Dealing with Trauma!

Have been training folks over the last two days about Underlying trauma and addiction. I have shared to all who will listen about the great work of San Francisco Psychotherapist Pete Walker. Here is a blog from his website. Hope it helps those who relate.

Flashbask Management in Treatment of Complex PTSD

The East Bay Therapist, Sept/Oct 2005
A significant percentage of adults who suffered ongoing abuse or neglect in childhood suffer from Complex Post Traumatic Stress Disorder. One of the most difficult features of this type of PTSD is extreme susceptibility to painful emotional flashbacks. Emotional flashbacks are sudden and often prolonged regressions ('amygdala hijackings') to the frightening circumstances of childhood. They are typically experienced as intense and confusing episodes of fear and/or despair - or as sorrowful and/or enraged reactions to this fear and despair. Emotional flashbacks are especially painful because the inner critic typically overlays them with toxic shame, inhibiting the individual from seeking comfort and support, isolating him in an overwhelming and humiliating sense of defectiveness.

Because most emotional flashbacks do not have a visual or memory component to them, the triggered individual rarely realizes that she is re-experiencing a traumatic time from childhood. Psychoeducation is therefore a fundamental first step in the process of helping clients understand and manage their flashbacks. Most of my clients experience noticeable relief when I explain PTSD to them. The diagnosis seems to reverberate deeply with their intuitive understanding of their suffering. When they understand that their sense of overwhelm initially arose as an instinctual response to truly traumatic circumstances, they begin to shed the awful belief that they are crazy, hopelessly oversensitive, and/or incurably defective.

Flashbacks strand clients in the feelings of danger, helplessness and hopelessness of their original abandonment, when there was no safe parental figure to go to for comfort and support. Hence, Complex PTSD is now accurately being identified by many as an attachment disorder. Flashback management therefore needs to be taught in the context of a safe relationship. Clients need to feel safe enough with the therapist to describe their humiliating experiences of a flashback, so that the therapist can help them respond more constructively to their overwhelm in the moment.

Without help in the moment, the client typically remains lost in the flashback and has no recourse but to once again fruitlessly reenact his own particular array of primitive, self-injuring defenses to what feel like unmanageable feelings. I find that most clients can be guided to see the harmfulness of these previously necessary, but now outmoded, defenses as misfirings of their fight, flight, freeze, or fawn responses. These misfirings then, cause dysfunctional warding off of feelings in four different ways:
1. fighting or over-asserting one's self with others in narcissistic and entitled ways such as misusing power or promoting excessive self-interest;
2.fleeing obsessive-compulsively into activities such as workaholism, sex and love addiction, or substance abuse (uppers');
3.freezing in numbing, dissociative ways such as sleeping excessively, over-fantasizing, or tuning out with TV or medications ('downers');
4.fawning in self-abandoning and obsequious codependent relating. (The fawn response to trauma is delineated in my earlier article on "Codependency and Trauma" in The East Bay Therapist, Jan/Feb 03).

As clients learn that their originally helpful defenses now needlessly hinder them, they can begin to replace them with the anxiolytic and therapeutic responses to flashbacks that are outlined and listed at the end of this article. I introduce this phase of the work by giving the client a copy of this list of cognitive, affective, somatic and behavioral techniques to use as a toolbox outside of the session. These tools are also elaborated ongoingly in our sessions. I continually notice that the clients who acquire the most recovery are those who carry the list with them or post it up conspicuously at home until they are thoroughly conversant with it.

As clients begin to derive benefit from responding more functionally to being triggered, there are more opportunities to work with their active flashbacks in session. In fact, it often seems that their unconscious desire for mastery 'schedules' their flashbacks to occur just prior to or during sessions. In helping them to achieve some mastery, my most ubiquitous intervention is helping them to deconstruct the outmoded alarmist tendencies of the inner critic. This is essential, as Donald Kalshed explicates throughout The Inner World of Trauma, because the inner critic grows rampantly in traumatized children and because the inner critic is the primary initiator of most flashbacks. The psychodynamics of this is that continuous abuse and neglect force the child's inner critic [superego] to overdevelop hypervigilance and perfectionism - hypervigilance to recognize and defend against danger, and perfectionism to try to win approval and safe attachment. Unfortunately, safety and attachment are rarely or never experienced. Hypervigilance progressively devolves into intense performance anxiety and perfectionism festers into a virulent inner voice that increasingly manifests self-hate, self-disgust and self-abandonment at every imperfection. Eventually the child grows up, but she is so dominated by feelings of danger, shame and abandonment, that she is unaware that adulthood now offers many new resources for achieving internal and external safety. She is stuck seeing the present as rife with danger as the past.

