Recovery Bill of Rights Part 4

A Recovery Bill of Rights for Trauma Survivors Part 4

For safety in your personal dependency in therapy you have the right to…

Hire a therapist or counselor as coach, not boss, of your recovery.

Receive expert and faithful assistance in healing from your therapist.

Know that your therapist will never have any other relationship with you – business, social, or sexual.

Be secure against any disclosure by your therapist, except with your consent or under court order.

Hold your therapist’s undivided loyalty in relation to all abusers.

Obtain informative answers to questions about your condition, your therapist’s qualifications, and any proposed treatment.

Have your safety given priority by your therapist, to the point of readiness to use all lawful means to neutralize an imminent threat to your life or that of someone else.

Receive a commitment from your therapist that is not conditional on your “good behavior” (habitual crime and endangerment excepted).

Make clear and reliable agreements about the times of sessions and of you therapist’s availability.

Telephone your therapist between scheduled sessions, in urgent need, and receive a return call within a reasonable time.

Be taught skills that lessen the risk of re-traumatization:

                Containment (boundaries for recovery work);

                Control of attention and mental imagery;

                Systematic relaxation.

Enjoy reasonable physical comfort during sessions.

 

This concludes the Bill of Rights for Trauma Survivors series.  I welcome any responses or reactions that you would like to share.

 

Bill

Crisis Managemet Questions

The Three “What” Questions of Crisis Management

I recently attended a meeting of Mental Health care providers who provide parenting classes for divorcing couples with children. During the meeting, one of the participants shared one of the tools that she uses to help the parents conceptualize how to manage the stress of “crisis” moments. She called it one of the principles of “Reflective Practice,” and to think of it as the most important three “what” questions to ask yourself when something distressing occurs. Specifically, the three questions are: “WHAT happened?”; “So WHAT?”; and “WHAT now?” 

WHAT HAPPENED? This refers to an honest, objective assessment of the event without adding value judgment or other extraneous thoughts about it. Not minimizing or catastrophizing about the event, but describing it realistically. For example, if there has been an accident, describe it. Describe injuries if they occurred. If there has been a fight or disagreement, just describe it. What happened, who did what to whom? Stick to the facts. 

SO WHAT? This refers to the actual consequences of the event, not how you feel about it. If you had an argument with someone and the two of you are not talking, describe it. Refrain from using energy thinking about how the person is a jerk or much you wish you could get even with him or her for treating you badly. If you or someone you care about suffered a financial hardship and paying bills is going to be a problem, describe it. It does not include feelings and judgments such as how unfair it is. Those things might seem very important to you, but they don’t help you actually manage or cope with the situation. 

NOW WHAT? This stage refers to planning what you need to do now given the situation that results from what has already passed. If there is a rift in a relationship that you want to repair, what steps can you take to repair it? If someone has hurt you and is likely to hurt you again, what steps are needed to keep yourself safe? If there has been an accident with injuries, what steps are needed to help heal the injuries in the best manner possible? If you are facing a financial hardship, what steps are needed to cope with it?

Dealing with events or crisis in such a way will free you from the chains that emotional crisis (different from the actual physical effects of the event) place on you. If it helps, write it down using the three “what” questions to help you sort out your response. You will find that a lot of what we think about in stressful situations keeps us from being effective, and actually helps keep the stress, and therefore the suffering, going.

Mark E. Hankla, MA

Children and Trauma

Do children react differently to trauma than adults?

The answer is yes. In adults some of the symptoms of trauma include night mares, flash backs, avoiding thoughts or feelings associated with trauma, detachment, feeling numb, depression, and anxiety.

When children experience a trauma, their reactions may look much different from adults. Younger children may regress. They may revert back to immature behaviors. For instance a child may begin bed wetting, having accidents during the day, or use baby talk. They may act out their scary situation with toys. They may also become clingy. Older children who experience trauma may act out, be defiant to authority, and have an excessive need to control things (and people) around them. They may have anger outbursts, they may steal or hoard items like food or lie. They may lash out at the very people who are attempting to help them. Sometimes, people who don’t understand what is happening in this situation, view the child as a trouble maker, they may think that the child is choosing to be “bad”.

If a child was abused by someone they knew or loved, they may have difficulty having trusting, loving relationships with their safe caregivers. They may unconsciously feel the need to test these relationships to see if the caregiver will protect them. Sometimes they may actually set themselves up to be rejected. For example, a child (who was abused in the home by a family member) may feel distrust of the remaining parent even though that parent stopped the abuse as soon as it was discovered. The child may focus his or her anger at the remaining parent, testing the limits, saying hurtful things, and at the same time be very clingy and dependent upon that parent. As a parent or caregiver in this situation, it can be very frustrating and exhausting.
 

