trauma Tag

Trauma; Honor For Your Healing Journey

Honor your healing journey

The four things your therapist wants you to know about your healing journey. When you’re healing from a grief, trauma, or resultant PTSD, you must be thinking about ‘how will I ever move on from this horrible, unexpected, agonizing reaction to the traumatic situation that I have experienced?’ Remember, PTSD is a reaction to witnessing or experiencing a sudden and unexpected event which caused one to feel powerless by delivering, threatening, or witnessing harm. How can I rise above these feelings and thoughts and create meaningful and complete healing? Maybe you want to go backwards in time and undo all of the harm that you have experienced. A common and reasonable response to all of these above disorders, particularly PTSD, is to try to avoid all triggers associated with the situation which evoked the trauma, hypervigilance, intrusive memories, nightmares, flashbacks and an increased risk for anxiety and depression. This disorder presents a mountain to ascend, and whether you have spend years in therapy or are only beginning to acknowledge the depth of the effects this has had on you, these are some points to keep in mind. These are the 4 things that your therapist wants you to know about healing that are not immediately evident.

Healed but not Forgotten

Some people have the unrealistic expectation that when they reach the end of their healing journey  they shouldn’t have any emotional reaction to their memories of the traumatic event which led to grief and loss. That is not how healing works. It is quite likely that you will always have some sort of reaction to the memories and thoughts associated with your grief or trauma. In fact, according to a 2011 study published in NIH by Sherin and Nemeroff, and according to all of science and psychology support the fact that there is potential for long term neuroanatomical and neurochemical changes to the central nervous system resulting  from trauma. These changes are especially evident in the way we respond to triggers or trauma associated stimuli. What we should be striving for in the healing from trauma is a ‘new normal.’ Healing means that you are able to function in professional or personal settings and that you are practicing resilience and positive coping when waves of thought and emotion do come.

Healing means Acknowledging Feelings

One of the ways that therapy works is by creating an intentional space for healing warriors to be honest with themselves, to create an understanding of their emotions.  After an awareness has been formed adaptive responses to feelings and thoughts can be generated. We create psychopathology by being critical and attempting to repress our internal honest responses. For some people like first responders, police, and paramedics, there may be an extra layer of difficulty and stigma attached to acknowledging ones feelings and seeking mental health support to manage trauma. This can cause further damaging denial of the effects of traumatic experiences, One of the core tenets of psychological theory present in every form of therapy is that the more we repress, judge or avoid our feelings, the more we cause problems. Repression elicits tangled feeling constellations, blocked energies, incomplete and unintegrated shadows. Mindfulness based stress reduction, EMDR, and Cognitive Behavioral Therapy, and Exposure Therapy, have shown efficacy in treating PTSD. Our feelings can turn into psychopathology that are bigger and sometimes socially unacceptable forms of the original emotional response.

Healing Happens in Relationships. Find your Healing Tribe.

It is especially true for trauma that happens in relationships, that this same trauma is healed in relationships. When trauma survivors open up to those people who they consider to be safe, there is an incredible potential for healing to happen. Healing relationships are those that resonate compassion, gentle acceptance, warmth, and non-judgement. Think about it, we become close to those who we can be really honest with, those who ask about our feelings and can share in a compassionate interchange, (Mgrath, 2001). Sharing trauma should be exercised with caution. However well-intentioned our healing tribe may be, its members may inadvertently respond in less constructive ways that judge, shame, or put down the survivor for having the pain or scars of trauma. Another risk is not being able to hear or understand what is being shared. What is really needed is non-judgmental acceptance, understanding, and compassionate warmth.

Find your healing tribe

Positive Psychology, Pop Culture and Non-Reality

You may have survived a trauma but that doesn’t mean you have to fall victim to meme reality. Scroll through a social media forum and you will see many posts and memes which declare that everyone should be happy all the time. That isn’t honest or possible. The healthiest among us are those who are honest with themselves about what they experience and then respond to their vulnerable reality in a constructive way. According to a 2016 study by Elizabeth Kneeland, pop cultures layman positive psychology is damaging. When pop culture got its hands on positive psychology its representatives distorted the message, and now laymen perpetuate unrealistic and uninformed messages which imply that we can think our way into a good mood.  It suggests that if we blink our eyes we can make trauma and psychological distress evaporate. Your therapist knows differently. Its ok to be outraged, disgusted, sad, hurt, angry, confused, and it is important to acknowledge where you are in your healing journey today.

