Heal Trauma and Grief with Storytelling

Storytelling 101 courtesy of kodomut via flckr

Sometimes people are so disturbed by the way someone died that they focus more on the deceased person’s “dying story” than they do on the person’s living stories. Yet reflecting on our living experiences with the deceased is an integral part of healing.

When I interviewed grievers for my book, they consistently stated one of the most healing experiences is hearing stories about their deceased loved one. Yet, people are often afraid to mention the name of the deceased to the bereaved. Please know that the majority of grievers enjoy reminiscing about their deceased loved one and want to remember their life, not their death. A reader recently wrote me about this stating:

“I read your book and thought it was fantastic! I have tons of memories [of my deceased mother], unfortunately all of the ones I remembered or chose to remember were painful.   After reading your book, I started looking through my photos and videos and I found myself laughing and remembering how that laughter came about.  My memories of my mom now have some laughter in them, and so do some of my dreams… You helped me to see a section that I have been missing, thank you.”

Constructing stories is valuable for another reason. Frequently after a traumatic event, feelings, sensory information, and implicit memories of the event are typically left hanging in fragments that researchers believe are mostly processed and stored on the right side of the brain. Yet, the logical, linear-oriented left side of the brain has a drive to make sense of these fragments and put them into some kind of logical order. Building a coherent story based on your memories incorporates these fragments, bringing context and structure to them, which can help you heal. I’ll be sharing more ideas about ways to use storytelling for transforming trauma and grief in future posts.

In addition, my colleague Juliet Bruce is offering a free teleseminar on June 20th from 8-9 p.m. EDT called, “Finding the Bones: The Essentials of Story Practice.” The workshop is for writers, therapists, teachers, and anyone interested in telling a story. To register go to Julie’s website at http://www.julietbruce.com/

PTSD Coach: New I-Phone App

Yes, there is an app for just about everything, including PTSD management. I downloaded “PTSD Coach” last night on my i-phone and have to say it is a handy little tool.

PTSD Coach contains all sorts of exercises someone can use to calm down and reorient themselves when they are triggered or feeling anxious.  The exercises are all instantly accessible, easy to use, and even customizable with your own photos and songs. You can choose from a progressive muscle relaxation exercise, visual imagery, music you enjoy, the RID exercise- which helps you identify the anxiety trigger and get present- and many more.

In addition there are assessment tools, charts to monitor progress, education modules that explain causes and symptoms of PTSD as well as treatment options. Last there is a support module that links you to online resources or your own personal support contacts that you enter from your phone.

PTSD Coach was created by the VA’s National Center for PTSD and the DoD’s National Center for Telehealth and Technology.

The VA stresses that people who think they have PTSD should also seek professional help and only use the app as an adjunct to professional counseling and therapy. I agree. While this tool can be somewhat useful when someone is having a mild to moderate level of anxiety, these are somewhat lightweight tools that won’t work so well for someone experiencing severe flashbacks or anxiety.

Fortunately, there are therapy options such as Rapid Resolution Therapy that can clear these severe reactions. Now we just need to create a Rapid Resolution Therapy app and we’ll have all the bases covered!

Coping with Waves of Grief Using Mindfulness

photo courtesy of Peter Kaminski

Current research suggests that grievers do not actually move through grief in a series of five “stages,” but instead tend to experience grief in cycles of recurring waves.

There are high tides during which emotions are intense and the griever is preoccupied with feelings and thoughts around the loss, alternating with restorative tides during which the griever feels numb or is more focused on adapting to life without the deceased. Although these cycles are normal and decrease in intensity over time, grievers often feel disoriented by these vacillating emotions and wonder how to cope with them.

One way you can cope with these waves is to apply the practice of mindfulness. Mindfulness is the practice of compassionately and curiously observing your feelings and thoughts and breathing through them without judgement. When we apply mindful awareness to an emotional response, we essentially notice the sensations, thoughts, and feelings that we are experiencing and accept them as they are, without judging them, or having a secondary emotional reaction to them.

When you pause and become mindful, you will notice that although emotions feel intense as they are rising like an enormous wave, they will crest and descend, decreasing in intensity within a few minutes. Breathing through the experience with an attitude of acceptance and loving-kindness toward yourself will make it more bearable. It’s akin to surfing a wave or flowing with it instead of futilely standing against it and getting knocked down.

