Good reads

https://chrissireads.wordpress.com/2017/08/29/ten-gems-in-mental-health-literature/

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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.

8th August 2016 – learning from Photographer Sue Bryce

If you are struggling with an illness, if you have a job you hate, if you are having a hard time in your relationships, if you are struggling with your weight, struggling with issues from your childhood, struggling to make ends meet financially or having money issues in general, if you are in physical or emotional pain — this talk is for you.

Sue delivers her most powerful talk to date in this series of self-value videos. What she teaches here can absolutely change the way you see yourself and, ultimately, change your life!

Sue explains in depth how the way you value yourself will show up in your body and your illnesses, in your bank account, in your career, and in your relationships.She dives deep into her own personal experiences and illnesses and how it is all a reflection of how she values herself.

Sue talks us through the feelings of self-hate, shame, and anxiety. Our journey with these intense emotions often can rule our lives, but ultimately, can be let go. You can get back to yourself — the self you want to be — on every level.

KEY POINTS

I Am Important:

* Sue experienced the collapse of one of her organs and she needed to know why. She began exploring how she was causing this to happen and she found her answers. She found that what we are the result of all of our illnesses.

* Sue believes that health, wealth, and love are all intertwined and they all come from a mirror of what you are worth.

* If you are born into poverty, you have the ability to become wealthy. You can achieve what you want to achieve!

* Every human being wants to be seen, heard, and loved.

Choose Your Pain:

* Once you start taking responsibility for what is “happening” to you, you can begin to take control and choose growth and success.

* Sue believes we choose pain, not joy. We gauge our day by how much pain we feel and when we feel that pain, that will measure how much further you are going to go.

* When you decide you want to make a big change, whether it’s moving or divorce or starting a business, there is both joy and pain that comes with it. Change can be terrifying and anxiety provoking and lonely — all part of pain. So, we are choosing our pain when we make these changes.

* What is the result you want? Are you willing to go through the pain to get there? You must be okay with the pain you will endure to get there!

* It’s the pain that stops us from making the big changes to actually get where we want to go because we are afraid of the pain! So you don’t move. You don’t progress. We don’t run from joy, we run from pain, but we must endure the pain to make the changes and have the joy!

* In reality, we project anxiety into our body and into our life by creating a scenario that hasn’t even happened! This puts you at a completely disempowered state. That is not fear — that is pain.

Distraction:

* Any addiction is a distraction.

* Instead of allowing ourselves to feel pain and allowing it to coming into our body, we anesthetize ourselves with food or alcohol or any other substance.

* When an emotion comes into your body, it will stay there for 90 seconds — no longer! * In order to empower it passed the 90 second mark, you have to re-empower it with a story. (Dr. Jill Bolte Taylor)

* If we ask ourselves, “What am I feeling right now?” and allow ourselves to feel whatever that is for 90 seconds, we can deal with it instead of avoiding it, pushing it down, swallowing it with distractions (addictions). We use so many distractions so that we don’t have to feel it.

Supporting Pain:

* The next time the pain comes to you, welcome it in and FEEL it. You can’t get to the next level in your business or relationship or any big change without feeling it and accepting it.

* Choose your pain! Don’t distract yourself from it with eating, drinking, smoking, shopping, etc.

* You get to be in control of your pain so that things no longer “happen” to you, but you get to make things happen!

* Don’t be afraid of the pain. You are going to get it anyway!

* When you are in pain and can’t deal with it any longer, people will start to support you. Once other people are supporting you (emotionally, financially, etc), you have lost all control of your life.

Validation:

* We are constantly looking for validation from other people and we think that getting that support and validation will help us to achieve our goals.

* The truth is, if you are asking everyone else to give you some form of acknowledgment or validation, it is not going to help you achieve what you want! You are giving them power instead of empowering yourself! You need to be the one supporting yourself!

* When you put your mind to something and decide you are going to do it, you will achieve it. You won’t need anyone else’s validation or permission.

* Are you talking about it and looking for validation or are you actually doing it? The person who is walking their path is DOING IT and the person looking for validation is talking about it.

* Any area you are not empowered, someone or something will overpower you!

