"Lothlorien" a psychotherapy student and trauma survivor just sent me a link to her rave review of Trauma Treatment Handbook. Check it out here.
Due to last year's audit, I now know that self-employed people and businesses must file 1099 forms to anyone whom they pay more than $600. Every consultant, your landlord, and the person who cleans the office. Since I own my office and don't pay rent, I sent three 1099's, one to the office cleaning person, one to my consultant, and the other, in my business as landlord, to the contractor who rebuilt a floor for me.
Why 1099's? The IRS wants to be able to know if your payees, the consultant and your landlord, are declaring all their income.
How 1099s? You want the 1099-Miscellaneous Income (or 1099-MISC) form. They come 2 to a page. I always ruin one by putting my consultant's name where mine should go. Read carefully. And you need to get the tax i.d. or social security number of every payee. Which, unless they're working under the table, they'll be glad to give you. Put the $ amount in the appropriate square (Probably not "crop insurance proceeds"). When you've filled them out, send the top layer to the IRS, one of the middle ones to the "recipient" and file the rest in your file. When you send the top layers, they need to go with form 1096, which just has the total. After you've done this once, the IRS sends you a pre-printed form.
To get forms call the IRS at 1800-829-3676 or go to www.irs.gov
If you don't do this, and you get audited, it will cost you for every audit year and every form. I know this the hard way. It will take you about an hour total, to figure it out. So order the forms, get the Social Security #'s, and start figuring out who you paid what in 2010.
David Schnarch and the dynamic duo of Ellen Bader and Pete Pearson tell us that the secret to happy marriage is the level of differentiation of each spouse. (Differentiated people show completely who they are and what they want, even when the other partner doesn't like it or agree. They also are able to accept their partners' differences and disagreements, to a reasonable point.) Researcher John Gottman says that for a marriage to last and be satisfying, spouses must know to whom they are married and avoid the "Four Horsemen of the Apocalypse": Criticism (attacking spouse's character), Stonewalling (Refusing to Talk), Contempt (Attacking the sense of self, sarcasm, sneering) and Defensiveness (Warding off spouse's attempt to talk as an attack, when it isn't). Tara Parker-Pope in today's New York Time writes about another variable of a happy married life: "self-expansion", the self-growth and new learning spouses gain from their partners. Read the article here. There is even a simple quiz that you can take about you and your partner here.
Page McBee writes a different kind of story in the Time's Modern Love column. She talks about her sense of unworthiness and her unrealistic black-and-white expectations of marriage that changed after she and her girlfriend survived a near-fatal armed robbery. After the robbery, her childhood trauma and related attachment issues arose, were acted out, and then slowly resolved. When it came time for the wedding, she approaches it through her reasoning and finally fully-present adult self, not her shamed, magical child. It's lovely. Right here.
Some of the best therapy I've seen on screen is in a great new movie, The King's Speech. Geoffrey Rush plays Lionel Logue, an Australian speech therapist who tackles the debilitating anxiety-driven stammer of Colin Firth's, "Bertie", who become the king of England on the eve of World War II.
The film shows the stifling lives and roles of the Royals, and the intense pressure on them from their subjects, the Anglican Church, their governments, and each other. It shows how a therapist to the King has to tear down the class barriers in order to make a strong, attached therapeutic relationship. Logue creates the frame be insisting that "Bertie" come to his office ("My castle, my rules."), be on time, and be addressed by his family name, rather than "Your Royal Highness". He sits close, and mixes standard speech therapy with elements of somatic and expressive therapies (some of which are riotously funny) and holds the therapeutic relationship above all. He watches his client carefully, and crafts his client-centered therapy and the environment in which the King must give his speeches to his client's needs. Logue leads his client to uncover the childhood traumas that precipitated the stammer, and the family dynamics that kept it going. And he uses brilliant and funny strategic therapy to hook his recalcitrant client into therapy, and keep him there.
Helena Bonham Carter plays Bertie's supportive wife, Elizabeth, and is excellent, as usual. Derek Jacobi is the Archbishop of Canterbury, with whom Bertie finally shows his adult and kingly differentiation. Michael Gambon plays King George, Bertie's father, as a well-meaning, impatient, worst father a stammerer could have. (It's strange to see Dumbledore be jerk.) Guy Pearce plays Edward, Bertie's brother who abdicated the throne for a woman Mrs. Simpson (Eve Best).
I knew a lot of the history, and I painlessly learned more of the particulars in this wonderful movie. The King's Speech is suspenseful, beautifully acted, funny, sad, and hopeful. I hope you see it, too.
James Risen writes about a soldier, Staff Sgt. David Senft, with PTSD who kills himself in Afghanistan. The article lists many things that predict successful suicide:
The military's mandate for suicide prevention completely failed this man. Read this sad story to know him and know the details.
"What Attachment Theory Can Teach about Love and Relationships" by Amir Levine and Rachel Heller, in the January 2011 Scientific American is a good introduction to attachment styles, how they affect our ways of relating, and how to get conscious control over some of our dating styles, despite our early experience.
Many of my clients are near my age, the mid-fifties. Many of us are dealing with ailing and dying parents, just as our own bodies are showing signs of mortality. Here are several issues that arise:
Here are some rules that I've made for myself and have suggested for my clients:
These are developmental issues, not pathological ones. I'm constantly normalizing peoples' fear, grief, and overwhelm, when dealing with these issues.
National Public Radio wrote and spoke about the "Battle Over the Science" of Tricare not paying for cognitive rehabilitation therapy (CRT) for Traumatic Brain Injury (TBI) "despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans does not to cover” cognitive rehabilitation therapy — a “limitation that could affect…tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.” See article in Veterans Today: http://www.veteranstoday.com/2010/12/21/battle-over-science-money-blocks-widely-recommended-tbi-therapy/ and the NPR story: http://www.npr.org/2010/12/21/132203864/philanthropist-provides-care-that-the-pentagon-wont
It turns out that Tricare hired a research company that it knew (or maybe told to) would find this well-researched therapy to be "not scientific", despite unanimous by 50 clinicians and researchers on a special governmental commission. The reason: It didn't want to pay. CRT is expensive. And necessary. Thousands of military people are returning from Iraq and Afghanistan with TBI's from exposure to roadside bombs. The shock waves from these explosions move through brains, temporarily jellifying the tissue and causing lasting cognitive problems and difficulties with affect regulation. CRT helps people learn to cope and manage despite brain damage. It's necessary therapy.
This is reminding me of Tricare's refusal, until just this week, to pay for EMDR therapy for vets, despite EMDR's acceptance by the VA, the APA, and other entities as an "evidence-based practice". This was more about politics than money. Cognitive behaviorist and exposure people had colonized Tricare's committees, not allowing support for other effective therapies. I'm sorry that our active duty people and veterans have been victimized by the political and financial b.s. at Tricare. They deserve better.