If you are caring for or parenting a child who has been traumatized, please be patient and understanding.  While kids need consistent limits, they also need nurturance, kindness and understanding.

Laurie Patton

 

Coming soon: Tips on how to deal with a traumatized child.

Bill of Rights Part 3

A Recovery Bill of Rights for Trauma Survivors, Part 3

 

Here is our lastest installment in the series.  I found this worthwhile for therapists as well as clients and hope you do too. 

For the integrity of your personal communication you have the right to…

Ask for explanation of communications you do not understand.

Express a contrary view when you do understand and you disagree.

Acknowledge your feelings, without having to justify them.

Ask for changes when your needs are not being met.

Speak of your experience, without apology for your uncertainties.

Resolve doubt without deferring to the views or wishes of anyone.

 

Bill

Recovery Bill of Rights

A Recovery Bill of Rights for Trauma Survivors, Part 2

In my last entry I posted the first part of Thomas V. Maguire’s recovery bill of rights.  This is the second installment.   I hope you find it interesting.

To guard your personal boundaries you have the right to…

Speak or remain silent, about any topic and at any time, as you wish.

Ask for help in healing, without having to accept help with everything.

Take action to stop a trespass that does not cease when challenged.

Choose to accept or decline feedback, suggestions, or interpretations.

Be touched only with, and within the limits of your consent.

Challenge any crossing of your boundaries.

 

Bill

Recovery Bill of Rights

A Recovery Bill of Rights for Trauma Survivors

Thomas V. Maguire published a recovery bill of rights with the National Council for Community Behavioral Healthcare.  I thought I would pass it along in some installments.  Here is the first, I hope you find it useful. 

By virtue of your personal authority you have the right to…

                Manage your life according to your own values and judgment.

                Direct your recovery, answerable to no one for you goals or progress.

                Gather information to make intelligent decisions about your recovery.   

                Seek help from many sources, unhindered by demands for exclusivity.

                Decline help from anyone without having to justify the decision.

                Believe in your ability to heal and seek allies who share your faith.

                Trust allies in healing so far as one human can trust another.

                Be afraid and avoid what frightens you.

                Decide for yourself whether, when and where to confront fear.

                Learn by experimenting, that is, make mistakes.

Bill

Rumination, Mindfulness, and Being in the Moment

One of the most common issues my clients struggle with in therapy is rumination. Rumination can be related to a wide variety of issues and types of emotional responses. For instance, we may feel we’ve been wronged or slighted by someone we “thought” we could trust and ruminate about how and why that person did the perceived dirty deed. During the ruminating the event is played over and over and the initial emotional response is experienced again and again.

Another example would be focusing on a “possible” future event that would be hurtful even though the actual likelihood of the event is inflated due to worrying. I’m sure almost everyone has had the experience of interacting with a family member or friend who was irritable or short with you, and then wondering what you might have done to offend or upset them (even though it may not have anything to do with you at all). What often happens next is rumination about why the other person is upset plus worrying about the next interaction. In this example there are an infinite number of possible scenarios for future interactions to ruminate about, and I will bet none of the ones you imagine are positive, causing negative emotions like anxiety, sadness, anger, and maybe even fear. Consequences for this rumination can include being distracted from current activities which in turn can have any number of negative effects.

Rumination is analogous to suffering and is something we can learn to reduce. There are usually distinct thought patterns that can be identified that can be changed and counteracted. Judgmental thoughts such as “if only,” “why,” “it shouldn’t have,” or “it should be” are often part of rumination. Replacing judgmental statements with acceptance and non-judgmental observation of facts can slow down and counteract rumination. Try visualizing an event you ruminated about in the past and then saying to yourself two types of statements. First say: “That was a very sad and hurtful thing that happened to me.” Then say: “Why does that always happen to me?” Do they feel different to say? Which one sounds like a statement that lets you move on? Which one leaves you feeling unsatisfied and needing to pursue an answer again and again? Learning how to reduce or stop ruminating thoughts will reduce your stress and improve your life.

 

Mark E. Hankla

Taking Hold of Your Mind

People experiencing trauma related problems often say that they have difficulty controlling their thinking.  They may describe being bothered by thoughts that keep intruding on their thinking, or impulses to do things that might be harmful.  Obsessional thinking or going over the same thought repeatedly is another disturbance that can be a big problem.  These, as well as other disturbances in the process of their thinking are often described by our clients. 