Here is a short beginning mindfulness practice you can use called the Mindful Breath:

Begin by noticing the rhythm of your breath without changing it. Place your hand on your belly and feel the expansion of your abdomen as you inhale. Then, feel the softening of your abdomen as you exhale. Do this for a several breaths.

When you become aware of any emotions you are feeling, notice where you feel them in your body, then gently inhale into this area of your body while you say to yourself, “I acknowledge my emotion.” Now, softly exhale while you say to yourself “I calm my emotion.”

As I wrote in a previous post, recent studies at Massachusetts General Hospital and the University of Wisconsin have demonstrated that regular practice of mindfulness meditation actually changes the structure of areas of the brain so that you can better cope with stress, manage emotion, and cultivate a more positive outlook. Moreover, I believe practicing mindfulness gives you a way to be fully present as you open up to the awareness that you still have a connection to your deceased loved one.

As Sameet Kumar states, “Grief only serves to highlight the depth of our capacity to love and be loved.” Engaging mindfulness brings you into the awareness of that love and is the first step I recommend in my book on transforming grief.

Next week, we’ll talk about the next step for transforming grief: Making Living Stories.

Get my new book and help the Red Cross!

Did you know there have been many recent advances in the effective treatment of traumatic grief that have not been featured in the mainstream literature?

Well, I’ve been working feverishly over the last six months to put these together in a book I’ve written called, Transforming Traumatic Grief: Six Steps to Move from Grief to Peace after the Sudden or Violent Death of a Loved One.

My motivation to write the book initially grew out of my excitement about the trauma and grief interventions I’d learned through Jon Connelly’s Rapid Resolution Therapy. Dr. Connelly helped me with my own traumatic grief several years ago and I’ve had phenomenal success using his approach with my clients over the last four years.

I grew even more excited as I began to research other methods for clearing grief and found they paralleled what I learned from Dr. Connelly. For instance, Columbia professor of psychiatry, Katherine Shear has developed an empirically validated model for treating complicated grief that was featured in the Journal of the American Medical Association (JAMA) that includes a protocol for reprocessing traumatic memories and having an imaginal conversation with the deceased. Similarly, Seattle psychiatrist, Ted Rynearson has a very effective model for helping families of homicide victims called Restorative Retelling that he’s been using for years.

In the book, I put together interventions that these successful models have in common along with other tools like mindfulness and community resources that help people heal. The book is written for both the bereaved as well as the people who help them such as therapists and clergy. In it you will find:

• Mindfulness and imagery scripts that promote healing
• Methods to stop nightmares and intrusive images/thoughts
• How to clear guilt/regrets and foster resilience from loss
• The value of connecting to “the living story” of the deceased and sensing them as a supportive presence in one’s life
• Ways to obtain social support through family, community, and online resources

Currently, you can get PDF and e-book versions of the book at Smashwords.com where I can offer you a 20% discount through 5/30/11. To get your discount, use the code: ST98L. I will also be donating 10% of the proceeds to the American Red Cross to help those negatively impacted by the tornadoes and storms in the southeast last week.

If you prefer paperback over digital, you will be able to get a print version of the book this June through Amazon.com and other online book retailers.

Over the next several weeks, I’ll continue sharing excerpts from the book here on the blog. We’ll be discussing big changes in the field of grief and trauma therapy as well as tools that promote peace and healing. Please join us in the discussion!

Healing Grief and Trauma with Prescriptive Art

"The Bright Lightness of Koot H." photo courtesy of Nancy Gershman

Did you know specialized artists and musicians will collaborate with bereaved individuals to custom create art or music commemorating deceased loved ones?

For example, Nancy Gershman, who coined the term “prescriptive artist,” is a digital artist who repurposes a griever’s life-affirming photos, memories, and stories of the deceased into a fine art photomontage (a “Healing Dreamscape”) to counter loss and regrets.

When I interviewed Nancy, she explained that prescriptive art is “custom-created artwork which recontextualizes memory, shifting the griever’s perspec­tive of the deceased from absent supporter to supportive presence. It also provides the griever with a tangible object that reinforces this shift.”

