Trauma & Attachment Therapy

Thyroid Disease and Other Differential Diagnoses

It's been 7 months since the start of my thyroid inbalance. Today, I have energy, a focused mind, and no squalls of irritated, anxious, or shut down states. I'm sleeping, my digestion works, my husband is cute again, and my desk has been cleared. I have long periods of contentment and even some joy! It took piles of Synthroid, Cytomel, hypnosis, accupuncture, TFT (Thought Field Therapy), an extra day off each week and an understanding husband. Everytime I took an antibiotic, it knocked out the affect of the thyroid medications. I've just climbed out of the temporary well one more time. It takes about 10 days, post treatment, to refind my equilibrium.

What have I learned? Don't take the body for granted in your diagnoses.

Joseph McCreery, a psychiatrist in North Seattle, sends this advice about diagnoses:

"Any moderately or severely depressed, anxious or chronically fatigued patient should have a medical lab screen (if not obtained within the last year) to include : Complete blood count, Thyroid functions, and a Chemistry panel including electrolytes, BUN, Creatinine and liver function tests. (CBC, TFTs, Comprehensive Chemistry panel).
Sleep apnea is another physical disorder that contributes to fatigue, depression, anxiety (and increased risk of cardiovascular problems). Any patient with snoring, periods of about 10 seconds of apnea (no breathing) followed by a deep snoring or snorting inhalation and accompanied by day time sleepiness should be sent for a sleep evaluation.
Medical abnormalities such as these, when screened for and treated, can do much to improve patients well-being and improve therapy outcomes. These tests can easily be done by a primary care provider at a therapists request."

If a bodily illness or imbalance is the culprit, therapy might still be useful. Stressed people often need support, permission to do more self-care, problem-solving, and real work to get through the trauma of the loss of their health. If I hadn't been teaching anger management to other people for so many years, I would have needed someone to teach me those skills. (I can now say, unequivocably, they really work!) Many physical changes are permanent, some even fatal. Don't say goodbye to your clients because the etiology of their problems arise below the neck, unless they're ready. Remember that containment of affect is often best done interpersonally. You may be the best regulator of your client's affect however it got dysregulated.

Brainspotting Class

David Grand brought his Brainspotting (BSP) class to Seattle this weekend. He was ably assisted by Lisa Schwarz, who teaches about using BSP with dissociative and other fragile clients. Lisa and I helped with the practica parts of the training.

Brainspotting is a powerful, flexible, client-centered therapy that appears to go more deeply and more quickly into the body/brain than other therapies I work with. Grand says that it works on the "reflex" level of the brain. I don't know how it works, but it's simple and gets into different and deeper levels of material and responses with clients. First you turn on a steady bilateral stimulation, Grand starts his sessions with "Biolateral" cds, coming through stereo headsets. There are two ways "in" after setting up the activated target: "outside window", when the therapist observes the client's response to stimulus, and sets up a focused gaze, or "inside window", during which the client collaborates with the therapist to find the "brain spot" on which to focus. (No, I'm not going to be more specific, because even though the techniques are simple, the therapy isn't.) Then the therapist waits and the client reports. Some clients have no words for their experience and no explicit memories or images. Some clients have a bunch of both. There are specific tracking techniques and good focusing questions to ask. I watched 50 people receive BSP in the practica. Each one experienced a change. One of my buddies saw her lifelong anxiety abate. Another buddy, 2 weeks post-surgery, experienced her shoulder pain disappearing. People moved trauma. People moved affect. People moved ADD!

I was a demonstration subject on the second day, working in front of about 50 people, half of whom were either my EMDR trainees or consultees, or both. I wanted to work on my experience of the thyroid condition and the underlying inflammatory process in my body, that some medical people think is driving a bunch of illnesses in my body (IBS, asthma, frozen shoulder, plantar fascitis, and the thyroid yoyoing). I put the headsets on and listened to different tracks of "biolateral" sounds and music move back and forth through my ears. Grand demonstrated "inside window" technique, having me put a blacked-out lens over my right eye, so that I could see only out of my left eye and focus on the end of the pointer he held still, so that I could gaze through my eye's "spot", as I attended to the thyroidal "buzz" in my chest and a feeling of grief. For the next 80 minutes sensations, affects, and associations roared through my body/brain. First came grief. Old grief. Staying with it, I found myself thinking about my friend and mentor, Thom Negri, who had died of AIDS 12 years ago. Then all the AIDS deaths came. I had lived on Seattle's Capitol Hill in the 80's, the gay neighborhood. I lost many friends, neighbors, colleagues and acquaintances. I founded the Seattle AIDS/Mental Health Network, which did nearly free trainings for any psychotherapist who wanted information. I was power of attorney or executor for people. I did funerals. I had a message on my phone machine. "If someone has died, don't leave it on this phone message," after I couldn't bear to pick up my phone. It all came back. Despite having moved this material with movement work (at the time) and EMDR (since), I sobbed and sobbed and felt many sensations, some quite painful, run through my body. Grand seemingly did very little. He had me focus on bodily things, a few times. He was present and receptive, very "there". Even during the processing, I thought about how client-centered this technique was.