In my experience, many "researchers" quote studies that support their beliefs and not the ones that support the facts. Or else cling to lab-based double-blind studies. Many effective therapies were not hatched or researched in labs. They work despite the lack of studies. Some, even after the "appropriate" research is complete are debunked because of the belief systems of the meta-researchers. My belief: Do what works for the client in front of you.
Fascinating article, The Insanity Virus, in the November online Discover magazine describes studies that show that schizophrenia and MS may be from viruses that trigger the Toxoplasmosis and CMV viruses that most of us already carry. It's a long read that got more interesting (for me) on pages 3 and 4.
This article makes personal sense to me because I've been around many people with AIDS whose impaired immune systems allowed the CMV and Toxoplasmosis to flourish and make them psychotic for the rest of their lives. I'm interested to see more about this research trend.
It's also interesting because last month at the EMDRIA conference I just heard Paul W. Miller MD, a Northern Ireland-based Psychiatrist, talk about how he has cured psychotic delusions in schizophrenic clients using psychotherapy that includes EMDR.
Dr. Kathleen Young, writes in her wonderful blog: Treating Trauma in Chicago, about when self-care is interpreted as abandonment. Read the article and the comments, then look at the rest of this great blog:
The outpouring of support after the spate LGBT suicides has been amazing. The latest and most moving part is a song by young Broadway performers "It Gets Better".
My homeboy, Dan Savage started the project with videos of gay and lesbian adults talking about how they survived harassment and worse and how life got better in the It Gets Better Project. (Many cool videos from all kinds of people)
President Obama recorded a video for the project, though the most moving one I've seen, besides the song, is a long video by a member of the Ft. Worth city council, Joel Burns, where he talks about bullying and a suicide attempt before it got better for him.
I started my career in 1981 working at Seattle Counseling Services for Sexual Minorities. If these resources had been around then (the internet, U-Tube, celebrities supporting gay teenagers to stay alive) I would have spent less time consoling grieving parents and friends and dealing with clients' failed suicide attempts. Back then, kids were routinely kicked out of their families for coming out. It still happens, but Oprah, Ellen, Rosie, and the increasing acceptance of gay people as human beings, legally and socially, has made this country a much healthier place to grow up gay, bi, or trans. Thank God.
I've had to confront evil again. In my every day life, I see it all the time. 60% of my clients have been sexually, physically, and emotionally abused by the adults, mostly their parents, who were in charge of them. As a consultant I hear therapists' most horrific cases. I read the newspapers.This political election is particularly ugly and full of disingenuous lies and distortions. African paramilitary continue to rape, murder, and hack off limbs. The wikileaks site has sent out another torrent of how people in power misused it to torture and murder. Members of our local Stryker Brigade are on trial for having tortured, then murdered Afghanis, for fun. And greed continues overpower humanity everywhere we look.
But it gets worse. I attended two conferences in three weeks, EMDR International Association (EMDRIA) in Minneapolis and International Society for the Study of Trauma and Dissociation (ISSTD) in Atlanta. The ISSTD conference is smaller and often more scholarly than EMDRIA, 400 people, many of them researchers. Most of the EMDRIA presentations were upbeat: How to use EMDR to cure schizophrenia, depression (mine), shame, dissociation, etc. At ISSTD, some of the research-based presentations were about dysfunction with no talk of cure. Dr. Martin Teicher presented research on how different kinds of child abuse affect brain structures and which developmental windows impact brain structures and function the most. He didn't discuss neuroplasticity and how we fix these things. Then Ellen Lacter presented "Torture-Based Mind Control: Psychological Mechanisms of Installation and Continued Control" with Alison Miller and Ada Sachs throwing in their awareness of torture in ritual abuse. The single most distressing thought that stuck with me is that the worse the torture, the more the victim becomes attached to the perpetrator.
M. Scott Peck defines "evil" as something possible only when one human doesn't see another human as a human being. I'd like to add that for evil to occur, one human has to have power over another and see that other as an object, a means to an end. Evil isn't a new idea for me. My step-father, Peter, was a survivor of the German Holocaust. I was beat up by neighbor kids for being Jewish. I work with the effects of abuse every day. And I spent 20 years clearing the trauma and dissociation of one ritual abuse client. But learning about the number of organized groups that are "breaking people", intentionally causing dissociation through torture, set me back and left the conference stunned and hunkered down.
How did I get through it this week?
It's worked well. I've been back for 6 days and I'm breathing fully, feeling more hope than despair, and about to have a book party for the my newest trauma book: Trauma Treatment Handbook, my contribution to healing trauma and making people whole.
The more stress and depression, the more inflammation. University of California, San Diego, medical school report from Newswise: http://www.newswise.com/articles/view/569853/
I've taken two different versions of April Steele's Developing a Secure Self course. Each time I learned more about creating good, strong, attachment experiences in clients with unfortunate childhoods. (Most of my caseload!) April teaches assessment, therapeutic stance, and has scripted protocols for bringing clients' loving adult attention to their infant and toddler selves. Clients can take home Cd's of the soothing protocols to enhance their experience of loving containment. Most of my attachment disordered clients loved them. A few, with phobias of their smaller selves, hated them, until we did enough trauma work that they could accept all parts. No matter what kind of therapy you do, April's training manual and scripted Cd's are very helpful.
April just came out with a distant learning course, complete with DVDs of lecture, power-point, and wonderful client videos. Because she's "practicing for retirement", she's no longer doing in person training. Here's what she says about it:
"Imaginal Nurturing, Ego States, and Attachment: An Integrated Approach to Early Deficits is the most up-to-date material on the Developing a Secure Self approach. It is not simply a video of a workshop you were unable to attend, but rather was created specifically for distance learning. In it, you will have the opportunity to "sit in on" segments of numerous sessions with a client who generously allowed some of her therapy to be videotaped to foster the learning of other therapists in the Developing a Secure Self approach. Many other clinical examples are given throughout the training. There are also two experiential segments so you have some personal experience of what you will be asking clients to do.
The 12-hour program consists of 6 DVDs, 2 CDs, and a comprehensive 53-page manual. It requires only a DVD player and CD player. More information is available at http://april-steele.ca/training-information.php or you can contact April directly at email@example.com."
It's $200 and for a bit more you can get 12 CE's for taking the post-test. I think everyone should have this training. If you need consultation after the training, April is available by Skype or phone from her home on Gabriola Island in British Colombia.
Jay Gelzer (who btw wants you to know that she loves to work with "gifted" people of all ages) gave great handouts. She suggests converting your business land line to a cell phone, and sharing office space. And she talked about looking closely at your revenue and expenditures: know what your real expenses are and your real revenue. Know what you're actually taking home as spendable income. She said that in this recession, or as a new practitioner, it might be necessary to support your practice, until it supports you. And market yourself (see above).
