Category Archives: Therapies

Concise articles about many therapies for the effects childhood trauma and related conditions such as complex PTSD and borderline personality disorder, including cutting-edge treatments such as dialectical behavior therapy, EMDR and body-focused therapies (such as somatic experiencing).

A Closer Look At Overcoming An Inferiority Complex

 

overcoming an inferiority complex

We have already seen that those of us who suffered significant childhood trauma are at increased risk of developing an inferiority complex as adults. For example, we may be at increased risk because our parents constantly criticized and derided us, making us feel we were of very little worth.

My own inferiority complex was so massive that in the evolutionary hierarchy I rated my place in it as falling somewhere between reptile and rodent.

In my previous article about the causes of an inferiority complex, I looked very briefly at ways we might be able to overcome it ; in this article, however, I want to go into greater depth as to how this may be achieved.

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1) Stop attaching so much importance to what others think about you :

People often look back on their lives and wish they had not allowed it to be so constrained by concerns about other people’s views and opinions about them. Stopping worrying what others think of us and living an authentic life is extremely liberating. After all, what others think about us is merely their opinion and may well be utterly invalid. Also, it is a fact of life that some people will always be critical of us. The adage that you can’t please all the people all the time is true for everyone.

Furthermore, people may criticize us due to their own feelings of inferiority, projecting their own sense of inadequacy onto us. Arrogant people, for example, tend to act arrogantly as a defense mechanism against underlying feelings of low self-esteem.

Most people, too, are far too preoccupied with concerns about their own failings to focus very much on ours.

It is our view of ourselves that really matters if we are to have good self-esteem, not that of others.

What would the Prime Minister achieve if he became paralyzed with uncertainty and self-doubt every time he was criticized in the media or by the Opposition? Nothing. He wouldn’t get out of bed.

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2) Concentrate on your qualities:

People with feelings of inferiority tend to over-focus, or even become obsessive, about the ‘failings’ they believe they have whilst ignoring or minimizing their positive qualities and characteristics.

It is known that those who suffered abusive childhoods very frequently have an unrealistic and irrational view of themselves as being of little worth; this is because they were conditioned to develop this inaccurate view of themselves by those who were supposed to be their primary carers when they were young.

People affected in this way may have developed thinking errors or cognitive distortions that can be effectively treated with cognitive behavioral therapy (CBT).

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3) Stop comparing yourself to others:

Whatever we do, there will always be people that are better at it than we are (unless we are the best in the world at something, and, even then, we can’t stay in that top position indefinitely).

Just because people are better at some things than we are, that does not diminish our value and importance as a human being. After all, we are all the product of the interaction between our genes and our environment. Some people just have luckier combinations of these two elements than others – this does not make them superior beings. Likewise, it does not make us inferior beings.

4) What we think of as our failings may, in fact, be positive qualities in the eyes of others:

For example, we may dislike our shyness, but someone else may view this shyness as an endearing quality. Or we may dislike being ‘naive’ and ‘inexperienced’ but, again, someone else may view this as touching innocence. Or we may think we’re not ‘clever’ enough, but others may see this as a refreshing  lack of pretentiousness.

RESOURCE :

STOP FEELING INFERIOR – SELF HYPNOSIS DOWNLOADS 

 

David Hosier BSc Hons; MSc; PGDE( FAHE).

 

Dialectical Behavioral Therapy

DIALECTICAL BEHAVIORAL THERAPY (DBT) has been found to be particularly effective in treating those who, in part due to their childhood experiences, have gone on to develop BORDERLINE PERSONALITY DISORDER (BPD).

Five skills are central to dialectical behavioral therapy (DBT); these are as follows:

1) CORE MINDFULNESS
2) TAKING THE’MIDDLE PATH’
3) DISTRESS TOLERANCE
4) EMOTIONAL REGULATION
5) INTERPERSONAL EFFECTIVENESS

 

1) CORE MINDFULNESS:

DBT describes the mind as having 3 components (these are concepts, not actual distinct physical part of the brain, obviously). The 3 components are:

a) the reasonable mind
b) the emotional mind
c) the wise mind

Let’s examine each of these in turn:

a) the reasonable mind: this can be summed up, according to DBT, as the part of the brain which acts according to reason, logic and rationality

b) the emotional mind: according to DBT, this is the part of the brain which operates on the basis of our feelings (when the ‘heart controls the head’)

c) the wise mind: ideally, according to DBT, we should allow this part of the brain to guide us; it is A BALANCE BETWEEN 1 and 2 above, when the reasonable and emotional brain are operating in effective HARMONY.

If we are able to operate in ‘wise mind mode’, this will mean we can maintain control and prevent ourselves from becoming a victim of our own intense emotions. In order to see the importance of this, we need only consider times in our lives when our behaviour has been dominated by our emotions and the negative effects this may have led to. Indeed, not learning to control emotions can leave our lives in ruins, not least due to the frequent self-destructive effects of our emotional outbursts.

2) TAKING THE MIDDLE PATH:

This is a metaphor for avoiding the trap of constantly seeing issues in terms of BLACK AND WHITE (eg all good/all bad and a marked tendency to perpetually think IN TERMS OF EXTREMES). DBT stresses the importance of teaching ourselves to FOCUS MORE ON THE GREY AREAS and to try to take A BROADER RANGE OF PERSPECTIVES when considering issues, to think more FLEXIBLY and to THINK LESS IN ABSOLUTE TERMS.

Taking the middle path, according to DBT, also involves BOTH VALIDATING OUR OWN THOUGHTS/FEELINGS AND THOSE OF OTHERS. Even if others don’t understand, DBT stresses that we need to comfort ourselves when distressed by reminding ourselves that how we are feeling is real and makes sense under the current circumstances we find ourselves in. We can remind ourselves, too, that no matter what others may think, NOBODY UNDERSTANDS US AS WELL AS WE UNDERSTAND OURSELVES (others can’t understand what it is ‘to be in our heads’; we should not be ashamed of how we feel). By applying this compassion and understanding to ourselves, as part of ‘taking the middle path’ it seems fair that we should extend similar understanding to others – we can accept what they feel, as non-judgmentally as possible, irrespective of whether we approve or not.

 

3) DISTRESS TOLERANCE

Practitioners of DBT try to instil the view in their clients that sometimes it is easier, and psychologically healthier, to stop struggling against reality, and,(they tell us) we need to accept that we, nor anybody else, for that matter, can prevent painful events from occurring in life (sometimes extremely painful ones, if we’re going to be up-front about it), nor can the painful emotions they bring with them. It is hardly a new idea, but practitioners of DBT also remind us that some painful things in life cannot be changed and that the only viable option we really have, therefore, is to accept the fact. This, of course, is difficult and requires considerable inner strength. By accepting the things which cannot be changed, though, it is reasoned, we free up energy which could have been wasted (by, say, being angry and bitter about the existence of these unchangeable facts) to deal with what CAN BE CHANGED.

DBT therapists tell us that there are certain skills we may wish to develop which will INCREASE OUR ABILITY TO TOLERATE DISTRESS; these are:

a) distraction/improving the moment
b) self-soothing
c) considering pros and cons of the situation
d) radical acceptance

Let’s briefly look at each of these in turn:

a) distraction/improving the moment – eg distracting ourselves with activities we enjoy, keeping our minds busy ; reminding ourselves of the good things in life ; reminding ourselves that it is better to think clearly and in a focused way about our problems ‘after the storm has passed’ (rather than try to make decisions when in the middle of an intense crisis which may be over-determined by our emotions) ; remind ourselves that difficult periods will pass

b) self-soothing – eg we can use postive self-talk (see my posts on cognitive behavior therapy for more on this – to access the posts just type ‘CBT’ into this site’s search facility) ; meditation/relaxation activities/breathing exercises ; using our imaginations to recall a soothing and comforting memory or place (if recalling a place it can be helpful to imagine, for a while, actually being there) ; thinking of things in life which are meaningful to us and give us the motivation to get through the difficult period.

c) considering the pros and cons of the situation : eg we may wish to consider how getting through a very difficult period may benefit us – for example, we may learn from it, it may strengthen us, it may make us more compassionate and sensitive towards others, we may be able to pass on the benefit of our experience to help others, it may even open up completely unexpected avenues in life which may not otherwise have been available to us (bad events do sometimes lead to positive outcomes, however indirectly – it is often worth keeping that in mind).

d) radical acceptance : this might involve trying to view what is happening, however undesirable, from as objective and detached a perspective as possible – a bit like watching the events unfold around somebody else in a movie ; another, perhaps surprising, technique suggested by DBT therapists is to try to, literally, half-smile. This sounds strange and even rather silly, but research shows that just as the mind can affect the body (eg thinking about something embarrassing and going red in the face) so too can the body effect the mind – in this case, the idea is that the half-smile ‘fools’ the brain into ‘believing’ things aren’t as bad as all that. It is obvious, however, that in certain situations this technique would be highly inappropriate (I need hardly list examples).

