I just finished reading Bessel van der Kolk’s The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. It’s an absolutely brilliant book, but since I don’t have a tremendous amount of free time to leisure read with all of my classwork, it’s taken me months to get through it. Still, I tried to open the e-book on my iPad during longer train rides to sneak a quick read and give my brain a break from school-related reading. I came across this passage recently, which seems incredibly relevant to the current struggles I’m having in therapy:

While human contact and attunement are the wellspring of physiological self-regulation, the promise of closeness often evokes fear of getting hurt, betrayed, and abandoned. Shame plays an important role in this: “You will find out how rotten and disgusting I am and dump me as soon as you really get to know me.” Unresolved trauma can take a terrible toll on relationships. If your heart is still broken because you were assaulted by someone you loved, you are likely to be preoccupied with not getting hurt again and fear opening up to someone new. In fact, you may unwittingly try to hurt them before they have a chance to hurt you.

This poses a real challenge for recovery. Once you recognize that posttraumatic reactions started off as efforts to save your life, you may gather the courage to face your inner music (or cacophony), but you will need help to do so. You have to find someone you can trust enough to accompany you, someone who can safely hold your feelings and help you listen to the painful messages from your emotional brain. You need a guide who is not afraid of your terror and who can contain your darkest rage, someone who can safeguard the wholeness of you while you explore the fragmented experiences that you had to keep a secret from yourself for so long. Most traumatized individuals need an anchor and a great deal of coaching to do this work.

I sort of just want to bring this excerpt into session with me and say,
“THIS! Can you do THIS?!”

Termination & Ethics, part 2

Last week I posted about the NASW’s ethical guidelines for Social Workers, particularly in regards to termination practices.

4113548Since then, I’ve been reading Treating Complex Traumatic Stress Disorders, by Christine A. Courtois and Julian D. Ford. Chapter 4, entitled “Best Practices in Psychotherapy for Adults”, outlines the best evidence-based practices for helping patients with C-PTSD and related disorders. They essentially highlight the same 3-phase model that Zooey’s DID “expert” supervisor advised her to use and that many trauma specialists accept as the best approach for trauma. I read the “expert”‘s book as well and I liked the model, so Zooey and I agreed to try that. It is also very similar to how they approach treatment in the residential trauma program I attended in the Fall. I’ll write more about that treatment and the phases in future posts, but here’s a basic rundown:

  • PHASE 1: Safety and Stabilization
  • PHASE 2: The Processing of Traumatic Memories
  • PHASE 3: Reintegration

My understanding is that the idea is to get the patient stable and in a safe place so that they are able to engage with their traumatic memories without resorting and/or regressing to unsafe/destructive coping skills. Then, once the memories have been processed, phase 3 is essentially a culmination of the previous two phases. The client is able to use their new skills and information to analyze themselves and move beyond the effects of abuse. Or something like that.

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