Trauma Treatment in the News

These days we are reading a great deal about trauma treatment. While we all hate to think of so many victims of trauma, this coverage is a good thing because trauma sufferers shouldn't feel like they're the only ones who've been handed a massive pile of shit like yours. However, it can be confusing when you have an array of choices and no 100% sure way to know what will work for you. Look at it this way: lots of people can take a couple of aspirin for a headache, but some people are not going to respond well to aspirin. Even something like a headache and its treatment have a zillion variations.



Same with trauma: if you need or want therapy to help you deal with your pile of shit, there are many options from which to choose. I suggest that you read up on the type of shit you're stuck with, look for data on what seems helpful, take a peek into online chat groups of people with your type of shit, and find the closest practitioner. I've known truly helpful practitioners from the most conservative old-fashioned psychoanalysts to yoga instructors and personal trainers, so with a little shopping around you can most likely find a guide who'll be a good "fit" for you.

For example, if you've had sexual trauma definitely look online; inquire at your nearest rape crisis center; contact rainn ([embed]http://www.rainn.org/[/embed]). Even the crime victims' unit of your local police will have a list of resources. If you're a veteran, the VA should know; your nearest Emergency Room should also have a list.

Sometimes it's easier (less embarrassing) to look into these things at home on your own without asking another person face-to-face, so don't forget resources like reddit's TwoXChromosomes - which is a place where sexual trauma is often addressed. If you go to TwoX keep in mind that reddit is a wide-open forum and sometimes assholes like to throw in their asshole opinions. But in general, on TwoX, assholes are jumped on like ducks on a junebug, especially dealing with topics like sexual trauma.

Keep in mind that not everyone who's been handed a pile of shit suffers from Post-traumatic Stress Syndrome; not everyone benefits from the same type of treatment; and therapy is a consumer product - meaning you get to shop around, you get to ask any practitioner about his or her results, and you get to leave if you don't think the therapy is helping you after a reasonable amount of time. Actually, you can leave whenever you want, but you should realize that good therapy often makes you feel worse before you feel better because you are facing very painful experiences (more about this in a future post).

Also keep in mind that most communities have low-fee therapy options. Look into local clinics; ask at the local professional associations; ask at the Emergency Room or helping agencies like the local Red Cross (they have to refer people for help after a public trauma, see?). A college Counseling Center will have a list of people to whom they send students needing therapy - your age is not a factor here; we are talking about a place to start.

(If I was embarrassed, and I sort of hate to admit this, I would lie. I would say I was looking for help for my sister. Because if telling a lie will help me make the call, and won't harm anyone, I say tell the lie. But try not to be embarrassed about carrying around a pile of shit, because the only people who will judge you are too small to listen to.)

Professional associations include local therapist groups. These groups usually have an organized way for local therapists to donate low-fee or pro bono hours to the community. If I suddenly landed in a strange city and my pile of shit started smelling really bad and I didn't know where to turn, I would (naturally) run a Google on "[Strange City's] Psychological Association," "[Strange City's] Social Workers' Association," and all the variants I could think of. The National Register of Health Service Providers in Psychology is a directory you may never have heard of, and I assume other helping professions have similar registries. Even if I were in a small town with none of these resources in evidence, I would call the closest university and ask for their Psychology and Social Work Departments, and tell them what I am looking for.

Why? Because universities train new therapists, and training new therapists means sending students out into the community to practice, and that often means sending students to low-cost therapy clinics. Having a student therapist is a crapshoot, sure; but so is choosing any therapist. All therapists are human, and not all therapists can work well with all kinds of people.

Student therapists tend to work hard, try hard, and work under close supervision. I'd look for a student who'll be around for more than one semester. Be sure to find out who their supervisor is and how to contact them is in case your student therapist sucks. You are absolutely entitled to this information and if your student hesitates or refuses, leave the building and contact the student's department at the university. It should be a mandatory part of any helping professional's training to support such a consultation!