4) EMOTIONAL REGULATION :

The fourth skill that DBT teaches is how to cope with intense and overwhelming emotions – this skill is referred to by practitioners of DBT as emotional regulation.

This skill is made up of three sub-skills : a) increasing one’s understanding of one’s emotions; b) decreasing one’s emotional vulnerability; c) lessening the degree of distress caused by one’s negative emotions.

5) INTERPERSONAL EFFECTIVENESS

The final skill of interpersonal effectiveness helps the person undertaking DBT to communicate with others effectively when interacting with others in a way that helps to improve his/her relationships.

In order to achieve this, s/he is helped to communicate with others in a more controlled manner and to be less prone to speaking impulsively and without forethought due stress or overwhelming emotions (such as anger).

 

Research Suggests That DBT Can Beneficially Alter Brain Functioning :

THE STUDY :

Research conducted by Schnell and Herpertz (2006) involved looking at the effects of DBT (specifically, training in emotional regualation, see number 4, above) on female patients’ brain functioning (this was done by taking magnetic resonance images, or MRIs, a type of brain scan) after they had spent 12 weeks undergoing an inpatient treatment program.

RESULTS OF THE STUDY :

The female, BPD patients who improved following the DBT / emotional regulation skills 12 week inpatient program were found (by analysis of their MRIs) to show:

REDUCED ACTIVITY IN CERTAIN BRAIN REGIONS ASSOCIATED WITH THE GENERATION OF INTENSE EMOTIONS, INCLUDING THE AMYGDALA AND THE HIPPOCAMPUS.

Such a reduction of activity in these brain regions is associated with an increase in the individual’s ability to prevent themselves from overreacting to stressful situations (overreacting to stressful situations, also known as impaired emotional regulation, is one of the hallmark features of BPD).

Conclusion :

The above can be interpreted as further evidence for the effectiveness of DBT for treating patients suffering from borderline personality disorder (BPD).

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

Cognitive Behavioral Therapy For Childhood Trauma.

WHAT IS COGNITIVE BEHAVIORAL THERAPY AND HOW CAN IT AID RECOVERY FROM CHILDHOOD TRAUMA ?

 

Cognitive behavioral therapy (CBT)  was initially devised during the 1970s by Aaron Beck and has since been developed by other psychologists (for example, David Burns, MD) and is now used to treat many conditions that individuals who have experienced significant and protracted childhood trauma are at increased risk of suffering from (especially depression and anxiety).

 

Put simply, cognitive behavioral therapy (CBT) works on the basic observation that:

 

1) how we think about things and interpret events affects how we feel

2) how we behave affects how we feel

therefore:

3) by changing how we think about things, interpret events and behave will CHANGE HOW WE FEEL.

I have over-simplified here but those are the essential three points and my aim in this blog is not to present information in an over-complex way.

 

RESEARCH :

CBT is widely used by therapists to treat survivors of childhood trauma and there is now a solid base of research which supports its effectiveness. I myself underwent a course of CBT some time ago and found it very helpful.

 

WHAT WE THINK ABOUT THINGS DECIDES HOW WE FEEL :

In this post I wish to concentrate on how our thinking styles affect our state of mind and emotions. Survivors of childhood trauma often develop depressive illness and, as a result, thinking styles often become extremely negative:
NEGATIVE THINKING

Depression often gives rise to what is sometimes called a COGNITIVE TRIAD of negative thoughts. These are:

– negative view of self
– negative view of the world
– negative view of the future

I have referred to this NEGATIVE COGNITIVE TRIAD in previous posts, but it is worth revisiting. The aim of CBT is to change these negative thinking patterns into more positive ones. It aims to correct FAULTY THINKING STYLES.

 

FAULTY THINKING STYLES:

Individuals who suffer from this cognitive negative triad of depressive thoughts, as I did for more years than I care to remember, are generally found to have deeply ingrained faulty thinking styles; I provide the most common ones below and give a very brief explanation of each type (if the examples seem a little extreme, it is merely to illustrate the point):

1) GENERALIZATION:

e.g. someone is rude to us and we conclude: ‘nobody likes me or ever will’.

So, here, the mistake is vastly over-generalizing from one specific incident.

2) POLARIZED THINKING:

e.g. ‘unless I am liked by everyone then I am unpopular’.

This is sometimes referred to as ‘black or white’ thinking ie. seeing things as all good or all bad and ignoring the grey areas.

3) CATASTROPHIZING:

e.g. ‘I know for sure this will be an unmitigated disaster and I’ll be utterly unable to cope.’

Here, the mistake is to overestimate how badly something will turn out or to greatly overestimate the odds of something bad happening. It often also involves underestimating our ability to cope in the unlikely event that the worst does actually happen. Also known as ‘WHAT IF…’ style thinking.

4) PERSONALIZATION:

e/g. taking an innocent, casual, passing remark to be a deliberate and calculated personal attack. Here, the mistake is thinking everything people do or say is a kind of reaction to us and that people are pre- disposed to wanting to gratuitously hurt us.

5) SELF BLAME :

e.g. someone says our team has not met its monthly target and we then look for ways to convince ourselves it is specifically and exclusively due to something we have done wrong. With this type of faulty thinking style, we blame ourselves for something for which there is no evidence it is our fault.

6) MINIMIZATION :

e.g. ‘I failed one exam out of ten, therefore I’m stupid and a complete failure’.

Here, the positive (passing nine out of ten exams) is pretty much ignored (minimized) and the negative (failing one exam) completely disproportionately affects our view of ourselves. Individuals who minimize the positive tend to also MAXIMIZE (ie. make far too much of) the negative.

 

CONCLUSION :

What tends to underlie all these faulty thinking styles is that we UNNECESSARILY BELIEVE NEGATIVE THINGS IN SPITE OF THE FACT WE HAVE NO, OR EXTREMELY LIMITED, EVIDENCE FOR SUCH BELIEFS. Therefore, we unnecessarily and irrationally further lower our own sense of self-esteem and self-worth. Because of these faulty thinking styles, we increase our feelings of inadequacy and depression.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

Compassion Focused Therapy for Effects of Childhood Trauma

compassion_focused_therapy

self-compassion

 

Therapy which emphasizes self-compassion (as well as compassion for others), not inappropriately called COMPASSIOIN FOCUSED THERAPY (CFT), has become increasingly utilized for the treatment of the effects of childhood trauma over the last decade or so. It is based on 3 main components :

– being mindful of one’s own suffering

– being kind to oneself (with positive internal ‘self-talk’, for example) and non-self-critical

– being open about own suffering and communicating it without feelings of shame or weakness

CFT is a particularly useful and effective therapy for those of us who tend to be ashamed of our internal emotional state, prone to severe self-criticism and come from an abusive and neglectful background (ie suffered such an environment during our childhood).

CFT motivates and helps individuals to develop a compassionate self-view as well as a compassionate view of others. Research suggests that many of us who suffered disturbed childhoods are fearful of giving compassion to ourselves or receiving it from others.

Neuroscience (the scientific study of the brain) has shown that giving oneself compassion or being self-critical (ie where the compassion or criticism is INTERNALLY GENERATED) has very similar biochemical effects upon the brain as would be generated by EXTERNAL STIMULI (ie others showing us compassion or criticizing us). For more about this very interesting area of research it is well worth reading the study on EMPATHY AND MIRROR NEURONS by Decety and Jackson (2004).

Because CFT is based on similar theory to cognitive behavioral therapy (CBT) it focuses on reasoning, rumination, behaviors, emotions and motives in a similar way to how CBT does.

 

EVIDENCE FOR THE EFFECTIVENESS OF COMPASSION FOCUSED THERAPY :

– A study carried out by Lutz et al (2008) demonstrated that showing compassion towards others led to beneficial changes in the PREFRONTAL CORTEX (a specific brain region) and a much increased sense of personal well-being.