No matter where you are today, the best we can do is to risk opening to ourselves, to create an honest internal dialogue that we are eventually able to share with others. We should unabashedly honor our own processes, giving relentless permission to feel, think and be; in reverence of joy, in honor of glorious fury, to the fullest expression of gaiety, to the utterance of insuperable hurt, to fully hone in on repugnant disgust. Keep developing your divine awareness, and eventually you will have created the unique meaning which understands with a lens of compassion, acceptance, and self love all that has happened to you.

With love and hope for resilience,

Stephanie Wijkstrom, MS, LPC, NCC

• Counseling and Wellness Center of Pittsburgh

              830 Western Avenue Pittsburgh PA 15233

• Counseling and Wellness Center of Pittsburgh

               2539 Monroeville BLVD, Monroeville PA 15146

Accepting new clients, our therapists accept UPMC, Highmark BCBS, United, Cigna, Magellan, Aetna, HSA, Self Paying and Sliding Scale.

Thank you to our Editor, Dr. Stellan Wijkstrom for his ever helpful alterations and contributions.

For More Reading

Kneeland, Elizabeth et al, Positive thinking Newsweek, 2016

https://www.newsweek.com/2016/09/23/positive-thinking-myth-498447.html

McGrath, Ellen. Psychology Today, published November 1, 2001 

https://www.psychologytoday.com/us/articles/200111/recovering-trauma

Post-traumatic stress disorder: the neurobiological impact of psychological trauma

Sherin, Jonathan E, Charles B. Nemeroff

Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/

Providing Grace and Resilience to Trauma Survivors, How To – Help Guide.

Provide grace & resilience to trauma survivors.

                           How to Provide Grace and Resiliency to a Friend or Family Member Who Discloses Trauma.

According to the United States Veterans Administration, about 50% of women and 60% of men will experience trauma at some point in their lives. Trauma is defined as an emotional response to a distressing event. Traumatic events can include witnessing or experiencing sexual or physical assault, violence, robbery, or attack. We are not all equipped with a vast understanding of psychology, and when a friend or family member turns to us with their memories of a traumatic event, more than ever we could benefit from some information on how to respond with validation, support, and compassion. The literature on trauma widely cites how important loved ones’ responses are to survivors’ disclosures of the events that they experienced. In fact, in a 2016 study by Lischner and Hong at the University of Washington, invalidating responses of friends, family, and others are correlated with an increased likelihood that the survivor will experience psychopathology including Post Traumatic Stress Disorder (PTSD). With the number of people who have survived trauma growing each year, it becomes ever more likely that someone will turn to you with their memories of a traumatic event. Below we will highlight some invalidating responses and provide validating responses so that each of us can do our best to provide caring support to those who may approach us with their heavy burden.

Validation is defined as responding with empathy, agreement, acknowledgement that we believe what was shared and that it makes sense. We can validate many levels of expression and meaning, feelings as well as thoughts. As a couples counselor, I help couples use the tool of validation to comfort each other in conflict. Validation is powerful. Some validating responses are;

• ‘Thank you for trusting me enough to share this.’
• Summarize the memories that were shared, always referring to them as memories or experiences.
• ‘That must be so (painful, scary, traumatic, other feeling word) for you.’ Summary of emotions, this is to indicate a full understanding of the feelings that the person shared.
• ‘You were so strong and brave in sharing your experiences.’ This is a compassionate response that highlights their survival skills.  
• ‘How can I support you further?’ Letting the person know that you are glad to discuss any of it further, that you want to be there for them in any way that they need.