Robert Odell and Heidi Wasch took questions. Odell suggested a web-based fax service: faxaway.com and a web-host: Aplus.com. Someone else suggested blogspot.com Heidi suggested swapping offices one day a week with someone in another location. It works for her and has expanded her client base.
It was a very nice 3 hours with a nice turnout for a sunny Saturday, about 35 people.
Why go through all this? The entire culture is moving to the web. If you want to be found, you'll move there too. Many people don't use phone books anymore, they type names and hit "search". People who teach, or work with other professionals, or who offer services like psychotherapy need to get their faces into the marketplace. Authors who have web pages support their books by creating easy online access to them.
My father was a business owner, selling industrial supplies. He sold everything from nuts and bolts to forklifts. From the ages of 8 to 16, I pasted hand-typed mailing labels and stamps on his catalogs to let other businesses know what he was selling. I'm doing something similar. By having a website, I'm letting people know that I'm here, what I'm selling, and how to get in touch. If you want to promote your practice, you may want to do the same.
My website was built by CHS Internet Development. I paid them $2000, met once in person, provided all the content, and had many phone calls, discussion, and some conflict. It is possible to do a simple website by yourself. Mine is a hybrid, developed by CHS, but I can modify it myself, as my professional life changes.
Utilization is the idea that therapists should use the culture and the language that their clients already use. If your client has watched Star Trek, they already know how to utilize these great tools.
My clients are delighted when I speak their language and use what's already in their brains. If they've spent years with Star Trek or Doctor Who or the mutants in Heroes, their mirror neurons have already had them doing the magical activities, and are ready to take them into a different reality.
Years ago, a cult-abused DID client cured her insomnia by imagining a Star Trek containment field around her bed, which she turned on before sleep. Later, after years of trauma-clearing and Vulcan mind-melds between related parts, she did a mind-meld between all remaining parts and integrated (mostly) in my office.
"This is a thorough, accessible, and very practical book, filled with resources and sound ideas, filtered through the intelligence and experience of a savvy, compassionate, down-to-earth, and very experienced clinician. It is like a travel guide to the land of trauma and trauma treatment: if you are new to it, it will orient you to all there is to do and see; if you're a frequent traveler, it is a worthwhile reminder of all that is out there, above and beyond the familiar places you always visit. Once could ask for a better guide. I highly recommend it."
I explain trauma, complex trauma, dissociation and how to assess them and prepare for treatment, and all the kinds of treatment that I know about from the main-stream to the obscure. I talk about working with military, sexually-abused, and relationally traumatized people, and how to take care of yourself while doing the work.
Some of my heroes comment on it. Dan Siegel wrote the introduction, despite my lack of research. Diana Fosha, Stephen Porges, Kathy Steele, and Onno van der Hart wrote very nice blurbs on the back. I'm humbled by their support.
This is the first book written completely by me. I'm amazed to be responsible for synthesizing so many people's therapies in one book. The design is great, and the photos, by Doug Plummer (my beloved) are gorgeous.
Posted at 07:22 PM in AEDP, Anxiety disorders, April Steele, Attachment therapy, Books, Brainspotting, Child Therapy, Cognitive Behavior Therapy, Consultation, Daniel Siegel, Diana Fosha, Ego State Therapy, EMDR, Hypnosis/Hypnotherapy, ISTDP, Mindfulness, Movement Therapy, Multiple Personality Disorder, Neuroscience, Obsessive-Compulsive Personality Disorder, OCPD, Polyvagal Theory, Professional Ethics, Psychiatric diagnoses, psychotherapy, PTSD, PTSD in Iraq war soldiers, Rape in the military, Stephen Porges, Structural Dissociation, Veterans, Writing | Permalink | Comments (5) | TrackBack (0)
Tags: Books, Dissociation, Psychotherapy, Trauma
I spent yesterday afternoon at a fundraiser for EMDR-HAP's Haiti project and last night at "Living in Emergency", the new Doctors Without Borders/MSF film, followed by a live discussion with MSF staff/volunteers. I'm left with two feelings: overwhelmed that there is so much untreated physical and emotional trauma in the world and gratitude and hope that volunteers have taken on the task of doing what they can to heal it.
(Full disclosure: I'm on the board of EMDR-HAP.)
The EMDR Humanitarian Assistance Program started 15 years ago as a sub-program of the EMDR Institute, to address the psychological trauma of disasters. HAP's first big project was sending therapists to work with first responders after the Oklahoma City bombing. After volunteers used EMDR to clear the trauma for medics, fire-fighters, police, and others, some stayed to train therapists to work with the rest of the population. HAP started out responding to disasters and now has a new mandate: building capacity to serve underserved traumatized communities. While they still respond to specific disasters like Katrina, the Turkish earthquake, the tsunami in Indonesia, etc., they are building capacity by training therapists to do EMDR in those places, and in underserved communities in the U.S. and around the world. HAP has done trainings for community mental health centers, rape crisis centers, children's agencies and military services in the U.S. Its volunteers have trained therapist who work in Israel, the Palestinean territories, Iraq, Egypt, India, Bosnia, Indonesia, Kenya, Mexico, Columbia, and many other countries. Therapists or agencies may pay the expense of the trainings (dirt cheap, since all trainers and facilitators work for free) or grants may underwrite the entire expense. HAP, under its wonderful director, Dr. Robert Gelbach, has turned to "building capacity". Its goal is for each country or region to eventually grow its own training capacity, so that we can bow out and send our volunteers to other places.
HAP is also promoting Trauma Recovery Networks, regionally-based mostly autonomous groups that train themselves to work with disasters or underserved populations. I'm in the beginning of starting such a group in the Seattle area.
Doctors Without Borders (Medecins Sans Frontieres/MSF) was started in 1971. It sends medical personnel to over 60 countries to deal with victims of war and other disasters. Volunteers sign on for a 6-month or more hitch and deal with the medical issues of extremely underserved people. Most of the medical people come from developed countries and most do their stints in places with inadequate supplies, electricity, and communications. In "Living in Emergency", I saw the doctors deal with the deaths of patients they would have been able to save in more modern settings. I saw them dealing without the basics of sanitary surgery and doing amazing work (as far as I can tell). Many doctors smoked. All drank. Many used sex to affirm life while surrounded by death. The stress was amazing. About half do a second stint. Some sign on indefinitely.
I noticed the difference between HAP and MSF. Most HAP volunteers fly away for 3 or 4 days or a few weeks, at most. HAP, being a mental health-based agency, pays attention to the stress of its volunteers. MSF, according to the movie and to the discussion, believes that volunteers are responsible for themselves and should deal with their own problems. There is debriefing, but no formal mechanism for support. It made me wonder about a HAP-MSF connection. Could we at HAP have our EMDR therapists available to assist traumatized MSF personnel?