-A study by Fredrickson et al (2008) demonstrated that 6, one hour COMPASSION FOCUSED MEDITATION sessions per week increased POSITIVE EMOTIONS, MINDFULNESS and FEELINGS OF PURPOSE.

– A study by Gilbert and Proctor (2006) focused on individuals with long-term mental health problems and found that COMPASSION TRAINING significantly reduced their feelings of shame, depression and anxiety; it also greatly reduced their previously pronounced tendency towards self-criticism.

 

RESOURCE :

Develop Self Compassion | Self Hypnosis Downloads

David Hosier BSc Hons; MSc; PGDE(FAHE).

Steps To Recovery From Childhood Trauma

recovery from childhood trauma

Research shows those who suffer childhood trauma CAN and DO recover.

Making significant changes in life can be a very daunting prospect, but those who do it in order to aid their own recovery from childhood trauma very often find the hard work most rewarding.

Some people find making the necessary changes difficult, whereas others find it enjoyable.

THE DECISION TO CHANGE

Change does not occur instantly. Psychologists have identified the following stages building up to change:

1) not even thinking about it
2) thinking about it
3) planning it
4) starting to do it
5) maintaining the effort to continue doing it

childhood_trauma_recovery

THE RECOVERY PROCESS

Each individual’s progress in recovery is unique, but, generally, the more support the trauma survivor has, the quicker the recovery is likely to occur.

Often recovery from childhood trauma is not a steady progression upwards – there are usually ups and downs (e.g two steps forward…one step back…two steps forward etc) but the OVERALL TREND is upwards (if you imagine recovery being represented on the vertical axis of a graph and time by the horizontal). Therefore, it is important not to become disheartened by set-backs along the recovery path. These are normal.

Sometimes, one can even feel one at first is getting worse (usually if traumas, long dormant, are being processed by the mind in a detailed manner for the first time). However, once the trauma has been properly consciously reprocessed, although this is often painful, it enables the trauma survivor to work through what happened and to form a new, far more positive, understanding of him/herself.

Once the trauma has been reworked (i.e understanding what happened and how it has affected the survivor’s development) he or she can start to develop a more positive and compassionate view of him/herself (for example, realizing that the abuse was not their fault can relieve strong feelings of guilt and self-criticism).

Once the reworking phase has been passed through, improvement tends to become more consistent and more rapid.

 

Steps to Recovery

HERE IS A SLIDE SHOW OF STEPS TO RECOVERY FROM CHILDHOOD TRAUMA (for more detail see below) :

  • STEP ONE : Remember that symptoms of childhood trauma such as hypervigilance and dissociation are normal reactions to abnormal experiences.

It is important to remember that, no matter how severe our particular experiences of childhood trauma were, people can, and do, recover from such experiences if they undergo an appropriate form of therapy ; cognitive behavioural therapy, or CBT for example, is now well established by research findings to be a very effective treatment.

In analysing the recovery process from childhood trauma, it is possible to break it down into seven stages ; I present these stages below :

RECOVERY STAGES :

1) The first very important thing to do is to stop seeing ourselves as abnormal because of the effect our childhood trauma has had on us, but, instead, to see our symptoms/resultant behaviours as A NORMAL REACTION TO ABNORMAL EVENTS/EXPERIENCES.

It is very important to realize that it is highly probable that other people would have been affected in a very similar way to how we ourselves have been affected had they suffered the same adverse experiences that we did.

Coming to such a realization is, I think, important if we wish to keep up our self-esteem.

The kinds of symptoms and behaviours that childhood trauma can lead to are examined in detail in my book ‘The Devastating Effects Of Childhood Trauma’ – see below.

2) A very therapeutic effect can often be achieved by opening up about our traumatic experiences and how we feel they have affected us by talking to others we trust about such matters.

3) If at all possible, it is important that, during the recovery process, we are in an environment in which we feel safe and secure, and which is as stress – free as possible.

4) It is also extremely important that we try to resume normal everyday activities and interpersonal relationships as soon as possible, even if this requires some effort at first. Indeed, the research suggests recovery is very difficult if we do not re-establish human relationships. Also, we need to try to build some structure into our daily lives, as this provides a foundation of stability.

5) We need to accept that we may need much more rest than the average person – this is because the brain needs time to recover. In relation to this, getting the correct nutrients  and sufficient sleep (I needed far more than 8 hours during my recovery) is also very important.

6) We also need to realize that while our experience of trauma entailed a great deal of suffering, many people not only recover from childhood trauma but develop as a human being in extremely positive ways as a result of it ; this phenomenon is known as post traumatic growth .

7) Therapy should be seriously considered as there are now many studies which provide extremely solid evidence that therapies such as cognitive behavioural therapy (CBT) can be highly effective. There are many other therapies and self-help strategies, too; I examine these in my book ‘Therapies For The Effects Of Childhood Trauma’ (see below).

 

Let Go Of The Past

 

The following six strategies can help us to let go of the past and move on with our lives more effectively :

 

1) VALIDATION :

According to Horowitz, if our past childhood trauma and the pain it has caused is, subsequently, invalidated (e.g. denied, ignored, dismissed, minimized, mocked etc.) by those who have harmed us, the psychological harm done to us is amplified. This makes it harder to move forward in our lives.

However, if this is the case, it can be helpful to seek and obtain validation from significant others, such as a therapist who is trained to work with childhood trauma survivors, or from what Alice Miller (1923-2010) referred to as an ‘enlightened witness.’ Miller defined an ‘enlightened witness’ as a compassionate and empathetic person who helps the childhood trauma survivor ‘recognize the injustices [s/he] suffered and give vent to {his/her] feelings.’

 

2) EXPRESSION OF PAIN :

This pain we have been caused does not necessarily need to be expressed directly to those responsible ; for example, we may describe our experiences and feelings in a journal, or, as Franz Kafka did, write a letter to the person/s responsible (in the case of Kafka, the letter was to his abusive and narcissistic father) without actually sending it (instead, his biographer informs us that he gave it to his mother to give to his father – he was too frightened to approach his father directly – but she never did, possibly because she believed it wouldn’t do any good).

Talking about our traumatic childhood experiences can, however, be very difficult ; you can read about why this is in my previously published article entitled : Why It’s So Difficult To Talk About Our Experiences Of Extreme Childhood  Trauma.

Sadly, too, some doctors may be reluctant to discuss our childhood trauma with us for reasons that I outline in my previously published article entitled : Why Don’t Doctors Ask About Childhood Trauma?

 

3) CONSCIOUS DECISION : 

Because we might have been ruminating, perhaps obsessively, on the trauma and injustice contained in our past, the process of turning things over and over in our minds may have become almost automatic. It is therefore necessary to make a firm, conscious decision to embark upon the journey of letting go. In connection with this, you may wish to read my previously published post : Mindfulness Meditation : An Escape Route Away From Obsessive, Negative Ruminations.’

 

4) ADOPT BENEFICIAL TIME PERSPECTIVE :

According to TIME PERSPECTIVE THERAPY (developed by Zimbardo, Sword and Sword, 2013)  we should use the past to our advantage (such as learning from previous mistakes and focusing on good things that happened rather than dwelling on the bad) ; develop the ability to live in the present and enjoy it, but not in such a heedless and hedonistic way that it endangers our future ; and, also, adopt an optimistic view of the future and plan for it (by setting achievable goals). To read more about TIME PERSPECTIVE THEORY, click here.

 

5) CULTIVATION OF COMPASSION :

Compassion-Focused Therapy (CFT) can effectively help people move on from their traumatic childhood experiences. It was initially developed in the early part of this century by Paul Gilbert and can be particularly effective in helping those suffering from feelings of shame resulting from their traumatic experiences (such feelings are a very common response to a traumatic childhood which is why I have devoted a whole category to the examination of it on this site : see the SHAME AND SELF-HATRED section).

Specifically, CFT can help with :

  • alleviating feelings of being ‘worthless,” inadequate’, ‘ a bad person‘ etc
  • alleviating negative emotions such as self-disgust and anxiety
  • reducing concern about what others think of one
  • reducing feelings of anger towards those who have mistreated us
  • reducing levels of arousal and hypervigilance

6) REFRAME :

Many people do not realize the damage that their childhood has done to them and may take a sanitized view of it due to what they are taught to believe by those who harmed them or by society more generally (in connection with this, you may be interested in Alice Miller’s classic book entitled : ‘Thou Shalt Not Be Aware : Society’s Betrayal Of The Child.’