While there are a variety of ways to address problems with the thinking process, using mindfulness skills is one that most people can learn and practice.   In her skills training manual, Psychologist Marsha Linehan devotes a major section to mindfulness skills which she titles “taking hold of your mind.”  I find this a fitting title because many people describe the experience of thinking problems as feeling like their mind is out of control. 

One of the first skills that Dr. Linehan covers is called “observe, just notice” which falls into the category of easy to say, difficult to do.  The skill involves observing your thoughts without getting caught up in what they are.  Dr. Linehan says to “…watch your thoughts coming and going, notice each feeling, rising and falling like waves in the ocean.”  I have found another useful metaphor to be that of standing beside a river watching your thoughts and feelings come floating down from upstream, drifting across in front of you and continuing to float downstream out of your awareness.  These and other observe techniques can be very helpful in learning to be in greater control of your thinking.  They are not very easy to use at first and coaching and a lot of practice is usually needed.  I think the time and effort taken to learn and use them is worth it.   I’ll describe more mindfulness skills in future posts.

Bill Bonacker

Acceptance

In the last post I wrote about Dialectical Behavior Therapy’s use of validation.  Another characteristic that Dialectical Behavior Therapy (DBT) emphasizes is the use of acceptance.  Marsha Linehan, the psychologist who developed DBT says that it adds the technology of acceptance to cognitive behavior therapy.  Years after DBT gained popularity, other therapies have included acceptance as a component but I think that DBT is the most organized and systematic in its use.

Dr. Linehan writes about radical acceptance in the DBT Skills Training Manual stating that “freedom from suffering requires acceptance from deep within of what is.  Let yourself go completely with what is.  Let go of fighting reality.” 

In later writing on DBT we find the equation, suffering = pain + nonacceptance.

Swiss American Psychiatrist Elisabeth Kübler-Ross included acceptance in her description of the stages of grief.  She wrote that people confronted with a loss pass through stages of anger, denial, bargaining, depression and acceptance.  Usually people visit the stages a number of times, working through them until they spend most of their time in the acceptance stage.  My clients often find this structure helpful in dealing with problems.  They usually can identify which stage they are stuck in and, with support, figure out what feelings and thoughts the acceptance stage would contain.  Then, of course, there’s the task of getting there.

Bill Bonacker

Validation

Validation

One of the elements that make Dialectical Behavior Therapy (DBT) unique is its emphasis on validation.     Validation can be described as the acceptance of what is.  The common popular comment, “it is what it is” sort of expresses this.  We don’t have to like it, we don’t have to approve of it, we can work to change it but there it is.  DBT’s creator, Marsha Linehan, contrasts DBT’s focus on validation with Cognitive Behavior Therapy’s constant focus on change.  She says that spending most of the time on changing is invalidating to many people.  They can feel that they shouldn’t have their feelings, thoughts or beliefs about what has happened to them.  They can feel that they should be doing better and that their current behavior is bad.  While Dr. Linehan recognizes that change is necessary and important, she stresses that change must be balanced with validation.  DBT’s individual therapy contains structured ways in which validation is used and therapists who have studied DBT are familiar with them.  Skilled DBT therapists are always working to find the balance between validation and change. 

Bill Bonacker

“Why do I have to talk about it?”

Most people who experience trauma do not get Post Traumatic Stress Disorder (PTSD) but those who do get it benefit from therapy.  Sometimes people in therapy for PTSD ask why the therapist wants them to talk about the traumatic experience.  It is usually painful or at least unpleasant so why do it? 

There are several ways to answer that question but brain researchers have recently identified some new reasons.  Psychologist Chris Brewin identified two areas of the brain that can reduce the upsetting effects of remembering a traumatic event.  But, in order to work effectively, these areas need practice.  One of the ways this practice occurs is by finding a way of explaining why the trauma happened – gaining understanding.  Putting it into words is very important in developing the ability to manage the trauma response.  Part of that explanation, or story about the trauma, involves describing how you got from the traumatic experience to the much safer present time.  Skilled therapists who have kept up with the progress in trauma therapy have a growing number of ways to help people through this process.  

If you have read some of the previous posts, you know that the process of treating Post Traumatic Stress Disorder is often difficult.  As we continue to study and learn, our ability to effectively help people with this condition improves.  New research techniques should provide us with much more information about how a traumatized brain operates and how to help people get better. 