Invalidating responses can cause survivors to feel anxious, depressed, panicked, overwhelmed, and called to defend themselves and their pain. Many trauma survivors cite that invalidation from family or friends of their traumatic event is at times just as distressing as the trauma itself. Invalidation can be consciously used as a tool to manipulate and coerce, and it can be unconsciously done because the recipient to the confidence doesn’t know how to respond or help. Some examples of invalidating responses are as follows:

• ‘Why are you bringing this up right now?’ Every survivor unfolds their trauma memories to different people and in varying times, when and how they will share their trauma and with who it feels safe to share. 
• ‘Are you sure you remember this accurately?’ The first duty of love is to listen and validate, provide understanding, care, warmth, and support. It is not a good time to put them on the witness stand for cross examination.
• ‘The perpetrator remembers it differently.’ Attend to the survivor’s feelings first and save the fact checking for a different time and day. Even if you feel called to defend the person or event that is being discussed as the source of trauma, this survivor is sharing something very vulnerable and the immediate need for understanding and care would indicate that we should triage and be delicate.
• ‘Try not to think about it and put it behind you.’ This response indicates that the person’s experience of grief, pain, panic, anxiety, is something that can be dismissed. Working with trauma clinically provides opportunity to experience the depth of the memories and emotions to be reprocessed. There is much evidence that the more we think we should be able to dismiss our responses to trauma, the more likely we develop PTSD.

Don’t be hard on yourself if you recognize after reading this that you may have been invalidating to someone in the past. ‘We all do our best and when we know better, we do better.’ Maya Angelou

Please pass this along. Every day another person survives and attempts to thrive in the wake of pain and anguish. Each of us has the potential power to be a safe zone, to provide support, help, and healing for those who are making sense of traumatic events, we have the ability to provide resiliency against emotional pain and we can create a buffer and reduce the development of Post Traumatic Stress Disorder.

With resiliency and hope,

Stephanie Wijkstrom, MS, LPC, NCC

Counseling and Wellness Center of Pittsburgh

*The is not a replacement for mental health support provided in a clinical setting by a licensed counselor, psychologist, or clinical social worker. If you or a loved one has experienced trauma and are working through its effects, reach out to a therapist near you.

Thank you to our editor, Dr. Stellan Wijkstrom.

For more reading;

Phan Y.Hong, David A.Lishner: General invalidation and trauma-specific invalidation as predictors of personality and subclinical psychopathology, Personality and Individual Differences. January 2016.

https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp

Trauma Informed Care; We Have Evolved to be at risk for Trauma; Here is Why

Trauma Informed Care

We have fantastic and astonishing memory abilities, the human mind and its processes, particularly in the way we store and retrieve the effective memories which then effect the way that we store and respond to our other memories and sensory input. Evolutionary psychology examines the way some things that can be problematic are often helpful to us in the past and as we evolved. This is especially true for trauma survivors. According to the American Psychological Association, Trauma is an emotional response to a event like an accident, rape, or natural disaster, abuse or assault. Immediately after the event, shock, emotional upheaval, loss of ability to function, and denial are typical. Trauma is especially present in situations where a person feels powerless and their sense of control are taken. Long term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea, nightmares, inability to rest or calm down, feeling tearful, experiencing fear and heightened startle response. While these feelings are very universal response to the paralyzing fear that is associated with trauma even if the survivor reports feeling neutral in the moment. Biology offers some rational for how we can feel afraid but work through it in the moment of the traumatic situation, but it is later when we are safe and comfortable that the panic can emerge, generally emotions are something that can be seen and felt most when everything is alright around us, meaning the traumatic event is over and we are safe. Some people have difficulty moving on with their lives because trauma can result in long term effects such as post traumatic stress disorder, acute stress disorder, anxiety, depression, and addiction.

There are so many events that we experience which are traumatic, whether these develop into the more complex constellation of behaviors which we identify as PTSD, really depends on an interplay of biological, social, and other environmental factors. Some of the situations which can cause a trauma response include, domestic violence, sexual violence or assault, car accidents, national tragedies, serving in war, robberies. It is possible that we can experience a traumatic response my witnessing these events even if we are not the direct recipient of the threatening attack.

