PTSD and Psychotherapy

SunsetTrauma is a condition that may develop after being exposed to threatening and chaotic events over which we have no control. These traumatic events create reactions in the body-mind, including fight, flight or freeze, the essential survival responses, changes in cortisol levels and other hormones altering our metabolism.

Even though the threat has passed the body-mind remains in a state of fear and hyper-vigilance, eventually showing up as chronic pain and illness.

If this condition is not treated, it can lead to post-traumatic stress disorder or PTSD where individuals will experience high arousal (easily triggered), flashbacks of parts of the traumatic event, low arousal (dissociation), disturbances in their social lives as well as muscle tension, numbness, digestive and immune system issues. It’s as if people have to continuously respond to threats with its accompanying physical and psychological pain.

Finding safety is an essential component to healing from trauma in the context of psychotherapy. As clients begin to feel the trauma-related fear they learn how to manage the overwhelming memories using various psychological strategies, relaxation techniques and movements while staying present with feelings and sensations.

Getting to a point of being able to simply feel the experience directly in the body is all that is needed to activate the body’s natural relaxation and restoration functions, the initial step toward healing.

As Fogel suggests:

Confronting trauma memories in the subjective emotional present is required in order to integrate dissociated parts into a more integrated embodied and conceptual self-awareness of accepting and letting go of symptoms. This can only be done, however, in the context of supportive resources, client-therapist co-regulation, ability to verbalize and at the same time to feel, and therapeutic support for a gradual return to re-engagement and self-regulation (p.172).

References

Fogel, A. (2009). The Psychophysiology of Self-Awareness. New York: Norton.

© 2013 Maria Stella, PhD. All Rights Reserved.

Working with Everyday Small Trauma

ReflectionA couple of weeks ago I came across an article in the New York Times that addressed the inevitability of encountering trauma in our lives:

Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder.

There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it. (Epstein, 2013)

Working with our everyday small trauma begins with acknowledging and being willing to experience the hurt:  the feeling of confusion and disconnection, the feeling rejection,the feeling of anxiety that accompanies that hurt.

And consequently paying attention to our body response (numbness or fidgeting) and letting the emotion move through while noticing the mind scrambling to blame another or trying to avoid the situation all together.

As Epstein suggests:

The willingness to face traumas — be they large, small, primitive or fresh — is the key to healing from them. They may never disappear in the way we think they should, but maybe they don’t need to. Trauma is an ineradicable aspect of life. We are human as a result of it, not in spite of it.

References

Epstein, M. (2013, August 3). The Trauma of Being Alive. New York Times, Retrieved from http://www.nytimes.com

© 2013 Maria Stella, PhD. All Rights Reserved.

Recovering from Car Accident Trauma

Leaves on car windshield by Charles Blackhall
Photo by Charles Blackhall

A car accident may trigger shock, fear, anger, confusion and feeling of guilt all that once. Counselling will help you deal with these emotions and the flash backs you may experience in the aftermath. Somatic therapy will reduce the anxiety and symptoms from the accident by working with the nervous system where the memory is stored.

Healing and recovering from a car accident during therapy takes a number of steps:

  1. Recalling when you felt safe after the accident to help your body realize that the traumatic event is over and to help you reconnect to your body’s ability to relax.
  2. When memories of the accident return you will be guided to switch to when it was over and safe. Going back and forth between the accident memory and the safety memory will help you discharge the activation (stored traumatic memory) in your nervous system.
  3. Bringing you back to the moment before the accident is also crucial in the final discharge: unthawing the freeze response of the body during the car accident.
  4. During therapy you will gradually slow down and be able to integrate the memories of the impact while leaving them behind along with the fear, panic and anger.

Trauma following car accidents can persist for weeks, months, or even longer. Counselling and especially somatic therapy will help you understand the symptoms, treat the health problems and gradually recover from the trauma brought on by car accidents.

References

D. Poole Heller & L. S. Heller (2001). Crash Course – A Self-Healing Guide to Auto Accident Trauma & Recovery. Berkeley: North Atlantic Books.