For example the photo above depicts a photomontage Nancy created for Hope after her son Ishmael was fatally shot. Through a review of photos and stories that Hope shared with Nancy about Ishmael, Nancy was able to illuminate the sensory qualities that Hope loved about her son, such as the way he looked as a baby and the way he loved to grill hot dogs on cold, windy days in Chicago. Nancy also included colors and meaningful objects that Hope found peaceful, integrating the imagery in a way that symbolized for Hope that she and Ishmael were forever connected arm and arm in spirit.

In an article, Nancy Gershman and Jenna Baddeley wrote for the American Psychotherapy Association’s Annals Fall 2010, Hope commented that the Dreamscape Nancy made for her created a turning point in her healing. The authors quote Hope as saying, “When I saw what we made, I just got caught up in the moment…It seemed as if Ishmael was here, alive. Because it’s physically here [as Hope’s screen saver] where I see it every day…He’s here and in my heart.”

As trauma therapists, I believe this is what we are also helping people to do- create a “preferred legacy” or  redemptive story out of what has happened. In our own way, we are also helping our clients to create “healing dreamscapes” so they can view themselves and their lives in a new light.

To contact Nancy about creating a prescriptive photomontage, visit her website at www.artforyoursake.com. Another site, www.bereavementartists.com features an entire directory of specialized artists who custom create works of art in a variety of media (including quilts, portraits, urns, and jewelry) to honor a loved one’s story and legacy.

Return to Freedom: Combat Veteran Defeats PTSD

Photo Credit Department of the Army

Last week, I had the honor of working with a courageous Iraq war combat veteran who sustained a traumatic brain injury (TBI) in the war and suffered severe flashbacks.

He asked if Rapid Resolution Therapy (RRT) would work for him, given the TBI. While I told him I was not sure how the TBI would impact things, I was sure we could clear the impact of the trauma. I reassured him that he’d already completed the hard part by surviving the war. He laughed and agreed that meeting with me could not be any worse than what he’d already experienced in combat.

When the soldier arrived at my office, he had a service dog with him, which led me to think he had a visual impairment. So, I offered to fill out the paperwork for him as he verbally gave me his answers. The soldier laughed and said,

“I can see just fine. My service dog accompanies me because my flashbacks have been so bad. When I have a flashback, my dog walks in a circle around me clearing the area to protect me and other people. Then, he licks my face and helps me wake up and come back to the present time and place.”

Wow. I was totally impressed with him and his dog, and it motivated me even more to free this guy up of those flashbacks. He told me he’d not been allowed to drive due to the flashbacks, and really wanted his freedom back. Here this guy dedicates his life to fighting for our freedom, and now this PTSD had imprisoned him. I was totally dedicated to this mission to fight for his freedom now.

We cleared his trauma in just under 2 hours. Though the TBI caused him to have some delay in his speech and thought process at times, he had a wonderful sense of humor and a keen intellect. His favorite part of RRT was the “goat and the snowflake” story (see this post for an explanation).

Upon hearing this story and playing the “pants” game to help him stay present, the soldier quickly realized that the horrific images were just images now, and the events were no longer in existence. We only had to discuss one event in detail, and he was able to apply the same concept to the other traumatic events he had experienced. I watched in amazement as he smiled and said, “Yes, there is no IED exploding. It no longer exists. My commanding officer is okay now and is not pinned under that truck. I am not getting shot at this moment. There are no piles of beheaded bodies that I have to clean up anymore. Those guys left their bodies and they are at peace now.”

Three days after our session, I gave him a follow-up call. He said, “I feel great. I have not had any flashbacks, even when my kids were screaming or I heard a loud noise. I have been driving again. I am able to imagine being on the beach watching the cranes when I feel stress and it immediately calms me. I am free again.”

I thanked this brave soldier for his service and we celebrated his return to freedom! You do not have to be imprisoned by trauma or your past. There is a way to return to freedom and reclaim your life.

Courtney Armstrong is a Licensed Professional Counselor as well as a Master Practitioner and Associate Trainer in Rapid Resolution Therapy. She has a private counseling practice in Chattanooga, TN where she specializes in treating trauma, anxiety, and grief. To contact Courtney, click here. To learn more about Rapid Resolution Therapy, click here.

