Grateful for our Hardships


How to derive strength and positive change from trauma and loss, especially with help.


When something tragic happens to us at first, it’s overwhelming, scary and painful. It takes all we’ve got to get through it, survive it, and heal from it. The thought of recovering from it enough to see the positive aspects of the event is remote and difficult. However, the ability to eventually find gratitude for our hardships helps make us resilient and stronger than before. It is an important aspect of healing, and transcending, trauma and loss. But what would allow you to be grateful for such a tragic event?

Dr. Martin Seligman stated that he and colleagues asked visitors of his website about traumatic events that happened to them, as well as a subjective wellness survey; he found that people who had survived at least one traumatic event in their lives had more strengths than people who had none (Dr. Seligman’s website). What is it about hardship that makes people become stronger? Is it the ability to relate to others? Maybe it’s being tested against extreme stress and surviving, that gives people a boost of confidence they might not otherwise have. Perhaps it makes a person appreciate their loved ones or re-evaluate their priorities in light of what happened to them.

I’d like to tell you about a training program that the US Military uses to foster gratitude after traumatic experiences, as relayed by Dr. Martin Seligman in Flourish. The name of the program is Post Traumatic Growth and is headed by Brigadier General Rhonda Cornum, Dr. Richard Tedeschi and Dr. Richard McNally. It’s based on the idea that “we should make the most of the fact that trauma often sets the stage for growth” and it teaches soldiers how to create ways to grow because of their traumatic experiences. Soldiers are given a psychological test that measures how much benefit they derived from traumatic experiences and are then taught to understand their response to the trauma, reduce their anxiety, tell other people about their experiences in a helpful way, and to create a “trauma narrative” that helps them see that they both lost and benefited from the experience. In addition, the life principles that foster strength in the face of challenge are spoken, and this helps people remember that they can get through other challenges in the future as well. To learn and grow from the traumatic incidences is the ultimate power over the events, and this program helps them do that.

I greatly admire this program and encourage you to think about sad or trying times in your life. Yes, there were pain, fear, sorrow, and anguish. But you’ve survived those times, and you have the opportunity to learn and grow from them.

When Your Partner Can’t Cope


Considerations when one member of a couple fairs better psychologically than the other does.


When I work with couples, there is sometimes a difference in the level of functioning between the partners. Sometimes, people who like to take care of other people wind up with partners who are very damaged psychologically. This can be challenging, because the partner who isn’t as damaged expects more out of their partners them what they can deliver. It is a fine line between accepting abusive behavior and understanding that the person has had a difficult childhood or difficult past experiences in general. I do think that compassion is always a good idea, but sometimes compassion can turn into enabling behavior. We can be supportive and understanding of each other’s painful past, and accommodate it to a degree, but when it starts becoming a one-way relationship wherein one party is always favored or given his or her way, it stops being healthy for both partners.

This difference in functioning is not necessarily restricted to heterosexual couples. It can also happen in gay, lesbian, or polyamorous couples as well. I use a heterosexual couple as an example here but it could be any two people whose psychological function differs significantly, enough to cause relationship problems.

Meet Mary and Mac

Let me give you an example. Mary and Mac have been together for six years. Mary has been through a lot of trauma and often has angry outbursts where she cannot be talk to in a reasonable way and she cannot control her anger enough to have a productive conversation. Mac, wanting to be understanding, allows himself to be talk to in a demeaning, hurtful way that makes him feel insecure and depressed. This is been going on for at least two years, and Mary expects back to tolerate this without question or objection. Mac has asked Mary on repeated occasions to get help, but Mary says that she’s not ready yet. The truth is that Mary is frightened of the idea of facing all the horrible things that happened to her, and would rather skip processing that and just go on with life as if nothing happened. I can understand why this would be more tempting, but when she drinks or is just stressed, the anger and frustration that she was never able to express to her perpetrators come out. What should Mary do, and what should Mac do?

