Trauma & Attachment Therapy

New blog and a new book

I've got a fancy new website at emdrsolutions.com. All of my old blog posts and all the new ones will be there. The full address is https://www.emdrsolutions.com/ It's easy to read and easy to use. I look forward to seeing you there! And Doing Psychotherapy came out last week. It's the newest book and it's full of everything I wished they would have taught me in graduate school: 1. How to stop and and how to end a session, or a therapy. 2. How to make goals, and meet them. 3. How to work with anxiety, trauma, depression, and many other problems. 4. How to take care of yourself. 5. How to deal with marginalized populations, abuse survivors, and more. 6.How to pick which, of many therapies to use with a client. 7. Even a bit of how to argue with insurance companies. https://professionalbooks.cmail20.com/t/ViewEmail/y/B3BB66A7B9693018/9DB5899D0880DA9CEBAD456BEB5F1DD6

Interesting 45-minute documentary of DID woman who got her father put in jail.

https://www.youtube.com/watch?v=lsXFcbPbvI4

Interesting, somewhat sensationalized, video from the Australian 60 Minutes show, about a woman who went to the cops and won in court.

The story is brutal, as is often the case for people with massive dissociation. The outcome is lovely.

Check it out!

Australian Prime Minister Apologizes to Sexual and Ritual Abuse Survivors!

Here is a link to speech by Scott Morrison, the Prime Minister of Australia, from 11/25/2018, apologizing for his society's lack of support for and belief of sexual and ritual and institutional abuse survivors. I would like to see every leader of every country make this speech.

For the video: https://m.youtube.com/watch?v=zp5IgxPhee4

For the transcript: https://www.sbs.com.au/news/i-believe-you-your-country-believes-you-pm-s-apology-to-child-sex-abuse-survivors

Caring for Our Clients and Ourselves in the New Political Landscape

Two weeks ago, I gave a workshop for forty Seattle-area psychotherapists about getting their clients and themselves through the new political situation. People spoke about their fears, their clients' distress, and specific issues that have come up in therapy.( Steal all that you want, but give me credit, if you teach it.)

1.Fear of getting beaten, killed, or yelled at on the street by people who are obviously not white or non-Christian.

2.Fears of losing healthcare and social security. Distress about the environment.

3.Trouble dealing with family or others who voted differently. 

4. Hopelessness and Overwhelm with Media Coverage.

Here are some of the slides:

For yourself and clients:

• Feel everything and name each feeling.
• Decide how much media to take in
• Decide how you will do more self-care
• Connect with positive community
• Pick your active response: calls, letters, marching, volunteering for a threatened community, etc. And figure out your level of activity. Don't overdo.

How to talk about it with clients:

Grist for the therapy mill:

• Fears, current feelings, trauma, ego states
• I’m here for you, whatever happens (unless your insurance is canceled)
• Sharing? Clients first. Then, you may say how you’re adaptively coping.
• “I’m in your corner, whatever our differences.” “Do you notice I’m still caring about you?”

Look at their trauma history for Tx targets:

• Generational: Immigrant, ethnic or religious minority, violence
• Personal: bullied, discriminated, assaulted/abused?
• Witness: clients, media, friends, community

And deal with their here and now mobilization and possible tx:

• Immediately connect with here and now.
• Are you safe?
• Are you supported?
• Will you, personally, be threatened?
• Is it time for trauma therapy?
• Bad dreams, intrusive imagery or thoughts when doing something else, mobilized body?
• EMDR, Somatic Work, etc.

For yourself or your clients: Coping with Hopelessness (Dorsal Vagal States)

• Sag (acknowledge what you can’t do.)
• Move: feel strength. (“NO!”, “I want.” Warrior stance. Deep breath. Legs pushed into floor.)
• Acknowledge what you can do: Time, $,
• https://99waystofighttrump.com/
• https://www.indivisibleguide.com/web
• https://www.bustle.com/p/100-ways-to-fight-back-in-the-first-100-days-of-the-trump-presidency-31817

Address the past first:

• dress the past first. “What old stuff is arising in response to Trump?
• “He’s just like my abuser.”
• “That pussy-grabbing thing reminds me of ______.”
• “The bullying I got for being ________.”
• “When my family had to ________.”

Sometimes it’s historical:

• “When my grandfather got shot by the side of the road, for getting his mail, while black.”
• Pogroms, Holocaust, Hidden Identities, Family stories, Genocide, Families split apart.