Bill Bonacker

Treating PTSD

In a previous post I described the basics of the diagnosis of Post Traumatic Stress Disorder (PTSD).  Now a little about treatment. 

I have found PTSD to be one of the disorders that responds best to treatment.  In the last 20 years (not a long time in the history of mental disorders) there has been a huge increase in the understanding of the problem and the ways of effectively treating it.  The International Society of Traumatic Stress Studies and The International Society for the Study of Trauma and Dissociation have supported much research and training and continue to do wonderful work.  The therapists that I work with have all participated in training from these organizations and I look forward to attending as many of their events as possible. 

We now expect the return of a large number of military veterans from the wars in Iraq and Afghanistan in addition to the people in other occupations who have experienced terrible events.  Some of these people will have problems with PTSD.   In recent news reports, I have heard that there are not yet enough therapists trained to treat these people.  Recent Congressional testimony has addressed this ongoing problem in regard to the resources of the Veterans Affairs organization. 

If you know of someone who might have PTSD (or might be one), it would be a good idea to get it checked out.  There are resources out there, the internet has lots of links and pages for interested people. While some medications can be helpful in the treatment of PTSD, psychotherapy is the primary method of treatment.  Taking a pill won’t make it go away.  When selecting a therapist, ask if they have any specialized training and are aware of the recommended treatments of PTSD (the Standard of Care).  As always, be an informed consumer. 

Bill Bonacker

What is PTSD?

PTSD is the abbreviation for Post Traumatic Stress Disorder, a condition defined officially in the diagnostic manual of the American Psychiatric Association.  PTSD is also increasingly in the news and in popular publications associated with the controversy about whether the diagnosis should be given to some members of the Military Services.  There is some uncertainty and confusion about what it really is and I hope I can add some basic clarity.

Psychologist John Read has said “bad things happen to people and it screws them up” – the basic concept behind PTSD.    The official diagnosis is, of course, more complicated (about 6 pages in my copy of the diagnostic manual) and specifies what “bad things” (trauma) and what kinds of problems qualify.  It is also important to remember that not everybody who goes through a terrible experience has serious problems. 

When people who experience traumatic events do have serious problems they come in particular types.  As I wrote in previous posts, people can experience an increase in the amount of time that their minds and bodies spend “on red alert”, prepared for more trouble.  This kind of problem can be a high level of anxiety or tension, being “jumpy” (we call this an exaggerated startle response), being unable to relax or sleep well, poor concentration and others.

An additional kind of problem that people with PTSD experience is an unwanted remembering of the trauma which can include dreaming about it, feeling like it is happening again and being upset when they run into situations where they are reminded of the trauma. 

The third type of problems involve trying to avoid reminders of the trauma.  We usually see people avoiding people, places or activities that remind them of the traumatic experience, a decrease in feelings (called numbing) drug/alcohol use and other ways of avoiding. 

Bill Bonacker

Coping or Curing?

Coping or Curing?

Being mindful requires that we be realistic and honest with ourselves and others. This is important because people who are facing difficulties such as grieving or anxiety tend to construct contingencies (I often think of them as “alternate realities”) by which they seek to eliminate the source of their distress before they move forward with their life, goals, etc. It’s a sort of “if, then” scenario which they seemingly demand or expect be satisfied before they will return to normal existence. We also refer to it as “bargaining” because it’s as though the situation can be changed for the better if only we can promise something enticing enough for fate to change the outcome.

An often heard comment from many of the people I see in therapy goes something like this: “I feel like I’m being told to just get over it and get back to (work, school, the task at hand, etc.).” In this scenario, it appears that people are waiting for their distress to disappear before they reengage in activities that they find difficult due to their distress. Around and around it goes, because which will happen first? Will they return to normal activities, or will the distress disappear? That is a question that they are unable to answer satisfactorily.

They are often angry, sometimes not so much because they are being asked to fulfill their obligations or duties, but because they believe they are being told to “get rid of” their distress first. This is where I am quick to jump in and totally agree with them. They cannot just get rid of their distress, and it would be totally unrealistic to expect such a thing. But, and this is the tricky part, that does not mean that they can’t still function. The right question to ask is: how does a person learn to cope with distress while fulfilling other obligations? Coping with an issue is NOT the same as resolving an issue. Coping can buy time during which someone can work on resolving the source of their distress, and in the mean time still function at a high level. While it is normal and understandable that people engage in bargaining and contingencies before moving on, ultimately the bargains will not be fulfilled and history will not be rewritten. While the love and support of friends and family can be invaluable, you may sometimes find that you need the help of a professional who understands the subtleties between coping and being cured. Make sure you get the kind of assistance that helps you truly move forward.