Go see "Living in Emergency". If you want to learn more about Doctors Without Borders/ MSF go to http://www.doctorswithoutborders.org/ . If you want to learn more about EMDR-HAP go to www.emdrhap.org . Feel free to leave a donation at the websites. These folks are doing great, life-giving work.
On July 1, 2010, insurance companies in Washington state will have to provide unlimited sessions for psychotherapy clients in most categories. After fruitlessly spending more than 10 hours trying to get Regence Blue Shield to flip an inpatient benefit into outpatient sessions, I remembered the new law. I then called up another part of the company and a nice man explained to me that the client will have unlimited sessions starting July 1.
Don't assume it with every client. Check with the company if you're not sure.I'm sure this means that we Washingtonians will have to be even more scrupulous in record-keeping and diagnoses to prove "medical necessity". Otherwise, Hallelujah!
This came about by the tireless efforts of the Washington State Coalition of Mental Health Professionals and Consumers http://www.wacoalition.org/ and especially the great work by Laura Groshong our amazing lobbyist. Thank you WS Coalition! If you are a therapist in Washington State, go to the website and join now. It's a wonderful organization.
If you get a phone call from Multiplan asking you to lower your fee with an insurance company in order to get "expedited payment", turn them down. This happened to me and to a colleague of mine. First your insurance company doesn't pay you for sessions that you did. Then Multiplan calls you and says that if you lower your fee it will help your client. They wanted me to lower my fee $30. After intensive questioning, the agent told me that it would lower the client's copay by $5. Guess who gets the other $25? That's right! It's the insurance company. Given that the companies make massive profits and the executives get millions in bonuses, I'm not willing to further subsidize them. And neither should you.
And what's with withholding pay and offering "expedited payment." WTF?
Susan Kravitz and Katy Murray, the wonderfully effective stewards of the Southwest Washington Regional meeting, organized a training for EMDR therapists in Olympia, at which they played an audiotape of Andrew Leeds teaching about enhancing positive affect. (2007, Learning to Feel Good About Positive Emotions, from the 2007 EMDRIA conference worshop on the Positive Affect Tolerance Protocol) This is what I came away with:
People who were poorly attached to their parents, who didn't get appropriate mirroring of their joy and excitement, may grow up to be unable to tolerate the positive affects of happiness, joy, and excitement. They may have been punished for showing too much exuberance (a depressed child is a quiet child). Or there may have been so much abuse and/or mayhem around them that they learned that "if it's good now, it will turn bad soon."
When you do regular EMDR processing with these folks, you may clear the distressing events, but the relief that we see with other kinds of clients ends up distressing these dismissive attachment folks. If you try to do Resource Installation, having them remember a good or strong time, they fall apart, avoid it, or dissociate, because they don't have the neural hardware to tolerate and assimilate the joyful feeling. They have trouble taking in the good feeling of a compliment. (I've noticed that compliments are ego-dystonic for my complex trauma clients who live in deep shame.)
Leeds and his colleagues came up with a few ways to start building in the appropriate hardware. One is available to any kind of therapist, or anyone reading this blog:
Practice this in the session. Have the client give you a compliment, twice, warning him or her that you will turn it down the first time, then accept it. Then give them a compliment and have them take it in say the words. Assign responding to compliments for the next week, (or the rest of their lives) and reporting to you about it.
The next part is for EMDR therapists:
Target moments of positive affect, using a slightly modified Standard Protocol: the Positive Affect and Integration Protocol.
Ask the client for "a recent moment of poorly tolerated shared positive feeling".
There are a few changes in the protocol:
Of course, it was much more complicated, with descriptions of how people develop dismissing insecure attachment, case histories, and some practica. Leeds said that he saw big changes in his clients' ability to tolerate their positive affect in five or six sessions. I'm looking forward to trying it with my complex trauma clients.
Other ways to build positive affect tolerance, laughing with clients. Sharing their good feelings in obvious ways: mirror smiling and eye contact. Show delight in their delight and talk about it (ala Diana Fosha): "What was it like for you when we laughed together?" "What was it like for you when you noticed that I noticed your happiness today?"
This meditation was generously shared by someone else's client who was neglected and abused as a child. She does it as part of breathing practice: breathing in each true line. In it she speaks to different parts of self and all parts of self, counteracting distressing and untrue beliefs and orienting parts to the present. The changes in type, underlining, etc. are as I received them.
To the writer: I don't know you, but I thank you on behalf of all the therapists who are going to borrow this for their clients who need to learn the same things that you are already learning. Thank you!
1. I am here now, in my body,
2. quiet and calm.
3. It’s OK to know.
4. It was not my fault, ever;
5. I had no choice and did nothing wrong.
6. I was not a bad girl;
7. I was good.
8. I am good.
9. It’s OK to know.
10. It was not her fault, ever;
11. she had no choice
and did nothing wrong.
12. She was not a bad girl;
13. She was good.
14. I am good.
15. It’s OK to know.
16. It is not your fault, ever;
17. you have no choice
and are doing nothing wrong.
18. You are not bad,
even though it sometimes feels good.
19. You are good,
even when it feels good.
20. You are good
even when it’s confusing
and you think maybe you like it.
21. You are good
even when you’re sure you’re bad.
22. You are always good.
23. I am good.
24. There has never been anyone there to help you.
25. You have been so lonely.
26. I see you now.
27. You are not alone anymore.
28. I can help you now.
29. It is OK for both of us to know.
30. It is OK for all of us to know.
31. It is OK for all of you to be known.
32. It is OK for me to know all of you.
33. We did nothing wrong.
34. Bad, confusing things were done to us.
35. I have compassion and tenderness
for all of myself.
I attended Lisa Erickson's Professional Ethics & Technology workshop today, sponsored by Cascadia Training. Here's what I came away with:
Skype, the computer phone and video-phone service, is encrypted and hard to break into. If Skype's employees wanted to listen in, they could. But why would they?
The picture can freeze, fragment, or lag. You can't do eye contact. And it's still often better than the phone because you can see each other.
If you are "skyping" or emailing a session, have a back-up plan in place (like the phone) in case the technology fails.
Many of us in the workshop wouldn't use Skype for regular sessions, but would use it for sessions if the client or therapist was out of town. Some do and many would use it for consultation or supervision.
You can only legally do long distance psychotherapy if the client resides in a state in which the therapist is licensed.
Add a new section to your consent form stating your rules about technology. For instance:
Other random issues Resources (a few of the many that Lisa Erickson gave us) M. Maheu has a great technology/therapy blog: http://telehealth.net/blog/ Mahue, Pulier, Wilhelm, McMenamin, & Brown-Connolly (2005) The Mental Health Professional and the New Technologies metanayoia.org: Safeguarding Patient Confidentiality in email.