© 2013 Maria Stella, PhD. All Rights Reserved.

Practical Steps For When You Feel Overwhelmed

Walking by the oceanTime of transition can bring about moments of feeling stressed, scattered and just plain overwhelmed. Perhaps we are pulled in many directions, perhaps we try to keep up with the demands; what if we can’t get ourselves together, what can we do in these moments? Over the years I found the following steps useful:

– Slow down, breath, and feel the body, any sensation is a good start. This will help you touch in and notice what is going on in your physical body.

– Turn off your phone and computer, then spend a few minutes making a to do list on a piece of paper. This will help your mind focus more on a task.

– Take time out, go for a walk, and pay attention to your feet, the ground you are walking on. If you notice your thoughts spiraling out of control bring your awareness to your surroundings: what do you see, what do you hear, what do you smell, etc. This will help you reconnect to the world.

Overwhelm occurs when we lose connection to our heart, our body, and our sensory experience. We feel overwhelmed and shut down our feelings. By slowing down we become more present, we begin to relax, we open our senses, and we reconnect to our internal energy.

Even when transition time is over most of us continue to experience stress as our society seems to make so many demands on our time and energy. These simple steps, and other tools of ST, can help you find inner balance in times of stress and distress so that you’ll be able to invigorate your life.

© 2012 Maria Stella, PhD. All Rights Reserved.

Rebuilding Trust after Trauma

RoseTrust is being able to rely on the integrity, ability, and strength of someone or something; good relationships are built on trust and confidence. Trauma often disrupts trust, and this can have a lasting impact on your life.

Traumatic experiences generally involve a threat to life or safety, either real or perceived, resulting in feeling overwhelmed, distressed, and alone. There are various types of common traumatic events. The cause of trauma calls for different intervention. In natural disaster connections need to be established with fellow survivors to provide mutual support. In relational trauma safety can be found in nature or spiritual connections.

Healing trauma and restoring trust include various activities such as learning relaxation skills, working to a somatic therapist, journaling, taking part in positive activity, joining a support group. These activities will help restore a sense of reliability to your life and help you rediscover trust after traumatic events.

Counselling can help you better understand and change how you experienced trauma and its aftermath. Somatic therapy engages the mind and the body, and works with the intention of changing the brain from experiencing dysregulation—strong emotions, anxiety, fear, doubt—to regulation—peace, calm, connection. This process supports your rebuilding trust in yourself and your world.

Trauma Treatment: Healing Through the Body

When we think of trauma, we often imagine events including physical or sexual abuse, childhood abandonment, violence, war, injuries and illnesses, natural disasters and loss of loved ones. However, Levine (2008) talks about trauma as a “loss of connection—to ourselves, to our bodies, to our families, to others, and to the world around us” (p. 9). Levine explains, “We become traumatized when our ability to respond to a perceived threat is in some way overwhelmed either in an obvious or subtle way” (p. 9). Thus trauma is more of a continuum from life’s catastrophic events to small traumas that we experience in our everyday life including minor car accidents, medical procedures, falls, sudden startles, and being left alone as a child.

In response to traumatic events we carry out fixed action patterns: fight, resisting and overcoming the threat; flight, avoiding and running away from the threat; freeze, physiologically holding the memory of trauma based on the evolution of survival behaviors. The memory of trauma then resurfaces in our life in a variety of symptoms: hyper vigilance, mood swings, sleep disturbance, flashbacks, social withdrawal, addictive behavior, shame, depression, numbing, that become chronic over time (Levine, 2008).

Since trauma is stored in the body, healing occurs when we access and shift the body’s memory that is fused, distorted, or dissociated. Somatic Transformation (ST) utilizes strategies to link or differentiate intense experience of complex trauma (Mortimore & Kingsbury, 2010) through helping regulate intense emotions and integrating the traumatic disconnected implicit memories in these four clinical processes:

  1. Therapist uses his/her own attuned, regulated body to connect and help co-regulate the client creating an empathic bond.
  2. Therapist tracks the shifts in the body occurring in the present moment representing fixed action patterns.
  3. Therapist uses intervention including inquiry of body sensations, working with gestures, tics and thwarted movements, imagery, metaphors, symbolism, oscillating between the fixed action patterns and resourced states. This process allows for regulation and integration of complex trauma.
  4. Therapist assists the client in reflecting on new meaning emerging from the experience that creates a new healthy narrative.