Often by the time they reach couples therapy, a lot of damage has been done because they say things to each other during fights that cannot be undone. Max starts to shut down more and more, or stonewall his partner. As Mary senses Mac pulling away, she becomes more desperate and her emotions more out of control. Usually these situations don’t work until individual therapy for the person who is in the most distress, has taken place. This is especially true if there is domestic violence going on. Couples therapy can bring up a lot of painful issues, and it’s important that both partners have a safe, responsible way to cope with their feelings. Sometimes therapists mistakenly think that they can see a couple where battery is going on, but it is best to refer them to anger management and other resources before attempting couples therapy.

 

Recommendations

It’s also important for the person who is coping better to get some help. Work on boundaries and self esteem is crucial when you have a partner who is emotionally needy or abusive. If you feel as though you’re always giving in the relationship and never getting very much back, it’s important to look at that and ask yourself why. A few books that can be helpful are Stop Walking on Eggshells, by Paul Mason and Randy Kreger, and¶ Coming Home to Passion, by Ruth Cohn. I also find a lot of couples like Seven Principles of Making Marriage Work by John Gottman and Nan Silver, although that book is more general in its audience.

The hope is that both of you can cope with stress and an effective, healthy way and thus truly enjoy your relationship. A relationship should be mutually beneficial, warm, and loving. If yours is not, consider getting some help.

Responsibility for Symptom Management


We need to have compassion for our loved ones with mental health and behavioral issues. We (and they) also need to minimize the damage that can come with mental illness symptoms. Taking responsibility includes getting consistent help and observing and managing our own behavior.


Much as some of us struggle to get well from mental illnesses like depression, Bipolar illness, and PTSD, sometimes we have a hard time keeping those troublesome symptoms to ourselves. This can make our lives miserable, and also be difficult for those whom we love. It can be hard for partners of mentally ill people to balance compassion with self-preservation, especially if the symptoms hurt or frighten the loved one.

I often see couples where one person has been traumatized by something that has happened in the past, whether it was done by the partner (as in infidelity or domestic violence), or by someone else in the person’s past. This increases the reactivity of the trauma victim. The trauma survivor can become very sensitive to noise, sound, tones of voice, or cues that remind him or her of the prior trauma. When the person gets triggered, they might yell, become angry, get scared, or act in ways that are hard for the other person to understand.

Often the person who acts differently feels bad about it afterward, once their brain has restored balance and they are no longer in the grips of overwhelming emotion. However, many times their loved one feels hurt and reluctant to trust them again, for fear of recurrence of the emotional instability and erratic behavior.

There is some grace that we allow each other in relationships, whether they are friendships, intimate/romantic relationships, or family ties. On the whole, if we know our loved one has a good heart and kind intentions, we can forgive some of the erratic or hurtful behavior. But the person with the mental issues also has a responsibility to take care of themselves as much as they can so that they can prevent hurting those they love. If a person keeps yelling at someone or treating them poorly, and says, “it’s because I’m triggered by you”, then they are not fully taking responsibility for their part in the interaction. It can be hard to forgive this kind of assertion. Yes, loved ones should educate themselves about their loved one’s mental illness and try to put the strange behavior in context. At the same time, however, the mental illness diagnosis doesn’t give a person carte blanche to act as they wish at that time.

There is nothing wrong with seeking help in coping with mental issues, and in going to groups like National Alliance for the Mentally Ill (NAMI) to get education and support. Both the person with the illness and the partner/friend/family member need to care for themselves and take needed medication, therapy, or whatever will help them cope better, as well as learn to act in a way conducive to healthier relationships.

Yoga as Trauma Care?


As I become more acquainted with the pioneering work of Dr. Bessel van der Kolk, I am impressed with the variety of approaches that he takes to trauma treatment. He is innovative in his thinking about how trauma affects the body and one of the main messages that I take away from his research is that trauma survivors need a way to be comfortable in their own skin. The challenge is how to help people achieve this, and traditional talk therapy is just one of the ways (although not entirely sufficient) to achieve this comfort.