“All I wanted was a trophy!”

photo courtesy of Cliff1066 via flickr

Recently, a client made this most insightful and delightful comment:

Courtney, you’ve really helped me overcome my childhood abuse. I’ve worked with a lot of therapists over the years and I now realize I didn’t want sympathy. I wanted a TROPHY- I mean a BIG Wimbledon-sized trophy and some applause. I’ve just wanted to hear someone say ‘Well done! That was a tough journey and you made it! That was quite an accomplishment, good for you.’

Her comment is something to which all therapists should pay attention. Most therapists were taught the way to help an adult heal from physical, sexual, or emotional abuse is to sanction the client’s status as a “victim-survivor.” Then the next steps in therapy might be to show a lot sympathy as you encourage the client to re-live the event over and over again to get “repressed feelings” out. After that, the therapist might urge the client to confront her abuser and do a lot of imagery and letter-writing to comfort her inner child. While all these approaches are certainly well-intentioned, I find they just keep people stuck.

I learned through my training from Jon Connelly’s Rapid Resolution Therapy to take a different attitude. With RRT, we acknowledge the painful impression a traumatic event may have left on a person’s psyche. But, then we are interested in revising this impression by making less of a big deal about the event itself, and instead, make a big deal about the client’s fortitude and resilience in surviving the darn thing! We encourage them to view themselves as heroes, realizing that not only are they still valuable and whole, but they are also wiser, stronger, and more compassionate. This is a far more accurate view of the situation and far more therapeutic for clients. Using this view, clients walk out of my office literally standing taller and smiling.

This particular client who made the “trophy” comment said in the past she had been thinking the way to heal was to forgive herself, forgive her father, and hope that one day he would show her the love and respect she’d been craving. After our work together, she was able to realize her father was just limited emotionally and interpersonally and that it was not her fault. We compared her father to the wizard in the Wizard of Oz. She had finally pulled back the curtain to see he was not so big and powerful, but a frail old man who was trying to keep the facade going. She’d been waiting for him to give her a “medal,” like the wizard hands out to Dorothy and her friends at the end of the story. Now, the story ends with my client realizing the wizard is too weak and preoccupied to hand out medals, so she decides to pick up the bag of medals herself and hand them out as she sees fit.

Recently in the media, there has been so much focus on horror and destruction around our world. Seeing such images over and over again can make us feel helpless. But, aren’t you more uplifted, inspired, and motivated when you hear stories of how people are helping one another, creatively surviving, and coming up with innovative ways to get through these tragedies? Let’s change our focus to where we can be resilient and creative in the face of adversity. Let’s start a new movement. Please share your “hero” stories here!

Trauma is in the Eye of the Survivor

Guest blogger: Mark Chidley, LMHC, CAP

This week’s post features excerpts from a wonderful article by my colleague Mark Chidley, LMHC, CAP. Thanks Mark!

Traumatic experiences may not always involve the imminent threat of death or dismemberment, nor even horror and helplessness. Trauma spreads out far beyond experiences of overt physical threat, violence, or even emotional horror or helplessness. What happened to the person may be more on the level of identity and meaning than what happened physically.

Indeed, in many cases the person was never actually touched, and yet for them their world shifted and neither their view of the world or themselves would ever be the same again.This is important because meanings affecting identity are often subtle and nuanced, not always what they would seem on face value. The temptation is always there to try to understand someone else in terms of how one would feel in a similar situation instead of how it was for them, thereby misreading the meaning and missing a chance for connection. Below are a few representative examples of such trauma arranged into categories I’ve noticed over time. There could doubtless be other categories added to this list.

Experiences of Humiliation

Many of us have heard clients tell of a moment of vulnerability or childhood incompetence and being humiliated in that moment . Wetting one’s pants in school, being the butt of jokes on the school bus, having a teacher single one out in a demeaning way, or being suddenly in the wrong viz. a viz. adult systems, as in church.

Experiences of Abandonment and Rejection

One lady remembered coming into her kitchen as a 9 year old. “I came home from school one day with a problem with my homework and told my step mom I needed her help. She was already overwhelmed with the other kids and my alcoholic dad. She just wheeled on me and said, ‘You need, you need, all’s you ever do is need. Well, I cant take care of you right now. Why dont you just leave me alone. Why don’t you just disappear!’” It was a phrase that had affected her for many years.

