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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!
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!
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.
Watch this witty and poignant talk by Brené Brown, a University of Houston professor who studies human connection. She found those who are happiest in relationships are those who are willing to feel vulnerable and admit that they are imperfect.
Thanks to my friend Linda Graham, LPC for sharing this video.
photo courtesy of nieve44 laluza flickr
How do you get through traumatic grief around the holidays, especially if a holiday marks the anniversary of a traumatic loss? Below are some ways that others have found to deal with their grief and ease the pain this time of year.
1. Alter your traditions- Sometimes it helps to do something different, even if it is just one thing, to shift the focus off the loss. I’ve known families who have decided to go away to the beach or some other place that has fewer associations with the loss. Others want to keep old traditions, but may just change them up slightly, signifying a fresh start.
2. Special tributes- One way to alter your tradition may actually be to include some sort of special tribute to your loved one during the holiday get togethers. You might light a special candle in honor of your loved one at the holiday table. Or, you may give people the opportunity to share special memories of your loved one verbally or in writing. You may just have a moment of silence to remember that person at some point in the day. A special tribute is not meant to highlight the loss, but rather to honor your loved one and affirm their presence with you through this holiday season.
3. Give yourself alone time- Grief can zap you of energy, so its important to plan some alone time time to rest. You do not have to attend every event, or endure the duration of each event. Find a balance between solitude and socializing.
4. Let others know its okay to talk about your loved one- Many people avoid mentioning the name or any memories of the deceased for fear it will be awkward or painful. But, most people enjoy hearing stories about their loved ones. Let people know, and reassure them if it is okay to openly talk about your loved one.
5. Attend special services or support groups in your community or online- More people are recognizing the value of having special services to honor those we’ve lost and support those who are grieving this time of year. On this blog, I’ve written about Blue Christmas services that many churches are now offering. If there is no such service in your community, perhaps you can get a small group of family members or friends to create one yourselves.
6. Remember it is just one day- The anticipation of a holiday or anniversary is often worse than the actual day itself. Remember this is just one day, one week, one season. You do not have to relive your loss or dive headlong into your grief on this day to prove how much you loved someone who has died. Instead use this time to acknowledge your gratitude for having known the person and find ways to affirm their presence with you throughout the season.
Take care and be well.
photo courtesy of alice popkorn flickr
Our culture tends to pressure people to use the holidays as a time of merriment and celebration. But, for many, the holidays can be a source of pain, stress, and grief. Therefore, many communities are including “Blue Christmas” services into the holiday season activities. These services are usually held on the night of the winter solstice, as it is the the longest night of the year. This year’s solstice falls on December 21st.
Far from depressing, Blue Christmas services give people an outlet for sadness and grief, while gently fostering hope for the future. Many people who have attended Blue Christmas services say the service helps ease their pain because they receive support and realize they are not alone.
My friend Lisa Kendall recently shared a blog post that Pastor Chris Owens wrote about the Blue Christmas service at his church. Pastor Owens commented, “It’s a quiet, reflective time of prayer, sharing, and singing meaningful songs of faith that are not loud and rapturous but tender and soothing… I could see the weight of unacknowledged grief coming off of our shoulders and peoples’ tears flowing steadily and unhindered. You could sense the release and freedom in that time of worship.”
Similarly, pastor, DeBorah Barnwell, started Blue Christmas services at her church in Virginia Beach several years ago. Pastor Barnwell said the service is not only for people grieving the loss of a loved one, but also for people who are struggling with illness, mourning a job loss, dealing with divorce, or just feeling down. The service also welcomes families separated by military deployment.
Four candles are often lit in these ceremonies: 1) One candle is lit for those who have passed, giving thanks to the memory that connects them to us this season; 2) One candle is lit to redeem the pain of the loss; 3) One candle is lit to honor ourselves; and, 4) One candle is lit for the gift of faith and hope symbolized in the Christmas story.
I am grateful more communities are offering these Blue Christmas ceremonies. Such services give us a way to honor our loved ones who have passed and feel more connected. In my opinion, ceremonies that can help us keep perspective and allow some quiet reflection time are so needed at this time of year. The richness and depth of the holiday season can get missed if we’re too busy trying to keep up with parties and gift exchanges.
Take care of yourself this season. Celebrate it in a way that makes sense and is special to you.
Could we have the potential to “erase” the fear from a traumatic memory soon? Would this relieve PTSD, or cause more problems?