People who later feel the emotional and physical effects of trauma may wonder, what is wrong with me? Also, even if the event seemed manageable in the moment, it seems bizarre that they keep seeing flashes of it months or years later. The answer is while the effects of trauma  can be debilitating, our cognitive processes are primed to be traumatized. Evolution explains that we and our ancestors are wired to hold tight to frightening or threatening experiences, imagine what happened to all of the humans who did not startle and produce massive amounts of cortisol and adrenaline at the sight of the saber toothed tiger just through the northern passage on the savannah. They died and did not evolve to have offspring in our gene pool. Having memory of dangerous events, people, situations, and gearing up to flee or protect one’s self is a sign of an evolutionarily healthy adaptation, it allows us to stay safe by avoiding possibly dire situations. In fact, our Vagal nerve which communicates directly to our bodies, without having to yield the advice of our logic, there are long term changes in the way that our Vagal nerve responds to triggers after we have experienced trauma. The vagal nerve is what allows healthy people to experience the ‘startle response’ for example when someone sneaks up behind you, usually we respond with a physical jerking motion in our bodies, and literally jumping. In domestic violence survivors, being ‘jumping’ and easily startled when a person raises their hand, is a well noted phenomenon that may last an entire lifetime.

We are wired to remember traumatic events. Survivors of trauma know that the sight of the perpetrator of their violence, even a coat that’s the same color as the one their attacker had worn can evoke the fear response. ‘Triggers’ are any stimuli which we associate with the traumatic event. These triggers and their associated memories can and do produce a jolt to the vagal nerve resulting in heightened, panicked, and anxious response in the person who is perceiving them. The biological response when we encounter a trigger are a plenty, our bodies enter a state of hyper-arousal, respiration becomes more shallow, heart beat rises, and fear settles in, even cognitive function is impaired as our higher order reasoning is impeded and all neurological resources are yielded to the hind brain and its motor and autonomic functions. The one and only thought becomes fight, flight, survive, and in some cases freeze. Remember, just like on the savannah in the seat of civilization, the extra energy our bodies create allow us to escape danger.

Cognitive behavioral therapy, systematic desensitization, and exposure therapy, and some therapies which aim to change the tone of the vagal nerve are recommended ways to work through the trauma and empower the survivor to be able to withstand exposure to triggers and regain emotional wellness. It is recommended that trauma survivors do their best to limit exposure to triggers as they heal from the event and associated memories. If you feel that you may be experiencing long term effects from a traumatic situation, it is recommended that you work with a therapist who is specifically trained in trauma informed care. Healing will allow the processing of the entire event, client and therapist will identify triggers, developing the capacity to respond to triggers with mindful balance, and work through the effects of any other psychological effects from the trauma.

Counseling and Wellness Center of Pittsburgh, Serving Western Pennsylvania with Individual Therapy, Couples Therapy, Family Therapy and Wellness Services.

Acute Stress Disorder

Acute Stress Disorder 

Acute stress disorder is a form of anxiety disorder which develops shortly or immediately after exposure to a traumatic event in which real or threatened harm or injury was experienced or threatened to the self or other. Acute Stress Disorder differs from Post-Traumatic Stress disorder in the time from in which the associated symptoms are exhibited. To reach the diagnosis of Acute Stress disorder symptoms should be exhibited less than one month after exposure to a traumatic event. Similarly to PTSD, symptoms involve flash backs, re-imagining, dreams, distress or anxiety at exposure to visual stimuli related to the traumatic situation or event, including hyper-vigilance, and anxiety about the possibility of the event or danger happening again. The duration of the traumatic event and time of exposure or repetitiveness of the exposure effect the likelihood that the person will experience Acute Stress disorder as there are certain internal risk factors which may affect resilience to the development of the trauma. Treatment for Acute Stress Disorder often involves trauma focused therapy, EMDR, short term psychotherapy, mindfulness based therapy approaches even including meditation, acupuncture, all therapy and counseling services should be performed with a licensed professional counselor or mental health specialist.

Post Traumatic Stress Disorder Therapy and Counseling

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder is a form of anxiety disorder which stems from exposure to a traumatic event or situation which caused real or threatened injury to and this can also be caused by the witnessing of an event or situation which injured or threatened injury to another person. According to the DSM IV, there is a lifetime prevalence rate of about 8% for the development of PTSD. Muggings, rape, terror, hostage attacks, natural disasters, car accidents, are situations that can increase the likelihood that a person may develop PTSD.