Dr. van der Kolk developed a study on how yoga can help people affected by PTSD and trauma gain a greater sense of safety with their own physical bodies. He explains that traumatic memories can be stored in the body and that yoga helps people change their automatic physical responses to trauma triggers. Yoga is also helpful for affect regulation, a fancy way of saying that it helps us cope with our emotional and uncomfortable sensations. It also helps calm the mind and assists participants in observing themselves as they experience their bodies and thoughts. Through use of the breath, we can learn to change our autonomic nervous system. He cautions that for people who are sensitive to traumatic stimuli, it’s important to study with yoga instructors who know how to deal with trauma survivors. For instance, he recommends that yoga instructors check in with participants before making physical adjustments to their poses, or being aware that certain poses (asanas) are more vulnerable for trauma survivors than others.

I found it exciting that an ancient spiritual and physical practice that is often-touted as stress reduction in general, can be helpful for healing trauma as well.

More information about this can be found here:
http://www.traumacenter.org/research/research_overview.php

More about EMDR


I recently found this article to be interesting and informative for people who are contemplating EMDR (Eye Movement Desensitization and Reprocessing) Therapy. I like that it explains the benefits even-handedly, and it’s a good little synopsis of what EMDR could do for someone with complex trauma (multiple traumas that affect the way people relate to themselves and the world). I share the author’s appreciation for how EMDR therapy emphasizes the importance of focusing on the somatic experience of trauma and re-processing. So much of what we experience in our lives is stored in the body, both pleasurable and painful experiences. I have also seen unresolved grief be stored in the body. The impact of these emotional and physical experiences become patterns that can become automatic, ingrained conditioned tendencies (to borrow a term from the great Somatic Coach, Richard Strozzi-Heckler).

What’s So Great About EMDR

While we’re on the topic of how body and mind respond to trauma, I would like to  recommend highly two wonderful books:

Waking the Tiger by Peter Levine, and

The Body Remembers by Babette Rothschild. Both are sensitive, highly experienced clinicians who write beautifully about how we can learn from our bodies to heal from trauma.

If you have more questions about EMDR therapy and how it could be helpful to you, I urge you to call me at 661-233-6771.

Thanksgiving Reflections


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In the face of tragedy, loss and trauma, it can be very hard to see the silver lining or be grateful for very much of anything. It may seem that we have lost so much, and that we will keep feeling the pain of loss forever. As mentioned before, sometimes we can experience extra sadness around the holidays because we are reminded of the people we no longer have on this planet, people who were close to us. The holidays are often celebrated with family and it reminds us of loneliness and heartbreak. Around this time of year I am reminded of my father’s passing, and how young he was to lose his life and vitality. At the same time, I am grateful for the relatives who are still alive, who persist in their struggles and with whom I can still experience closeness and joy.

Alternatively, for people who grew up in abusive and/or homes with addicted family members, the holidays can bring up a different kind of pain. We may be reminded of violence in our homes, seeing people hurt or neglected, or forced into situations where we felt out of control. How do we find peace when the holidays remind us of dysfunction and disconnection, you might ask.

As trite as it may sound, we can be grateful for the fact that we have survived our childhoods. We can be grateful for the wisdom that we have gained from surviving those situations. We can feel sympathy for the younger versions of ourselves who had to endure that pain, while still feeling relief that we are safer now. We have control over our lives. If someone mistreats us, we can walk away from the situation. If we can’t, we can figure out a way to do so in the future. We have more resources, physically and psychologically, to escape dysfunctional relationships and situations. We now know that we don’t deserve to be mistreated or lonely. We can make different choices that lead to better outcomes for ourselves. All these ways we empower ourselves are gifts that may not seem obvious on the surface, but we need to bear them in mind when contemplating trauma and loss. If we don’t remember that life is dynamic and flowing, and that we are not sad or scared or angry forever, we risk remaining stuck and suffering longer than we need to.