Tipping Point:

* You have the power to decide what dream it is you want to “tip”. You have the power to d

* YOU HAVE THE POWER TO DECIDE TO MAKE THE CHANGE! To get out of debt, to leave your partner, to start your business or whatever it is you want to do. You just have to walk that path of pain so that you can grow to get there!

* I don’t believe in myself = I haven’t tried yet

* You will experience the same drama in your life until you don’t need it anymore, until you have no identity in it, until you learn from it.

* When people don’t believe in you, YOU have to believe in you!!

* Prepare yourself that you will have a pain breakthrough when you are making change. Just remember that it will take you to a place that is better than where you were!

Take A Knee:

* When Sue receives criticism from someone, whether it’s trolling online or from a client or from within a personal relationship — basically anytime she feels hurt — she asks herself WHAT IS THIS SHOWING ME?

* Whatever that criticism is, there is something you can learn from it. If someone is disrespecting you, you must be disrespecting yourself. If you’re not feeling love, it’s because you’re not giving love. If your business is suffering, you are clearly not valuing yourself enough.

* Now this can be a hard thing to accept because, again, it goes back to being responsible for everything that happens to us! The hard part is accepting it without judging it.

* YOU MUST START DOING WHAT YOU ARE NOT GETTING

* Taking a knee is to ground yourself in the present moment. Experience fully what you are feeling.

Disempowerment:

* Before getting to the point where Sue is at today, she was so deep into her pain and the stories around her pain, that she wasn’t even conscious of what her life pain was.

* If you are at this point, you are likely not living a life that is congruent with your dreams and you are not the person you want to be!

* When you get to the point when you start overcoming your pain, look back at your pain path that you just took! Remind yourself how incredible you are! You took a chance and believed in yourself and you were brave and courage! You knew it would hurt, but you kept going because you wanted the result more than you wanted the pain. And now you’ve got the result! You will no longer feel afraid of what you cannot do.

Parents:

* The biggest story you will tell will is the story around your childhood. Your ability to achieve what you have started from what your parents have taught you and what you learned from them.

* When we reach a certain age, usually around 30, we start to think about what we missed out on as a child and we might even have some resentment towards our parents.

* There are so many wounds that we carry from childhood and we have a big story around that. But the truth is, this does not need to be your story any longer. YOU CAN BREAK IT TODAY.

* In order to do that, you must rise above your parents and have compassion for them. They were doing the best they could with what they had and knew. And it’s time to release them. Because whatever story you are telling around this is stopping you from having something NOW.

* What you can’t do now, we often blame our parents for what they didn’t do then. So instead of taking responsibility, you blame your parents.

* You must go beyond your perceived childhood dysfunctions. You are an adult now and you need to forgive them, love them for it, and move past it.

* YOUR CHILDREN WILL DO WHAT YOU DO, NOT WHAT YOU SAY

What You Are Not Getting:

* There is often a perception that if you had the world’s perfect parents, you would have all of the things you wish you had.

* The reality is that everything you want is available to you NOW if that is what you really want!

* Even if you have the worst possible parents on the planet, you can still have what you want!

Bring It Back To You:

* Sue believes that mirroring is the answer to ALL growth. You might feel like everything is happening to you and it’s not your fault and it’s not fair, but the truth is that YOU are the protagonist in your own story.

* You must keep bringing it back to YOU!

* If everyone at everyone else’s reactions as a reflection of what they are going through and nothing to do with you, it would change the world. Yet, we just can’t seem to do this.

* When you walk into a room, you see how people are seeing you through the filter of your own mind! We create what we THINK people are thinking about us based on what we think about ourselves!

* You can decide right now that you are worth more. More love, more income, more respect, whatever it is that you want. You can decide this RIGHT NOW.

If You Hate It, Look At It:

* When you don’t like someone, the first question you should ask yourself is: What is it about them that I don’t like? Because whatever it is I don’t like, I’m doing it. You can see yourself reflected back in everybody — whether it’s in a good way or a bad way.

* Often, we are confronted by people who upset us. But, they are also messengers. They are telling you where you need to do work.

* So in business, if you client doesn’t buy from you, Sue is going to ask you where did YOU go wrong!