As a therapy practice which also specializes in marriage and family counseling, we support the research which suggests that individuals who have experienced an infidelity in their relationship may also go on to develop symptoms of PTSD or Acute Stress Disorder.

There are certain occupations which put people at risk for developing Post Traumatic Stress Disorder by exposing them to frightening and dangerous situations. Those who work as military/armed forces, policeman, fireman, and detectives may be particularly vulnerable for developing PTSD. Finally, there is a second form of PTSD, Vicarious or Secondary trauma, this form of trauma is caused by exposure to information related to traumatic events and is commonly seen in therapists, social workers, attorneys, judges and persons who offer support and services to those who have had trauma.

The Diagnostic Criteria for PTSD are;

• The person has witnessed, was confronted with or in some way threatened with death or serious injury to the self or others.
• The response to this event or threat was intense fear, horror, anxiety, and or helplessness.

1. The events is then continually and persistently re-experienced in the form of imagery, thoughts, perceptions, the person may also experience frightening and recurrent dreams related to the traumatic event. The person will then attempt to avoid any associated triggers of the event and have an over all numbing and or a hyper-vigilance meaning they become hyper-aroused when exposed to triggers for the trauma. They also may have difficulty falling asleep, concentrating, regulating mood, and have an increased startle response. Individuals exposed to trauma may too are also at increased risk to develop mood disorders such as depression and are also at increased risk for developing substance abuse.

Treatment for Post-Traumatic Stress Disorder often involves Trauma Focused therapy with a licensed professional counselor or therapist as well as medication therapy in certain instances. Another form of therapy which has proven effective in clinical models is EMDR.

Your Inner Voice, A Counselors Thoughts on Thoughts

Your inner voice, or more accurately, inner voices each of them tugging to be the declarer of your thought and action. Their presence is perfectly normal as they are the culmination of your past, present, and anticipated future experiences melded into your very little internal advisors. At their best, these voices are a valuable hot bed of wisdom! They are the voices that guide one towards the enjoyment of positive choices, healthy boundaries, positive self-talk, and confidence. The utterer of syllables such as, “Maybe you should tap those brakes as the odometer is speeding towards 75, we would like to arrive alive in here! ”I know that wine is really good but how about having a glass of water before your next!?” “John hasn’t called you back in several days and you can’t keep leaving those messages, you deserve better treatment and by calling him you are encouraging him to treat you this way.”

Most of us have experienced some version of this little inner savior, provided this is balanced by properly free spirited fueled actions sometimes then it is perfectly well to enjoy the kind of lifestyle that our inner voice will guide us towards. I notice however that those persons who have suffered childhood victimizing, perhaps by the many forms of parental or peer abuse/neglect and also for those who have suffered from later life trauma, for them,  we find that soothing inner voice is dominated by an inner critic. The inner critic may become so overwhelming for the individual that they are desperate to quiet the mind!

Our inner voice typically develops to primarily mirror the kinds of messages that we received from our early caregivers. For those lucky folks who have been the recipients of plenty of hugs, kisses, and assurances in those formative years an inner voice develops to say that everything will be ok when times are hard, to have confidence in the face of adversity,  to develop basic coping skills which will help us pass us through life’s trials while maintaining some structural integrity. For the many others who have not been plagued by a stream of criticism, scoffed at for their feelings, or having been victims of deception or outright physical or sexual abuse, then the development of the inner voice becomes quite different. It may say things like, “stay quiet! Nobody wants to hear your opinion!” “Stay in that abusive relationship, you will never find better and are too weak to be alone!” “Drink some more wine, it’s the only way to calm your nerves and you aren’t going to succeed anyways!” So we begin to see the very different internal world of one who has a well-developed inner voice to the one who has a well-developed inner critic!

