What is it to be traumatised?

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Clients often report feeling fraudulent entering therapy, stating that they had a happy childhood and no significant traumas in their life to date. In their mind, it is they who are fully responsible for their ongoing depression or anxiety. We tend to think of traumatic events as those extremes we hear about in the media: rape, assault, terrorism etc. In reality, the link between trauma and a traumatized brain is less clear cut.

Life is littered with uncertainties and perceived threats, to our lives, self-esteem and confidence. In the face of such threats, some of us are simply unequipped to deal with the psychological fall out – through no fault of our own. To assume full responsibility for how we react to these events, is inaccurate and disregards all that we now know about the brain. Brain imaging has revealed our limitations as human beings to differentiate between perceived and real danger. As a result, it may be more accurate to attribute some responsibility to our innate physiology.

I prefer to use the word ‘traumatized’ in therapy rather than labeling specific events as the moment trauma occurred. This allows clients to identify behaviors, emotions and thoughts that may indicate a ‘traumatized brain’. Put simply, a traumatized mind is a ‘confused or disorganized’ mind, involuntarily firing on all cylinders and largely out-with our control due to our evolution.

A traumatized mind is separate from the traumatic event. We are not born with the skills to self-soothe in the face of danger (perceived or real). We may seek them out in infancy but there is no guarantee these needs will be met through our environment. We have to learn these skills, to enable our brain to successfully access the parasympathetic nervous system, which essentially sends in the ‘para’-troupers in times of stress to calm the flames of anxiety and fear.

We learn key nurturing skills in early childhood, largely from care givers. Given that care givers are only human, and may well be inexperienced at managing their own emotions, we may find ourselves vulnerable to developing self-compassion. This is not to say our parents or peers are to blame for our underdeveloped brains rather that it is in no way our own fault as individuals for getting trapped in a traumatized mindset.

The good news is, no matter how traumatized our brains may be, brain imaging has shown that these key nurturing skills can be learnt at any age with the help of psycho-education and/or appropriate psychotherapy. Schema Therapy, Cognitive Behavioural Therapy, Psychoanalysis and Mindfulness all offer ways to calm the traumatized mind and gain essential self-regulatory skills.

It might be useful to consider the mindset that is engaged in the face of danger for you personally? Remember, our brains may be limited by insufficient development, but they are also extremely flexible, allowing new neural pathways to develop and arming us with more efficient and effective skills. A traumatic event can never be eradicated from our memories but we can significantly re-wire how our brains relate to these memories.

Shame and Compassion Focused Therapy

I wrote a while back about the impact of shame and how often this can lie at the root of psychological distress. Here’s a few more pointers on how shame can be tackled with compassion focused therapy.

Shame often disguises itself in more easily identifiable emotions, including, anger, disgust, anxiety, and depression. When shame is unresolved it can lie dormant for a long time. Typical behaviours that we might find ourselves caught up in are, self harming and aggression (attack), submissiveness to other’s demands (submit), and withdrawal from others (hide).

Shame is a normal human emotion, essential for the survival of social evolution, however, if left to eat away at us, it will often raise its ugly head again and again when we are feeling vulnerable or stressed. The power of shame is such that it can feel like a knife in the back, knocking our confidence and sense of direction and self worth. We can feel shamed socially, leaving us vulnerable and highly alert to other people’s judgments, and shamed internally, where we become our own worst and punitive critic, irrelevant of other people’s comments.

The good news is, no matter when or where our sense of shame comes from, the shameful mindset has been learned and therefore, we have the opportunity to learn a new mindset, one based on compassion.

The compassionate mindset involves first looking at the root cause, usually a situation or comment from others in the past, that first sowed the seeds of shame. This is followed by skills based training in Mindfulness, a meditative technique, which opens the door to a new way of interacting with our emotions, behaviours and thoughts. In a nutshell, Mindfulness increases self awareness of the shameful mindset, promotes self healing, and nurtures our ability to develop kindness, compassion, and a non-judgmental stance towards ourselves.

A great book for anyone struggling with shame and looking for an alternative path to freedom is The Compassionate Mind Approach to Recovering from Trauma by Deborah Lee.

Psychoanalysis – session one

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Well, that’s my first psychoanalysis session done and dusted. I was nervous to start, however, the relaxing hypnosis session at the beginning definitely reduced my anxiety. It’s true that consenting to hypnosis does elicit a fear of losing control, in my case anyway, despite my understanding of the processes involved ie. your conscious mind can always call a halt to the session and won’t buy into any suggestions that are not right for the individual. I should mention at this point that my goal is to merely explore the origins of my(self) with a view to managing unhelpful behaviours and patterns of thought that continue to haunt me despite my best efforts to rationalise and reorganise.

The script used by my analyst was The Wise Old Man (which can be found and purchased here). It was a pleasant imaginary journey that concludes with a silent and mental communication with whomever you choose to confide in. I found this exercise empowering and the memory of what occurred remains vivid and most importantly, private to me.