Other random issues
(a few of the many that Lisa Erickson gave us)
M. Maheu has a great technology/therapy blog: http://telehealth.net/blog/
Mahue, Pulier, Wilhelm, McMenamin, & Brown-Connolly (2005) The Mental Health Professional and the New Technologies
metanayoia.org: Safeguarding Patient Confidentiality in email.
Here is a 9 minute video of me talking about how trauma therapy works. Expect more pieces of this video in the future. My husband, the videographer and photographer, Doug Plummer made the video.
Here's how we prepared, what we did right, and how it went:
Our returns were "flagged" by the IRS because my husband, Doug Plummer, has a home office and $20,000 of travel expenses, and because I never gave 1099's to my three consultants, and because of our two rentals (one of which is my office.)
We did several things right:
What I did wrong:
I had no idea that we are supposed to issue 1099's to other professionals we pay. I had a few thousand dollars of expenses, split between 3 consultants, and I should have issued 1099's to each of them, and 1096 forms to the IRS about them. And, no, you can't declare your personal psychotherapy to be consultation. And it's only for people you paid more than $600 in one year. If you pay rent for your office, you must issue a 1099 to your landlord. It's supposed to go in by Jan 31 of the next year. I'm working on the 2009 1099's right now.
My 25 consultees and 4 office tenants have never given me 1099's. It doesn't effect me, but it will get them dinged in an audit. I'm paying the not so horrible penalty of $50 for every 1099 I didn't issue in 2007 and 2008, about $300.
We paid our accountant about $900 for helping us prep and then being with us for some of the audit. We lost two days of work each, for the audit. And about 40 hours each in preparation. And I owe about $300 in penalties. It could have been worse.
So, keep good records, issue 1099's, have Quicken or the equivalent, have separate accounts for personal and business, and don't throw anything out. Hire an accountant, we couldn't have done it without one. And I hope all my readers can avoid audits forever.
Research shows that anxious people have different wiring than non-anxious people:
Kathy Steele, cocreator of the Structural Dissociation Theory, patiently defends the existence of Dissociative Identity Disorder to Ira Flatow and Numan Gharaibeh (a clueless psychiatrist) on NPR's Science Friday. Worth a listen: http://www.sciencefriday.com/program/archives/200911133
I've run into this blindness before, mostly in analytically trained psychiatrists, despite all evidence.
Video of military woman with PTSD: Video
Article about military women with PTSD: Article
Check out Damien Cave's article in today's New York Times. Women are less likely to be granted disability on the grounds that they weren't in combat, even though they are seeing plenty of action in Iraq. Unrecognized, they feel shame about having the flashbacks and aggression that characterized PTSD and are even less likely to seek treatment than male soldiers.
As trauma therapists, we are privileged to watch our clients’ trauma fade from terrible, here-and-now experiences to mere memories; their dissociation shift to integrated presence, and their pain disappear. We are also privy to the gut-wrenching details of rape, accidents, war, and story after story of child abuse, domestic violence, and horrible neglect. The more terrible the abuse and the more dissociated the clients, the more they project the actual emotions of their trauma into us. Some therapists become grim. Some avoid complex trauma clients. Some help their clients avoid expressing affect in the sessions. Some burn out and leave the profession. Here are some ways to keep yourself whole while doing this important work.
1. Do your own work. If you’re not able to tolerate your own history and your current affect, you won’t be able to tolerate the despair, rage, shame, and grief that move through many trauma survivors.
2. Learn mindfulness. Meditate, do yoga, do chi gong, do breathing exercises. It will help you “stay in the chair” while witnessing whatever is there to see. Learn to breathe and ground yourself while being with anything.
3. Know yourself. If you start a session in a state of equilibrium, and you start feeling rage or exhaustion in the session, guess that it may be the client’s rage or dissociation. If you then say “What are you feeling right now? There’s something in the room.” The client is likely to say, “Oh, I’m angry, I guess it’s about X.” or “Oh, I was just spacing out.” When you know where you are, you’ll know when you are being drawn into someone else’s experience and use it for their benefit.
4. Know the signs of burn out:
a. You aren’t excited to go to work.
b. You talk only about work and have no other interests.
c. You treat everyone on earth like a client.
d. You dream about clients, all the time.
e. You’re angry at clients for being the way they are.
f. You feel shame for your human limitations.
g. You have vicarious PTSD: flashbacks, anxiety, depression, avoidance around client material.
h. You want to drink, gamble, or otherwise dissociate after work.
5. Get support.
a. Join a supportive consultation group. (Not just about the technique, but about you, too. And no shaming allowed.)
b. You might get individual consultation for the most troubling cases. As a consultant, I’m going step-by-step with a few consultees with their most fragile, barely tractable cases. It’s good for the therapists and good for the clients.
c. Increase your therapeutic arsenal. If what you’re doing isn’t working, find something else that does.
d. Do your own work. Hire a good trauma therapist who can help you clear your vicarious trauma.
6. Develop other interests that have nothing to do with therapy. Make sure some of them involve unmitigated joy.
7. Do things that bring you into your body: Run, stretch, work out, dance, do yoga.
8. If you have any control over your schedule, limit the number of the most complex, dissociated, abused, unstable clients. And don’t put them all on one day.
9. You will probably learn your tolerance the way most of us do, by exceeding it. Once you know, keep your own boundaries. Follow the Platinum Rule: “Fill your own cup first, then give away what’s left over.” And another rule, “To Thine Own Self Be Nice.” Trauma is compelling, but don’t let it run your entire life.
10. Watch out for grandiosity. You can’t fix everything. Know your limits.
11. If you have a spiritual practice, use it to support your work. Ask whatever higher power you have for help when stuck.
From Laura W. Groshong, LICSW, Director, Government Relations, Clinical Social Work Association:
I have just returned from three days of lobbying in Washington DC for the Clinical Social Work Association and have some new ideas of what the President and Congress (the five committees and one informal "Group of Six") are doing to develop a health care reform plan.
I think the President is trying to pull together at least four major political groups in Congress (Democratic progressives, 'Blue Dog' conservative Democrats, Republican conservatives, Republican moderates), which are being influenced primarily by PHarma, the AMA/other clinical groups, insurers, hospitals, and AARP/other consumer groups. Any of the political groups could theoretically sink health care reform. Mental health groups/associations (57) are working well together in the Mental Health Liaison Group, but don't have the kind of influence that the AMA does. We are working with the AMA on several issues where we have common cause, e.g., stop the proposed 21% Medicare cut to providers scheduled to go into effect in 2010, keep the "evidence based practice" provisions from taking clinical decisions out of our hands (even though this concept started in medicine, and has increasingly become the de facto way that insurers operate), expansion of care to include the uninsured, etc.
As a clinician and lobbyist, I think there is rarely a time when you can accomplish everything you want, in working with patients or in legislation, no matter how strongly you feel. I think President Obama, Speaker Pelosi, and Majority Leader Reid are trying to deal with the reality that the conflicting interests here will not allow wholesale reform of the health care delivery system or expansion of the kind that would be most humane.