I sometimes think of this phase of the work as rescuing the client from the hegemony of the critic. Despite the negative connotation rescuing has in many circles, I believe there is an unmet childhood need for rescue that I help meet when I 'save' my client from the critic. like mom didn't save her from abusive dad, or like the neighborhood didn't rescue her from her alcoholic family. This rescue process then, is a gradual emancipation from self-alienation, and a gradual deliverance from the internalized parents who trigger the client with flashback-inducing catastrophizations and perfectionistic invectives. If no one shows the trauma-locked individual that extrication from the self-torturing processes of the critic is possible, he rarely learns to rescue himself. He may live forever without discovering that he now has a variety of helpful responses [detailed in the list below] available to him to resist the triggering and exacerbating dynamics of the critic.

Over the course of therapy, I often reframe flashbacks as messages from the wounded inner child about the denied or minimized traumas of childhood. In this vein I paint flashbacks as the inner child righteously clamoring for validation of past parental abuse and neglect. Flashbacks are the child pleading for unmet developmental needs to be met, none more important than the gradual awakening of a healthy sense of self-compassion and self-protection. This is fundamental to recovery because without self-compassion, clients rarely evolve any substantive self-care habits. Similarly, without reconnecting to the instinct of self-protection, clients rarely develop effective resistance to either internal or external abuse.

When clients get that their emotional storms are messages from an inner child who is still pining for a healthy inner attachment figure, they gradually become more self-accepting and less ashamed of their flashbacks, their imperfections and their overall affective experience. They understand that the lion's share of the energy of their intense emotional reactions in the present are actually appropriate but delayed reactions to various themes of their childhood abuse and neglect. As they learn to effectively assign this emotional energy to those events and perpetrators, they metabolize and work through these feelings in a trauma-resolving way. This in turn leads to a reduction of the emotional energy that fuels their flashbacks, and flashbacks in turn, become less frequent, less intense and less enduring. Eventually flashbacks can even begin to automatically invoke a sense of self-protection as soon as the individual realizes she is triggered. Eventually this can even happen at the moment of triggering, as well as just before encountering known triggers.

Some final words. I have seen so many of my clients respond well to this model, even those who 'only' suffered neglect, I have come to conceptualize Complex PTSD as being on a continuum of severity. In this vein, it seems that with enough neglect, certain children automatically over-identify with the superego and adopt an intense form of perfectionism that, via the critic's "not good enough, not pretty enough, not smart enough, not helpful enough, etc.," triggers them over and over into painful abandonment flashbacks every time they are remotely less than perfect or perfectly pleasing.

MANAGING FLASHBACKS
1. Say to yourself: "I am having a flashback". Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are experiencing are past memories that cannot hurt you now.
2.Remind yourself: "I feel afraid but I am not in danger! I am safe now, here in the present." Remember you are now in the safety of the present, far from the danger of the past.
3.Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat you; you are free to leave dangerous situations and protest unfair behavior.
4.Speak reassuringly to the Inner Child. The child needs to know that you love her unconditionally- that she can come to you for comfort and protection when she feels lost and scared.
5.Deconstruct eternity thinking: in childhood, fear and abandonment felt endless - a safer future was unimaginable. Remember the flashback will pass as it has many times before.
6.Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never had as a child. (Feeling small and little is a sure sign of a flashback)
7.Ease back into your body. Fear launches us into 'heady' worrying, or numbing and spacing out.
[a] Gently ask your body to Relax: feel each of your major muscle groups and softly encourage them to relax. (Tightened musculature sends unnecessary danger signals to the brain)
[b] Breathe deeply and slowly. (Holding the breath also signals danger).
[c] Slow down: rushing presses the psyche's panic button.
[d] Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down in a closet or a bath, take a nap.
[e] Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you if you do not run from it or react self-destructively to it.
8.Resist the Inner Critic's Drasticizing and Catastrophizing:
[a] Use thought-stopping to halt its endless exaggeration of danger and constant planning to control the uncontrollable. Refuse to shame, hate or abandon yourself. Channel the anger of self-attack into saying NO to unfair self-criticism.
[b] Use thought-substitution to replace negative thinking with a memorized list of your qualities and accomplishments
9. Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and abandonment, and to validate - and then soothe - the child's past experience of helplessness and hopelessness. Healthy grieving can turn our tears into self-compassion and our anger into self-protection.
10. Cultivate safe relationships and seek support. Take time alone when you need it, but don't let shame isolate you. Feeling shame doesn't mean you are shameful. Educate your intimates about flashbacks and ask them to help you talk and feel your way through them.
11. Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and triggering mental processes. Practice preventive maintenance with these steps when triggering situations are unavoidable.
12. Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our wounds from past abuse and abandonment. They also point to our still unmet developmental needs and can provide motivation to get them met.
13. Be patient with a slow recovery process: it takes time in the present to become un-adrenalized, and considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real recovery is a gradually progressive process (often two steps forward, one step back), not an attained salvation fantasy. Don't beat yourself up for having a flashback.

http://www.pete-walker.com

Recovery Icon John Bradshaw passes away.