If you have a student therapist and things seem to be going badly, ask for a consultation with their supervisor. Don't be afraid; if the student turns you down you are going to put on your big-kid pants and contact the supervisor. It will be good for you because you will be standing up for yourself and your needs. If the supervisor refuses to help, pick up your pile of shit, walk away and find another source of assistance. Even if the therapy sucked, you will have made great improvement simply by owning your experience and summoning the strength to move forward.

Anyway, there are a number of ways to find low-fee therapy.

And just because you have great insurance or twelveteen tons of money, that's no guarantee that your therapist will be a genius. I tell you, it's a consumer product. You may need to shop around.

On the other hand, remember that no one in this wide world can "cure" you but your own personal self. A therapist is a guide, not a fixer. The work on your pile of shit will have to be done by you, and in my opinion the vast majority of the work takes place outside the therapy office. If you hate all the therapists, go get yourself a cognitive-behavioral workbook designed for piles of shit like yours and do every single exercise until your pile of shit starts to look different. If it's not different enough for you, get another workbook and do every single exercise in that one. Et cetera. And that is perfectly fine, too.

This past Sunday's New York Times has a piece about one mode of trauma therapy that seems to have some data backing it up. I should say this is definitely not the type of treatment every therapist is trained to do. Nor does it look like your typical outpatient once-a-week-visit therapy to me. It's the type of therapy that will stir up extreme emotions; you need time beyond the 45-minute therapy hour; and it takes highly trained professional support for that kind of work. It can absolutely be profoundly helpful to many trauma survivors.

[embed]http://www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?hpw&rref=magazine&_r=0[/embed]

How on earth do you decide if a treatment like this might be a good idea for you? There are a few variables to consider.

This "Psychomotor Therapy" reminds me of the Psychodrama we used to do in the first psychiatric hospital I worked in, and as you see from the article it is intense. In a hospital setting, back in the day of lots of insurance and long stays, we had round-the-clock staff to check in and monitor patients as they were undergoing intensive treatment like that.

These types of therapies involve re-enacting aspects of your trauma in some form or fashion, or at least visualizing them, and not everyone is up to that. (Of course I do not mean that if you were assaulted someone in the therapy workshop is going to assault you! That isn't therapy, that's a felony.) Even if you are just guided in intense recollection of your trauma, it can be very, very unsettling and it takes a while to "metabolize" all the feelings that can be stirred up. I would worry about people driving themselves home right after a session. At the very least, I would see this kind of intensive therapy in a weekend workshop approach in a specialized setting where you wouldn't be too far from help in the hours between sessions. With plenty of time for a good debriefing before you head home.

However, I should say that the general trend these days is helping trauma victims "move toward" the memories of their trauma rather than avoid the pain and fear. Some therapies will do this gradually; other therapies take a more active approach and move you more quickly into the past events. Some therapies are strictly talk; others involve physical work ranging from yoga to EMDR (more about that in a later post, too). Again, there are many modalities from which to choose and one size is definitely not going to fit all.

If you decide to try a therapy like the one described in the Times article, be sure to ask the practitioner(s) about their training and their results; about what to expect during the process; about the kind of support you might need outside the therapy session(s) and all that kind of stuff. Just as you would if you were going to have your eyes dilated for a vision exam. What I mean is, there is no embarrassment or shame attached to these questions!

For example if it's a weekend workshop type of thing, having someone drive you there and pick you up might be a good idea. Or even having someone there with you the whole time. It is perfectly ok to tell a therapist that you don't want to end up like a cartoon puddle of a person at the end - how will they help you debrief when it's time to go home? Any therapist who tells you, Don't worry about that, it's no problem, is a therapist you get to walk away from.

The idea, and I believe this wholeheartedly, is that memory is stored all through the body. For some people, recovery from trauma involves stirring up the memories of traumatic events until they are deeply felt within the body. At that point a "redoing" experience takes place: the therapist(s) basically stand in your pile of shit with you and guide you toward changing the nature of your shitpile in a way that will prove helpful to you.

Here's a quick example: You might be visualizing a specific scene from your childhood in which you were terrified and there was no one around to help you. Once you are deeply feeling that scene, you may be guided in "redirecting" the scene - perhaps by imagining a wonderful, nurturing person there with you. It's reworking your pile of shit, in a nutshell, by going from utter isolation and fear to the presence of a truly healing helper. And you will have done it yourself, which means a piece of mastery over that traumatic episode.