By reframing the past, with the help of a psychotherapist, we can start to obtain a genuine insight into what really happened to us which, in turn, empowers us and makes us less of a slave to the unconscious forces that may be ruining our lives.

 

 Resources 

eBook :

Childhood_trauma

Above eBook now available on Amazon for instant download : click here

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

Child Trauma andTrauma Focused Therapy (TFT)

trauma focused therapy

What Is Trauma Focused Therapy?

Trauma Focused Therapy (TFT) utilizes the following treatments, either on their own, or in combination :

1) EXPOSURE THERAPY – this type of therapy encourages the person to confront the stimuli connected to the trauma which s/he fears. The exposure may be IMAGINAL (ie a mental picture of the feared stimuli is imagined, often using hypnotherapy to stimulate imagery and visualization) or IN VIVO (ie in real life). Repeated exposures to the feared stimuli lessens the emotional impact it has on the individual.

2) SYSTEMATIC DESENSITIZATION – this is similar to the above but the individual is gradually introduced to the feared stimuli (ie stimuli which remind the individual of the trauma and trigger memories of it). The person is taught relaxation exercises to utilize whilst having the memories of the trauma which has the effect of inhibiting the fear response. Again, this therapy can be combined with hypnotherapy.

3) BIOFEEDBACK – this technique uses electrophysiological instruments to provide feedback to the trauma sufferer about physiological states connected to anxiety, fear and panic (eg of heart rate) which helps him/her in relaxation training (the instruments show the individual when s/he is using relaxation techniques effectively).

4) DIALECTICAL BEHAVIOUR THERAPY – to read my article about this type of therapy, please click here.

5) ACCEPTANCE AND COMMITMENT THERAPY (ACT) – this technique is based upon the idea that much of human suffering is the result of trying to control internal states (ie feelings and emotions). We try to avoid unpleasant feelings like sadness and guilt – this has been termed ‘EXPERIENTIAL AVOIDANCE’. According to this therapy, we should not try so hard to avoid our unpleasant feelings, but, instead, accept our personal, internal experiences and make a commitment to live our lives in accordance with our personal values, irrespective of how it makes us feel.

6) STRESS INOCULATION TRAINING – this technique includes education, muscle relaxation, training in breathing techniques which induce relaxation, role playing, guided self-dialogue, thought stopping and assertion training.

7) COGNITIVE BEHAVIOUR THERAPY (CBT) – please click here to read my article on this

8) COGNITIVE PROCESSING THERAPY (CPT) – please click here to read my article on this.

RECENT DEVELOPMENTS IN TRAUMA FOCUSED THERAPY :

a) Cognitive Behaviour Therapy (CBT) is now being used to specifically treat those who suffer from trauma related nightmares

b) Trauma Focused Therapy is now making use of VIRTUAL REALITY innovations (eg during Exposure therapy – see above)

c) Trauma Focused Therapy is now being delivered over the internet

THE ROLE OF MEDICATION : it has been found through research that trauma tends to be treated even more effectively if the above therapies are combined with appropriate medication

TIME FRAMES FOR TREATMENTS : generally, trauma focused therapy involves about 8-12 sessions which are usually carried out at weekly intervals. However, some studies have demonstrated that just 1-4 sessions can lead to significant improvements. Sessions usually last from 60-90 minutes and the individual undergoing the treatment is given homework to complete between sessions.

EVIDENCE : Overall, the evidence for the effectiveness of trauma focused therapy is compelling. Numerous studies, which have been well controlled and have adhered to high methodological standards, have shown it to work.

RESOURCE :

How To Find A Therapist Near You – click here.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Childhood Trauma: Eye Movement Desensitisation and Reprocessing (EMDR).

EMDR

Individuals who have suffered severe childhood trauma may, as a result of it, later suffer from Post-Traumatic Stress Disorder (PTSD), or similar condition. Some professionals advocate a relatively new technique which aims to address this; it is known as Eye Movement Desensitisation and Reprocessing (EMDR).

WHAT IS EMDR?

The therapist administering EMDR will first examine the issues related to the individual’s psychological difficulties and, also, help him/her develop strategies to aid in relaxation and deal with stress. After this, the therapist encourages the individual to recall particular traumas, whilst, simultaneously, manipulating his/her eye movements by instructing him/her to follow the movements the therapist is making with a pen, or similar object, in front of the individual’s face). The theory is that this will facilitate the individual in effectively reprocessing his/her traumatic experiences, thus alleviating psychological distress.

THIS SOUNDS A LITTLE ODD; WHAT IS THE RATIONALE BEHIND EMDR AND, HOW, EXACTLY, IS IT THOUGHT TO WORK?

My first reaction to hearing about this particular therapy was that it sounded somewhat strange. However, the rationale behind EMDR is that disturbing memories from childhood need to be PROPERLY PROCESSED by the brain in order to alleviate symptoms associated with having experienced childhood trauma (eg PTSD, as already mentioned); this is because the view is taken that it is the UNRESOLVED TRAUMA that is the cause of the psychiatric difficulties the individual who presents him/herself for treatment is suffering. Those professionals who recommend the therapy believe that the EYE MOVEMENTS INDUCED BY THE THERAPIST IN THE INDIVIDUAL BEING TREATED LEAD TO NEUROLOGICAL AND PHYSIOLOGICAL CHANGES IN THE BRAIN WHICH AID IN THE EFFECTIVE REPROCESSING OF THE TRAUMATIC MEMORY, and, in this way, ameliorates psychological problems from which the individual had been suffering.

 

WHAT ARE THE STAGES INVOLVED IN EMDR THERAPY?

These are briefly outlined below:

1) The first stage is the identification of the specific memory/memories which underlie the trauma.

2) Next, the individual is asked to identify particular negative beliefs he/she links to the memory (e.g. ‘I am worthless’)

3) Then, the individual being treated is asked to replace the negative belief with a positive belief (e.g .’I am strong enough to recover’ or ‘I am a person of value with potential to have a bright future’ etc)

4) In the fourth stage, the therapist moves a pen (or similar object) in various, predetermined motions in front of the individual’s face and he/she is instructed to follow the movements with his/her eyes (e.g repeatedly left and right). Whilst this is going on, the therapist instructs the individual to simply, non-judgmentally observe his/her own thoughts, letting them come and go freely and without trying to influence them in any way – just to accept them, in other words, and let them happen.

5) This procedure is repeated several times.

Each time the process is undertaken, the therapist asks the individual being treated to rate how much distress he/she feels – this continues until his/her self-reported level of distress becomes very low. Similarly, each time the process is undertaken, the individual is asked to report how strongly he/she now feels he/she believes in the positive idea given in stage 3 (see examples provided above); therapy is only concluded once the level of reported belief becomes very high.

N.B. The therapy is actually more involved than this, so the above should only be taken as a brief outline. There are, too, different variations of procedure outlined above which can be employed within the EMDR range of therapies available.

 

EMDR CAN HELP UNBLOCK TRAUMATIC INFORMATION HELD IN THE BRAIN AND HELP US TO HEALTHILY INTEGRATE IT INTO OUR LIFE STORY AS A WHOLE :

When we suffer severe trauma we are not able to fully mentally process what it is that has happened to us and the trauma becomes mentally entrenched – in other words, what happened to us becomes locked or ‘stuck’ in our memory network. The effect of this may include us experiencing various symptoms such as irrational beliefs, painful emotions, anxiety and fears, flashbacks, nightmares and phobias. It may well also cause blocked energy and greatly reduce our self-efficacy.

When we experience events that trigger memories of the trauma, images, sounds, physical sensations and beliefs which echo the original experience of the trauma cause our perception of current events to be distorted.

EMDR (Eye Movement Desensitization and Reprocessing) can unblock this traumatic information and thus allow us to healthily mentally integrate it with our other life experiences and our life story as a whole.

Trauma can occur in the form of SHOCK TRAUMA and DEVELOPMENTAL TRAUMA. Shock trauma consists of a sudden threat which is overwhelming and/or life threatening – it occurs as a single episode such as a violent attack, rape or a natural disaster. Developmental trauma, on the other hand, refers to a series of events which occur over a period of time. These events GRADUALLY ALTER THE PERSON’S NEUROLOGICAL SYSTEM to the point that it REMAINS IN THE TRAUMATIC STATE. This, in turn, can cause interruption in the child’s long-term psychological growth. Experiences which can lead to developmental trauma include : abandonment by parent, long term separation from parent, an unsafe environment, an unstable environment, neglect, serious illness, physical and/or sexual abuse or betrayal by a care giver.