Most successful legislation in my 12 years of experience is incremental and works pretty well because most issues do not arouse the conflicting passions that health care is right now. I think it has become the lightening rod for other sources of anger and anxiety, not the least of which is job loss and income reduction in general. This is unfortunate because it could stop our getting some improvements in health care delivery and coverage altogether.
Much as some legislators and interest groups have framed this as an all or nothing situation, it does not have to be. The HELP draft bill, HR 3200 in the House and the Baucus/Group of Six bill draft all contain several pilot projects which would give us a chance to see what works best in containing costs, the driving force behind any health care reform.
The legislator working the hardest to make sure that any bill has a strong mental health and substance abuse benefit is Rep. Patrick Kennedy (D-RI), with some help from Rep. Barney Frank (D-MA). Neither House wants to determine what the basic benefits package should look like at this time. A new Federal oversight body may be created to do this, the Department of Health and Human Services could be charged with developing the package, or Congress could eventually decide to do it themselves.
Here's the time frame as I see it. Things are on hold until the Baucus bill comes out on Tuesday or Wednesday. After amendments are considered by the Finance Committee (the 'mark up'), the bill will be passed by the Finance Committee. Then the full Senate will consider the HELP bill and the Finance Committee bill and reconcile them. This will influence the bill, HR 3200, which has been passed out of three committees in the House, but has not passed the whole House of Representatives. The Majority Leader intends to pass a bill by mid-October; the President has asked for a bill to sign before Thanksgiving, so the two bills which emerge would have to go to conference committee as soon as possible to be integrated. Again, the Baucus bill is seen as the most likely framework for a bill that could be passed by both Houses.
A word about the "public option", or a government health plan to cover the uninsured who cannot find insurance that they can afford. Though this is a popular concept for liberal representatives in particular, and some clinical groups, keep in mind that the way it is being developed is to tie payment to Medicare rates, possibly plus 5-10%. That could be a reimbursement decrease for some mental health clinicians. It appears that the public option will not be part of the final bill but I wanted you to be aware of the financial piece which is not widely known.
I hope this is helpful in understanding the incredibly complex process taking place in Congress which will affect all mental health and medical clinicians, in some way. Please let me know if you have any questions.
Laura W. Groshong, LICSW, Director, Government Relations
Clinical Social Work Association
I'm 13 chapters into writing Trauma Treatments Handbook, Across the Spectrum. Here's the advice I'd give anyone doing the same thing:
Don't worry about people hating it. Some will. I'm writing a book that will piss off every true believer, by showing the usefulness of every trauma technique that I know about, and by talking about the shortcomings, too. Take some time to only write. I just took two weeks off, writing about 5 hours a day. I was able to hold all the chapters in my mind and let the obsession take over me: waking at 3 and 5 a.m. to scribble notes. Up at 6:30 with my brain ready to go, moving things from one chapter to another. I finished 4 chapters, including one very long one. My brain needed time to nail the structure of the book. Make a list of acronyms to put at the end of the book. I've wanted every therapy book to have them. Put them on the list the minute they pop up in the text. I'm up to 3 full, double-spaced, pages of acronyms and 9 pages of references, so far. Talk over difficulties with anyone who is around. Everytime I began to tell my husband about a quandry, it solved itself before I was done explaining it. Use the thesarus on dictionary.com Read many sources. Share milestones with your friends, virtual or in person. Let your publisher know too. They worry about books not being on time. If you don't know something that you want to include, ask everyone. I still don't know where Kluft said, "The first integration, isn't." Do you? Or was it Kluft? Enjoy the process of writing. Let the "alter" that writes take over and type. It's easier than torturing yourself over every word. Don't fall in love with your words. Reread. Edit. Reread. Edit. Reread. Edit. But don't worry. Your brain knows. Trust it. And trust that there will be mistakes in y our book. Despite you, your professional copy-editor and your friends. Back up everything to an external hard drive, every day. Every done chapter, send an email with attachments of all chapters to a few friends who don't live in your town and ask them to put the attachments on their hard drive. If you have gmail, as I do, you can send the attachments to yourself and they'll live in the gmail "cloud" of servers. Losing a book is a terrible thing. BACK IT UP! Exercise, get massage, socialize. You live in a body with needs. Take care of yourself. A book is a great excuse to neglect your blog. Sorry everyone!
Don't worry about people hating it. Some will. I'm writing a book that will piss off every true believer, by showing the usefulness of every trauma technique that I know about, and by talking about the shortcomings, too.
Take some time to only write. I just took two weeks off, writing about 5 hours a day. I was able to hold all the chapters in my mind and let the obsession take over me: waking at 3 and 5 a.m. to scribble notes. Up at 6:30 with my brain ready to go, moving things from one chapter to another. I finished 4 chapters, including one very long one. My brain needed time to nail the structure of the book.
Make a list of acronyms to put at the end of the book. I've wanted every therapy book to have them. Put them on the list the minute they pop up in the text. I'm up to 3 full, double-spaced, pages of acronyms and 9 pages of references, so far.
Talk over difficulties with anyone who is around. Everytime I began to tell my husband about a quandry, it solved itself before I was done explaining it.
Use the thesarus on dictionary.com
Read many sources.
Share milestones with your friends, virtual or in person. Let your publisher know too. They worry about books not being on time.
If you don't know something that you want to include, ask everyone. I still don't know where Kluft said, "The first integration, isn't." Do you? Or was it Kluft?
Enjoy the process of writing. Let the "alter" that writes take over and type. It's easier than torturing yourself over every word.
Don't fall in love with your words. Reread. Edit. Reread. Edit. Reread. Edit. But don't worry. Your brain knows. Trust it. And trust that there will be mistakes in y our book. Despite you, your professional copy-editor and your friends.
Back up everything to an external hard drive, every day. Every done chapter, send an email with attachments of all chapters to a few friends who don't live in your town and ask them to put the attachments on their hard drive. If you have gmail, as I do, you can send the attachments to yourself and they'll live in the gmail "cloud" of servers. Losing a book is a terrible thing. BACK IT UP!
Exercise, get massage, socialize. You live in a body with needs. Take care of yourself.
A book is a great excuse to neglect your blog. Sorry everyone!
This distressing article, http://www.nytimes.com/2009/08/10/us/10juvenile.html?_r=1&pagewanted=all by Solomon Moore in today's New York Times shows us how the mental health system in most of the country is failing teenagers. Kids who need medication, psychotherapy, and structure act out until they end up in detention, often physically and sexually abused by both fellow inmates and staff, with little or no treatment. I worked with one of these guys in a day treatment program. The PTSD was the worst part of his disorder. With what little we knew about trauma at the time, we got him through it, and out of the system.
