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:

SE Intro Flyer_Boulder, CO_July 19, 2014 (Bruce Gottlieb)

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:

The Unworthy Expert, Making Offerings.

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.

I spent last weekend at the Colorado Gold Rush conference, an event sponsored by the Healthcare Guild and the GIC.  The conference was originally designed as a resource for transgender folks who needed a safe space to find common ground and provide mutual support for each other.  Once upon a time, the conference was one of the few places where people in the trans community could get the information they need to live their lives.  Since more resources exist, the conference has become less necessary…but still very useful.  Now, the conference has expanded its purpose to include presentations that are geared toward mental health workers.  That works out great for me, of course.  It helps me stay updated on the latest information and provides opportunities to participate in interesting discussions.

One of the most engaging presentations was “Intersections of Trauma and Gender Variant/Transgender Identity:  Treatment Considerations for Compassionate, High-Quality care.  This was presented by Erin Jacklin and Kendra Doukas from the Catalyst Center.  One major issue discussed was the prevalence of complex PTSD in gender-variant people.

“Complex” PTSD may not fit the pattern of symptoms that plague victims of single-incident trauma. Single-incident “shock” trauma often results in flashbacks to the event, often leading to avoidance of situations that trigger memories.  While untreated shock trauma can be devastating, victims are granted one saving grace…at least they know where their symptoms come from.

Complex trauma is a whole different animal.  It is often misdiagnosed, and people can go for years without receiving proper treatment.  Fortunately, this is changing, largely thanks to Judith Hermann and her seminal book “Trauma and Recovery.”  We’ve still got a long way to go.  One complication with cPTSD is that clients (and often, therapists) can’t pin down one “Big T” trauma that caused the symptoms…and yet the client may be chronically anxious, depressed and hyper-vigilent.  They may struggle with maintaining stable relationships or employment, despite their best efforts.  Or, they may walk around in a constant state of feeling disconnected, without knowing why.

There is always a reason for symptoms.  People do not choose to live this way.  cPTSD can be the result of physical or sexual abuse…but sometimes, it’s not.  Sadly, the impact of emotional abuse is often underestimated.

Trauma is often defined as a reaction to an event perceived as life-threatening.  That definition seems simple enough.  But let’s look at what we perceive as life-threatening.  Threat-perception is a tricky thing.  It’s subjective, based on circumstances and individual characteristics.

Let’s look at one example of stress, which may or may not be traumatic:  rejection.  If a mature adult is rejected or treated coldly, they may be hurt, but not traumatized.  If a small child is raised by cold or emotionally rejecting parents, trauma will almost certainly occur.  Even if the child’s physical needs are met, the absence of emotional nurturing can be perceived as life-threatening.  A child depends utterly on parents.  They will not trust parents who are emotionally distant, and they will grow up perceiving the world as unsafe.  Likely result?  cPTSD.

Now, what about adults?  Can they experience complex emotional trauma?  Again this depends on the circumstances.

If an adult experiences a single incident of being rejected or treated coldly, they may be hurt, but not traumatized.

If an adult experiences chronic, repetitive instances of rejection from their community, even if the person’s physical needs are met, the absence of emotional nurturing can be perceived as life-threatening.  A person depends very much on community.  They will not trust a community that is emotionally distant, rejecting or cold.  They may live their life perceiving that the world is unsafe.  Possible result?

Complex trauma.  Because, even if we live with abundant food, clothing and shelter…what happens in a crisis?  Can we count on the support of family, friends and even complete strangers?  Would our neighbors loan us their phone to dial 911?   Hopefully…but do we know for sure?

If we are living our lives as straight, white cisgender folks, we may take our community’s support for granted.  We may lose sight of the fact that some people can’t presume to have that safety net.  I celebrate the fact that the Affordable Care Act contains non-discrimination policies for Transgender people (Thanks, Obama). I lament the fact that the polices had to be there in the first place.  About one in 5 trans people have been denied basic medical care, simply because of their gender identity. It is possible, then, for some people to live in a chronically unsafe, potentially traumatizing situation simply by living in America.  Small rejections or microaggressions can be painful reminders of this lack of safety.

