’s very natural to search your memory for signs you may have missed, to wonder what you could have said and done differently. It’s natural to feel like you did something wrong or didn’t do something right, that somehow you could have prevented this from happening.

What can help?

Support groups can be helpful. Here is a resource to help you find one near you, and the website it’s on provides a lot of other good resources.

If you feel you need professional support, you can find a therapist who specializes in grief or trauma.

There are also hotlines dedicated to helping people in crisis.

from After Trauma

21st June 2014

What Does the Treatment for Complex Trauma Look Like?

Lack of research and exclusion of truly complex cases

Research for complex trauma and dissociation is severely underfunded relative to the numbers of individuals with these conditions. As such, there aren’t any randomized control trials that assess a specific protocol, like there are for other disorders. The few studies that claim to include survivors of complex trauma will include people who have been exposed to the traumatic events I described a couple of posts ago, but then exclude people who are suicidal, have self-harming behaviors, have comorbid disorders, have psychotic symptoms (people who are dissociative can appear to have psychotic symptoms) and/or have substance abuse. Since this describes individuals with dissociative disorders, the studies are excluding clients who have truly complex trauma. This study, for example, claims to study the efficacy of CBT and CPT, relatively short term evidence-based treatments for classic trauma. However, they exclude people with almost all of the symptoms listed above, so while the participants may have some features of complex trauma, they definitely don’t resemble the complex trauma clients that I work with, or that are described in case studies of extremely dissociative cases.

This study did show that when TF-CBT is adapted to be administered in a phase-based fashion (up to 30 sessions instead of 12, assessing for safety and stability throughout), it can be helpful in treating adolescents with complex trauma. Unfortunately, they say almost nothing about their participants except to note how difficult it is to assess youth for complex trauma, so we don’t know how severe their symptoms were when they started.

So what do we know?

What does exist are some case studies and a large, international prospective study by Bethany Brand that examines what practitioners are currently doing and assesses how that is working. The good news is that practitioners who take on complex trauma clients (the suicidal, self-harming, addicted, dissociative ones with disorganized attachment) are doing solid clinical work that is consistent with complex trauma treatment guidelines and are unequivocally helping clients get better.

What is currently recommended to treat complex trauma and dissociation is a three phase treatment approach. Incidentally, if you’re seeking a therapist for complex trauma a great way to find out if they know what they’re doing is to ask if they use this (or if they even know what it is).

Phase I- Safety and Coping

in some cases, this phase can take months or even years

a great deal of attention is paid to rapport to address attachment phobia

emotion regulation and grounding are used to help the individual stay in the present and in their window of tolerance

safety and stability for individuals who have suicidal thoughts or self-harming behaviors

distress tolerance and coping to help

Evidence based practices that are helpful at this stage can include DBT, mindfulness, CBT skills (including those from ACT and CPT), and Resource Development and Installation from EMDR. Also there are several group treatments that can be helpful, particularly Seeking Safety.

Phase II-Trauma Processing

Prolonged exposure, by definition is not recommended. Instead, trauma exposure should be gradual. A significant feature of complex trauma is that clients experience frequent intrusions of the trauma, and they aren’t able to avoid it the way that many people with classic trauma can. Therefore, they are already experiencing flooded exposure to their trauma and more of that isn’t therapeutic. Instead, re-experiencing is done while within the window of tolerance and while the client has a dual awareness with the present so that they know they are safe.

Safety and coping interlaced throughout

May be interspersed with checkup/integrative sessions. Many of my clients experience a whole new perspective on their experience and need a session between memories to process this.

Techniques from EMDR, somatic work, and trauma narratives from CBT exposure-based therapies listed above are effective here

Phase III

Integrates new skills, insight and stability

Helps client develop sense of new normal

For clients with Dissociative Identity Disorder, final integration of parts into the whole takes place

June 2014

What are the Symptoms of Complex Trauma?

In one of my early posts I described how trauma symptoms are really the brain’s way of continuing to protect itself from further harm. For example, think of the classic PTSD example of the veteran who dives for cover when a car backfires. Diving for cover was a protective response that may have saved the life of the veteran many times over during combat. Now that he/she has returned, however, the brain hasn’t unlearned this protective behavior. As we discuss trauma symptoms, both classic and complex, it is helpful to remember this principle.