Recognizable Minorities: Race, Religion, Accent, etc:

• Instantly Identifiable: No where to hide
• Historical Trauma
• Currently even more targeted
• VALIDATE the reality of the fears
• Go after the past
• Go after the present
• Look at the future: Safety, allies, working for the community, including self

LGBTQ:

• May have lost family, church, and/or community for coming out
• Bullying for identity or gender-nonconforming appearance
• Targeted by Religious Right and Trump administration, 
• 30% of transgender youth report a hx of at least one suicide attempt. More in female-to-male people. (https://www.sciencedaily.com/releases/2016/08/160831110833.htm) Rate goes down when recognized as chosen gender.
• Scared of what happens now: marriage, adoptions, legal protections for jobs and services
• “When We Rise”, amazing new 8-hour show: http://abc.go.com/shows/when-we-rise: watch it if you want deep background on the community

Sexually or otherwise abused as kids or adults:

• Many triggered by Trump’s demeanor.
• “Grab them by their pussies.”
• Some now being harassed or grabbed in the name of Trump.
• Flashbacks, deskilled, regressed, or “switched”.
• Calof: “Every time you work with sexual abuse, you’re committing a political act.”

No trauma history, but

• Watching our country fracture, daily shocks
• Fear for the environment, healthcare, status of our country.
• Loss of healthcare
• Distressed by shootings, immigrant and border hassles, oligarchy, erosion of rights.
• More bad news, almost daily.

Discussing the Situation with Clients:

• Stay Client-Centered
• Share, for the client.
• Let clients bring it up
• Ask questions about their experience and their affect.
• “Does this connect with anything from your past?”
• “What age goes with this feeling? What was happening then?”

Trauma Therapy: Go after historical and clients' past traumas first.

1.Use the best trauma therapy you know with past occurrences—may be a lot

(EMDR, Ego State, Life Span Integration, Somatic Tx, etc.)

2.Go after the current traumas: threats, shootings, Trump’s demeanor, the news

3.Look at future occurrences. It’s not over. How will they cope if _________?

4.Plan for current life,

1.media (how much to watch)

2.community (hang with people who care for you and support you) Singing? Dancing? Snuggling?

3. self-care: what works to make you feel good? Exercise? Meditation? Good food? 

4.action: political, volunteering, phone calls, letters, talking to people, marching.   How much is enough? Have limits, pick what works, do it.

YOU CAN'T FIX THE WORLD. YOU CAN HELP YOUR CLIENT COPE WITH THE WORLD.

And here is an article from the Seattle Times about the same thing: http://www.seattletimes.com/life/wellness/mental-health-therapists-see-uptick-in-patients-struggling-with-postelection-anxiety/

 

Theodicy: Spiritual Views of Evil and Abuse That Help or Impede Healing

This article arose from a discussion on listserve that deals with clients who have suffered unspeakable abuse and torture. Rev. Lynn James wrote a wonderful response on the subject of Theodicy: Spirtuality, Evil, and Suffering, that is the best thing I've seen on the subject.  She expanded it for Ellen Lacter's blog. Here is the link, http://endritualabuse.org/healing/spirituality-2/ 

It's a must-read for every therapist, since these issues come up every day with abuse survivors.

Steps To Take When You Suspect A Family Member Is A Victim of Abuse

Written by Josh Anderson

One in four women has experienced domestic abuse at some point in their life, according to statistics from The Centers for Disease Control and Prevention and The National Institute of Justice. While not all abuse is physically apparent at first, over time signs of abuse become more difficult to hide. When these signs appear and you suspect a family member is a victim of abuse, there are several steps you should take. 

Warning Signs
Before approaching your family member about potential abuse, learn to read the warning signs of an abusive relationship. The most obvious signs are physical, such as cuts, bruises, broken bones and other injuries that occur on a consistent basis without reason. However, not all signs are as visible. Watch for changes in character or appearance. People who are being abused often isolate themselves. The development of anxiety, depression and low self esteem, especially when coinciding with the start of a relationship can also signal abuse. The dynamic between the family member and the potential abuser also shows signs, such as feeling anxious or afraid to please the abuser, and a negative or verbally abusive dynamic when together. 

Investigate
If you suspect a family member is being abused, talk to them. Silence does not help the situation, and knowing that someone else knows may provide the bridge necessary for your family member to get out of the abusive situation. In many cases the family member may deny the presence of abuse out of fear, denial or even shame. In these cases, continue to be present and allow opportunities for your family member to confide in you for support. Point out specifics details of what you have seen and describe why it's wrong. Do not approach or investigate the abuser yourself. In the case of suspected child abuse, skip this step and move directly to reporting. 

Report
If you have reason to believe your family member is in imminent danger or you witness the abuse, contact the proper authorities. In the case of child abuse, report your suspicions immediately to your state child protective services agency or law enforcement. Do not investigate the situation yourself, leave it to the professionals to determine whether or not abuse is occurring so the child can be removed from the situation without incident. In many states you are required by law to report child abuse, especially if you hold positions such as nurse, doctor, teacher or daycare worker. Not reporting the abuse can result in you serving jail time. 

