Monday, September 7, 2015

How do I work? Part II: trauma

If you have anything to do with the psychotherapy world, then you know that trauma is the watchword - its on everyone's lips.  Its the in thing right now.  I think there's very good reason for this.  We're getting some good results with some innovative therapies - developed over the last several years (and longer) - that focus on trauma and our theoretical understanding of what trauma does to our nervous system.

To put it really briefly, we've all got trauma of some form or another.  Maybe its trauma, or maybe its Trauma. For example - I still have unreasonable emotional reactions to things that remind me of certain childhood situations, long past adverse experiences, and difficult relationships.  That's trauma - it left scars, and the scars influence how I feel, think, and behave even today.

Now - when someone is in a horrible accident, or survives a war, or a horrific near experience with violence, or are chronically abused or neglected as children - that is Trauma with a capital "T" and people sometimes develop PTSD as a result.  Not always, interestingly. Not even most of the time.  But too often. The lesser traumas our lives present us with can cause us to develop responses that seem related to PTSD even if it isn't the full horror that some of us suffer.

On the one hand, as adults we often feel as if we should put on our big people pants and get over it. But the truth is that there are some things we just can't seem to get over easily and even if they seem trivial and childish, they still have a lot to do with some of our most painful emotions.

Now I know what you're thinking.  You're thinking about Freud and the couch and "tell me about your mother." And about some poor soul discovering that their fear of asparagus comes from the awful accident they had in the garden when they were three - and poof, they're cured.  Funny enough, even though that kind of scene is still a staple of film and TV - Freud abandoned that theory in about the second year of his practice.  He was certain he had found the scarring event in a patient's past, and the insight could produce a kind of relief-through-understanding in his patients - but it didn't cure them.  Their problems persisted in spite of knowing the apparent cause.

And yet - the trauma therapies that counselors are using now are remarkably similar to that fictional "eureka" scene.  I won't really try to explain what the different therapies are or what they do here - I'm getting long winded enough.  But the key is that there are certain kinds of emotional reactions we all have, that bother us deeply, often to the point of a diagnosable disorder, that seem to derive from trauma and the reactions our brain and nervous system have to the flight-or-flight response.  The new trauma based therapies work with inspirations from neurological theory to help us unlearn those responses, often quickly, and often without the long verbal psychodynamic inquiry into our past that we all associate with therapy.

So - when people start talking their emotions feeling out of control, and stress, and anger issues, and even anxiety and depression - I start looking for trauma.  It isn't always trauma - but often it is and it helps to treat it that way.  I've benefited a great deal from trauma based therapy and it is clearly an area I need more training in - because many, many people who walk through my door need it.  They need it yesterday.

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