Classic trauma symptoms are usually defensive against physical threats. Again, think of the combat example.

Hypervigilance is helpful in surveying one’s surroundings,

avoidance can help someone stay away from harmful settings (or thoughts/memories that are overwhelming), and

flashbacks are a reliving of the experience, perhaps the mind’s way of rehearsing against future similar threats, or resolving unrealized fight or flight strategies.

Complex trauma symptoms, on the other hand, are usually related to emotional harm done when the individual is a child and unfortunately, many times it is a caretaker who is causing the trauma through neglect or abuse. What happens then is that the regulatory system that pushes us into fight/flight/freeze is activated way too often by routine events. The result is that much of the emotional regulatory system is dysregulated. It also likely means that the child wasn’t able to integrate properly.

Here’s the deal. As we mature, we learn to manage complex needs and agendas. So while a baby or toddler can only handle one thing at a time–I want to eat! Now!—adults usually juggle several of these at a time. I want to eat, but I’m going to wait for my partner to get home first. Also, while I crave sugar another part of me wants me to be healthy, and while I’m tired, another part of me values that I do try to cook… and so on. We are constantly managing competing interests within ourselves and our environment to stay as safe and healthy as possible.

Someone who is being repeatedly traumatized often has no model for how to do this. When paired with a constantly heightened stress response, there’s a lot of dysregulation and dissociation happening.

Emotional dysregulation is often the result of an emotional/social hypervigilance. Clients that I work with are often highly sensitive to my facial expressions, my energy level, a glance at the clock, anything. Someone’s tone can drive someone who is dysregulated into a rage or despair. Meeting a new lover can inspire great heights of rapture. Not surprisingly, many people with complex trauma wind up with a Bipolar II diagnosis.

Attachment problems can show up a lot of ways but primarily a person will have

anxious attachment, clinging quickly to others and worrying about being abandoned,

avoidant attachment, where they want to connect but remain withdrawn and distant emotionally, or

disorganized attachment, where they will alternate in an I hate you, don’t leave me sort of fashion.

Maladaptive coping strategies develop when someone isn’t prepared to deal with their trauma in a healthy way. An otherwise healthy adult who is in a car accident and has subsequent trauma symptoms may seek out friends, exercise, get professional support, play music and other healthy coping strategies that allow them to experience their feelings and work through them. When the feelings or memories are too much, the individual will instead do something that helps them avoid these. Addictions, including drugs, alcohol, sex, gambling, eating and others are popular methods. Cutting and self-harm can serve this purpose.

Dissociation is also common. Dissociation occurs on a spectrum, ranging from daydreaming or highway trance to parts of self that are not aware of other parts. Studies show that more severe trauma is associated with dissociation. A few important points about dissociation:

All parts are part of the individual; no one has separate people inside of them

A person does not split into different parts; rather early trauma results in a failure to integrate our parts

Everyone has parts, like the ones I described above. It’s just that when we’re well integrated we tend not to notice how these different parts are interacting and negotiating. I’m not afraid of my angry, protective (fight) part because I’m not worried that it will take over and cause me to harm someone. If I were less integrated, this would be a concern and my angry part might be exiled and silenced.

Complex trauma symptoms are really what people mean when they talk about complex trauma. Not everyone exposed to chronic abuse develops complex trauma symptoms, so defining complex trauma as the event has allowed many researchers to only include the “wellest of the traumatized” into randomized control studies of specific interventions. At the end of the day, the event isn’t nearly as important as how the individual responded to it. That’s why it is crucial when researchers say they are including complex trauma survivors in their study, they aren’t including folks who report chronic child abuse but then excluding people with the symptoms listed above. In my next post, I share more about the state of evidence based practice for complex trauma.

This was a VERY brief overview. For more reading on complex trauma symptoms, check these out:

http://www.traumacenter.org/products/publications.php

http://www.isst-d.org/default.asp?contentID=52

from After Trauma