While it is indeed a fact that even the healthiest among us has a variety of intimations existent within our psyche, meaning we all have both a seat of inner wisdom and an inner critic. It is the balance which is my concern, our thinking should represent vigor, calm, and confidence as this is our natural state and anything else is a residue of this natural progression having gone astray. If you are experiencing this brand of suffering and these inner voices have turned to stresses and symptoms then you are likely eager to begin your journey towards healing. Whether you choose to begin that journey in therapy or by utilizing some other method of transformational growth it will be a magical path and well worth the effort. As a part of your healing, take a look inside and develop an awareness of your inner wounded child. You may try keeping a journal and writing down or simply imagining how would you describe this younger you? What are some of your early memories, for each painful memory consider an alternative ending, what kind of memory would you have liked to experience? Remember now that this is your own story and you may create it however you would like so enjoy the opportunity to be creative! Imagine the younger version of yourself crying and pained, go to the child and offer him/her soothing, love, care, and warmth. It is by healing those parts of ourselves which have suffered that we become whole, healthy and content just as we are meant to be! May the best of preparation and guidance serve you on your journey!

Light and Love,

Stephanie McCracken MSPC

Reviving Minds Therapy

412-215-1986

The Art of Compassion

When talking with a friend recently the discussion turned to compassion, her gaze drew down and her feet shifted bashfully. After a moment of silence she admitted that she had little to know idea what the full meaning of this abstract concept is, and without even knowing she did not believe that it could offer any relevance to her practical life. Yet the truth is that for many of us who may be contending with the myriad of issues pertaining to basic cognizant living we could reap exquisite benefit from exercising compassion. While it may be initially trying to redirect thinking and acting towards this more illuminated stance especially when the nifty old synaptic wiring recalls pain, trauma, anguish or even simply waking up 20 minutes too late for your morning cup of coffee. Still however, when we share compassionate responses with the world we are not only benefiting others, we too are exhilarated by the positivity which we is then set coursing through our inner sanctum. Why bother interrupting a cycle of careless or hostile mode of being with something a bit more Buddha like? We are all ultimately weighted with the handsome burden of free choice pertaining our reaction to self and others. If you sometimes wonder why you notice a bewildering pattern of melancholia or inner-conflict then perhaps you may benefit from a mild dose of compassion.

The Merriam Webster definition of compassion is a deep awareness of the suffering of another along with the wish to relieve it. Unwittingly many of us may practice compassion already, when you notice the homeless person huddled beneath blankets along your stroll to your office, or the friend who can barely help himself but to become completely obnoxious when he drinks, the colleague who is unrepentantly ten minutes late for each and every meeting. You may notice yourself resisting the urge to be irritated by these and many others along the path of life. Maybe by leaving a pair of hand warmers for the homeless person and having a talk with both your colleague and friend about what may be going on for each of them respectively. Having compassion for those we interact with does not mean that we don’t notice or even that we don’t become irritated with the mystifying ways of others but it does require that we respond in a way that is a reflection of our most wise and caring truth and that our response is rooted in an attempt to relieve the others suffering.

I make no remark that consistently compassionate thought, speech, and action is simple, nor do I state that it is an entirely natural collusion with our at times wicked or selfish human mannerisms. I do however promise you that by living with greater compassion we become the ebullient bringers of joy, and the gregarious gesticulators of grace, the sort of buddaesque persons enthralled under our very own Bodhi trees in a whirlwind of calm clarity. I would like to encourage the reader to take the practice of compassion even one step beyond reaching outwards with this conundrum of kindness. Empathy fueled action towards others is a wonderful way to begin but just as importantly, extend greater compassion towards yourself! According to Buddhist wisdom “Our sorrows and wounds heal only when we touch them with compassion.”  If you turn your attention towards your own inner world, in what ways are you your own harshest critic? Which feelings do you carry followed by that additional burden of shame? How do you unflinchingly hammer yourself upon the proverbial cross? Perhaps with just a touch of compassion for yourself you can finally lay those old wounds to rest. Keep in mind that once we become aware of our patterns of thought and deed we are afforded the opportunity to respond to life in a variety of manners and it is my insistent offering that a compassionate response to you and the many nameless and faceless others of the world will unveil a much more lovingly lived life! How may your hour, your day, your week be different if you were practicing compassion?

In health and wellness,

Stephanie McCracken MSPC

Offering Psychotherapy and Marriage Counseling

Reviving Minds Therapy

1010 Western Avenue Pittsburgh Pa 15233

412-215-1986