In separating the implicit memory of the trauma from the present moment experience and reintegrating it in the body the therapist assists the client’s healing process (Stanley, 2011).

References

Levine, P. A. (2008). Healing Trauma. Bolder: Sounds True.

Mortimore, L. & Kingsbury, M. (2010). Somatic transformation: Linking neuroscience, the body and the therapeutic relationship. Insight into Clinical Counselling, 4, 6-7.

Stanley, S. A. (2011). Somatic transformation: Healing trauma in and through relationship. Two year program: Victoria, Canada (Unpublished curriculum).

Habitual Patterns of Behavior – Defense Mechanisms

How often do you react to people and situations based on old habits (perceiving, thinking, feeling, behaving)? Have you ever noticed how you become defensive? Before even realizing it you automatically respond as if those old experiences were happening again (defense mechanisms). All of us have developed habitual patterns of behavior—automatic reactions are based on past experiences.

Many of the core beliefs about ourselves and the world are formed from the time of conception through adolescence from parents, relatives, teachers, society, etc. The natural response to birth or childhood trauma is to create defense mechanisms that go on to become unconscious habitual patterns. As we grow up these patterns can manifest as addictions, self-sabotage, phobias, anxiety attacks, and other self-defeating patterns that cause us to act unconsciously or negatively.

Here is a summary of excerpts from Kalsched’s understanding of defense mechanisms per Sieff (2008):

Psychological defense system

When as children we are shamed, or abused, when our caretakers can’t meet our needs, our healthy development process is compromised and psychological survival system kicks in. As highly dependent children we can’t withdraw, so a part of us withdraws. This part is our essence—the creative, authentic, innocent, vulnerable self— this part goes into hiding into the unconscious. We still grow up, but begin to develop a rigid psychological defense system that will use whatever means it can to protect that essence.

At the time we are shamed, abused, ignored as children we begin to separate from the experience (psychological dissociation) in order to survive and go into a trance, the trance of unworthiness. Our capacity for genuine and trusting human relationships disintegrates. We start to believe that we are in pain because we are fundamentally at fault: “I would not be suffering like this if I was an worthy person…There must be something wrong with me… I am not loveable…I am not good enough…”

Anger is used to create a self-blaming system, self-protecting but also self-persecuting. This is how the self-defense system ends up turning against the very person it is supposed to be protecting.

Ways in which the self-care system keeps life away

  1. Our inner voice stops us from venturing into the world by saying: “you are unlovable, you are too fat, you have nothing interesting to say, you are crap at communicating, nobody can trust you, you are a failure.”
  2. It creates additional psychological dissociation, often becoming a disembodied observer. People are cut off from experience, from feelings and from life in order to survive. This self-care system is experienced as trance covering unbearable pain.
  3. It encloses a person into a fantasy world, providing a vibrant private life where the fundamental essence can live safely.
  4. If often foster addition and looses the ability to root in real life.

This is a universal system. Not all of us have unbearable trauma, but we are all hurt to some degree. We all grew up in a home or society where only parts of us have been allowed to blossom, while others parts that were unacceptable have been locked away.

How to move beyond the prison of our self-care system

We can rewrite the shameful and self-blaming story that we developed to explain our original pain (where suffering got turned into violence and directed inwardly). The process of healing depends on transforming that violence back into rightful suffering. To do that requires a lot of grief work and this is tricky because the self-care system has a whole story about grievance we have suffered and so we have to distinguish between true grief and superficial grief.

Sometimes people don’t have a trauma story, but a conviction of not being good enough. The pain that surrounds this meaning is superficial grief—nevertheless it is painful. The self-care system is designed to prevent the deeper original pain from surfacing.