Mark E. Hankla

How Much Fear? Part 3

How Much Fear? Part 3

Part two of this series of posts describe some of Gavin de Becker's ideas about intuition and making predictions about dangerous behavior. In his book, The Gift of Fear, Mr. de Becker writes that the solution to violence is the acceptance of reality. One aspect of this reality is the understanding that people have reasons for being violent. de Becker describes a system for gaining this understanding. He calls it "the algebra of aggression."

An easy way to remember the elements of the algebra of aggression is the acronym J ACA. J refers to justification. People will act aggressively if they feel justified in using aggressive behavior. There are many ways in which people can justify their behavior, aggressive and otherwise. These can be reasonable such as the use of aggression to escape a life-threatening situation or less reasonable. An example of a less reasonable justification would be rationalizing your use of aggressive behavior just because someone was driving badly.

The first A in J ACA stands for alternatives. People will act aggressively if they feel it's the only or best alternative in meeting their needs. Teaching people nonaggressive alternatives to getting their needs met can be an important part of therapy. The goal is to help people recognize that they are not out of options and their only alternative is aggressive action.

C is for consequences. When the consequences of aggressive behavior are acceptable, people are more likely to behave aggressively. If they stop and think about the consequences of aggressive behavior and recognize that the consequences are serious and ongoing problems for them, the likelihood of aggression decreases.

The second A in J ACA is ability. Does the person have the ability to behave aggressively? While almost everyone has the ability to be aggressive, the degree of aggressive ability may range from verbal complaining and rudeness to the use of a weapon. Good to know.

If your mind and body are telling you that you may be in a dangerous situation with someone, figuring out that person’s justification, alternatives, consequences and ability might help you understand important information and respond to your fear in the best way possible.

Bill Bonacker

Shame and Behavior

Shame and Behavior

Of all of the influences on behavior, shame may be one of the least understood. Shame influences and warps behavior in multiple ways. This includes behaviors such as isolating and avoidance, and often leads to behaviors that make things worse. For example, a person who is consumed by shame may try to avoid people or activities that remind them of what they feel ashamed of. It may also result in deception, or lying about the issue to avoid having to face it.

One can easily see how such behavior can cause further issues, effectively digging a deeper hole for the person who already feels ashamed. We see it often in therapy, both as a personal issue and as a source of frustration or anger when interacting with others who are affected by shame. For instance, I often hear parents expressing anger at their children who “lie” or “fib” as though the child is doing so just to be deviant or defiant of them, and they take it personally. But many times when the child is questioned about the behavior, it becomes evident that the deception is due to a desire to not disappoint the parent, which is the opposite of how the parent perceives it. An example might be when a child “lies” about not having homework or says it is already done even when it is not. It might be that the child just doesn’t want to do the work and is trying to get out of it. But it also possible that the child is ashamed that she or he didn’t get the work done already, or doesn’t understand it, or is afraid they won’t do it well enough. Either way the behavior is an issue that needs to be addressed. However, to address the behavior effectively it is important to understand the etiology of the behavior.

People feeling shame tend to avoid others, hiding their activities, avoid eye contact, and are quieter than usual. People feeling proud or happy tend to share their experiences or triumphs, feel more confident around others, and tend to look directly at others while maintaining eye contact. These are markers or indicators that you can use to monitor your own, or other’s, level of shame and vulnerability. If you notice your behavior is indicative of feeling shame, it may be time to discuss your feelings with a trusted friend or with a professional to help you relieve the distress, and help you improve your confidence and self-esteem. Shame can be dealt with so it does not negatively affect behavior.

Mark E. Hankla

How Much Fear? Part 2

How Much Fear? Part 2

In the previous post, we talked about the physical and psychological parts of our fear response. Published in 1997, The Gift of Fear by Gavin de Becker gave us some additional ways of looking at fear. In addition to recommending this book to many clients, our organization also provides a copy to anyone who comes to work here. The subtitle of the book, survival signals that protect us from violence, points to its main emphasis - how do we identify what is truly dangerous and avoid harm?