In 1983, I saw Ronald's Reagan's gutting of the community mental health system gut treatment for mentally ill adults. I ran a day treatment program that actually worked. We got most of our clients, except the most psychotic, main-streamed into jobs and schools. When Reagan cut the funding medicaid funding, our program closed, and many of our clients who had been maintained on 3 hours of group, 3 times a week, had no where to go. Some lost their housing. Some lost their lives.
If we truly get health care for all and it includes mental health care for all, this may change. I hope so for the lives of all the sick and mentally ill people in our still wealthy country.
A client has given me permission to post about her situation: the effects of Provigil, Prozac, and time on trauma processing:
Round 1, 15 years ago: She was bright, effusive, and had the odd habits of jerking her head up to look around and writing down everything I said. We worked for eight months using EMDR to clear the PTSD from the physically and emotionally abusive marriage that she had escaped 17 years before. She seemed dissociative, but in a strange way, staring off, then going to the head jerk. The EMDR worked, the flashbacks stopped, the client, satisfied, went off.
Round 2, 10 years ago: After her narcolepsy diagnosis, she started taking Provigil. A few days later, the flashbacks from the abuse began again, and she returned to therapy. We went after the abuse, in greater depth as more details arose. Again, we cleared all we could find, and she left therapy feeling good.
Rounds 3 – 5: I saw the client through the illness and death of a sweet boyfriend, and various stressful work situations. Then as she became more constitutionally anxious, then obsessive, which became manageable when she started Prozac.
Round 6: last week: Planning her 45th high school reunion, to which her abusive ex-husband had been invited, brought up the next round of distress over the marital abuse. SUD 10, when she thought of him. She processed through fear and rage, bringing up memories that had not arisen in rounds 1 or 2. She left, after a 60 minute session, feeling safe, calm, and able to ignore him, if he came to her reunion.
She and I think that whether or not her narcolepsy was a dissociative response, the Provigil allowed her brain to stay on task with the trauma processing, and that the Prozac with the Provigil keeps even more of her brain online and on task in trauma processing. She and I would love to hear if other people have had similar reactions with these medications affecting the depth of trauma processing.
Last Wednesday I flew down to Fresno, CA, and flew back up with an old friend who, after battling AIDS for 25 years, is losing the fight. R''s brother and a few other friends and I have been managing his care up in Seattle for the last week.
R is one of my favorite flavors of people, a skinny nervous person, smart, funny, charming, talented, and relational. He has also had OCD since I met him in 1980. The OCD, related to a bipolar diagnosis, manifested in several ways, eating disorders, an inability to get out of the house without carrying half his belongings with him (the bag-lady syndrome "what if I need something"), and extreme indecision. The OCD also carried avoidance behaviors. R. avoided conflict, asking for what he wanted, and anti-retrovirals. He would get busy controlling the minutiae of his life while avoiding the big issues. In the last few years, he would worry incessantly about his belongings in storage units, while not chasing down the health care that he needed. Several of his Seattle friends offered to fly down to help him. He couldn't accept their offers because his appearance (another obsession) wasn't up to par, his apartment wasn't clean, and he would have to take care of them (another compulsion.)
Two months ago, R got pneumonia and began to show signs of dementia. His California social worker, Frida, and I talked him through getting on an ambulance to the Emergency Room. We both thought for sure that he would be admitted, but he was cut loose with some heavy-duty antibiotics and sent home. After a few weeks of daily calls by the Seattle support group, he had managed to take his pills daily, but was obviously losing his mind. A month ago his brother flew down and took over. 10 days later his brother's boyfriend drove down to help. R. was emaciated, covered with KS, and had about 2 minutes of short term memory. He didn't know where his own bathroom was. He didn't finish a meal without constant reminders. Last week I flew down and flew up with him. He was hospitalized at the best AIDS hospital in town and will go to Bailey-Boushay, a state of the art AIDS care facility, with loving staff and loving volunteers and really good art.
My feelings are extremely mixed. My lovely, vain friend, has a wasted body and a wasted mind. He's in pain much of the time. I'm grieving. I'm sad. But we have him now, he won't die alone, and he's in the best possible care, so I'm relieved, too. I'm also, clinically, fascinated by the dementia process (when I'm not frustrated by it or laughing.) R. can remember people and activities from 30 years ago. He can charm nearly every nurse and doctor who comes in the room. He remembers, at this point, all the people who love him and whom he loves. His right brain is working pretty well. His left brain doesn't tell him where he is, anything that happened in the last 6 weeks, what day or time of day it is, or the name of the person in front of him whose name he just asked. He is often sweet and charming. The more confused he is the snarkier he gets. He is very sarcastic, especially with his long-suffering brother. R. confabulates what he doesn't know. His brain makes up stories to fill the holes in his memory. Some are quiet elaborate. I haven't seen R in 8 years, nor has he been on a plane in that time, but evidently we've been on several long trips together. His brain told him that he has an apartment in a neighborhood of Seattle, not Fresno, and he wanted me to take him out of the hospital and take him home. Much of the time he thinks he's in Fresno, despite the view of Puget Sound out the window. His friend, Joe, says, "is that Fresno out the window?" and R. replies, "Oh, we're in Seattle." R., the compulsive care-giver, asks for back and foot rubs, tells the doctors that he wants us in the room to supply information that he won't remember, and has allowed us to talk him into many medical procedures. The right brain relational trust is working, even though the left brain thought process is not. His sentences are complete. His syntax is perfect. He knows his social security number. And he doesn't know who visited him or what vile procedure they just did or that his body is wasted or that he has AIDS. The KS constantly suprises him. (Advanced Kaposi's Sarcoma looks like an archipelago of red, mountainous islands everywhere but his feet, hands, and face. Sometimes it hurts like hell, sometimes it itches, sometimes it's hot to touch.) He asks, "Why am I so weak? Why do I hurt?" "Honey, you have advanced AIDS." "When did that happen?"
Back in the 80's, I lost about a hundred friends, clients, mentors, colleagues, and neighbors to AIDS. I started the AIDS Mental Health Network, which gave free training to therapists about psychosocial issues, safe sex, dying, resources, anything we needed to know. It was before the AIDS agencies arose and we were flailing to find information and the skills we needed to take care of all these dying young men. Back then we created care committees: chosen families of caregivers that ran errands, cleaned houses, did pharmacy runs, took the person to the doctor, and generally hung out. There was no internet, so we communicated by phone, and sometimes by a log at the PWA's (person w/ AIDS) house. R. has an AIDS nursing home to go to, the Lifelong AIDS Alliance, and a group of about 5 people, including his brother, who are the support team. In the 80's, PWA's died within 16 months. R. has lived with AIDS for 25 years, at least, and is in the last stages with good medical and social support.