The effects of developmental trauma include damaging the child’s sense of self. self-esteem, self-definition and self-confidence. Also, the child’s sense of safety and security in the world will be seriously undermined. This makes it far more likely that the individual will experience further trauma in life as an adult as his/her sense of fear and helplessness remain unresolved.

EMDR works by allowing the locked or ‘stuck’ traumatic information to be properly, mentally processed. This leads to the disturbing information becoming psychologically resolved and integrated.

HOW DOES EMDR ACTUALLY WORK?

EMDR is based on the idea that it is our memories which form the basis of our PERCEPTIONS, ATTITUDES and BEHAVIOURS. Because, as we have already established, traumatic memories fail to be properly processed they lead to these perceptions, attitudes and behaviours becoming DISTORTED and DYSFUNCTIONAL. In effect, the trauma is too large and too complex to be properly processed so it remains ‘STUCK’ and DYSFUNCTIONALLY STORED. This often leads to MALADAPTIVE ATTEMPTS TO PROCESS AND RESOLVE THE INFORMATION CONNECTED TO THE TRAUMA SUCH AS FLASHBACKS AND NIGHTMARES (Sharpio, 2001).

When this problem occurs it is EMDR which is being increasingly turned to allow effective processing and mental healing to occur. I will look in more detail at what EMDR involves in later posts.

 

WHAT DO EVALUATION STUDIES OF EMDR THERAPY SUGGEST ABOUT ITS EFFECTIVENESS?

A recent meta-analysis of evidence (ie an overview of a large number of particular, individual studies of EMDR) supported the claim that it is effective, as have other meta-analyses. However, some researchers have suggested that it is not the EYE MOVEMENT PART of the therapy which is of benefit, but only the act of repeatedly recalling traumatic memories which is the effective component (based on the idea that these repeated mental exposures, under close supervision and in a supportive and safe environment, of the traumatic memories alone facilitates their therapeutic reprocessing).

In response to this criticism, its exponents (and there are many professionals who are), regard the EYE MOVEMENT COMPONENT of the therapy as ESSENTIAL in giving rise to the NECESSARY NEUROLOGICAL CHANGES which allow the EFFECTIVE REPROCESSING OF THE TRAUMA; these proponents also emphasize that the therapy only requires short exposures to the traumatic memory/memories, thus giving it an advantage over therapies which utilize far more protracted exposures.

Research into EMDR is ongoing.

eBooks :

borderline personality disorder ebook

 

Both above eBooks available on Amazon for immediate download. CLICK HERE.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Cognitive Hypnotherapy for Stress Related Disorders.

Stress can be defined as the perception that the psychological demands being made upon us exceed our ability to cope with them. It has been well documented that the experience of stress (especially chronic stress) is linked to both physical and psychological disorders.

Sometimes, if the stress experienced is very severe, such as in the case of suffering protracted childhood trauma, the condition of post traumatic stress disorder (PTSD) can develop. For example, research carried out by Donovan et al., (1996) found that childhood physical punishment was strongly associated with the later development of PTSD.

Indeed, childhood trauma in general (be it sexual, emotional, physical, or a combination of these) very significantly increases the probability of developing PTSD later in life – one of the reasons for this is that such adverse early experience can greatly lower our later ability to cope with stress. Thus, as well as being badly affected by stress in childhood, we are also, as a consequence, then far more vulnerable to the effects of stress in adulthood.

Siegel (1996) identified three specific categories of symptoms of PTSD; these are :

A) INTRUSIVE SYMPTOMS (e.g flashbacks, preoccupation with trauma related thoughts which are extremely hard to dispel from the mind)

B) EMOTIONAL NUMBING (e.g the inability to experience feelings of pleasure – this is formally referred to as ANHEDONIA)

C) HYPERAROUSAL (extreme and uncontrollable responses – for example, the startle response – to trauma related stimuli)

REASONS WHY HYPNOTHERAPY MAY BE OF PARTICULAR BENEFIT TO SUFFERERS OF PTSD :

Hypnotherapy may be particularly beneficial for those who suffer from PTSD due to the fact that there is an analogy between the above three types of symptoms and the three major components of hypnosis. The three components of hypnosis which are analogous to A, B and C above are :

A) ABSORPTION

B) DISSOCIATION

C) SUGGESTIBILITY

Let’s look at why the analogy exists in relation to A, B and C :

A) Because those with PTSD have deeply absorbed their traumatic experiences, it is likely, too, that they will be able to effectively absorb information provided to them whilst in hypnosis

B) Emotional numbing is a form of dissociation (you can read my article on dissociation by clicking here). As hypnotic trance is also a form of dissociation, it is likely that PTSD sufferers will be easily able to enter into the hypnotic trance state

C) Hyperarousal involves heightened responsiveness. This suggests that those who suffer from PTSD will be highly responsive to therapeutic hypnotic suggestions.

HOW ELSE CAN HYPNOTHERAPY HELP THOSE WHO SUFFER FROM PTSD?

Hypnotherapy can help the individual with PTSD to DISTANCE THEMSELVES and DECENTRE from the immediacy of their traumatic experiences.

Also, hypnotic suggestions can be given that help the individual restructure and modify the memory of the trauma in a way that makes it less distressing

Furthermore, it can reduce, or eliminate, any feelings of self-blame the individual may have in connection with their trauma.

THE TELESCOPE TECHNIQUE :

The telescope technique is sometimes used to help individuals recover from PTSD : under hypnosis,  the client is instructed to imagine ‘viewing’ his/her trauma through the wrong end of a telescope – using this mental image, the client is told s/he can increase the length of the telescope to make the trauma ‘look’ yet more distant and tiny. The client practises this technique, and variations of it, throughout several hypnotherapy sessions. Eventually, s/he will be able to apply the technique at will without the assistance of the hypnotherapist. Whilst the technique may sound a little facile, many have found such a technique, or techniques similar to it, can be highly effective at reducing feelings of anxiety and distress connected to the trauma.

RETURN HOME TO ABOUT CHILDHOOD TRAUMA RECOVERY

 

David Hosier BSc Hons; MSc; PGDE(FAHE)

Ego State Therapy For Treatment Of CPTSD

ego states therapy

EGO STATE THERAPY is an approach to treating complex posttraumatic stress disorder (cPTSD) and is sometimes referred to as ‘parts work.’

In particular, this therapy is designed to help treat symptoms of CPTSD which come under the headings of :

  • avoidance symptoms
  • intrusive symptoms
  • depressive symptoms

Let’s briefly look at each of these three types of symptoms :

AVOIDANCE SYMPTOMS :

These include avoiding places, people, events and situations which remind one of one’s past trauma. However, individuals often employ psychological defenses (usually unconsciously) as a way of avoiding accepting the reality of their childhood traumatic experiences; these psychological defenses include :

Finally, people who have suffered traumatic childhoods may use dysfunctional coping strategies to avoid their emotional pain which, in turn, can lead to addictions such as :

  • addiction to alcohol
  • addiction to drugs (both illegal and prescribed such as sleeping tablets and tranquilizers)
  • addiction to gambling
  • sex addiction
  • comfort food / carbohydrate addiction
  • excessive exercise
  • addiction to self-cutting / self-harm with short-term effect of relieving unbearable stress/anxiety

INTRUSIVE SYMPTOMS :

These include nightmares, flashbacks, hypervigilance, anxiety, feelings of aggression and irritablity ; such symptoms can also be categorized as high-arousal symptoms.

DEPRESSIVE SYMPTOMS :

These include despair, shame, inadequacy, unworthiness, hopelessness, helplessness and a sense of being trapped in a tormenting frame of mind, with no escape route (this is sometimes referred to as ‘learned helplessness.’
Feeling one has no hope is a particularly invidious symptom as it is known that feelings of hope, even when highly distressed over long periods, lowers the probability of suicide attempts; logically, therefore, the opposite holds true.

Depressive symptoms can also be categorized as low-arousal symptoms.

‘PARTS’ WORK :

Ego states theory involves a technique known as parts work.