* If you keep attracting the wrong clients or the wrong partners or the wrong friends, at what stage are you going to wake up and realize that YOU aren’t learning the lessons that are being presented to you?!

* You only hate something that you fear and there is a big lesson in it for you and you must confront it.

* IF YOU HATE IT, YOU NEED TO LOOK AT IT. YOUR GREATEST LESSON IS THERE.

* If you want the illness out of your body or the pain out of your body, or the person out of your life, you need to walk through it. You need to see yourself in it.

* The wrong question is, “How do I attract the right client”? The right question is, “What am I seeing shown back to me over and over again?” That your work isn’t good enough? That your value is not good enough? That you can’t engage with people? Your clients and the people in your life are showing you over and over again what you should be working on!

* When Sue’s business starts to fall off, she looks at what SHE IS DOING WRONG! You can turn the energy in your business overnight. But, you have to take full responsibility for it!

Bullying:

* When someone hurts you, remember that they are only disempowering you for a moment, but only long enough for you to see what your weakness is. The person did not give you pain, but simply brought back a very familiar pain that sits so close to the surface.

* Something only hurts us when it’s true.

* You must choose to grow through the pain instead of becoming a victim.

* You can learn to elevate yourself without putting someone down.

* The worst bully is the bully that you are to yourself.

Action & Daily Practice:

* Sue is a firm believer in making an action list and walking towards it with daily practice. She calls is The Vision Paradigm.

* We only see so far and yet we are capable of moving mountains! We see the first surrounding energy and we feel trapped here, but it’s our own perception and reality and it can be distorted and so wrong.

* So you get this belief that you are in a bubble and all that you are allowed to achieve is what is inside that bubble and it’s not true!

* Be aware that as you start to move forward, something on your pain path might knock you back. But, you must keep moving forward.

* How you value yourself is a direct reflection of how you are getting paid.

* If you believe that you can’t have a certain future because of your past, YOU NEED TO STOP EMPOWERING THE PAST.

Empowered Emotional State:

* If you are in an empowered emotional state, you have certainty, confidence, conviction and value.

* If you are in a disempowered emotional state, you are overwhelmed with uncertainty and fear and you are lacking self-value.

* You cannot attract work, clients, money, or abundance if you are in a disempowered state.

* If you are working in a disempowered state, you are going to disempower your clients! If you feel this way, you need to acknowledge it before going into your session with your client.

* Take control of the situation. Turn it around to empowerment! Give love and compassion to the person who is about to walk into the room.

* The most empowered state is to give service.

* When you empower others, you will feel an instant shift inside you!

* Remember, feelings stay in our body for 90 seconds unless we continue to tell a story around it. So if someone hurts you, wrongs you, criticizes you, you have 90 seconds to feel it and then you need to manage the state in which you are dwelling.

What Do You Want?:

* When Sue (or anyone) asks you what you want, don’t tell her what you think she wants to hear. And don’t say, “I don’t know”. YOU KNOW WHAT YOU WANT!

* If you are someone who declares what you want and goes after it, you are going to be more successful. You must go after what you want! Yes, there will be pain along the way, but there will be even more pain if you spend your whole life yearning for what you could have had.

* We spend more time over nurturing others and not nurturing ourselves.

* Write down your goals. Make them realistic and actionable and walk towards them every day. Read them every single day and empower them with excitement and enthusiasm. Every. Single. Day.

* Don’t get stuck on the “how”!

* If you say you don’t know what you want, you either don’t believe you can have it or you don’t know how to get it.

The Wheel of Misfortune:

* Sue doesn’t believe so much in manifestation, but in fully in taking action — saying you want something and taking action towards it — as the way to get things, to make things happen, to achieve your goals.

* But, you must be careful and clear with what you ask for. Your energy is being infused in everything you say out loud, what you are doing, what you are being. If you are unclear, the Universe or God or whatever you believe in, gets confused about what you REALLY want.

* WHAT YOU HAVE IS WHAT YOU WANT! BECAUSE THAT’S WHAT YOU ARE DOING! You are getting something out of whatever situation you are in that you are saying you don’t want. You just have to pay attention to the lesson!

* The Wheel of Misfortune to teach you how what is happening with you internally is a direct reflection of your money issues!