Who should stay away from therapies like this one? Again, it's difficult to say with 100% accuracy. I would say if you are suffering from anxiety and/or depression that have not yet been treated nor brought under reasonable control via therapy and/or medication, leave the more intense therapies for later. If you have been diagnosed with a thought disorder, or a personality disorder such as Borderline Personality Disorder, this kind of therapy may be way too unsettling for you. If you are in the very raw, very intense stage of Post-traumatic Stress Syndrome, give yourself some time before you go for a therapy that's just going to stir you up even further. You need to be able to live your life while you heal, after all.

It is absolutely essential that to go through an intense therapy treatment you should be thoroughly screened and informed about potential benefits and risks, just as you would expect from any medical treatment. If it looks like they just want you to sign up and hand them your credit card, I say turn around and go home. Good psychotherapy does not involve a lot of top-secret mumbo-jumbo. It is a process, a dynamic process; and the more you understand about the process the more benefit you will obtain.

My friend and colleague Dr. Karen Habib suggested that I make a kind of "list" to help with the potentially overwhelming prospect of choosing a type of therapy for dealing with trauma. Too many choices! I hope to talk about therapy choices on an ongoing basis, so this only represents one out of many possible lists.  As I said in the beginning of this post, I think it is a very good idea to look online and see what is available and recommended for people who have gone through a trauma similar to the kind you went through.

Here are a few possible choices. A licensed professional is usually going to be your best bet: they've gone to school, they've taken tests, and they have a Licensing Board to answer to. Your health insurance may be helpful, maybe not. I'm not sure going into huge financial debt is going to help you transform your pile of shit, really, so do consider affordability.

-Weekly appointments with a psychologist, social worker, or counselor who has experience with your type of shitpile. If medication might be helpful for you, you'll need a recommendation to an M.D. in many states. In some states, psychotherapists who are not M.D.'s can prescribe medication.

-More frequent appointments with such a professional can help you get stabilized if you're still in the stage where you and your whole world feel like they are falling apart. You need to be able to eat, sleep, and work! Seeing your therapist more than once a week may also stir up lots of emotions more quickly, perhaps moving your healing along. Your checkbook may help you decide.

-There are many "alternative" therapies that can be very helpful, from art therapy to music therapy to dance. See if you can find a local source with experience in helping people shift from being victims to being survivors. Weekly sessions with a personal trainer, martial arts master, or yoga instructor who has experience working with your kind of trauma. Again, you may up the intensity by increasing frequency, but in these cases you'll want to avoid inflicting physical injury on yourself, or escaping your feelings by compulsively exercising. A former TA of mine takes war veterans out on Outward Bound excursions with very precise therapeutic goals and exercises, and impressive results. You never know what healers are doing out there until you start looking around!

-Therapeutic workshops, many of which are held on weekends at hotels or other gathering places. These offer the benefits of intense emotional experience with instructions about where to take your pile of shit from here. Do your homework about the treatment being offered and the practitioners who are offering the treatment.

-Day programs and workshops are offered by many psychiatric hospitals and clinics, with a wide range of treatment options. Any hospital's web page will have a menu of their offerings.

-We'll talk about therapy theories in almost every post. Remember that the data indicate you'll get the best results from a therapy and a therapist who feels like a good fit to you. Your friend may swear by EMDR but it might not help you at all. Your best healing may take place in a journal writing workshop.

-The self-help section of any bookstore will probably have a few pounds of books devoted to precisely your kind of trauma. These can be very helpful, perhaps especially for those of you who are still hesitant to talk with someone else about what you have survived. Many have workbooks, and that's a key tool in cognitive-behavioral therapy anyway. Most of those books will also have suggestions about where to look for face-to-face help in your area.

It's a good thing to have trauma treatment in the news. The more informed you are, the better choices you can make. Just always, always keep in mind that therapy is a consumer product and you want to be a good consumer, so read up on what's available and read as many reviews as you can.