Parts work is based upon the theory that as a psychological defense we unconsciously ‘compartmentalize’ different aspects of our personalities to enable us to ‘mentally partition-off’ the ‘parts’ of ourselves that we find unacceptable, and/or that contain intolerable memories, from the more acceptable ‘parts’ of ourselves that allow (at least a semblance of) day-to-day functioning.

These ‘parts’, or ego states, that hold we find unacceptable and/or hold distressing memories frequently reflect earlier developmental phases in our lives that occurred during our traumatic childhood and that are therefore related to traumatic memories.

How Can These Parts That Reflect Earlier Developmental Phases Manifest Themselves Now We Are Adults?

These parts may manifest themselves when we are under stress in the form of regressive behaviors.

For example, under extreme stress we may display child-like tantrums or behave in an aggressive, rebellious manner like that of a young teenager. Or, when upset, we may curl up on our beds clutching a soft toy.

Internalized Parts :

We may, too, possess ‘parts’ of ourselves that we have internalized from emotionally significant others (usually parents or primary-carers) during our childhood.

For example, if we had a parent who was highly critical of us when we were children, we may find we are prone to judging ourselves with a very unforgiving and self-lacerating attitude, constantly feeling that we failed to meet the exacting standards that we’ve set ourselves.

Or, if we had a parent / primary-carer who was highly religious and regarded us as fundamentally flawed and sinful, we may, as adults, find ourselves tormented by fears of ‘eternal damnation’.

INTERNAL FAMILY SYSTEMS (IFS) THERAPY:

IFS therapy is perhaps the most well known therapy to incorporate ‘parts work.’ It is based on the idea that the individual has three types of parts; these are as follows :

  • Exile parts
  • Manager parts
  • Firefighter parts

ego state therapy

Let’s briefly look at each of these in turn :

EXILE PARTS :

As the name suggests, these are the parts of ourselves that developed as a result of the damage done to our personalities by our childhood trauma and which we largely keep banished and cut off from conscious awareness / repressed / suppressed.

The exile parts are kept closed off from conscious awareness as a means of psychological self-protection as these parts contain distressing memories and painful emotions such as neediness/dependency, intense anger, grief, fear, shame, loneliness and vulnerability.

MANAGER PARTS :

These are the parts of ourselves that try to keep us in control and allow us to function on a day-to-day basis and keep extreme/distressing/counterproductive emotions at bay. Frequently, too, these parts are extremely self-critical.

FIREFIGHTER PARTS :

These parts attempt to protect us from the emotional pain the comes upon us when our exile parts start to break through and impinge upon our consciousness and behavior (as may happen,for instance, during periods of intense stress and/or when we are reminded – either consciously or unconsciously – of our childhood trauma).

However, they do this by causing us to behave in impulsive, and, in the long-term, self-destructive ways such as excessive drinking, abuse of narcotics, workaholism, risky, promiscuous sex, gambling and overeating.

Link :

To learn more about IFS therapy and how it works, click here.

EBook:

CPTSD ebook

Above eBook now available on Amazon for instant download. Click here.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

How to Cope with Difficult Memories, Part One.

intrusive_memories

https://childhoodtraumarecovery.com/2013/04/20/exciting-early-research-findings-on-the-medication-propranolol-a-beta-blocker-effectiveness-of-treating-symptoms-of-trauma/

In a previous post, I wrote about traumatic memories and talked about how psychologists have divided them into two types:

1) Flashbacks
2) Intrusive memories

Such memories can be very painful and emotionally distressing, and, according to Ehlers et al. (2010), three main factors need to be considered when aiming to eliminate, or, at least, reduce the negative impact of, these kinds of memory. They identified the three factors as follows :

  1. Becoming aware of what is triggering the memories
  2. Understanding how the individual is interpreting the memories
  3. Identifying and understanding behavioral and cognitive responses to the memories

With this in mind, let’s look at strategies which we can implement to help manage our problem memories:

1) Flashbacks: strategies which are helpful in managing them:

There are three main ways which can help us to achieve this:

a) PLANNED AVOIDANCE
b) ‘GROUNDING’ TECHNIQUES (which act as DISTRACTORS)
c) THOROUGH REVIEW OF THE FLASHBACK (this technique is connected to the psychological technique known as DESENSITISATION – by repeatedly exposing oneself to the feared object, or, in this case, memory, gradually weakens its negative psychological impact)

intrusive_memories

PLANNED AVOIDANCE: this technique involves avoiding TRIGGERS that, by experience, we know trigger our traumatic memories. This can provide valuable ‘breathing space’ until we feel ready to try to process and make sense of our memories, usually with the help of a psychotherapist. In order to use this technique, it is necessary, of course, to, first, spend some time thinking about what our personal triggers are.

GROUNDING TECHNIQUES: this technique is based upon DISTRACTION; the rationale behind it is that it is impossible to focus on two different things at the same time. So, the idea of the technique is to strongly focus on something neutral, or, better still, something pleasant – the brain, when we do this, will be unable to focus on the memory which was giving rise to distress and emotional pain.

It does not really matter what we choose to focus on in order to distract us – it might even be, say, the chair in which we sit: what is its colour, its shape, its texture and feel to the touch, the material from which it is made…etc…etc..? I know this sounds rather silly, but, if we concentrate on it like this for a while, almost as if we were carrying out a forensic examination (think Poirot or Sherlock Holmes), it can act as a powerful, temporary distractor when we feel, potentially, we could be overwhelmed by our thoughts and memories.

We can implement the grounding technique by using what are known as ‘GROUNDING OBJECTS’ – this term refers to physical objects (ideally, easily transportable, so, a full sized model of, say, Stompy the Elephant, for instance, might not be such a great idea). But, seriously, it could be something as simple as a shell from the sea-side – it can really be anything, just so long as it evokes a feeling of safety and comfort. When feeling distressed, the object can be held and looked at with the intense focus referred to above in the description of the grounding technique. Also, as Proust helpfully pointed out, aromas can be very evocative – something relaxing such as lavender could be used.

As well as using grounding objects, we can also use what are known as ‘GROUNDING IMAGES’. This involves thinking of a place in which we feel safe, secure and comforted. It is a good idea to make the image as intense and detailed as possible (although people’s ability to visualize varies considerably – I’m hopeless at visualizing). If you are able to visualize it in such a way as to allow you to mentally interact with it (e.g. imagine walking around in the location you are imagining) so much the better. To get to the safe imaginary place in your mind, it is also useful to have what is known as a ‘LINKING IMAGE’; again, as this is an imaginary way of linking (getting) to the ‘location’ it can be anything; for example, when feeling distressed, you could imagine yourself ‘floating away’ to your ‘safe place’. Once mentally ‘located’ in the safe place, it is again helpful to imagine then ‘place’ as intensely as possible, using our old friend the GROUNDING TECHNIQUE, so that it almost feels you are really there, where NOTHING CAN HARM YOU.

It is also possible to employ the assistance of what are referred to as “GROUNDING PHRASES‘. These can be very simple, such as “I am strong enough to deal with this, I always get through it’, or, even more simply, ‘I’m OK’. We can try to bring these phrases to mind and repeat them to ourselves when we are feeling distressed.

There is even a technique known as ‘GROUNDING POSITIONS’. This, very simply, refers to altering our body’s position to produce a psychological benefit; for some, this might be standing up straight with shoulders back to produce a feeling of greater confidence; for others it might be curling up in bed in embryo position to produce a feeling of greater safety and security. Such techniques, whilst, possibly, sounding vaguely silly, can be surprisingly effective.

I will continue looking at how we can help ourselves cope with difficult memories in part TWO, starting with ‘c’ above: a THOROUGH REVIEW OF FLASHBACKS.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Family Therapy And Adolescent BPD Sufferers

family therapy and adolescent BPD

 


Borderline Personality Disorder In Adolescents :

I have written elsewhere about why some mental health clinicians are reluctant to diagnose borderline personality disorder (BPD) in adolescents. However, when an adolescent is believed to be suffering from this extremely serious psychiatric condition, family therapy can be of potentially crucial importance.

What Is Family Therapy?

Quite simply, family therapy is a form of counseling that treats more than one member of the family in the same therapy sessions; this is predicated on the notion that the behavior of a specific individual within the family is intimately connected to how other family members interact with him/her. (Two related posts that I have previously published about this phenomenon are : ‘Did Your Dysfunctional Family Make You Identified Patient?’ and ‘The Dysfunctional Family’s Scapegoat’

How Does Family Therapy Help?