Mr. de Becker talks about using our intuition to identify danger and to guide us towards safety. He helps us to gain a greater understanding of intuition by listing "the messengers of intuition." These are: nagging feelings; persistent thoughts; humor; wonder; anxiety; curiosity; hunches; gut feelings; doubt; hesitation; suspicion; apprehension; and fear. If you take some time to think about your experiences with these thoughts and feelings, you may be able to remember what they told you or what you should have learned from their presence.

de Becker’s book contains real life examples of dangerous situations that illustrate the points that he is making. He also describes ways of making predictions about dangerous behavior and situations.

After reading his book, I found myself thinking about dangerousness and fear differently. Instead of something to be avoided, fear has become another piece of information. Information that is essential in making important decisions.

Bill Bonacker

How Much Fear?

How Much Fear?

We all know that there are many things to be afraid of. Bad economic conditions, health concerns and, sometimes, other people. We also know that when we are afraid, our bodies and minds experience changes. In his extensive work as a military psychologist, Dave Grossman has written about the effects of fear. He has described five levels or "conditions" and the effects of each of them.

In condition white, we experience our normal resting heart rate and feel calm and relaxed. As we become more alarmed, our heart rate rises from a normal rate of 60 to 80 beats per minute (bpm) through condition yellow (around 100 bpm) to condition red (from 115 to 145 bpm). Dr. Grossman says that in this range, we are at our best for performing complex physical activities and have optimal reaction time for responding to danger. This is not a comfortable state.

If we become even more distressed, our heart rate increases and our bodies experience additional changes. Breathing speeds up. We become less effective. Our ability to make complicated decisions decreases we experience changes in vision and hearing and most of our bodies resources are dedicated to simple physical activities important to survival. This is the state commonly known as "fight or flight." Dr. Grossman labels this as condition gray. Above 175 bpm, we enter Dr. Grossman's condition black. Our thinking may become irrational; we may experience a temporary shut down or freeze. We may still be able to run or fight but doing anything more complicated is unlikely.

Obviously, these reactions have been essential to our survival for centuries. The problem is that although most of us don't run into situations that are so dangerous that conditions red and above are helpful, our bodies go there anyway. Stress and panic reactions can be triggered by reminders of past danger or intense worries about loss or harm. Learning to calm ourselves when no immediate physical danger is present becomes an important skill. In order to function but our best we need to use our physical and mental resources most effectively and stay below condition red most of the time. There are a number of ways to do this ranging from breathing exercises to changing the way we think about the things that happen to us. In future posts, I'll go into more depth about managing our fear reactions. For now, remember to breathe.

Bill Bonacker

Self Injury

Self-Injury



Self-injury refers to the deliberate, direct destruction of body tissue that results in tissue damage, such as cutting, burning, scratching, or hitting oneself. The person’s intention is not to kill oneself. So why is it then that people self-injure? One theory is that self-injury serves as a form of coping and as a preferable alternative to suicide. Self-injury may be used for emotion regulation when used as a distraction from emotional pain by causing physical pain, to feel alive or real, to relieve tension, to feel numb or at peace, or to feel euphoric feelings. Another theory is that self-injury serves as a form of communication of pain, anger and other emotions, or need for help.

Treatment for those who self-injure includes addressing the function of the behavior and learning alternative coping skills. One treatment that specifically focuses on stopping self-injury and that research has shown to be effective is Dialectical Behavior Therapy. Until alternative healthy coping strategies have been learned and underlying issues addressed, substitution behaviors can be used when having the urge to harm oneself. They are done by matching an activity to the feeling the person is having when wanting to self-injure. For example, doing something physical, when angry, or doing something that creates a strong physical sensation, when wanting to feel something.

Warning signs for family and friends include social withdrawal, injuries, scars, secrecy, excuses for wounds, defensiveness, wearing long sleeves or pants in warm weather, and finding objects used for self-injury in odd places. As for what to do and what not to do if suspecting self-injury. Don’t ignore it, blame yourself, get angry, demand answers, or demand that they stop. Do pay attention, express concern, listen, encourage the expression of emotions, and let your loved-one know that you are there for them and want to help them find the help they need.

Jaci Pekarek

Trust

Relationships and Trust
“I can’t trust anymore”

A very common issue discussed in therapy is a feeling that “trust” is forever broken and therefore its impossible to have fruitful and rewarding relationships. After betrayal and deceit, most people would understand at least a temporary pulling back of trusting feelings and the need for more verification and reassurance in interpersonal relationships. But for some people, trusting is such an internal battle and causes such distress they have difficulty maintaining relationships. An enduring lack of trust erodes the basis of a relationship, and can lead to behaviors (e.g., controlling, jealousy, accusations, stalking) that can end relationships outright.