Following this rather pleasant journey, free association was introduced, whereby I was gently invited to follow wherever my thoughts took me. This does feel rather odd at first and at times I did find myself feeling a tad self-conscious. However, for the most part, I felt relaxed and surprised at the images and thoughts that came to mind.

It is only now, a few hours after today’s session, that I find myself reflecting on the content uncovered. There are clearly themes to my recollections (mostly childhood in origin) and none that come as a great shock. I had prepared myself to feel exposed and similarly vulnerable to my unconscious insights but find myself with a greater sense of clarity and optimism. There was a sense of resistance at times, which was at once both reassuring (I really did have control!), and frustrating in that they precluded me from venturing further. I understand that these intermittent reflexes are most likely my conscious mind signalling that the way ahead may be bumpy. I am intrigued and hope to venture further as therapy progresses…..

Therapists in therapy…

Now this will be interesting…I’ve decided to undertake some therapy of my own – essential really for any practicing psychotherapist – we are human after all! I’ve tried counselling, Gestalt and CBT before but have always had my reservations about psychoanalysis (first thought that comes to mind is Freud and for some reason he’s looking at me rather critically…)

It turns out my reservations are largely based on misconceptions and inadequate knowledge of this particular field of therapy. So, having had a brief free association session with a trusted colleague, I’m keen to pursue whatever path my unconscious mind chooses to take.

Having recently undertaken a course in hypnotherapy, I am still blown away by the fact that we only use around 10 percent of our brains! I’m hoping a course of treatment will give that extra 90 percent of my brain a well overdue MOT.

I’ll be sharing my progress online so, if you’re interested…watch this space.

Warning signs and relapse prevention

Exercise and adopting a generally healthy lifestyle are often key factors credited with helping to sustain good mental health. Naturally, most people who are coming to the end of psychological therapy are keen to maintain their improved health; what is not so commonly cited is the benefit of knowing your own particular warning signs.

Recovered alcoholics are all too aware of the triggers that can pose a threat to maintaining a sober lifestyle. Willpower can be helpful in some cases, but faced with a Christmas party or a sudden life crisis, the recovered alcoholic can find themselves once again staring their demons in the eye. Even our thoughts can blind us in times of stress and worry, the idea that we can be ‘cured’ for life is misleading. It would be wise to keep in the back of our minds that we all have our vulnerabilities and though they may not haunt us in our day-to-day lives any more, they have shown themselves to be extremely powerful and deserve a degree of respect and caution as we move forward.

Any therapist worth their salt, will dedicate sufficient time towards the end of therapy for the client to explore their own ‘warning signs’: essentially emotional, physical and behavioural signs that might indicate a step towards that slippery slope. Maintaining good mental health is just that; a maintenance job, that in itself can prove rewarding as a reminder of how well one we are doing.

The less conspicuous warning signs can often be difficult to spot in order to swiftly nip them in the bud. These include sleep disturbance following a period of relative stability, weight gain or loss, physical aches and pains and even a period of elated mood that is not common to the individual despite all the positive feelings that come with it.

Relapse prevention is often best supported by checking in from time to time with a trusted clinician for a mental MOT. The simple act of keeping a diary with a view to reviewing day-to-day observations that might be impacting on our mood can also be extremely useful.

As someone who struggles with mental health issues, I am all too aware of the importance of keeping an eye on any signs that have in the past snowballed and led to a drop in self-esteem and a fear of relapse. In no way do I live my life under the microscope of these fears, scrutinizing my every move, rather, I take each day for what it brings with an awareness that just as life can be unpredictable so too can my moods. I own my vulnerabilities as well as my strengths and this alone makes me feel all the more confident moving forward.

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How to be a really good listener

Haven’t been here for a while, but keen to get back into the swing of all things blogging! The link above takes you to a a great article on just that … how to be a really good listener. Whilst there are sadly many psychological practitioners out there who would greatly benefit their clients by taking this advice, this is most certainly relevant to all.

The greatest ally someone can have, no matter what challenges they may be facing (from a bad day at work to life and death deliberations), is a freind, colleague, family member, or a good samaritan who genuinely wants to listen.

With things being as they are, in terms of restricted funding in the NHS and long waiting lists to access psychological support, it is you who holds the key to helping your fellow humans. Even where people are already receiving psychological support in some form or another, please, please do not assume that they are in any way ‘home and dry’ in terms of overcoming their own personal challenges. Just as a hairdresser can disappoint with a shoddy haircut or colour, so too can a psychologist or mental health nurse (they are only human after all).

It is a fact that many, many people have been brought back from the brink of suicide by a non-professional and a great deal of those who go on to take their own lives were not receiving any support whatsoever, or it is seen to be ineffective at that point in time.

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Failed by the NHS

Please do check this documentary out. It aired on BBC 3 last night so will be available for some time on BBCiPlayer.

Despite the title, it left me feeling incredibly proud of all the young people who refuse to let shoddy mental health care treatment received determine their future lives.

A personal message to Norman Lamb MP, Minister of State for Care and Support, who features in the documentary:

Please keep to your promised commitments, you hold so many peoples’ lives in your hands.

A message to all those who have survived poor mental health treatment;

Do not despair, you are not alone, together we can bring change about.