I try to make it a point to find at least five things for which I am grateful each day, throughout the year, so that Thanksgiving Day is every day. Does it work to pull me out of a bad mood 100% of the time? I wish I could say yes, but realistically it’s more like 80-90%. Nonetheless, if I don’t do it I feel despondent and cynical, and I can’t afford to do that. As Jon Kabat-Zinn says, “we only have moments to live.” This means that we only have the present moment to live in, and we have a choice as to whether to make that moment enjoyable, pleasant, and wholesome, or negative and depressing. Feeling gratitude and keeping that in the forefront of our minds is one way that I have found to be in a more pleasant moment.

Veterans Day


Every November we honor our veterans in this country, many of whom suffer from serious mental health conditions. Many commit suicide, have depression, substance abuse problems, traumatic brain injuries, and anxiety, not to mention physical problems. According to the National Center for PTSD, 5.2 million veterans suffer from Post Traumatic Stress Disorder (Source: http://www.ptsd.va.gov/public/index.asp). I find it very sad how few veterans with mental health problems can get timely help from the VA centers in our country. Our own county, Los Angeles, is one among a few other places where veterans have to wait over two weeks to get treatment for their problems. Given how much these men and women have sacrificed to their country, it seems that quality mental health care should be available on demand. Sadly, however, many veterans that I have talked to cite distrust as one reason they stay away from the VA Centers. This begs the question, what is the solution? It is a complicated problem, I believe, for political and financial reasons, not to mention the very nature of PTSD itself. Many people with PTSD, combat-related or not, have an extremely hard time trusting other people. When they do reach out for help, they need to feel that they can rely on those who provide it to be consistent, caring and professional. I hope that we can improve our service delivery to our veterans, as well as to all US citizens, so that more people can get the help they need when they need it. Perhaps if more people receive treatment early and effectively, the need for interpersonal violence and war will decrease someday.

What is EMDR and how can it help for grief and trauma?


EMDR stands for Eye Movement Desensitization and Reprocessing. It can be helpful for traumatic things that happen to us, including loss of a loved one. It was developed by Dr. Francine Shapiro to help people fully process traumatic events and to recover more quickly and thoroughly than with regular psychotherapy. The EMDR International Association describes EMDR as a “physiologically based therapy that helps a person see disturbing material in a new and less distressing way,” and EMDR seems to directly affect brain functioning. Nonetheless, how it works exactly is not known. It’s believed that EMDR is similar to what happens during dream or REM (rapid eye movement) sleep. When we are very upset, our brains do not function normally, so that disturbing events can become “frozen in time.” The sensory information gets stored in the right hemisphere, but the left hemisphere is not available to help you understand all this sensory input. Thus, when we remember that event it can feel as bad as the first time it happened because the images and sensory information attached to the memory have not had a chance to be integrated with language, time, and sequential functions of the left hemisphere. This lack of processing the memory can affect how we relate to the world, and can limit our ability to enjoy life.

EMDR can help with a number of different emotional blockages, including complicated grief and traumatic events. I have seen EMDR allow people who were “haunted” by the memory of their deceased loved ones become less captivated by the images and memories of their loved one. Then they can move into a healthier relationship with the deceased, and forge a new life without the intense sadness and pangs of longing that people often have with complicated, or traumatic, grief. With trauma it can help people reduce the nightmares, intrusive images, and hyper-vigilance that often accompany PTSD (post traumatic stress disorder) and traumatic events. Even more interestingly, you see new aspects of the trauma that you might not have accessed otherwise (i.e., through regular talk therapy). The end result is being able to think about the loss or trauma without getting emotionally aroused to the same degree. With grief, there is still a sadness, but it is nowhere near as strong as it was before. People with traumatic events often report that they don’t even think about the event anymore, and their fear and anger are tremendously dissipated.