Experiences of Implied Violence

One doesn’t have to be hit or beat to be affected by violence. One woman was selected to be the observer as her alcoholic father would stage punching matches between her brothers. She was forced to look on as one brother would beat down the other to escape the greater threat of the father’s violence crashing down onany unwilling contestants. She exclaimed, “It was like the Roman Coliseum, and it took place on my living room rug every Friday night!”

Experiences of Demolished Values or Vulnerability

Many people have the innocence of their values or their childhood sensitivities taken from them in a way that is traumatic. Having lived near rural Midwestern farmlands, I remember more than one client tell of witnessing an animal’s untimely death or an adult family member’s cruelty. Seeing a family pet run over in the driveway, or seeing wildlife slaughtered out of a pickup truck window, for no good reason other than the shooter wanted to kill something, can have a profound effect on a child. And the effect can be anchored at various levels–the abruptness and unexpectedness of the act, the dying gasps of an animal as its eyes glaze over, the stark brutality and indifference demonstrated by an attachment figure, and the inference that small and defenseless life forms are dispensable. Children are vulnerable and that vulnerability can be demolished at any age.

Trauma, for the survivor, is never spelled with a small “t”. But if we are listening only for certain types of experiences or experiences of a certain magnitude, like war, rape, or a plane crash, we can miss what is real for the client.

As a Rapid Trauma Resolution therapist, I was also taught that part of what makes trauma “hang” in a timeless limbo is the mind’s tendency to make matters worse by taking an already negative event and attaching meanings of even greater negation or diminishment of personal worth. All of this can still be driving symptoms, warping beliefs about self and world, and troubling relationships. I am grateful for clients who have taught me what it’s like to be suddenly without connection when you need it most or suddenly exposed to the pathology in another when you weren’t prepared for it. I feel it is crucial to build a solid connection with clients early so that my attention is easily drawn to what still has to be cleared for that person to regain fullness of life and functioning. And so doing, I feel more satisfied in serving those whose trauma may have otherwise continued to affect them.

*Note- This post is highlights excerpts from Mark’s article. To read the full article on Mark’s blog, click here.

The Beauty of Solitude

Just want to honor single folks on Valentine’s day, acknowledging the gifts of being alone and enjoying one’s own company. This film by Andrea Dorfman featuring poet/songwriter Tanya Davis is absolutely beautiful and uplifting!

Meditation produces brain change in just 8 weeks: Implications for trauma treatment

photo courtesy of oddsock via flickr

Need more incentive to meditate? A recent study headed by Sara Lazar and colleagues at Massachusetts General Hospital documented measurable changes in brain regions associated with memory, empathy, and stress after just 8 weeks of daily meditation practice.

More specifically, the MR images showed increased grey-matter density in the hippocampus, known to be important for learning and memory, and decreased grey-matter density in the amygdala, known for its role in fear conditioning and stress. This has strong implications for utilizing mindfulness meditation in treating trauma, as people with PTSD have been shown to have reduced volume of the hippocampus and larger volume in the amygdala area of their brains, making them more prone to anxiety and memory problems. Could a trauma survivor reverse this through regular practice of mindfulness meditation?

In this study, the participants demonstrated brain changes after only 8 weeks of attending a weekly mindfulness meditation class and practicing meditation at home for an average of 27 minutes a day. Lazar and others had published previous studies that demonstrated experienced meditators appeared to have thicker areas of the middle pre-frontal cortex, an area associated with empathy, emotional regulation, and attunement to others. Yet those studies could not prove that these differences were actually produced by meditation. In contrast, the participants in this study had no prior meditation practice and therefore the researchers were able to surmise the measurable structural brain changes were associated with daily practice of meditation. Moreover, this study included a control group that did not meditate and did not show any changes in the study’s pre and post tests.

In my opinion, this study provides further evidence that integrating mindfulness practices into treatment for anxiety, PTSD, and other trauma related problems is a good idea. Traditionally, research has indicated practicing meditation at least 20 minutes per day produces measurable benefits within 2-3 months. To give people even more incentive, I am offering a free 20 minute Mindful Relaxation audio download on my website, get it by clicking here.

To read the full article, refer to: Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 2011; 191 (1): 36; authors: Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar.