“Complex” PTSD is well recognized in clinical circles, despite the APA’s refusal to acknowledge it in the DSM-5. This unofficial diagnostic category represented a dramatic shift in our understanding of trauma. It led us to a more compassionate understanding of symptoms that were once dismissed as attempts at manipulation. Even in the early days of my career, some colleagues discouraged me from paying too much attention to clients who engaged in self-harm or expressed recurrent suicidal thoughts. Why? Because there was still the belief that they were just “doing it for attention.” This was a mere 10 years ago. This is an exciting time to be a therapist, when our understanding of trauma is evolving at a rapid pace.
As a general rule, most human beings have a natural biological drive toward health. Self-destructive behavior defies the fundamentally sacred instinct that allows us to grow and evolve as a species. So, why would anybody harm themselves, through self-mutilation, substance abuse or any other high-risk behavior?
The answer: It is precisely because of our fundamental desire to survive that we will employ any and all means to avoid things that feel like death.
For those who do not have complex PTSD, most normal life stressors do not feel like impending doom. Such people have well-regulated nervous systems and a capacity to calm themselves down. They can accept criticism, make mistakes, handle rejection and weather emotional storms that naturally arise from being alive. When you suffer from complex trauma, the emotional reaction to such circumstances is so intense that you may experience emotional shutdown, AKA, dissociation, sometimes manifesting as depersonalization, derealization and a general sense of either feeling like you do not want to exist or already DON’T exist as a real person. In some circumstances, external means of self-soothing must be employed to return to a state of equilibrium. Those who have learned DBT skills or similar interventions may have developed safe ways to calm themselves down. Those who have not learned such skills may resort to behaviors that are a serious threat to themselves or others.
I’ve got two things to say to people who struggle with these compulsions: It’s not your fault, and it does get better.
Complex PTSD does not result from a single traumatic incident. It results from chronic and prolonged exposure to situations perceived as life-threatening. It is impossible for a person to learn how to calm themselves down if they have lived in a world that is never safe. Why calm down? Another threat is just around the corner. In many (if not most) circumstances, the trauma occurred in early childhood, when the vulnerable nervous system was still developing. In cases like this, the nervous system learns to stay in a state of constant agitation and/or shutdown. Many SE practitioners describe this as living with the brakes on and the gas pedal floored at the same time.
I’ll say it again, in case you need to hear it: It’s not your fault. Congratulations on staying alive. You’re stronger than you think, and the world is better for having you in it.
With regards to “it gets better”, here’s how it happens:
You find a small island of safety. Here’s the trick…it has to be an island that you create for yourself. If it’s conditional on another person constantly being around, it’s not going to feel stable. No matter how much you love someone, or how much they love you, nobody can be around 100% of the time. Actually, your loved ones will be better support people for you if they take time for themselves. So, let your island be something you can control.
No matter how small that island is, let yourself trust it, and enjoy it completely. Five minutes of fresh air? One chapter of a good book? Great. Stop thinking about how it won’t last. Yes, I know it’s hard. Stop, or at least notice the gaps between worrying. I guarantee they are there. Let yourself sink into that island. Watch it grow. The more you attend to that place and nurture it, the larger it will get. I promise.
As you notice what it’s like to feel pleasure, tell yourself that you deserve pleasure. I know, I know…this is hard too. You may need to hear it from a therapist on repeated occasions. Eventually, though, you will find that you start treating yourself like a human being. This leads to the belief that you deserve to be treated like a human being by others around you.
You start to set boundaries. Toxic relationships either become less toxic or fall by the wayside. The friends who matter stick around. New friends come in as you feel more comfortable reaching you to people who are good for you. Your support system widens, and your relationships deepen. You no longer feel like somebody who is constantly in need of help, but you know how to ask for help without feeling ashamed.
This all takes time, and patience with yourself. Therapy will initially focus on getting the self-destructive behaviors under control. DBT or recovery groups may be recommended in addition to individual therapy, if the behaviors are severe. Working on the actual trauma will happen once safety is established. Therapeutic progress is often measured in years, rather than weeks or months. Medication may be necessary, at least on a temporary basis. There will be setbacks. There will be plenty of opportunities to forgive yourself, and learn what it’s like to deserve forgiveness. That, in and of itself, can be a healing experience.
I have one last bit of good news: you made it through this entire article. That probably means you have a sense that some if it is true…and that you can make it. All of the work mentioned above is a lot of work, but you probably have a sense that life is worth it. Otherwise, you wouldn’t be looking up therapists and thinking about getting help.