While it is small-minded for therapists to assume all transgender clients (or clients belonging to any marginalized group) have complex PTSD, it is vitally important to be aware of how discrimination might affect a client’s way of being in the world.  This often requires us cis therapists to look at our own privilege, and commit to ongoing self-examination regarding any microaggressions we may inadvertently commit.  We are (sorry to say) part of the healthcare system that has been guilty of discrimination.  Let’s keep looking at our position with critical analysis, courage and compassion for ourselves.  This will allow us to change the system, one therapist at a time.

This was a beautiful and touching article about a man supporting his wife as she recovered from sexual assault.  Trigger alert:  the depictions of her rape and resulting injuries are graphic, so you may want to check in with yourself before clicking the link.  It’s worth reading if you’re in the right space for it.  The tenderness and compassion that he feels for her are downright inspiring:

http://goodmenproject.com/featured-content/cc-how-men-an-support-women-post-sexual-abuse/

Here is some good advice the article gives, for partners of survivors:

1. Most importantly believe her, never question her when she says she’s been assaulted.

2. Ensure she gets medical care immediately and offer to stay with her.

3. Although it’s a normal reaction to want to hurt those who hurt her keep that to yourself. She’s been violently assaulted and does not need to see you wanting to be violent.

4. Advocate for her. Keep non-essential people away in the initial crisis.

5. Understand the police are doing their job but make sure it’s not detrimental to your partner either.

6. Help her regain control. If she doesn’t want police involvement that’s her choice not yours.

7. Don’t withhold physical affection but give her the choice as to whether or not she wants it.

8. Reassure her constantly that you love her and that it is NOT her fault.

9. Never pressure her to resume sexual activity and when you do find ways to help her relax. Never take rejection personally and make it easy for her to say no.

10. Look after yourself and your stress levels. (For example, the author states that he found running and working out in the gym helpful.)

11. Don’t be afraid to talk to someone you are comfortable with about everything.

12. Communicate with your partner and do whatever you can to maintain her trust.

13. Learn and understand as much as you can about rape and its effects.

This is all excellent advice that I would give to any couple who came to me, if one of the partners was a survivor of sexual assault.  I also want to add that relationship counseling can be immensely helpful in these circumstances, in addition to individual trauma therapy.

Here’s to all the men out there who are strong enough to be patient and kind.  You are true warriors.

Today, I am taking some time to reflect on one of the most powerful mindfulness practices I have ever encountered…the process of orientation.

It’s a very simple practice, and it’s often the way I start a counseling session.  I invite clients to ground themselves in the space by noticing the room around them.  I encourage them to take in the room, using their senses.  Often, this has to do with taking in visual stimuli.  Clients may find something in the room that calls to them, like the sunlight outside the window or the colors of the leaves.  Tactile orientation can also be useful.  Some people are very touch-oriented, and may be drawn to the texture of a cushion or the warmth of a tea cup in their hand.

I encourage clients to attend to pleasurable things, and notice how they feel in their bodies, when they pay attention.  People often report a release of tension or sense of ease.  This tends to get a counseling session off to a good start.  If therapy begins from a place of relaxation, clients are more likely to have the resources to handle difficult material.

Dissociation often leaves people feeling “stuck” in their own inner world, isolated from others and the world around them.  The inner world may be a stagnant and constricted place. At the same time, it can seem preferable to focusing outward, especially if a client’s outside world was once a threatening place.

One key to healing is developing a felt sense that the world is not always threatening, and that we do not have to be on guard all the time.  Attending to pleasurable stimuli can allow people to encounter safety, and get a break from the traumatic memories that may be running in circles around their minds. Some people have been dissociated so much, for so long, that the simple act of noticing their surroundings in the presence of a supportive person can be transformative.  Sometimes, this alone can contribute to noticeable healing progress in a short period of time.

Spring is coming.  It will soon be time for opportunities to walk with clients by the creek in Boulder, and notice the sound of the rushing water.  I am really enjoying the new Denver space, especially the loft at People House.  It’s full of comfortable pillows and plenty of space to explore.

2014 has been a great year, so far.  I am looking forward to the coming spring with hope and curiosity.

One of my own new year’s resolutions was to set up shop in Denver.  That’s one resolution I can already scratch off the list.  I’ve found lovely space at People House, 3035 West 25th Avenue.  I’m excited to start taking clients there, and to get acquainted with all the other qualified professionals who use the space.