Support
Continue to support your family member regardless of the decisions they choose to make. While they may not leave the abuser right away, knowing they have a supportive family member may turn into the catalyst needed to end the relationship. Do not pressure them, blame them or judge them as this can have the opposite effect of what you're looking to do. 

While it's difficult to step forward when you suspect a family member is a victim of abuse, not saying something allows the potential abuse to continue. Unfortunately, it's not uncommon for abuse to escalate, which can end in injury or worse for your loved one. Do the right thing and help your family member by starting the process of removing them from a harmful situation. 

Domestic Violence Resource Center: Domestic Violence Statistics 
http://dvrc-or.org/domestic/violence/resources/C61/

Jeremiah Granier wites all about health, self-help and happiness. His recent work is on the Top Online Masters in Counseling Programs.

Defining Rape and Sexual Assault

I've been working with survivors of rape and sexual assault since I started in the mental health field. Here are my definitions:

Rape: The sexual use, involving penile, digital (fingers) or objects on a woman's, man's or child's body without that person's consent, with forced consent (threats) or if that person cannot conset due to age, mental disability, state of drunkeness or druggedness, or relative social position to the rapist (employee, slave, patient, lower rank, parishoner, etc.)  

Rape can include penis in vagina, anus, or mouth, or forced masturbation. It can include objects. It can include rubbing genitals on a person with clothes in between. Women can, but rarely do, rape people by forcing them to touch or otherwise sexually interact. People of any age can be raped. People in an otherwise consensual sexual relationship can be raped, if they say "no" or are asleep or passed out, and their partner is sexual with them without their consent. 

Sexual Assault: Unsolicited, unwanted touching, grabbing, or other sexualized physical utilization of another person. All rape is sexual assault. Not all sexual assault is rape.

Molestation: See Sexual Assault. Often used when describing either the Sexual Assault or Rape of children. I wish this word would go away. I'd prefer "Child Rapist" to "Child Molester" since it's the true definition of what happened.

Effects of Rape and Sexual Assault: It depends on what happened, by whom, and to whom.

• Adults who are raped by strangers tend to experience full-blown Post Traumatic Stress Disorder. No matter the circumstance, they tend to feel dirty, culpable, and ashamed. It ruins, at least for a while, their healthy sex lives, their sense of safety and trust in the world, and their image of an autonomous, safe self. If the adults had a history of childhood sexual abuse, the new rape often brings forth the same feelings, ego states, and flashbacks of the earlier time. Sexual situations with beloved partners can bring up flashbacks of the rape. Men who are raped can have a sense of loss of maleness and a whole other level of loss of self.
• Children who are raped by strangers tend to experience all of the above including a pervasive sense of "badness", and without treatment may carry that sense of shame and fear of sexual situations to adulthood
• Date rape: Rape by someone in dating situation, when the victim has said no or cannot show consent, brings another layer of self-blame, lack of trust, questioning of "fault", and social complications. ("I shouldn't have worn a short skirt; drunk so much; gone out with someone I didn't know well; etc.") along with PTSD.
• Rape of a child or teenager by a parent, coach, teacher, older sibling, uncle, step-parent: Kids can't give consent, even if it's "friendly", it's rape. The worst thing I often hear is "It's (being an object of sex) what I'm for." Child rape by a person on whom the child relies for protection creates huge issues of identity, safety, goodness, worth, and sexuality.  Some kids, after chronic sexual abuse/rape, become prostitutes. 75 - 95% or prostitutes were sexually abused as children.  http://www.womenslaw.org/simple.php?sitemap_id=148. Many have flashbacks for the rest of their lives, unless treated. Many are not believed by their families. (The response of the family and/or institution in which the abuse occurred is strongly correlated with healing, or not, after the rape.) Kids who are raped tend to freeze, then go limp during the act. Afterwards, any sexual threat or even solicitation can bring the same passive, obedient response, making further exploitation more likely. Some re-enact their role with sexual acting out, a warped attempt of mastery of the situation. Most, but not all, people involved in sadomasochist "scenes" were sexually abused/raped as children. Child rape by trusted adults is a factor in most serious dissociative and Borderline Personality Disorder diagnoses. 

Complicating factors:

•     Not all rape is violent or actively coercive. When attachment bonds are used to manipulate kids or adults into sexual activity it confuses the issue of desire, identity, and fault.
• People can be physically aroused and even orgasm during a rape -- by the mechanics of the act. It still doesn't mean they wanted it. This is a huge issue in therapy.

Treatment: Many psychotherapies are helpful with rape and sexual assault survivors. My favorites are EMDR, Somatic Therapies, and, with victims of child rape and long-term abuse, Ego State Therapies. With permission, my favorite phone message from a client, after 3 sessions of EMDR for childhood sexual abuse: "Robin, I just called to tell you that I had sex with my husband today and it was great. After 12 years of marriage, this was the first time we made love and my grandfather wasn't in the room! Thank you!" 
 