One of the few directive things he did, when I had a huge pain arise in my right (non-frozen) shoulder, was to tell me to be aware of the same spot on the left shoulder. When I focused to the left, the pain on the right abated. Eventually when I focused to the right, the pain was nearly gone. (It disappeared completely by the end of processing.)

Most of the sensations were up and down my core. Some painful, some just feeling. The only affect was grief, then relief. At the end of the processing Grand had me "squeeze the lemon" and try to bring back the grief and then the initial sensations. They're gone now. My head is more clear (also attributable to 4 days of thyroid meds) and the "buzz" is cleared for the first time in several weeks. It will be some time before I know what effect this work will have on the inflammatory process. Grand and Schwarz report using BSP with chronic pain, with fibromyalgia, and other physical ailments, to good avail. What I can tell you today, is that I feel lighter, clear-headed, and pain-free. My nose is dripping less. I'm breathing more easily. And I'm tired.

When it was all done, yesterday, Grand wondered aloud about what kind of an imprint those multiple losses can have on a body. I thought about his work with post-911 firefighters and families of lost firefighters. I thought about anyone who lives in violent Baghdad or Darfur or the Congo or all the African places where AIDS continue to reign.

I recommend Brainspotting. I recommend listening to David Grand. He has been one of the innovators in EMDR for many years. Now, as he teaches BSP, he constantly tells us to make it ours, to do what works, to innovate, and to use phenomenology (seeing what is and acting accordingly--by observation not theory) as our guide. I like it. I still do EMDR. I've done Brainspotting since last fall. I continue to do whatever works for my clients. Brainspotting works.

Hyperthyroid II

A man came to see the village rabbi. "Rebbe," he said, "my house is too small. We have 4 children, a mother-in-law, and my wife and me in three small rooms, and I can't stand it. The rabbi said, "Bring the horse into the house for the week and come back and see me." The man did as he said, and came in kvetching loudly: "That horse takes up the whole kitchen. He poops all over the place. It makes it worse." And the rabbi said, "Bring in the cow." Each week, the man came back. Each week the rabbi prescribed more animals. Finally, after 6 weeks, during which the horse, the cow, the dog, the chickens, and two more cows had moved in, the man returned, in absolute despair. "Rebbe, I can't stand it. It's dirty, it's filthy, it's noisy, and there is no where to stand, sit, or sleep in the entire house." So the rabbi said, "Take all the animals back to the barn and clean up the mess." Two days later the man came back. "Rebbe, I don't know what happened, but my house is now a palace. It's huge, clean, quiet, and perfect. Thank you!"

That's what happened when my doctor took me off girl hormones for a week, so that she could get a clearer picture of what was happening. I lost much more cognition. I was monumentally irritable and/or weepy. My energy cut out at 3 in the afternoon and came back at 10 pm. I had to cancel some late afternoon clients, toward the end of the week, because I didn't have the brain to see them. The hot flashes all day and all night didn't help much. And a few days after the blood test, when I resumed the hormones, I could think, sleep (mostly) and not want to kill anybody. But I feel so much better.

I've done a lot of research about Graves. My eyes aren't bugging out and I don't have goiters. I do have the cognitive troubles, sleep problems, and fatigue. I'm not anxious, per se, but any triggers, a car coming too close or a loud noise occurring, make me jump out of my skin. Few web sites talk about the emotional roller-coaster part, but people who have had these problems say that they've had those symptoms. I don't have the weight loss part either, the only symptom I was looking forward to. In about a week, I'll see a specialist and find out what he says to do. In the mean time, I've knocked seafood, kelp, and iodized salt out of my diet, and switched to grass-fed organic meat sources. I'll keep you posted.

Differential Diagnosis: Thyroid Disease

I ticked down the list: Fatigue, early morning waking, fuzzy head, forgetfulness, no patience, irritability, weepiness, and an anxious buzz in my chest. My life is good. I love my work. I have a great marriage to the quintessential great guy. Finances, o.k. Even politics are better, with the change of administration. Yes, Iraq. Yes, Darfur, Yes, W. But it didn't bring me down so much before. It must be chemical. I'll join the rest of my family on anti-depressants. Sigh.

Actually it's Graves Disease, Hyperthyroidism: too much thyroid output. The strange thing is, that I have swung from Hypothyroidism, too little thyroid, and have been on drugs for it for years. As my friend Karen says, "welcome to the roller coaster."

Click here for more information. I'll let the experts do the deep explaining. Here's what you most need to know: If you've got a client who is uncharacteristically lethargic, anxious or speedy, do think depression, anxiety, or mania.  Also think about thyroid disease. If your client is female, think twice. If her hair is brittle, her skin dry, her mood, irritable, or her eyes are bothering her, there's unexplained weight loss (hyper) or weight gain (hypo) send her to an endocrinologist immediately. Even if it's long term, untreatable dysthymia. You may have a slightly hypothyroid case. Not every doctor will give the right blood tests, so send your clients to someone who has a clue. Tell them that borderline low is worth medication. It can change lives. I'll vouch for that.