Psychologist Dr. William R. Stone once defined trust as “the ability to predict how someone is going to act.” In healthy situations, confidence in predicting another’s behavior is most often correlated to the length of time that person has been known and her or his behavior observed. There are real criteria and guidelines we can use to gauge the reasonableness of the trust we put in others. But “predicting how someone is going to act” is an imperfect science and there is always some risk involved. Unfortunately people regularly hurt one another, and betrayal of trust is often identified as the most damaging part of the hurtful act.

There is more to feelings of trust and distrust than how one person feels about another. Some people direct their feelings of distrust toward the individual or individuals who they feel betrayed them. Some react by becoming suspicious of practically everyone and develop a very dark and malevolent world view. Still others direct their feelings of distrust inward as they doubt their ability to discriminate between trustworthy and deceitful people, effectively blaming themselves. Perhaps not surprisingly, some people report all of the above as their reasons for not trusting, which usually is accompanied with very high levels of emotional distress.

So what can a person do if they if they feel they cannot trust? First of all, think of feelings of distrust as anxiety toward allowing yourself to be vulnerable. Emotions are internal messengers and the discomfort of anxiety is like a dashboard warning light. Would you stop driving altogether if a warning light came on? Probably not. A responsible driver would take steps to find out why the light was on and attend to the problem, which would result in the light switching back off. Then you could resume driving normally.

Deciding not to trust at all may reduce the anxiety (at least temporarily), but it would prevent good relationships from forming. So like the driver, acknowledging the internal warning and attending to your needs is the place to start. And where is it written that you are supposed to trust without question, or that different levels of trust are not appropriate? Listen to the anxiety, take into account why it is there, and make an informed decision about how much trust you are willing to give someone. Coping with anxiety does not mean dismissing it or its message, so healthy coping does not mean that you have to put yourself at risk. Talk to trusted friends to get others’ perspectives on trusting in similar situations. High anxiety may indicate you have trauma experiences that you need professional help to resolve. Talking out your deepest fears can help you gain a healthier perspective, and who knows, maybe you can start to trust again!

Mark E. Hankla

Part 2.

“I Can’t Slow Down/ I Don’t Do Anything” – part 2.

In my previous post I described the kind of trauma reaction that involves being upset and agitated. The other common trauma reaction is to shut down. This condition is a lot like depression, but it is really an attempt to avoid reminders of the trauma. People try to avoid feelings that remind them of the trauma by numbing their emotions. Their attempt to avoid sensations that are reminders may take the form of becoming physically less sensitive to all sensations and avoiding activities that put them into contact with strong sensations.

People can change their behavior so that they spend less time with other people and less time engaging in challenging activities. They withdraw in an effort to avoid lots of things. Not opening the mail (or e-mail), leaving home only for essential activities, and cutting back on talking to friends or family are common results. Decreasing their participation in hobbies, interests, and exercise can also occur.

For people who are doing a lot of avoiding, engaging in therapy may be a really big challenge. Sometimes the last thing they want to do is go and talk to someone about the things they have been seriously avoiding. If you know someone who is struggling with this kind of avoidance you know that they will respond better to support and encouragement than the stress of confrontation. Encouraging them to gradually resume their participation in life may help. Letting them know that there are professionals out there who understand that they need support and reassurance in working with trauma issues and that there is a helpful treatment for their problem can help them to get back on the path of taking an active role in their own lives.

Bill Bonacker

"I Can't Slow Down/ I Don't Do Anything - part 1

“I Can’t Slow Down/ I Don’t Do Anything - part 1
We sometimes hear clients say that they can’t settle down, that they are always tense, hurrying or rapidly thinking about things. Feeling jumpy, and under pressure are also frequent problems. Sometimes the problem can be traced back to something that happened in the past. Something that has put the person on “red alert.” This condition may last long after the event that caused the upset or fear in the first place is over. Recent examples can be found in some veterans who have returned from a war zone and still feel on edge. They may recognize that they are now safe in their homes but don’t feel very safe or calm.

In persons who have had traumatic experiences this can be the mind’s way of trying to cope with the experience by staying alert for any future threat or danger, an attempt to find safety.

One of the tasks of therapy is to help these people recognize these attempts to protect themselves because they are sometimes unrecognized. People think that they are just nervous, especially if they have been repeatedly told this by friends and family. Once a person has found the connection between their “red alert” lifestyle and its protective purpose, we can work on finding a sense of realistic safety. We can work on making changes to help protect from real threats and teach calming techniques to deal with threats that are not present any more. Yes, it’s a lot easier to describe than it is to do. Like most persistent problems it will take some sustained effort and much support and encouragement.