The self-care system covers our original pain with trance and feelings of unworthiness, of badness—our victim story. Hidden behind the story is the more profound original pain, or the pain of the threatened part of the child that had to go into hiding from fear of alienation.

It is the pain of the innocent child that suffered terribly (true grief). When we open to the deeper pain with self-compassion, we begin to cry the tears that bring healing.

Change and healing

Change is possible when we become aware of our own protector/persecutor system, appreciate the survival value, we accept that it is outdated and take the risk of letting go. Healing is possible once we take responsibility for the limiting destructive system we have constructed and when we grieve the trauma we have inflicted upon ourselves by our defense mechanism.

“Trauma is a loss of connection—to ourselves, to our bodies, to our families, to others, and to the world around us. This loss of connection is often hard to recognize, because it doesn’t happen all at once…We may simply sense that we do not feel quite right, without even becoming fully aware of what is taking place; that is, the gradual undermining of our self-esteem, self-confidence, feelings of well-being, and connection to life. Our choices become limited as we avoid certain feelings, people, situations and places. The result is this gradual constriction of freedom is the loss of vitality and potential for the fulfillment of our dreams” (Levine, 2008, p. 9).

Shift is possible if we are able to look at ourselves with deep compassion and forgiveness realizing that our self-traumatizing system was the only way to ensure psychological survival; thus protecting our essence.

If we remain focus on our self-blaming defense mechanism, our sense of unworthiness, we get into our victim story and get stuck in superficial grief, preventing from going into our more profound wounds. When we take responsibility for how we created our own pain we open the doors to our lost essence imprisoned within. Then we feel true grief and begin on a path of real healing—meeting our inner struggles and fears on the way.

Physiology of trauma

Have you noticed that every time you experience a shock or trauma of any sort, you stop breathing – you catch (or hold) your breath? The effect is an energetic imprint of the sights, sounds and smells of the trauma incident are energetically recorded in your body and the defense mechanism kicks in. There is an adrenaline rush with the classic ‘fight, flight and freeze’.

Sympathetic system sends messages up the spine to prepare for danger—instinct to run, high arousal. At the same time the parasympathetic nervous system goes into overdrive; the dorsal vagal part (of PNS) tends to toward shut-down—we experience fear, shame and freeze. These two responses occur within seconds of each other, almost simultaneously and they get coupled together. Healing occurs by slowly beginning to uncouple the two systems.

“When we begin to move out of immobility response we are often frightened by the intensity of our own energy and hidden aggression so we brace ourselves against the power of sensations. This un-discharged energy is stored back into the body and we get trapped by our past…When we are able to access our body memories through the felt sense then we begin to discharge the instinctive survival energy that we didn’t have a chance to use at the time of the event. This discharge can be dramatic and visible or subtle and quiet” (Levine, 2008, pp. 30-31).

According to Kalsched (Sieff, 2008):

Process of healing

  1. Many of us have grown up by learning to get by with limited creativity saying no to life.
  2. The counsellor sees the client’s as a whole, including his/her essence their potential; this has a profound effect on the client, initiating the healing. The client is fully seen and heard.
  3. Client risks letting down her/his defenses and begin to hand over their self-defense mechanism to the counsellor (uncovering habitual patterns, releasing trauma). The counsellor helps client see that there is a better healthier way to live—a more fulfilling vibrant life.
  4. Both the counsellor (by showing the client their habitual patterns/defense mechanisms) and the client (by choosing life instead of their fantasy world) have to let go and open the door to start a new life.

Every time we are successful in challenging our habitual patterns our world expands and we take a step towards being fully alive.

References

Brach, T (2003). Radical Acceptance. New York: Bantam Books.

Levine, P.A. (2008). Healing Trauma. Bolder: Sounds True.

Porges, S.W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123-46.

Sieff, D.F. (2008) Unlocking the secrets of the Wounded Psyche – An interview with Donald Kalsched. In Psychological Perspectives 51 (2), 190-207.