Politics: Misinformation by the anti-choice people has muddied this issue. Some of them don't want women to have abortions. Some don't want women to be able to get pregnant from rape, necessitating the need for discussion of incest and rape exceptions in laws. Women who are ovulating can get pregnant from rape. It's a fact. "Legitimate Rape" appears to mean a violent rape by a stranger, only one kind of rape. 

A Song: Illegitimate Rape. the only good thing to come out of this political kerfuffle: http://youtu.be/mg_4O6XmKAQ

Penn State: Was the abuse too horrible to acknowledge?

Here are two similar views of the Penn State child abuse debacle. One from the anonymous humble2humble blog (obviously by a man of faith who understands child abuse): http://humble2humble.blogspot.com/2011_11_01_archive.html. The second is by David Brooks, from yesterday's NYT's: http://www.nytimes.com/2011/11/15/opinion/brooks-lets-all-feel-superior.html

Both speak to the commonality of denial and avoidance. Both are great writing. What do you think?

In Ego State Therapy, Let the Client Run the Internal Show.

Twenty-seven years ago, when I worked with my first DID client, I became the "go to" person for soothing the young, distressed ego states. As a result, I was on-call 24/7, never took longer than a week's vacation, and was constantly fielding emergencies. Finally, a savvy consultant told me to put the "oldest, wisest part" of the client in charge of all distressed, younger, or destructive alters. What a relief! Within three sessions, the client could self-soothe, make adult decisions, and deal with new alters as they popped up. (This was a complex ritual abuse case with lots and lots of parts.) Therapy sessions became case consultions. I worked with the most adult parts of my client to create safety, internal communication between parts, internal and external boundaries, and good, safe rituals of orienting "new" parts to the present and giving them the rules.  The therapy wasn't over then, it lasted 10 years, through trauma processing (which got more efficient when I learned EMDR), lots of sorting out "then" from now, the grief process about her awful losses, and coming to terms with her current life.   The client still contacts me every 9 months or so for a tune-up session.

So, all of you who work with parts: If you help the oldest, wisest, most nurturing parts run the show, the client gets to do more of the work, feel effective and in charge of his or her life, self-soothe, and heal faster. If you want to communicate with younger parts, ask an adult, the adult, or the "team" to ask about or talk to the part. "Can you go inside and tell me how that 2-year-old part is doing now? . . .Can you remind her that you are always there for her so she's never alone again? . . . That she's safe now. . . And that she lives with you in your nice house. . . ."

I do ego state work with 85% of my clients and I rarely speak directly to any but the presenting adult. The only time I do, once a decade, is when I'm working with a new client, who pops into a part I don't know that's amnestic for the rest of life. (The ultimate "Oh S--t!" moment of therapy.) Then I introduce myself, if the part doesn't know, explain that we're in my office, and gather information: age, name, and what it needs, or what it does and "Did you know that you're part of John?". Then ask for "Adult client", to come back. Sometimes, with a count of three. It's always worked. If the presenting client doesn't remember the situation, I offer to set up an introduction. When I do, I refer to the presenting adult, team, etc. as the boss.

Most ego state work is much less dramatic. I often ask people to tell me how old something feels and if they can talk to that 3-year-old, 5 y.o., etc. part. Most people can do this. It doesn't take formal dissociation. For the dissociative disorders of complex PTSD, Axis 2 diagnoses, DDNOS, and DID, formal ego state work, combined with EMDR or Brainspotting or Somatic work for trauma, in conjunction with attachment-based therapies are always called for.

The Names of Love

The Names of Love is a hilarious, serious, heart-breaking, heart-warming French movie that I recommend to everyone. It deals with generational PTSD, Holocaust survivors, war survivors, culture, temperament, politics, art, political correctness, and sex as a positive political tool. (Did I say that it was French?) Here's a website: http://www.namesoflovemovie.com/

One plot line shows a survivor of childhood sexual abuse, treating her body as a tool for her political ends, until she meets a man who truly sees and accepts her while adoring her. (I've heard many survivors who were prostitutes or used sex as a means to other ends who said, "But that is what I'm for."  

Another character, who saw her parents dragged away to a concentration camp, brought her fearful silence into her marriage, infecting her non-Jewish husband and her child. That child, the male lead, is able to open up and speak the truth when he is finally seen, reflected, loved, and well laid. 

And it's a romantic comedy, so you know how it ends. This is my favorite movie since UP! It's lovely. And you must stay through most of the credits.

Beautifully written survivor blog

I stumbled on an interesting blog. What makes it unusual is that it's by a man, beautifully written, spiritually and religiously and literarilly informed. The writer deals with themes of shame, humility, power-over, abuse, right speech and right action. He's not sanctimonious at all. He seems to know whereby he speaks. The blog is anonymous. Here's the URL: www.humble2humble.blogspot.com