To all Boulderites:   I’m still taking clients at the Walnut Street office.  I’m looking forward to expanding the scope of my service, while being committed to maintaining a presence at both locations.

Today is the day of the Winter Solstice, otherwise known as the longest night of the year. For those who follow earth-based spiritual paths, this can be a day of great spiritual significance.  It is a day to celebrate the returning of the sun’s warmth, as the days begin to lengthen.

It can be a time to look forward to new beginnings.  I usually use this time to think about my resolutions for the new year.  When engaging in holiday celebrations, surrounded by friends and family, resolutions are supported and encouraged.  It is very easy for me to say “This year, I will focus more on self-care.  This year, I will follow my inspirations.  I will make more time for the things that are most important to me.”

It’s easy to forget about these resolutions after the celebrations fade.  The trees get taken down, and everyone returns to their ordinary life.  The return to ordinary routine can seem jarring, when facing three more months of bitter cold.  We may have expectations for ourselves, that we will face the new year with renewed energy.  Meanwhile, the weather does not seem to be cooperating.  I often hear people joke that they want to “hibernate” this time of year.  There seems to be a basic, instinctive impulse toward reduced activity when sunlight is scarce.  No wonder we often experience Seasonal Affective Disorder, this time of year. Our bodies want a break, but we have to keep going!

I think about the Solstice, and the symbolism of the new-born sun.  How is this consistent with the lethargy and depression that can come in winter?  Very consistent, if one thinks about new-borns.  They don’t jump out of the womb and start undertaking a bunch of new tasks.  They must be nurtured, while they begin to grow and learn about how to experience the world.  That nurturance requires patience, doesn’t it?

With regards to “hibernation”, we can take lessons from other mammals with similar instincts.  A black bear gives birth to her cubs in late January or early February.  She does not push them out into the cold right away.  She holds them close until spring.  If we, like  the sun, are “reborn” in the winter…can we give  ourselves some added nurturing?  At the very least, can we cut ourselves a little slack?

If you’re noticing yourself experiencing winter “blahs”, it’s time to increase self-care.  There are very simple you can do for yourself.  For one thing, it’s important to get as much sunlight as possible.  Lack of sunlight can lead to vitamin D deficiency*, in addition to depression.  If you’re like many people, you might find that the sun has already set by the time your work day ends.  You can try taking a walk on your lunch break.  Not only does this give you exposure to sunlight…it also gives your body an opportunity to move.  That can be a tremendous benefit, all by itself.

It is also important to schedule things to look forward to.  If you’re stuck indoors, make time for indoor activities that you enjoy.  This is great time to focus on art projects, spiritual practices or anything that you find nourishing.  Schedule these activities before you get hit with the cold-weather blues.  That way, you don’t have to spend energy “planning” when you don’t have energy to spare.

Most importantly: don’t isolate.  People tend to gather together during the holidays, but they can lose contact after New Year’s.  This doesn’t have to happen.  You can arrange meetings with friends on a regular basis.  Most people enjoy getting together for board games or movies, and they’ll appreciate your efforts to plan these events.  Just don’t get yourself into a position where you’ll be overwhelmed.  It’s reasonable to ask for help with cooking and cleaning, and accept help when it’s offered.

There are, of course, times when depression gets severe enough that medication is necessary.  If you’re experiencing frequent suicidal thoughts, or you are unable to function in your day-to-day life, then it’s time to call the doctor.  There is no shame in that.  At the same time, there are often things we can do to prevent depression from getting to that point.   The key is to have compassion for ourselves as we navigate this journey through winter.  When we do this, winter can be an opportunity for self-exploration and renewal.

*Note:  taking a walk is no substitute for vitamin D supplements, if you have a serious deficiency.

I thought I would take a moment to post this article from Vanessa Hughes, from the SE blog.  She writes about her experience using Somatic Experiencing with combat veterans.  It explains a little about how SE works, in lay-person’s terms.  What I love most is her description of the spontaneous authenticity that she shares with her clients.  She writes:

My first session to “go astray” was with a frequently dissociated Vietnam vet who sat across from me, week after week: arms folded tightly across his chest, eyes locked blankly on me, and legs planted in place. I suggested we play catch. His eyes widened, “What? You wanna do what? Why would we do that?”