Congratulations on taking the first step. You can do it.
Often times, new clients come to my office without much prior experience of therapy. Sometimes, I am the first therapist they have ever seen. Some nervousness is understandable, if you have never been to therapy before. It is not uncommon for me to hear questions like “how do I do this?” or “where do I start?” There is no need to worry about doing therapy “right”. That said, there are several things you can do to maximize the benefits of your sessions.
–Come early: Allow yourself some extra time, in case of unexpected delays. This will ensure that you get the benefit of the full hour, instead of losing precious minutes trying to find a parking space. This is also a way to help yourself arrive in a calmer state, giving you more energy to focus on the work we do together.
-Come often: Weekly therapy is usually recommended, at least in the beginning. Some clients reduce the frequency of their sessions to bi-weekly, as they start to feel better. This is totally fine, and actually a great indication that therapy is serving its purpose. Regardless of how you choose to set your schedule, it helps keep that schedule consistent and predictable. This gives therapy a sense of continuity and flow.
-You do not need to rehearse: Some people set very specific expectations of what a session will look like. Often, these expectations include discussing upsetting or traumatic material. While telling your story can be important, it can be counterproductive to focus on traumatic memories outside of therapy. Rehearsing the story can lead to re-living the memory. This can actually exacerbate PTSD symptoms, rather than healing them.
When you feel ready to work with a traumatic memory, make note of this in a journal (without going into detail) and bring the journal to session. Then, we can discuss how to work with that memory in a slow, supported way that will not lead to re-traumatization.
-Plan something fun or relaxing after therapy: Therapy is not always an intensely emotional process, but sometimes it can be. It is helpful to give yourself a “break” after a session. If you have a strong sense that you need a walk or maybe a nap, listen to your body and do what you need to do. If you need time to yourself, turn your phone off. If you need friends around you, call somebody and go out to dinner. Of course, it is possible that you will need to return to work, class or other obligations after therapy. If that is the case, plan a “break” later on, when you have time. Give yourself something to look forward to.
-Have your own vision for therapy: Have a clear idea of what you want your life to look like, once therapy is complete. What has changed? What type of work are you doing in the world? What do you do for fun or spiritual fulfillment? What do your relationships look like? This vision can change or evolve as therapy progresses, but it is important for that vision to be there. That way, you can gauge how well therapy is working. It will also give you a sense of when you are ready to complete therapy, since the decision is ultimately yours. Your vision may be discussed periodically during the course of therapy, to make sure we are on the same page.
-Talk to your loved ones about therapy: Nobody heals in isolation. Discuss your progress with a trusted person who can support your vision for recovery.
-Have a sense of humor: Therapy does not have to be serious all the time. After all, therapy is a human relationship, and healthy relationships involve humor. Laughter can be a great resource. Allow yourself to play a little. You deserve it.
I am filled with musings and ponderings after a week of Advanced Somatic Experiencing training with Steve Hoskinson in Burlingame, CA. My career is a process of lifelong learning, and I always enjoy my SE workshops. On the surface, they may just seem like opportunities to grow my professional skills. They are more than that, though. They are similar to meditation retreats. I always return feeling renewed and reaffirmed in the intention of my therapeutic practice.
Pretty much any modern therapist will tell you that most of the healing process comes from the client, not the practitioner. I know that I have said this, time and time again…to the point that it may seem trite. Right now, however, I am so profoundly aware of the truth of this statement. It feels appropriate to share this with any clients who may be seeing this…be they past, present or future.
As I have undertaken my private practice journey, I have been continually impressed by the resiliency of the people I work with. All this SE training sounds complex, but it has taught me essentially one thing: How support people to show up as who they are, and engage in a process of radical self-acceptance. When people allow themselves to be present with themselves, holding a non-judgemental awareness, it’s amazing what happens. I see people make healthier choices. They start eating more nourishing food. They set better boundaries with the people they love. They quit their jobs and find work that feels congruent with who they are. They choose healthier relationships. Why? Because they start trusting their own guts, and the awareness of what they really need arises naturally.
You all did that. I didn’t do it for you. I’m just here, sharing in your excitement and joy as you embrace your own wholeness.
And so, it is with excitement and deep appreciation that I return to Colorado to resume my work. I would also like to extend my appreciation to everyone in the SE community, for making every training feel like a homecoming.