Well I am just l learning this news. God rest his soul and support the hearts of Family and close friends . 

The loss must be indescribable .

To the rest of the recovery community we have lost an icon. A man who humbly stated that he stood on the shoulders of giants, only to become a true giant himself. His illumination on the damage of dysfunction to child development was ahead of its time. 

The interpersonal neurobiologists of today's fame owe an enormous amount to Bradshaw. He was at the coalface, and his concept of Toxic Shame and Healing the Shame that Binds You reconnected many souls.

His acknowledgment of the Shame core and the passionate healing that comes through his work in Homecoming restored hope to generations to come that they could interrupt the pattern of generational abuse.

 The Family series was ground breaking and life saving, always impressed me that it was shown in prison throughout the USA to all those second child scapegoats.

 

I have his voice regularly in my head and as a survivor of childhood trauma  and being in recovery from many addictions, some for over 30 years now, I am in debt to Bradshaw for my life. He will always be one of the voices within me that leads me to my true north.

You will be missed you beautiful man. 

http://m.chron.com/news/houston-texas/houston/article/John-Bradshaw-self-help-guru-dead-at-82-7424137.php

Love- The only Mental Health

Working from home. Movemeber is fully underway, I am passionate today, about healing, about Spirit, mostly about LOVE. The best thing about recovery, is LOVE, deep loving, feeling it, living it, living in it. God I am grateful for the grace that saved a wreck like me, giving me back my connection to my heart. Its a painful road to make your way back home, and the anxiety at times literally is breathe taking, but I cannot stop trying to live in the essence of life itself, I will not run from it anymore Springsteen inspiring me today. https://www.youtube.com/watch?v=rOPDhoZH91g

Mothers

Well tonight, Movember Day One, just finished a Country wide Skype mens meeting. The house is quiet here, I'm exhausted after staying up for the Wallabies. However, the value of deep sharing from grown man to grown man, from the heart, is a currency of Kings! My mental Health and well being has been stabilized and foundationalized by fostering relationships with men, in a way that my fathers generation was not able to . Viva the Evolution!

Tonight's topic Mothers, I shared about my alcoholic birth Mother , my adopted mother and her challenges of dealing with mental illness, and my wife, who has health challenges now, but is one of the most deeply loving spirit-filled beings I have ever met. Our two beautiful boys have an anchor in them created by her commitment, every minute of everyday to this family.

She is my Queen Scout.

I am grateful to have met with and stayed in contact with my birth mother. I am grateful to recovery that I stayed through the grief process of growing up with my adopted mother and the impact of the trauma of mental illness, to now have healed from both our pasts and I have a loving relationship with my mum. She did the best with what she had, and he was given a rough start to. We have that in common, but we have both changed the family legacy.

I have a poem I will sign off on tonight , I wrote about being the surrogate spouse as the eldest to my mother, here it is. I was written years ago, but it is still important, that work and the wound.

A Gift from the Cook.

How long has my worth been determined by others?

My need to be needed,

Reflects my self perception.

It seems to be the only substance to fill this hole.

To make me complete.

Yet I have always been empty.

The approval have always been an illusionary filler,

For I remain always trying to fill the same hole.

Showing people I was worthy of their need.

And keeping them needy.

For if they grew beyond that place,

What would become of me?

To my mother I was a possession.

She needed me to need her,

So she could feel special,

Whole and complete.

And I grew to need her love, approval and protection.

Yet, there was something wrong.

An anger or resentment,

At my acquired need.

Like it sucked at some life blood that did not exist.

A hunger that was induced,

But no food could be supplied.

And as the years have past,

I have lived with this constant hunger.

To be needed or not feel complete.

And for the women of my life,

They served the same meal,

And for a while I enjoyed.

But somewhere the food soured,

And the hole inside grew to the size of a cavern.

My wife found she needed herself more and left.

My mother just grew tired,

And occasionally just turned off the stove.

And now I am alone,

Me and my need to be needed.

And for my father,

Who sat for my entire life

A spectator to this feast,

Resented me.

For I ate his food, from his wife,

And many times he went hungry.

And now we live many universes apart,

And speak very different tongues,

Both with a hole,

A gift from the cook.

S.J.S

Trudging the Road to your Happy Destiny. PTSD and CPTSD Grand Round for South Pacific Private.

"Our bodies don't run from danger because we're afraid - rather, we're afraid because our bodies run."

- William James 1884.