Last month, Science Express published research done by Dr. Richard Huganir and colleagues at Johns Hopkins University suggesting we may be able to manipulate fear-based memories. Laboratory rats were conditioned to fear a tone that was paired with an electric shock. The scientists found calcium permeable proteins, labeled AMPARS, formed in the amygdala for a day or two in the brains of the mice after the shock. The scientists administered a drug to some of the mice to keep their brain flooded with AMPARS longer than 48 hours. These mice retained fearful responses long after the shock, while the mice without the drug gradually appeared to forget the tone had been associated with a shock. The scientists believe this will lead them to develop drugs to manipulate AMPARS to reduce fear-conditioned responses.
However, many folks have voiced ethical concerns, worried this research suggests that scientists are attempting to erase memories. For example, Katie Farinholt, executive director of NAMI in Maryland and Paul Root Wolpe, director of the Center for Ethics at Emory University, opined that “erasing” an aspect of a memory could significantly alter a person’s personality and history. Yet Dr. Huganir clarified that blocking AMPAR’s just eliminates the strong emotions attached to a memory. The process won’t erase the memory entirely.
But, I suspect PTSD and developmental trauma disorders are more than a set of fear-conditioned memories. All sorts of learning takes place when we experience something terrifying or overwhelming. Say you were bitten by a chihuahua as a kid and had avoided them for years until you had this drug administered. Now you may no longer fear chihuahuas, but you still don’t trust your mother who let the darn thing bite you. Yet, now you don’t remember why you don’t trust your mother.
I don’t know if it would work that way, I’m just thinking we can’t control all the neural circuits that get activated around a traumatic memory. Apparently Dr. Huganir believes this too. He sees this research and any potential drug development as an adjunct to trauma therapy, not a replacement. After all, Dr. Huganir notes many behavior and trauma therapies are attempting to do the same thing he is doing. Manipulate memories. Decondition fear responses. Clear negative associations. What’s the difference?
I do appreciate Dr. Huganir’s work. He seems to be very level-headed about what he is doing and is not promising miracles. Honestly, the media seems to be jumping to more conclusions about the potential of this research than Huganir and his colleagues.
What are your thoughts? Do you think there are advantages to having drugs that can manipulate proteins involved in fear-based memories? What concerns you about it? As always, I would love to hear your thoughts!
photo courtesy of Eddie~S via Flickr
Another middle-aged client presented today with chronic anxiety related to bullying she experienced in elementary school. I am amazed at how frequently clients report some experience of bullying in their past that continues to affect them even 30 or 40 years later.
I almost wrote about this issue after the Rutgers student took his life in September. Unfortunately, bullying seems to have increased among teens aged 12-18, according to recent polls. Increases may be related to the ease of taunting one another in cyberspace where people can hide behind their LCD screens. More than half of 15-16 year olds say they have experienced cyberbullying. But, frankly, I am often astonished by the cruelty being exchanged on Facebook by adults my age and older.
Who becomes a bully? A recent study at DePaul University found that kids who felt they were being arbitrarily punished at home were more likely to become bullies. Ironically, studies suggest bullies are not suffering low self-esteem. Often the bullies turn out to be kids that have popularity, intelligence, and a drive for power and status. Similarly, the kids that get picked on are often not the “nerdy”, “fat”, or so-called “different” kids. As Rachel Simmons wrote in her book “Odd Girl Out,” the girls who got picked on were usually girls perceived as being smarter, prettier, or more athletic than the bully.
On the other hand, there does seem to be an increase in bullying toward homosexual young people. The incident with the Rutgers student really brought this to light. Fortunately, this incident also seemed to promote more public advocacy for this population. Dan Savage’s “It Gets Better” video campaign has received over a million hits, inspiring straight and gay people all over the world. Even the federal government has gotten involved by holding the first anti-bullying summit in August and setting funds aside for anti-bullying programs in schools.
However, experts on bullying behavior like Izzy Kalman believe anti-bullying programs are the wrong approach. Dr. Kalman states, “… Anti-bullying” policies that turn a school into a totalitarian police state in which it is a crime for kids to upset each other will intensify the bullying problem… What I am interested in is victims and victim behavior. When I teach you how not to be a victim, no one can bully you. You don’t have to wait for society to get rid of bullies for you to become happy.”
Perhaps we can use Izzy Kalman and Dan Savage’s example by using cyberspace to build up immunity to bullying and judgmental behaviors. One of the things I love about Dr. Connelly’s philosophy in RRT is that we promote the resilience of the client. That’s what I did with my client today. She said it never occurred to her to recognize the strength and creativity she demonstrated through the bullying incidents. Instead of focusing on old feelings of fear, she left the session voicing increased awareness of her fortitude.