This is a reminder that I need for myself, sometimes, and I thought I would share it with all of you. Do you have a mile-long “to do” list? Remember, all you can do is all you can do. It is important to listen to your body and track your own level of energy. If you’re honestly out of oomph, take a break!
Do you beat yourself up when you do not accomplish everything you set out to do? I know I have a tendency to do this, sometimes. I found myself doing it a lot less once I realized that self-punishment does not lead to increased productivity. Actually, it does quite the opposite…it saps the energy that I need to fuel my passions and accomplish my goals.
So, treat yourself gently, today.
How does recovery begin? This is a common question asked by trauma survivors, as they begin their healing journey. Where does one even start? When a person’s life has been dominated by chronic, severe stress or threats of violence, it can be challenging to find one beacon of hope amidst a stormy sea. When we experience trauma, our nervous systems can become “wired” to perceive threats around every corner. This is adaptive. This hyper-vigilence was warranted when the threat was imminently present. It unfortunately leads to suffering when we cannot turn it off, even when we know, on an intellectual level, that we are in a safe space.
Have you ever been told that you are “in a safe place?” Did you find those words comforting? Sometimes, hearing those words can be a helpful reminder. At the same time, our nervous systems need to be shown that we are safe, not just told. For example, a client may not feel “safe” with a new therapist until several sessions have taken place. It takes time to establish trust. A wise therapist will understand this process, and be patient. Trust is earned through consistent, non-judgemental presence…and sometimes it happens in baby steps.
Those baby steps in therapy are often accompanied by a parallel process of slow, gentle steps toward learning to trust ourselves. Therapists, friends, partners and family can provide emotional support, but sooner or later, we have to become our own primary caregivers. So, how do we show (not just tell) ourselves that we are in a safe space?
Try this experiment: next time you are at home, check out the space around you. Notice your emotional reaction to the colors, the sounds, the textures and scents. Notice if you feel relaxation in the presence of some stimuli, moreso than others. Do you like soft fabric? The color of your flowers? The sound of coffee brewing? What is your favorite type of music? When was the last time you allowed yourself to listen to a piece of music that you really enjoy, without doing anything else at the same time? We live in a world where we are so constantly bombarded with stimuli that we rarely enjoy one thing for its own sake.
You may have objects of personal significance. Do you have images of people who are safe and supportive? Perhaps your most comforting images are pets, or spiritual figures. Do you look at them frequently, or just pass them by? Are they prominently displayed? If not, have you thought about moving them to a more centralized location?
What are some things you can do to make your environment more soothing, and conducive to healing? Think of just one. It may be something as simple as getting softer light bulbs or keeping the curtains open. Notice how you feel after taking that one step.
When we take care of something, this gives our subconscious mind a message that this something (or someone) is worthy of care. When we take the time to create a nurturing environment, and really enjoy that environment, we can slowly start to believe we are worthy of nurturence. Slowly, we can begin the process of relaxing into a sense of safety.
I’d like to offer an announcement for my fellow mental health workers. The Somatic Experiencing Trauma Institute is doing another round of trainings…and the first one’s free:
It will be at the Reynolds Branch of the Boulder Public Library on July 19th, from 10:00 a.m.-1:00 p.m.
I highly recommend these intro trainings for healing professionals who have always been curious about SE, and would like to get their feet wet. Bruce is a highly knowledgeable and engaging presenter, with 40 years of experience in counseling. Warning: there’s a chance that this first presentation might get you hooked on SE.
I’m hooked because SE allows clients to make dramatic progress in a short period of time. It supports emotional equilibrium from the ground up, and is immensely helpful for clients who struggle with dissociation or self-harm. Since it’s such a gentle method, clients can work with complex trauma at their own pace without getting overwhelmed.
I encourage everyone to check it out for themselves. Also, stay tuned for more announcements about trainings. We’ll have opportunities for full-day “Fundamentals” classes, in addition to the full training, starting in December!
Over the last couple of weeks, I have spent considerable time musing over the UC Santa Barbara shootings. While grieving the tragedy of the lives lost, I have found myself confronting the implications of living in the society that influenced Elliot Rodger. While his actions cannot be excused, it is useful to view them within a larger cultural context. His heinous acts are symptoms of a systemic disease, which has been festering for a long time.
Like many feminist bloggers, who have observed Rodgers’ circle of influence, I have been disturbed by the violent misogyny that is rampant in his online networks. So-called “Men’s Rights” organizations are not hard to find, and it appears that they are getting increasingly vocal.