The aim of family therapy is to educate all its relevant members about :

  • how family dynamics influence and maintain the behaviors of individuals within it
  • communication within the family
  • how adaptive (desirable) behaviors can be reinforced
  • ways in which the family can collaborate (work together) to solve problems within the family

It is often the case that, prior to such therapeutic intervention, the adolescent, due to his/her acting out‘, was seen (by the other members of the family) as the source of the family problems but, as the therapy sessions unfold, it becomes apparent that, in fact, the collective dysfunction of the whole family is at the root of the issue.

It is also not infrequently the case that through the process of family therapy it is revealed that other members of the family, too, have serious psychological conditions which need addressing (e.g. many adolescent sufferers of BPD will have a parent with the same condition or a similar personality disorder such as narcissistic personality disorder). When this found to be the case, such parents can also be helped (assuming they are willing) by the therapist which can, in turn, help them to relate to their family in a healthier way, hopefully culminating in a less dysfunctional relationship between them and their adolescent child.

Another very important aspect of family therapy is the therapist’s close observation of non-verbal communication between the parents and the adolescent (e.g. body language, facial expressions, intonation etc). By carrying out such observations, the therapist can point out to the family when such non-verbal signals may be less than helpful.

Family therapy can also include group training in parenting skills which can provide parents with :

  • emotional support
  • advice on how to create less dysfunctional family environments
  • how to set their children good examples / be good role models
  • how to reinforce their child’s positive behaviors

RESOURCES :

Enhance Parenting Skills – click here for further information.

Couples Therapy – click here for further information

eBook :

adolescent borderline personality disorder

Above eBook now available on Amazon for intant download. Click here for further details or to view other titles.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Childhood Trauma : Coping with Rejection.

childhood-trauma-fact-sheet

 

‘We are never so defenceless against suffering as when we love, never so unhelplessly unhappy as when we have lost our loved object or its love’

Sigmund Freud, 1856 – 1939

My mother threw me out of the house when I was thirteen years old, so it was necessary for me to go and live with my emotionally aloof father and religious fundamentalist step-mother (she was prone to shout at me in ‘tongues’). Later in my adolescence, she manipulated my father into throwing me out of the house, too. The irony was that my step-mother had founded and ran a charity for the homeless, called Watford New Hope Trust, which still exists today. The irony seemed to be completely lost on her, however.

If we find we have relationship difficulties in adult life, frequently this can be traced back to the kind of childhood trauma I describe above. As a result of these difficulties, we may find that we perpetually repeat meeting with rejection in our adult relationships,  mirroring the rejection we experienced in childhood.

Being rejected, for most of us, is a deeply painful experience, and, at the extreme end of the scale, can lead to suicide.

One reason why the pain of rejection can be so acute is that it reawakens the feelings of profound distress we experienced due to the rejection we suffered in childhood.

OUR EMOTIONAL RESPONSE TO REJECTION :

The kinds of emotional response being rejected by someone important to us entail include :

a) grief

b) anger (e.g. ‘why has this person hurt me so badly?’)

c) depression

d) fear (e.g. of future loneliness or of having to cope without the person’s emotional support).

e) hate (linked to anger, above, but can also involve self-hatred due to the lowering of own self-esteem in the face of having been rejected).

THE DIFFERENT WAYS IN WHICH REJECTION MAY OCCUR :

One important form of rejection can be termed ‘self-rejection.’ This kind of rejection has its roots in us having been rejected as children. Examples of such rejection may include :

– having a parent walking out on us,

– having a narcissistic mother (click here to read my post on this) who was too self-involved to meet the emotional needs of her children

– having an emotionally distant and aloof father

– having an alcoholic parent who consequently neglects us emotionally

– losing a parent through suicide

NB If the child has someone else in their life who provides a lot of love and affection the effects of the kinds of losses outlined above may be mitigated.

If, due to such early experiences of loss and rejection, we do indeed become self-rejecting, it can take the form self-damaging behaviour that makes us unattractive to others. Examples include : over-eating to the point of obesity, not bothering about personal hygiene, substance misuse,  wearing deliberately unflattering clothes, or behaving in such a way that it makes it highly probable we will drive others away. Such self-rejection usually operates on an unconscious level.

CHILDHOOD REJECTION LEADING TO THE REPETITION COMPULSION :

If we have experienced a significant rejection in childhood by one of our primary caregivers and were unable to make sense of it, mentally process it or come to terms with it we may develop, on an unconscious level, a deep-rooted psychological need to perpetually repeat the experience of rejection. The compulsion to repeat the experience will tend to continue until we become consciously aware of what it is we are doing. This can mean, as adults, a pattern is developed in which we unconsciously seek out relationships with those who are bound to reject us, just as we were rejected as children. 

For example :

– a gay man may try to establish a relationship with a straight man

– we may behave in such ways that we ensure our partner rejects (making impossible demands, extreme possessiveness etc) us

– we may form relationships with people who emotionally or physically mistreat us and who show little, if any, affection

Of course, there are many other ways we might put ourselves into the position whereby we will drive others to reject us ; however, underlying them all is a desperate attempt to come to terms with the primary, childhood loss. By re-experiencing it, we unconsciously hope to master it.

HOW DO WE BREAK OUT OF THE CYCLE OF REPETITION COMPULSION?

Psychologists have identified the following steps as being necessary in order for us to break out of the cycle of repetition compulsion :

1) the acknowledgement that we are stuck in a pattern of behaviour whereby we have been ‘courting rejection.’

2) the acknowledgement that we have been behaving in this way, up until now, due to the profound pain we have been caused by our childhood rejection (and of which, up until now, we may well not have been fully aware).

3) making a definite decision to try to alter our behaviour in such a way that the likelihood of further rejection is minimized (whilst accepting nobody can completely eliminate the possibility of meeting with rejection in life and therefore being prepared to take some level of risk with future relationships)

4) a concerted effort (ideally through therapy) to come to terms with, and fully mentally process, the original childhood loss

5) we need to come to terms with the realization that our future behaviour need not be dictated by our past experiences and that we are capable of making a proactive decision to stop self-sabotaging.

RELATED ARTICLE : THE LONG-TERM EFFECTS OF PARENTAL REJECTION

RESOURCE :

Dealing With Rejection | Self Hypnosis Downloads

David Hosier BSc Hons; MSc; PGDE (FAHE).

Prolonged Exposure Therapy And Posttraumatic Stress Disorder (PTSD)

Major symptom of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD)click here to read about the difference between these two conditions – are fear, anxiety and even terror induced by :

– situations related to the traumatic experience

– people related to the traumatic experience

– places related to the traumatic experience

– activities related to the traumatic experience

Prolonged Exposure Therapy Involves Two Specific Types Of Exposure To Trauma-Related Phenomena :

a) In Vivo Exposure

b) Imaginal Exposure

In Vivo Exposure :

Prolonged exposure therapy works by encouraging the individual with PTSD / cPTSD, in a supportive manner, very gradually, to confront these situations / people / places / activities whilst, at the same time, feeling safe, secure and calm. Because this part of the therapy involves exposure to ‘real life’ situations / people / places / activities it is called in vivo exposure.

This is so important because avoiding these situations / people / places / activities, whilst reducing the individual’s anxiety in the short-term, in the longer-term simply perpetuates, and, potentially, intensifies, his/her fear of these things.

Imaginal Exposure:

The therapy also involves the PTSD / cPTSD sufferer talking over details and memories of the traumatic experience in a safe environment and whilst in a relaxed frame of mind (the therapist can help to induce a relaxed frame of mind by teaching the patient/client breathing exercises and/or physical relaxation techniques; hypnosis can also be used to help induce a state of relaxation). Because this part of the therapy ‘only’ involves mental exposure to the trauma (i.e. thinking about it in one’s mind), it is called imaginal exposure and can help alleviate intense emotions connected to the original trauma (e.g. fear and anger).

Both in vivo and imaginal exposure to the trauma-related stimuli are forms of desensitizing and habituating the patient / client to them, thus reducing his/her symptoms of PTSD / cPTSD.

How Effective Is Prolonged Exposure Therapy?

Prolonged exposure therapy is a type of cognitive behavioural therapy (CBT) and research into the treatment of PTSD suggests it is the most effective treatment currently available.

What Is The Duration Of The Treatment?

The length of time a patient / client spends in treatment varies in accordance with his/her needs and his/her therapist’s particular approach. However, the usual duration of the treatment is between two and four months, comprising weekly sessions of approximately ninety minutes each.