What do you think is the best response toward bullying and cyberbullying behaviors? Support anti-bullying programs? Build up immunity to bullying? I think ideally it will have to be some combination of the two. Let me know your thoughts!
Photo Credit Department of the Army
Earlier this month, the United States Army posted an article on their website featuring Rapid Resolution Therapy as an alternative trauma therapy treatment for soldiers experiencing combat PTSD.
Click here to read the article on the Army’s website.
While the Army has not officially approved RRT as a treatment they offer, the article lets people know they can seek treatment from private therapists trained in RRT. The article features comments from Chicago therapist Dr. Laura Bokar, explaining how the treatment works. In addition the article reports testimonials from a client of Dr. Bokar’s, as well as a client of Florida RRT therapist, Dr. Jason Quintal.
In the article, Col. Elspeth Cameron Ritchie, medical director for the Army Medical Department’s Office of Strategic Communications notes the Army offers several support programs for soldiers experiencing PTSD, such as Battlemind, Post Deployment Health Reassessment, and specialized psychotherapy sessions.
However, the article reports “private treatment can offer individuals options currently not available through military medicine; and Rapid Resolution Therapy is one of those options.”
Special thanks to Jacqueline M. Hames for publishing this article and letting people know that PTSD is treatable and that there are are a myriad of treatment options now to help people end suffering.
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, visit her website at www.courtneyarmstronglpc.com.
Should there be a separate diagnostic category for complex PTSD related to childhood trauma in the DSM-V?
Physicians and researchers such as Bessel van der Kolk, MD, Robert Pynoos, MD, and Marylene Cloitre , PhD think so. Over a year ago, these medical professionals formed a task force advocating that a diagnosis called Developmental Trauma Disorder be in the DSM-V.
The task force notes the diagnostic criteria for the current diagnosis of PTSD was based on symptoms of World War II combat veterans. We know that many people who have have experienced chronic childhood abuse or neglect also exhibit some PTSD symptoms. But, they also display problems with emotional regulation, learning disabilities, and attachment that are given separate diagnoses and treated differently.
At a conference I attended in February 2010, Dr. van der Kolk opined this lack of an adequate diagnostic code resulted in dangerous consequences for kids. He estimates that as many as 8 million children in the U.S.A. have been diagnosed with Bipolar Disorder and/or ADHD and prescribed large doses of medication. Yet, he’s observed the root of the problem for many of these kids lies in disrupted attachment, abuse, or neglect that is often left untreated.
Similarly, as abused kids reach adulthood they are given diagnoses of recurrent depression, anxiety disorders, personality disorders, or somatization disorders because they don’t match the current criteria for PTSD. Not only do these patients have to live with the stigma of other diagnoses, but it also leaves the root cause of the problem untreated.
Fortunately, Cloitre et. al just published an article in the August 2010 addition of the American Journal of Psychiatry that lends more support for this new diagnosis. Their research illustrates that treatment for issues related to chronic childhood traumas is different. See my post titled “Complex PTSD requires emotional skills training + trauma focused therapy” for information about this research.
Similarly research by Pitman, et al. presented at the 2008 ANCP meeting found that diminished volume of the hippocampus and ventro-medial pre-frontal cortex seemed to make a person more vulnerable to developing PTSD. We know that people exposed to chronic stress, especially as a child, tend to have diminished volume in these areas. Having diminished volume in these areas makes it more difficult to regulate emotions and assemble memory.
Diagnosing these issues appropriately has important implications for treatment. For example, Cloitre’s research suggests we have to do a combination of emotional skills training and trauma focused therapy for optimal treatment response. For children, it suggests family counseling with parenting support and coaching is needed for optimal treatment responses.
Even if the new diagnosis is accepted for the upcoming DSM-V, it would only be approved as a diagnosis for children and adolescents at this time, not adults. Still, it would be a step in the right direction in terms of getting these folks appropriate treatment.
What do you think? Do you think there needs to be separate diagnostic category for complex PTSD related to childhood trauma in the upcoming DSM-V?
For more information about this proposal and the suggested diagnostic criteria, visit www.traumacenter.org.
Courtney Armstrong is a Licensed Professional Counselor who specializes in trauma therapy. She has a private practice in Chattanooga, TN and also trains mental health professionals in creative ways to treat trauma. To contact Courtney, visit her website at www.courtneyarmstronglpc.com
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