Today's Grand Round went really well. There was a great group of professionals and good presence in the room. I was to present with our Medical Superintendent, Dr Ben Teoh. Ben has many years experience working with Complex Trauma and PTSD from shock Trauma, and gave the opening presentation.
Dr Teoh covered comprehensively the DSM IV & V definitions of Trauma and highlighted their deficiency when dealing with clients symptoms who present with Complex Trauma issues as a result of Childhood Trauma.  He presented statistics from the Adverse Childhood experience study, and linked it to Dr Bessel Van Der Kolk's proposed Developmental Trauma Disorder diagnostic criteria, making the point that Developmental Trauma is still very prevalent in families today.

 I had the pleasure to then link SPP's treatment model , and how we have been incorporating the Body Focused Treatment modalities  of Pat Ogden, Peter Levine, Bessel Van Der Kolk, Dr Allan Schore and Dr Stephen Porges and how they have been very complimentary to Pia Mellody model of developmental immaturity that we have been working form at South Pacific Private.

For many years we have addressed the two recoveries that are suggested by Pia Mellody at the Meadows Arizona at SPP. Firstly, the recovery from our Secondary Symptoms , especially the Addiction Issues, Mental Health Issues and Physical illness. The the second recovery is from our history. The Developmental Trauma that has left a lasting affect predisposing us towards the secondary symptoms. For recovery to take place we need to work on both fronts. Fortunately this day and age there are more resources than before to seek support for addiction and mental health issues, but the recovery from our history, and the immaturity it leaves us to live in gets largely overlooked. Leaving clients in states of Negative Control issues, Resentment and Rage issues, Spirituality issues, Enmeshment and Avoidance issues, deep problems with dishonesty, for example not being able to truly share their reality with others with out feeling any Toxic Shame. All this protected by defense mechanisms that initially saved us at the time of the trauma, but leaving us in our adult life disconnected from our viscera, in a way inhibits any connection with self and others. Also leaving us with regulation issues that promote the trigger a pathological relationship with mood altering substances or behaviors.
Fortunately treatment for both is available at a level that we now have evidence leads to change in the brain in regards to neuroplasticity and the malleability of the existing structure. Extraordinary.

It does not mean that it is easy. As a survivor myself I was encouraged reading Pete Walkers book "Complex PTSD, from Surviving to Thriving". I resonated with his shared experience. For many years I have used walking and stretching to get me in touch with the Body that I disconnected from in childhood due to the Toxic Shame and visceral discomfort I felt being connected to the stress when I felt triggered. It has always felt better when I was finished, but the act of doing  it always took commitment. I use to think it was case I was unmotivated or lazy.
 It was pointed out to me by a mentor that I was the most unlaziest person they had ever met, and they suggested it was fear and shame as I was connected to myself. They were right.

These days when I am travelling well, I do it, feel better after it and see it and mindfulness as essentials to my well being and CPTSD recovery, and part of my 11th Step practice that is my insurance policy against relapsing. Pia Mellody quoted the phrase that in recovery we are " Trudging the road to our happy destiny". That is an apt saying, however words will never encapsulate the reality of the complex difficultly of trauma recovery. "John Bradshaw stated that when we experienced the Toxic Shame core firing in an attack , that it was the "Intolerable experience of being". If you let that statement wash through you, examine it at depth, that comes closer. 

In we attempt the two recoveries, it will get worse before it gets better, but it will get better, in most cases better than you could ever know. 

Don't quit before the miracle happens...

It's Friday night, I'm still at the coalface, been a powerful week of growing awareness, confronting old patterns, and growing through relationship. As Pia Mellody says, sometimes  recovery  is like "Trudging the road to happy destiny"
There was some trudging this week, that's for sure. However, there was the glow of many miracles lighting the way.
Pia talks about the disconnection that happens from the soul when we experience developmental trauma, but the warming reality is, if we stay in recovery, moving from the disconnection to connection, then we get that soul re-connection through recovery at depth.', leading to a life better than we have ever known.
Not stopping before the miracle happens means to me, that I cannot stop at just abstinence, just stop at dealing with the secondary symptoms. The miracle happens when I go beyond that, dealing and healing the deeper wounds that lead to the disconnection from self, resulting in the Toxic Shame, that I then spent the rest of my time needing to medicate myself away from.
Therefore, recovery cannot just consist of an abstinence to the medication, it can go far deeper than that. It can be the deep healing of the wound, where once in the process of healing I get back into relationship , not only with myself and others, but with God as I understand God. That is the miracle on offer, that quitting before I get it would mean I was ripping myself off.
Having had a spiritual awakening as a result of these steps, means once I am in this deep soul connection, then the world opens up for me. This connection gives me a message to carry to others, and a set of values and principles that when I actively live them,  leads to a deep wisdom, and the ability to be in the now, spontaneous and open, to giving and receiving in my humility and my humanity.