Jon Hamilton reports on NPR about three research studies showing that schizophrenia, while having a definite genetic component may need a viral kicker to turn on the appropiate genes in utero. An old Danish twin study that I read about 25 years ago, and can't cite, shows a link between birth trauma, in genetically susceptible people, and schizophrenia. I guess you have to have the genes, then have something else needs to happen.
Here's the link: http://www.npr.org/templates/story/story.php?storyId=106151437
(Dear readers, I'm deep into writing Trauma Treatment Handbook and have been neglecting my blog. Here's an email exchange that the correspondent has graciously given me permission to post.)
From the asker: I just came across your site while researching heart rate coherence. I have Servan Shreiber's book(s) and actually had forgotten about heart rate coherence until it recently came up again while doing research for my father's heart disease/stress.
I was hoping you might be able to help me navigate in terms of finding the right tools to help myself with what seems to be social phobia (as it's outer manifestation anyway). I have come to realize that I avoid going out and being around others and have managed to avoid talking on the phone although it is a source of stress for me. If you met me, you probably wouldn't know this(well maybe YOU would) most people don't but I sense people do notice my discomfort when I have it. I feel as if I'm never in my own skin and i don't really feel truly in the moment very often. When I look back...i believe this has been the case for decades but I just wasn't conscious of it. I don't feel joy very often and I have a hard time remembering things from the past....as if I wasn't even there.
If I have given you the impression that I am suicidal or depressed i assure you I am not:) I have really been taking care of myself in many ways and I'm trying not to make this into a "problem". I eat well, I recently gave up smoking...again. I go to acupuncture, I excersise every day as always and take my supplements(incuding the 7:1 epa:dha which is new). It's as if the more conscious I am of the issues, the better i am taking care of myself but the worse I feel. Maybe this is just part of the process. But still, the anxiety/fear gives me constant problems in my every day life and I'm concerned that they will not be resolved . Case in point-my boyfreind of 7 years just mentioned his brother and nephew want to come for a visit again(they were here recently). I found myself making all of these excuses as to why it wouldn't work right now but the truth is It takes my all to pull it off even when it's my own family. I put a great game face on but it's as if it's a performance and it sucks every last bit of life from me and I feel like I can't keep it up the way I used to. Bottome line.....I'm tired of feeling like this!
I keep wondering if there's something internal that isn't being dealt with. I'm not sure I believe therapy is what is best for me. I was in therapy on and off for years and iscovered I had a better understanding of how I felt but in the end I still felt like crap. I am, however, intrigued by what I read about EMDR in Servan Shreiber's book. My fear is it won't be helpful to me and I will humiliate myself in the process........I tend to freeze/go blank when the focus is on me which becomes yet another source of anxiety.
Any ideas on what I may be able to try by myself . Do you think the heart rate coherence is enough based on your experience. Any thoughts about the EMDR or any other therapy I might consider? I'm in a fairly rural area but I'm near a large town and discovered that there are 5 or 6 therapist trained in EMDR. I know it's near impossible to give any suggestions for someone you've never met.
I have never done this before but you struck me as the right person to ask. I would be most grateful for anything you may have to offer. Thanks for your time Robin!!
My Reply: In my opinion and in other people's research there are a clan of people who feel anxiety more strongly. Research shows that social anxiety can be predicted by a 3-week-old baby's reaction to a puff of air in their face. The bad news is, you're anxious. The good news is, even though your body may be more aware of its anxiety response than some other people's bodies are, there's a lot you can do to manage it.
EMDR can be a great way to clear out the trauma part of your sensitivity and give you internal practice at dealing with social situations. And do exercise, take O 3's and D's and learn how to calm your body.
Read: Elaine Aron's The Highly Sensitive Person. If it's a fit for you, it's like a care and feeding manual for anxious people.
I'm married to an HSP, who used to have social anxiety. He's still high strung, but he no longer lets it stop him from doing anything. Through therapy he's learned to ask for what he wants, say no when he needs to, and accept that he's never going to love crowded places. He's even doing some public talks, now and then. Years ago, he wouldn't knock on neighbors' doors to talk to them about the block party. He doesn't think twice about it now, in fact he's been the Block Captain. And he's still very sensitive to his anxiety, still predicts the worst outcome for everything (he's the designated worrier in the marriage and I'm the designated pooh-pooher), still thinks that we'll be late, and there will be a disaster. (Then we're not late and he has a better time than I do.)
Get therapy. Get EMDR from the best person in town. If you don't like them, try someone else. Tell them to read my chapter about anxiety if they haven't done it. And if you had some deficits in your childhood and are not an HSP, they can nail it completely and clear the anxiety, unlike my genetically nervous husband.
Asker: You're a sweet heart! I don't feel like a freak after reading this. I think my judgement of what I'm experiencing makes it much worse.
Book Signing Party!
On Beautiful Bainbridge Island June 14, 2-5PM
On Beautiful Bainbridge Island
June 14, 2-5PM
Sandra Paulsen, Ph.D & Robin Shapiro, MSW, LCSW will be there to sign and read excerpts of their 2009 books. We may have a special guest reader, Yaak Panksepp.
Bring your checkbook if you want to buy a book. Save shipping costs!
Location: 9054 Battle Point Dr. NE, Bainbridge, Island, WA 98110
At the log house in the woods of Sandra Paulsen, Ph. D and Tim Iistowanohpataakiiwa, MA. Weather permitting, there will be a campfire in the pasture with the horses.
From Seattle: Take the Bainbridge Ferry to wy 305, turn left at the third light--Sportsman's Road--and an immediate right on New Brooklyn. The next light is Miller Road, turn right, go two blocks, then left on Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway. If you pass Bainbridge Gardens on the left you have gone too far.
From Poulsbo: Take Hwy 305 across Agate Pass Bridge to the first light. Turn right on Miller Road and veer left. Go straight for several miles. Turn right just past Bainbridge Gardens, onto Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway.
Presented by Sandra Paulsen, Ph. D. and the Bainbridge Institute for Integrative Psychology.
There's a new fantasy show on Fox: Mental. It's supposed to take place in an inpatient psych unit.
So, first, the new head of psychiatry strips down in a room full of clients to connect with a psychotic guy who has pulled his clothes off. Later, he breaks into a woman's house in order to check out his hunch that her schizophrenic brother is an artist. And he thinks it's a good idea for his patients to go cold turkey off their antipsychotic medications. And he doesn't lose his contract, immediately.
All the psychiatrists are cute. All the patients are reasonable. The families just don't understand. And the residents and other psychiatrists have endless time to spend with their clients. Oh, and they invented a radical new idea: intensive outpatient day treatment.
I saw bad treatment, silly ideas, and a romanticization of extreme mental illness. I saw nearly every 1960's cliche possible. It's really bad. Except that all the psychiatrists are cute. And the new head of psychiatry looks to be about 32. That would happen, too.