On top of this, the patient / client will need to undertake some therapeutic exercises/activities in his/her own time, set by the therapist as ‘ homework assignments’. These assignments will include listening to recordings of imaginal exposure therapy sessions.

RESOURCES :

The National Center For PTSD has developed a PROLONGED EXPOSURE APP, or PE APP. Click here for further information and download instructions.

eBook :

 

Above eBook now available from Amazon for instant download. Other titles available. Click here for further information.
 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

Rational Emotive Behavior Therapy (REBT).

rational emotive behavior therapy

rational emotive behavior therapy

Rational Emotive Behavior Therapy :

People are disturbed not by things, but by their view of things.

-Epictetus

REBT emphasizes that the key to emotional health, even in the face of life’s adversities, is RATIONAL THINKING. In the context of REBT, it is useful to consider the reasons the 4 words: RATIONAL, EMOTIVE, BEHAVIOUR and THERAPY have been used to make up the name:

1) RATIONAL – REBT stresses that irrational thinking leads to emotional problems. Irrational thinking, in the context of the therapy, has the following characteristics: it is rigid, it is extreme, it is false and it is unconstructive. Rational thinking, on the other hand is seen to be flexible, true, non-extreme and constructive.

Irrational thinking tends to lead to unhelpful emotional responses such as anxiety, which, in turn, lead to unhelpful behaviours.

2) EMOTIVE – in this context, the word ’emotive’ means ‘relevant to emotions’. REBT is concerned with reducing feelings of emotional distress, but, importantly, it also recognizes the fact that, in life, people will, inevitably, experience NEGATIVE FEELINGS WHEN FACED WITH ADVERSITY, BUT THESE NEED NOT BE UNHEALTHY.

REBT sees NEGATIVE EMOTIONS AS BEING SPLIT INTO TWO DISTINCT CATEGORIES:

i) UNHEALTHY NEGATIVE EMOTIONS (UNEs)

ii) HEALTHY NEGATIVE EMOTIONS (HNEs)

The theory states that UNEs we experience as a reaction to adversity are a result of IRRATIONAL BELIEFS ABOUT OURSELVES, OTHERS and THE WORLD IN GENERAL. We need to change our irrational beliefs to rational ones so that we may experience HNEs rather than UNEs. The theory incorporates the ABC model to help illustrate this. In the ABC model A,B and C stand for the following:

A : Adversity

B : Beliefs

c : Consequences of beliefs (eg emotions)

Let’s consider, with this model in mind, the following scenario :

First, an adverse event occurs (A) – a colleague at work snaps at you

this leads to you having a belief (B). The belief (B) may be IRRATIONAL or RATIONAL. Let’s look at examples of both:

(B) IRRATIONAL : ‘It is imperative that my work colleague likes me’

or

(B) RATIONAL : ‘I would prefer it if my work colleague liked me, but it is not a catastrophe if she does not.’

These opposing two responses then give rise to commensurate emotional responses:

(B) IRRATIONAL leads to UNEs eg Anxiety

and

(B) RATIONAL leads to HNEs eg Concern (the emotion of concern, whilst a negative emotion, is also a healthy one).

In order to illustrate further how negative emotions can be both healthy and unhealthy, below are two lists. The left hand column is a list of unhealthy negative emotions (UNEs), whilst the list on the right gives the healthy negative emotion equivalents (HNEs):

UNEs — HNEs

ANXIETY — CONCERN

DEPRESSION — SADNESS

GUILT — REMORSE

SHAME — DISAPPOINTMENT

HURT — SORROW

 

INTELLECTUAL VERSUS EMOTIVE UNDERSTANDING : it has already been stated that REBT views irrational beliefs as rigid, false, not sensible and non-constructive. The example given of an irrational belief was ; ‘it is imperative that my work colleague likes me’ whereas the rational response would be : ‘it would be nice if my work colleague liked me but it is not a catastrophe if she does not.’ REBT states that we need to understand ON AN INTELLECTUAL LEVEL that the second response is the rational one but that this INTELLECTUAL UNDERSTANDING is not sufficient on its own.

rational emotive behavior therapy

 

Above : A diagrammatic representation of the mental process encouraged by REBT.

If we only understood intellectually, our ‘head would understand but our heart wouldn’t’ – this would mean we would not FEEL any different : we would still have a UNE (ie anxiety), consistent with an IRRATIONAL BELIEF. So, REBT emphasizes that our understanding that the rational belief is the correct one needs to be not only INTELLECTUAL, BUT ALSO EMOTIVE. Only then can we feel, think and act in a way that is consistent with the rational belief (ie in a CONCERNED rather than ANXIOUS manner).

3) BEHAVIOR : REBT states that IRRATIONAL BELIEFS lead to NON-CONSTRUCTIVE BEHAVIOR whereas RATIONAL BELIEFS lead to CONSTRUCTIVE BEHAVIOR. In our example about the work colleague, this idea might be illustrated by the irrational belief leading us to AVOID our work colleague whereas the rational belief might lead us to approach her assertively and talk the problem through calmly and maturely.

Below are examples of how UNEs can lead to unhelpful behavior whilst HNEs can lead to helpful behavior:

UNE – DEPRESSION leading to withdrawal from enjoyable activities/EQUIVALENT HNE – SADNESS leading to participation in enjoyable activities after period of adjustment

UNE – GUILT leading to begging for forgiveness/EQUIVALENT HNE – REMORSE leading to asking for forgiveness

UNE – SHAME leading to withdrawal from others/EQUIVALENT HNE – DISAPPOINTMENT leading to contact with others and talking things over

UNE – HURT leading to sulking/EQUIVALENT HNE – SORROW leading to assertiveness and communicating with others.

4) THERAPY – in order to get the most out of REBT it is necessary to first address one’s maladaptive (unhelpful) responses to life’s adversities BEFORE dealing with the practical side of the actual problems. The rationale behind this is that otherwise the unhelpful responses will impede the individual’s ability to deal with the particular adversities in an effective way.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

Somatic Experiencing Therapy : Healing The Dysfunctional Nervous System

somatic experiencing

Dr Peter Levine’s somatic experiencing therapy is predicated upon idea that the disturbing symptoms of PTSD are substantially caused by the adverse effect our traumatic experiences have had on the way our body and nervous system works.

In essence, Levine contends that if we are suffering from PTSD it means we have become stuck’ in the fight/flight/freeze response.

In order to understand this, consider how wild animals respond to danger; let’s use the example of a zebra :

If a zebra is stalked by a tiger, it will enter the flight/fight state and run away. Whilst running away, it is in the fight/flight state, meaning that it will be highly physiologically aroused (e.g. fast heart rate) in order to provide it with the energy to (hopefully) escape.

If it is lucky enough to escape to safety, the zebra’s level of physiological arousal will quickly return to normal because the immediate danger has passed.

In other words, the zebra only remains in fight/flight mode for a short period of time to deal with immediate danger.

Below – The Physiological Effects Of Being In Fight/Flight Mode :

somatic experiencing

Getting ‘Stuck’ In Fight/Flight/Freeze Mode :

However, in sharp contrast, individuals suffering from PTSD have, like the zebra had their fight/flight response triggered by their traumatic experience but, unlike the zebra, remain stuck in this state of heightened physiological arousal even though the danger has passed; it is this, according to Levine, that causes the distressing symptoms of PTSD.

The Root Cause Of The Symptoms Of Trauma : Trapped ‘Survival Energy’ :

Levine states that, in those suffering from PTSD, the initial great stress caused by our traumatic experience, whatever this may have been (including the complex, cumulative effects of childhood trauma such as emotional abuse) leads to the production of ‘survival energy’ which is not discharged once the traumatic experience is over but remains bound up and trapped in the body.

It is this trapped survival energy that, according to Levine, is at the root of the debilitating symptoms of traumas

The Need To Discharge The Trapped ‘Survival Energy.’

Levine suggests that discharging the trapped survival energy held in our bodies will allow our heightened physiological state and the operation of our nervous systems to return to normal and thus alleviate our symptoms of trauma.

Levine’s somatic experiencing therapy is designed to help us achieve this therapeutic discharge of survival energy.

In order to find out more about somatic experiencing therapy you may find the link provided here useful.

Resource :

   Complete Stress Management Pack. Click here for further information.
David Hosier BSc Hons; MSc; PGDE(FAHE)

 

 

 

 

 

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