Bill Bonacker

Mindfulness and Sustained Recovery from Depression

Mindfulness and Sustained Recovery from Depression


A study focusing on factors related to those affected by episodes of recurrent depression found that in the first episode of depression, 50% of subjects had experienced a traumatic triggering event, while in the second episode this number was 20%, and in the third, 10%. These findings suggest that our thoughts can assume the power of an actual set-back. Even when feeling well, people remain vulnerable to recurrent episodes of depression due to mental associations formed between mood and negative thinking patterns, so that mild states of depression can reactivate negative thinking patterns that can result in a full-blown episode of depression. Sustained recovery from depression depends on learning how to keep mild states of depression from spiraling out of control. Mindfulness is helpful in reducing these downward mood spirals.

So what are these downward mood spirals and how can mindfulness be helpful? Often when starting to feel low, people react as if their emotions were a problem to be solved, they attempt critical thinking strategies, re-double efforts to use them when they do not work, and then end up over-thinking, brooding, and ruminating which only succeeds in prolonging and deepening the mood spiral. “What has gone wrong, why is this happening to me, where will it all end?” This can result in a return of negative thinking, “What is wrong with me? I’m back to square one. This is horrible. It will always be this way.” This negative thinking can become a pattern which then results in another episode of depression.

And how can mindfulness be helpful? Mindfulness can be helpful in reducing downward mood spirals in many ways. One way is in by having more awareness of mind states one can recognize earlier the beginning of the spiral and “nip it in the bud” earlier than before. Another way that mindfulness can be helpful is by teaching us how to focus on the present moment rather than re-living the past or worrying about the future. Mindfulness also helps us to shift mental gears from a state of mind dominated by critical thinking to one in which we experience the world directly, non-conceptually, and non-judgmentally. So rather than having resistance to unwanted emotions and thoughts or getting caught up in them, one increases their willingness to experience them, allowing for them to come and to go while being held in awareness with acceptance and compassion.

Jaci Pekarek

Mindfulness and Reactions

When we discuss “mindfulness” it may sound like an abstract concept that is nice in theory but difficult to implement in practice. But it doesn’t need to be something difficult, complicated, or mysterious. You can practice mindfulness in very specific and targeted ways to change your experience and behavior.

An example would be to understand your state-of-mind before an interaction with another person occurs to help temper your response. More specifically, what is your mood, what are your expectations, how are you likely to interpret words or behaviors?

I bring this up because on numerous occasions over the past few weeks when working on communication and relationship skills, I’ve needed to create a simple starting point. The solution I’ve used is for each individual to concentrate on how to affect change within their own sphere of influence, and not expect to control or force change in others. In other words, take ownership of your reactions before you worry about others changing their actions.

Oh sure, I understand that relationships are two-way streets. At some point people need to see some mutual change and effort. How the other person behaves or acts is important. But believe me, making your change contingent or dependent on the other person changing first, or at least simultaneously, means nothing will change! It will never happen!

And this is where “mindfulness” comes in. For example, if you are in a bad mood, feeling cranky, or still remembering something you are upset about with a friend or partner, then you are more likely to interpret anything they do as somehow an affront to you. But can it really be true that the other person’s behavior, mannerisms, mood, etc., are meant as an affront or attack on you? Every time? Really?!!

You can be mindful that something the other person does bothers you. For instance, let’s say the other person involved seems to obsess about an issue, like being on time for everything. You may feel like that person is just “nagging” you to hurry up. Asking “are you ready yet?” all of the time. If you get angry, what are you really angry about? Is it really worth a fight, as if he or she does this just to attack you or make you miserable? What does the conflict do to the relationship?

Using mindfulness means that although you can acknowledge that you find the other’s behavior annoying or irritating, you can also acknowledge that she or he may just be distressed at the thought of being late. Perhaps they feel embarrassed when late. That has very little if anything to do with you. It’s just the way he or she feels, and wants to avoid feeling that way. So before reacting, take a deep breath, or a moment to gather your thoughts. The other person can’t just stop feeling stress about “being on time.” That is a part of their makeup and personality. But you can, by being mindful, change your response. Learn to slow down, consider alternate reasons and motivations for the other’s behavior (e.g., maybe they don’t mean to nag).

Less needless conflict means less stress and tension (for both of you). A less tense environment means the other person may be able to relax and not obsess as much about being on time. Now that’s a win-win situation.

Mark E. Hankla