Ironically, one of the prominent symptoms of PTSD is avoidance, as noted above in Jim’s story. Consequently, let me state this as boldly as possible (I’ll even use bold print): Prescribing only psychotropic medication without healing psychotherapy may contribute to the client avoiding the problem, rather than addressing and healing it! In fact, while I’m out of a controversial limb, “medication only” treatment for unresolved emotional trauma can be tantamount to enabling the client to remain stuck in the symptoms of PTSD.
Medicating clients’ suffering without addressing the place where they are stuck in the pain of the past supports them in remaining mired there without having to address and resolve the underlying issue(s). Moreover, if clients are numb enough to function (albeit unhappily), they can avoid facing their pain head-on, which is a requirement of effective psychological treatment. After all, people don’t tend to present for psychological treatment unless they are in crisis mode—in layman’s terms, not unless they’re coming apart at the seams. Alas, as the great Dr. James Framo4, a former professor of mine, used to say, “People don’t change unless it’s too painful not to.”
If medication separates people from their pain, they are less likely to address their underlying issues. Allow me a crude but hopefully accurate analogy: If a client has a large, unpassable kidney stone trapped in the ureter, the pain motivates the client to find a doctor who can remove it. But if allowed generous amounts of opioids, that same client may postpone (i.e., avoid) the surgery indefinitely, as long as the pain is manageable. If the stone isn’t removed from the ureter, though, it will do long-term damage.
I’m not opposed to medication; I’m only opposed to medication that prevents the root cause of emotional trauma from being addressed. The psychological community appears to be equally culpable in Jim’s forty-five years of misery. Let me illustrate: At a recent professional psychology conference, I listened to a capable presenter discuss the two “leading treatments for PTSD.” She shared that Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE) were the best treatments we had at this time.
I sat there stewing, knowing she was wrong. But how could she have been so unaware of the much more effective alternatives to treating emotional trauma? Here’s how. Various psychological schools and practitioners, past and present, offer an abundance of training, research, and theories on everything from psychological development to personality theory to effective treatments for psychological disorders. There is no one paradigm or model from which to draw. Psychologists emerge from their training with the theories and styles that best fit each practitioner. That only makes sense, but it also guarantees that if you enter six psychologists’ offices, you are likely to receive six different (albeit potentially similar) therapeutic styles and treatment plans to address the very same presenting issues.
One therapist, for instance, may operate from the belief that you the client have suffered enough trauma already, so the last thing you need to do is revisit the scene of the crime. What the client needs instead are coping tools. This well-intentioned approach, though, may help you cope but not thrive. You may be able to maintain a relationship and a job but probably never be able to enjoy either. Until you make peace with the pain in your past, you will never do much more than cope.
Other therapists try to help you to rethink the traumatic event. These therapists might have tried to convince Jim that he’d had about three minutes to locate his two sons, rescue them from the icy water, and revive them, and that given the impossibility of doing so within this time frame, he should free himself from his guilt. They would provide him with other types of useful and realistic information to alter his beliefs about the trauma. This might help Jim to some extent, but it wouldn’t allow him to release the intrusive attacks of the undigested trauma.
Some psychologists believe in using highly specialized approaches, such as eye movement desensitization and reprocessing techniques (EMDR), which requires clients to visualize the trauma while watching an object such as a pencil move back and forth. While the visualization of the trauma is necessary for healing to occur, the eye movement is extraneous and completely unnecessary. What is paramount, however, is the need to release the traumatic event permanently, which in my opinion, EMDR does not accomplish effectively.
And there are therapists who base their treatment on a behavioral principle called “flooding”, which employs a technique called prolonged exposure (PE) where clients are asked to revisualize and re-experience the trauma continuously until they are habituated (i.e., stop responding emotionally) to it. While remembering the traumatic event fully is important (as you will see, it’s step one of the Fritz), simply remembering it over and over again is unnecessarily torturous, forcing people to relive the biggest horror of their lives repeatedly. This is cruel and unusual punishment, especially given that a single return to the trauma is all that is required to find peace with the intrusive recollections and stop the nightmares.
Assess Your Own Treatment
As you read about these various treatment types, at least one of them may have struck a chord with you because of your own journey. It’s worth assessing that particular form of therapy (or those therapies) and what went wrong; or what failed to go sufficiently right so that you could now be living a life free of the effects of your trauma.
Take a look at the following questions and think about your answers:
•What type of therapy did you use? What method did your therapist employ (assuming he or she disclosed this method), or from what therapeutic school of thought did your therapist develop his or her method?
•How long were you in therapy? Did you stop for a particular reason?