It is important to differentiate “Men’s Rights” groups from constructive and helpful Men’s movements. There are those who explore issues facing men in our modern society and work toward making the world a safer place for all forms of gender expression (for more information on that, the Good Men Project is a good place to start). However, groups who operate under the label of “men’s rights” tend to be nothing more than hate groups, something that is becoming painfully obvious in the wake of the recent shootings.
Such groups grow by targeting men who feel lonely, angry and socially isolated. They quickly convince these men that women are the enemy, and that violence is justified. Of course, very few of these men will go on mass killing sprees, but there are some who entertain fantasies of doing so. The others may commit less visible acts of violence, such as date rape that goes unreported. They will go home to their Reddit accounts and receive emphatic support for their actions, while their victim suffers in shame and silence.
And why the silence? I have found that many rape survivors are very dismissive of their experience. Quite often, there is resistance toward exploring their trauma in therapy, not only because the memories are overwhelming, but because they believe their experience is not valid. Perhaps alcohol was involved, so the client believes the experience was partially hir fault. It may be that the client initially said “yes”, but then had a felt sense that something was wrong. They told their partner to stop, but they refused. Perhaps no physical force was involved, but there was emotional manipulation, verbal abuse or incessant guilt-tripping which led to eventual participation in an unwanted sexual act. Clients in these circumstances can show up with the same PTSD symptoms as those who were physically forced. They often hide those symptoms for years, telling themselves that the experience was not a “real” rape, while their body bears the burden of a real violation.
Despite over 100 years of feminism, there are still plenty of people out there who believe men are entitled to women’s bodies. Our toxic views of masculinity exacerbate the situation. If a man is not having sex, he is seen as unmanly. If a woman refuses his sexual advances, it is seen as a slight to his manhood. This puts pressure on women to help a man prove his manhood (which, in our culture, can be equated to his worth as a human being). When he shames her for denying him, she may feel that she is a bad person. If she agrees to sex, knowing that the only alternative involves being a “bad person”, then how is this consensual? Her partner is only offering her the illusion of a choice…and his internet friends believe she deserves no better.
This is a time to examine our cultural assumptions and seriously consider how we might challenge them. When was the last time you heard a man get mocked for not getting laid? Such jokes are so common that we do not question them. Let’s take a serious look at what that means. Mocking abstinence as unmanly turns rape into a manly act. There are men out there who have remained virgins because they respected women’s boundaries. They are currently being shamed for this…perhaps not directly, but by subtle cultural messages about what it means to “be a man.” That’s pretty terrifying, if you stop to think about it.
When we tie sexual prowess to our definition of manhood, we are reinforcing rape culture. I am grateful that there are some men’s groups which support a different view of masculinity…one that involves respect, integrity and personal responsibility.
I was very touched by this article by spiritual teacher and activist Thorn Coyle, and thought I would share it:
She addresses the issues of self-worth that prevent us from reaching out to our communities, doing the good work that our hearts call us to do. Sometimes, we might see a need for change but doubt our capacity to make it happen. This can lead to feelings of helplessness, even despair, when we see suffering around us but feel powerless to change it.
She points out that sometimes the simple offering of compassionate presence, in the face of suffering, can be tremendously healing. All too often, we doubt the power of simple human connection.
I have met a number of therapists who doubt themselves. A common sentiment that I hear is “How can I possibly help others? I have so much baggage…so much trauma. How can I be a counselor?”
It’s funny, because these are often the people who turn out to be the best counselors in the field. Why? Because they are capable of really getting into their clients’ worlds, and understanding what they have been through. Such therapists have a beautiful gift to offer the people they serve. They have inspired me to be brave and authentic about admitting that I have faced my own demons. This has probably been one of the healthiest decisions I have ever made, regarding my practice. It turns out that most clients prefer working with a therapist who admits they are a human being.
True contact cannot happen from a place of perfectionism. Sooner or later, we have to let ourselves off the hook, and commit to showing up as our perfectly imperfect selves.
As you head into spring, and new growth starts to form, think about what type of growth you can bring into your life…and into the world. What positive change would you like to make? What is holding you back? If you feel that it is lack of competency, think about whether this comes from an accurate assessment of your skills, or a fear of unworthiness. Skills can be learned, after all. Worth is inherent. Presence is a gift that we can all offer, and the foundation upon which all healing, connection and change is based.