* The Wheel of Misfortune = Avoidance, Overspending, Overgiving, Guilt & Shame, Resentment, No Boundaries, Not Receiving, Tight Fistedness

* Money will stay with those who value it most. If you avoid it and don’t pay attention to it, it’s gone.

* We avoid facing our money issues because we don’t want the pain of fronting up to what we are doing. But, the truth is, you will get hit with even more pain because you end up overspending, letting someone else manage your money, over giving, not managing it, not saving it, and then you are in debt and the money runs out and you are in a serious amount of pain — much more pain that if you had taken action to face what you were doing in the first place!

* You might be repelling money because of guilt and shame of receiving money.

* You might have so much difficulty receiving money because you don’t believe you deserve it.

* You must figure out your money leak to change your money situation!

No More, No Less:

* The Rule of Cosmic Ordering is: You will receive no more and no less than what you ask for and what you action every day.

* So whatever you are experiencing, you are somehow asking for it. This is the truth!!

* Reset what you think you want because you will get NO MORE AND NO LESS than what you want!

Your Body & Stop Eating Your Pain:

* When Sue was very overweight and her gallbladder had collapsed, she kept repeating to herself over and over “go on a diet, go on a diet, go on a diet”. When, in reality, it had nothing to do with food. It had everything to do with what she was holding onto.

* Your body is a clear representation of what you are holding onto. If you don’t value yourself, it doesn’t matter if you are slimmer or younger or prettier. You will continue to attract what you have now no matter what your body looks like! You must change your own self value and self love to change anything else!

* This goes the same with business and relationships and everything else. Until you change your own self value, nothing else will change!

* Your problem is not what you’re eating, your problem is how you’re feeling and what you’re not dealing with. Your problem is your pain.

* You must separate the calories from your pain.

* You need to go back to the root of the emotion!

Exist in Photographs:

* You know how Sue feels about existing in photographs. She wants to teach the world that you must exist in photographs not hide behind them because you don’t feel good enough to be in them.

* If you die tomorrow, your family are going to look for photographs of you and what are they going to find?

* You need to accept yourself and who you are NOW!

Emotion = Energy in Motion:

* Emotion is Energy in Motion. So when energy becomes trapped, it becomes weight, illness, or pain.

* As soon as you can shift it and not trap it, IT CHANGES EVERYTHING.

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.

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

21st June 2014

Trying to understand my illness…

What is Complex Trauma?

Post-traumatic Stress Disorder was defined in order to describe the symptoms of many Vietnam War veterans that were returning to the United States. Physically unharmed, many of these veterans were presenting with obvious disturbances that impacted their functioning. So, the APA scrambled and in 1980 Post-traumatic Stress Disorder made its debut. Though early on the Veteran’s Administration told Bessel van der Kolk that “It’s never been shown that PTSD is relevant to the mission of the Veterans Administration,” now they spend millions each year on the research and treatment of combat-related PTSD and “by far the largest group studied is male combat veterans”. Which is awesome. Veterans deserve the best treatment we can offer.

But what about the rest of us? Prior to the creation of the PTSD definition, a handful of studies had described symptoms that appeared in some people after a traumatic event, including combat, rape, a nightclub fire with a 50% mortality rate and natural disasters. Thing is, most trauma survivors aren’t combat veterans. Most trauma survivors experienced neglect or abuse from their caregivers and they have different symptoms and treatment needs than adult survivors of single-event trauma (p. 374). It’s becoming more and more clear that the “pure form” of PTSD is actually not representative of most trauma survivors and that many trauma survivors receive different diagnoses because the PTSD diagnosis does not fit them. Complex trauma still isn’t a diagnosis in the DSM, for a lot of different reasons—political issues, lack of uniformity in complex trauma cases, difficulty evaluating complex trauma and dissociation and most importantly, lack of funding to study complex trauma.

This week, I’ll be sharing about complex trauma—what is it and what’s important to know. As the name suggests, it is a complex topic, so I’m not even going to try to cram it into one entry. Here’s what you’ll see this week:

Sunday: the types of events that precipitate it

Wednesday: complex trauma symptoms and how to talk to professionals about them

Friday: treatment: what’s helpful and what can cause harm

from After Trauma