•Are you a serial therapy-seeker? How many different therapists or types of therapy have you had?
•Have you been prescribed any medications to help you deal with the problems stemming from your trauma? What are the medications, and how effective have they been, both in addressing the short-term symptoms as well as in helping you heal and lead a fulfilling, successful life?
•How much work on your issues have you done on your own? Did your therapist suggest you should be working on healing outside of his/her office? Did your therapist give you any tools or techniques to use on your own?
•How has the emotional trauma you suffered affected your life negatively? Has it negatively affected you in terms of your careers, relationships, moods, or ability to enjoy life? Has therapy helped you deal successfully with any of these problems, especially in the long term?
Analysis: Putting Your Therapy on the Couch
•What type of therapy did you use? What method did your therapist employ (assuming he or she disclosed this method), or from what “school” of therapy did your therapist develop his or her method?
If you don’t know what type of therapy or school of thought your therapist uses, you’re not alone. Your therapist may not have divulged this information to you for a variety of reasons—he or she may not have found it therapeutically beneficial, for instance. It’s also possible that your therapist does not endorse a particular approach or theoretical construct to treat trauma. In either case, as a client, you’re in the dark, and you shouldn’t be.
•How long were you in therapy? Did you stop for a particular reason?
You may have been in therapy for many years and continued to wait for it to work. You may have also tried therapy for a short period of time and quit because you weren’t seeing any results. In either case, the lesson learned is that time is not a predictor of effectiveness. Every client is different, and it takes longer to heal some emotional traumas than others. That said, the right therapy should work relatively quickly.
•Are you a serial therapy-seeker? How many different therapists or types of therapy have you had?
Bouncing around from one therapist to another is incredibly frustrating, and if this has been your experience, I apologize on b
ehalf of our profession. The odds are that if you’ve seen multiple therapists without much success, then you probably didn’t feel safe or heard when you were in therapy. With Jim, I assured him that effective trauma treatment existed for his particular issues and that healing was possible, and I did this in our very first session. Without believing a therapist “gets” what you’ve been through and that (s)he can help you, you won’t feel safe or heard and will leave, usually sooner rather than later. Maybe therapies you’ve experienced have been focused on coping instead of healing. Remember, many therapists focus on coping rather than healing, as such therapists don’t believe that you can really heal from emotional trauma.
•Have you been prescribed any medications to help you deal with the problems stemming from your trauma? What are the medications, and how effective have they been, both in addressing the short-term symptoms as well as in helping you to heal and lead a fulfilling, successful life?
If you have tried medications, I hope that they helped at least somewhat. Zoloft, Prozac, Wellbutrin, Abilify, Seroquel, Effexor, Trazodone, Ambien, and others are all typically prescribed for a diagnosis of PTSD. Again, I think medications can assist in trauma treatment, but as you may have experienced, medications may work, but only until you stop taking them, either because you don’t like the side effects, hate being dependent on them, or even become frustrated with the whole process. Medications may help with some trauma symptoms, but as soon as you stop the medications, your symptoms will return. As previously referenced,3 most medications will help some, however, without the addition of effective psychotherapy, all medications are prone to a relapse in symptomology when the medication is stopped.
•How much work on your issues have you done on your own? Did your therapist suggest you should be working on healing outside of his/her office? Did your therapist give you any tools or techniques to use on your own?
If you have attempted to work on these issues on your own, kudos to you, because that requires a great deal of courage. The odds are, though, that your therapist didn’t encourage this or didn’t provide you with tools and techniques to do so. Healing can be done at home, and I will often recommend that people use various techniques such as cognitive exercises or writing letters to help themselves when they are not in session. While the typical Cognitive Behavior (CBT) therapist will assign you homework to complete (e.g., thought records, behavioral interventions, and various worksheets), remember that it’s not simply the amount of time you spend on healing, but how you spend the time. Working to heal through remembering, feeling, expressing, releasing, and reframing are critical, active techniques, and so using these techniques is far more important than spending huge amount of times doing less critical activities.
•How has the emotional trauma you suffered affected your life negatively? Has it negatively affected you in terms of careers, relationships, moods, or your ability to enjoy life? Has therapy helped you deal successfully with any of these problems, especially in the long-term?
There are subtle ways and then there are obvious ways that experiencing trauma can impact one’s life. Working too much, as Jim did, is an example of an obvious response to his trauma. More subtly, he lost his enjoyment of life because his mind was anchored in the past. Therapeutic treatment is designed to address and permanently resolve these issues. Anything less is ineffective treatment.
Many people are dissatisfied with their emotional trauma treatment; and people who have stopped treatment or never bothered with it may grit their teeth and try to muddle through life with all the burdens that trauma creates.