When you seek EMDR, the therapist needs to determine whether EMDR will help you or not, and if it seems like it will help, the therapist develops the target for EMDR. What this means is that I will help you bring to the forefront of your mind, what happened in the original event. This includes how you felt about it and how you think about yourself when you remember that trauma. As you call all the sensory and emotional aspects of the memory to mind, I will guide you through a set of eye movements that will often lead to a new understanding of the original event. Your feelings about it may seem to become unglued from the event, and you may get a more detached perspective on it. As you reprocess the material, you may feel intense emotions, but generally by the end of the session, you feel a lot less upset by the event. Every person has a different experience of EMDR, and there’s no wrong way for you to do it.

I have seen EMDR work for not only traumatic memories, but anxiety disorders, stress reduction, creative blocks, and phobias. I have advanced training in EMDR and use it regularly in my practice, and clients have been very satisfied with the freedom they gained from their disturbing memories.

(From EMDRIA, “What is EMDR?” Austin, TX. Internet Home Page: http://www.emdria.org)

Control


Some of the suffering that people experiencing grief and trauma have comes from the idea that they could have controlled what happened. In some instances that was true, but much of the time people think they should have done something differently. Had they made different choices the outcome would have been better, in their opinions. That kind of thinking can sometimes lead to anguish and agonizing about their past choices. It leads to unnecessary guilt and can contribute to depression and complicated grief.

Some examples of this kind of thinking include the following examples:
* A rape survivor thinks that if she had worn different clothing, she would have avoided being raped
* A bereaved husband thinks that if he had catered to his wife’s needs more, she would have lived longer (assuming that he was reasonably helpful to her while she was alive)
* A person with a chronic illness or chronic pain thinks that if she had been a nicer person, she wouldn’t have developed her illness
* An incest survivor thinks that because he didn’t tell his parents, it must mean that he wanted his relative to abuse him sexually
* A man believes that if he had been more religiously involved, his son would not have perished unexpectedly

Much of grief and trauma is beyond our control, but how we handle it is within our control, if we work on how we make meaning of it. This is something that can be changed, thankfully.

One thing we can do when we have such thoughts is to reality-test them. If you can’t do this within yourself, talk to a friend or a professional who can help you distinguish the control you did and didn’t have in those past situations. Another way is to imagine how you would talk to a little boy or girl, or a good friend in that same situation. Would you really blame him or her for what happened to him/her? Would you be more compassionate, perhaps? That is something to consider when you are unkind to yourself with such thoughts: have the same compassion for yourself as you would for a loved one. I am a professional who helps people with grief and trauma; my number is 661-233-6771.

Traumatic Grief


This is a new way to think about grief, which is a more intense and prolonged form of grief that disrupts people’s lives over a long period of time. There are elements of PTSD or Post-Traumatic Stress Disorder, as well as sharp pangs of longing, searching for the dead loved one, and excessive avoidance of reminders of the dead loved one. A person can have strong sadness and other severe emotions, including fear and anger, and hostility and bitterness about the death. Intrusive thoughts, fantasies and memories about the deceased often plague these sufferers, and they have a hard time functioning. Sometimes people develop severe fears of illness and death in themselves or other family members, and they have a hard time separating their fears from reality. It is as though the death of their loved one acts like a wound, and any subsequent stressor feels like salt on the wound.

Some things that make traumatic grief worse include involvement in a court case, since that keeps the details of the loved one’s death fresh in their minds. Just when a person starts to recover, they have to re-experience the trauma of the loss all over again for a deposition or court date. Another factor is how close the mourner is to the deceased, as well as how their relationship was before death. I often see that when there was conflict between two people who were close, it is harder to let the death go because of intense guilt and/or anger. Lastly, the type of death can make a difference as to whether the grief is traumatic. Sudden or unexpected death of the loved one can trigger traumatic grief because there is no preparation for the loved one’s death. This is often the case with murder, suicide and accidental deaths.

If you or someone you know is having some of these symptoms, it is a good idea for them to get help for it. Grief support groups like the ones offered at hospices and through Compassionate Friends (for parents and siblings of deceased offspring) are one possible source. Another is psychotherapy. Please call me at 661-233-6771 if you would be interested in getting help for Traumatic Grief.