It doesn’t have to be this way. To help make the case for an effective alternative and a model for trauma treatment, let me share six different approaches that have contributed to my model on healing from emotional trauma. In this way, I think you’ll start to understand the roots of trauma and how it might respond to the right treatment protocols.
Six Contributions to My Understanding and Treatment of Emotional Trauma
Before introducing my model for treating trauma, let’s explore trauma from six distinct perspectives: those of stress response, neuroscience, cognitive behavioral theory, Gestalt Theory, Freudian psychoanalysis, and religious training. Each of these topics will provide insight into the method I use and why it is so effective in the treatment of all types of emotional trauma.
The Stress Response
In 1956, Dr. Hans Selye at the University of Montreal described in his book a three-step response to challenges, which he called the stress response5. More specifically, he coined the term General Adaptation Syndrome6 (GAS) to illustrate a three-step progression of what happens to an organism (including you, the human) when stressed. Selye noted that stress is a specific, predictable, internal response to a non-specific stimulus or threat. In other words, whatever threatens you, be it a subpoena, an IRS audit, or an episode of Real Housewives of New Jersey, evokes a predictable physiological response: secretion of stress hormones like norepinephrine and cortisol, accelerated heart rate and respiration, shutdown of digestion and sexuality, and increased blood flow to the major muscle groups, including the chest, back, arms, and legs, all of which prepares the organism for “fight or flight.”
This first stage is called the alarm reaction, and it is entirely normal and appropriate. The extra fuel you receive from norepinephrine, for instance, aids you in staying up all night for the final exam or rescuing a child from a burning house. When the threat is over, the body returns to homeostasis.
The second stage of the GAS is the “resistance stage.” Here, the stressor is ongoing, so your nervous system remains in high gear. For example, your high-conflict marriage becomes a high-conflict divorce, your financial woes worsen, or your child’s hyperactivity continues unabated. This stage lasts as the perceived stressor goes on—or until the body’s coping mechanisms give way to the third stage, “exhaustion.”
Exhaustion is exactly what you think it is, a breakdown of the nervous system resulting in fatigue, dysphoria (low mood), anhedonia (an inability to experience pleasure from previously rewarding activities), free-floating anxiety, insulin spikes, panic attacks, infections of all kinds (since your immune system no longer fights off intruders), muscle cramping and aching, every one of your least favorite gastrointestinal symptoms, and so much more. People in the third stage are hospitalized or suffer from “nervous breakdowns,” depressive episodes, psychotic breaks, or panic attacks. Our coping mechanisms are temporarily defeated and require help.
So what does this have to do with treatment of trauma? Unresolved trauma causes the stress response to be left in the “on” position, or perhaps it is like a faucet that is continually running. A primary goal of treatment is to shut off the stress response, return it to the “off” position, or shut off the faucet, whatever analogy you prefer.
And how is that done? The mind must believe that there is no longer a threat (or that it is manageable) and that all is “okay.” It’s that simple. And yet meeting this condition is imperative for turning off the stress response. In reality, there are a thousand ways to get to “okay.” For instance, the surgeon looks down at you in the recovery room, smiles, and says, “We got it all, you will recover completely,” and you believe her. Likewise, the insurance guy calls and says, “We’ve reviewed your case, and we are going to pay for 100 percent of the flood damage,” and you believe him. Your wife says the affair is over and she only wants to be with you, and you believe her. The nanny says she will forgive your children for tying her up in the playroom and will not resign after all, and you believe her.
Again, the mind must conclude that somehow all is okay once again for the stress response to be shut down. So you, the trauma sufferer, need to believe that whatever the trauma—rape, betrayal, financial loss, death of a loved one, abandonment, the sounds and images that form the experience of combat, etc.—there is hope, and you and it will be okay. For Jim to resolve his issue, he will have to be
lieve that despite the loss of his two sons, he can recover and live a meaningful life. All will be okay.
Neuroscience
Trauma can quite literally change your brain7. Various neurological studies and research conducted since Selye’s discovery of the stress response have further illuminated the impact that trauma can have on brain structure.8 9 Thanks to modern neuroimaging, we can now observe some of the fascinating complexities of the brain. For instance, the hippocampus is the structure responsible for memory. More specifically, it creates new memories, storing them away for later, and also retrieves memories in the brain. If I ask you to recall the name of your third-grade teacher, more than likely, you would be calling upon your hippocampus to do the dirty work. But as Bremner (2006) notes, it appears trauma is responsible for reducing the volume or size of the hippocampus.7
Keep Pain in the Past Page 2
