A Few Points Regarding Trauma and Free Will

It is important to observe how such a characteristic can be developed even when trauma has been present. Several clients come into our offices talking about their individual traumas and how they have made things difficult for them. They also talk about how it has affected their relationship with the perpetrator(s), other close people, the community, and God. Many of them have guilt and blame themselves and/or hold severe grudges and harbor anger and hate towards the perpetrators. At times they question why life has been more difficult for them than for others and how they were dealt such a poor hand. The following is going to be more of an explanation based on psychology and spirituality in hopes to answer some of the above questions.
Traumatized clients’ relationships change and function on a level that deviates from the norm. Much of that is due to the trust that has been broken time and time again. According to Maslow’s hierarchy of needs, their level of safety, love, and esteem have not been established or maintained. Therefore, their ability to self-actualize (Maslow’s hierarchy) is not possible. The only level that is actually, at times, maintained is their physiological needs (i.e. food, water, shelter, etc.), though that is questionable with neglected children/childhood as well. On the level of safety, an individual must feel comfortable and secure in their environment with minimal attack on their physical, mental, emotional, and spiritual self. If attacked, their capacity for moving to the higher hierarchical needs is diminished. They may struggle with giving and receiving love or having esteem for themselves and others. Thus, can be a large factor with esteem. When a client has been traumatized time and time again they begin to lose trust with initially the perpetrator, and then it can spread to others who are close to them, the community, and to God (depending on their beliefs). Recently, a client (whose name we’ll call Matthew) disclosed horrific traumas from his childhood. Much of it involved abuse and neglect from his family and a large part involved a neighbor who befriended then molested him time and time again. He did not trust his family for help so endured the continued abuse. He described other economic difficulties, physical health problems, and general loneliness. He asked why it is that he was given a difficult life. He felt that it must have been something he did to deserve the pain and suffering without much respite. To try to escape the pain he had attempted suicide many times, though without success. When asking why he had to suffer I explained something to him, that I hope will help others. First and foremost, everyone has the right to act (free will). Anyone can do what they want. Whether they are conscious of the results depends on each individual. Some people, however, have made the choices to act against others in a way that is harmful, degrading, and usually self-serving. Such acts can be considered abusive, because it is in an attempt to remove or negate another’s free will and control them or change their acts. Such self-serving acts do not serve the victim (the receiver of the self-serving acts) in any positive ways. It can change the victim’s life perspective (specifically on relationships) and attacks their general need for safety (Maslow’s hierarchy). Therefore, the abuser (the one who acts self-servingly) is responsible for their acts and how it affected the victim. Responsibility lies solely with them and none other, especially the victim. Therefore, the victim is not the guilty party. The guilty party in the technical sense is only the abuser. Guilty signifies “1 : justly chargeable with or responsible for a usually grave breach of conduct or a crime. 2 obsolete : justly liable to or deserving of a penalty” according to the Merriam-Webster online dictionary. Therefore, it is not possible for the victim to be guilty for the self-serving act when they were the individual being acted upon rather than acting. Matthew blamed himself as that was the only logical reason he could come up with. Why else would it happen if there wasn’t something so terribly wrong with him or his character–something innate that called to abusers “Here I am! Hurt me! That’s what I’m here for!” The truth of the matter is that each person can act in whichever way that they please, selflessly or selfishly.
That brings us to the next point that Matthew brought up, which is also a point other clients have made regarding God. If God was a merciful and a just God, how is it that he could let such terrible things happen to undeserving people and let the abusers go unpunished? At that point one can revert back to free will. If free will is truly something that exists, an ability given to all to act; and God is God–all powerful and all knowing with the ability to do what He wants, would he not allow the individual to exercise their free will “according to the dictates of their own conscience?” Any other way would be tyrannical, dictatorial and contraindicative of what free will is.
The power of free will is that many can exercise it in a way achieve Maslow’s highest achievement which is self-actualization. In spite of the difficulties one has faced, or the traumas caused, one can utilize and strengthen their ability to act to achieve safety and overcome the trauma–thus developing resiliency.

Teenagers...

I received a few responses on my teenager problem/question. All of them were from separate people, and none of them knew about the others. The irony is that the responses were nearly the same. One indicated that it is a maturity thing--their brain has not yet developed to the point where egocentric thought is no longer present. Another said that it is an agency issue--they have to choose it. They have to want the change to occur. That makes perfect sense. Therefore, the only logical choice to helping teenagers means to be doing activities or interventions at their level--to kill boredom. Activities that are thought and emotion provoking. Experiential and recreation therapies do such that. Our clinic needs to add that to the therapeutic repertoire. It is a style that is not yet used. I'll work on it.

Treatment For The Homeless

Dr. Rob Bagley from the Trauma Awareness and Treatment Center (where I work) was interviewed by KSL Channel 5 last night and the story of the treatment we do with the homeless was aired on the 10 o'clock news. Here is a link for the story...

http://www.ksl.com/?nid=148&sid=1062420

More on teenage boredom...

I haven't received any responses from my many readers. Here is a great link on teenage boredom.

http://www.cbsnews.com/stories/2002/09/04/national/main520718.shtml

A question for anybody who cares...

What drives a teenager to seek only activities that bring immediate gratification rather than activities that require delayed gratification??? This is bothering me a lot with some kids. Let's see how many people read this thing.

Piaget and Erickson were on to something...

I had a "well-duh!" moment today while working. I received permission from this individual to use their ideas in my blog. We were discussing childhood development and the stages that were developed by such professionals as Piaget and Erickson. I personally am more apt to pay attention to Erickson's explanation of human development. If you are interested in reviewing it, Wikipedia has a helpful overview at http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development
Check it out and it might help understand my psychobabble. The first stage occurs during the first year of a child's life and is "trust vs. mistrust." For anyone who has read my earlier blogs on safety, trust vs. mistrust is highly correlated with a sense of personal safety. A child must have the ability to feel safe in their environment which is created and maintained by their caretaker. If the caretaker provides for the basic emotional, mental, physical, and developmental needs the child will develop trust and move on to the next stages of development. While softly touching upon this stage, this individual indicated that she realized that a child usually knows where to go for comfort. If the child gets hurt he/she can run to their caregiver in pain and have the pain resolved and feel safe and peaceful once again. They learn how to develop the capacity to release the emotional or even physical burdens through trust and care by their parent/caregiver. If a child's caregiver does not give that reassurance, nurturing or love, the child's development will be stunted. For example, if the child runs to their parent/caregiver in tears complaining of an "owie" and the caregiver says something to the effect of, "stop bawling, or I'll give you a real reason to cry..." they are taught to suppress the pain and are put on a heightened state of alarm or fear when it comes to experiencing personal pain due to the negative reinforcement by their caretaker. Not only is this abuse, but it is also neglect. Abuse, to me is a type of negative reinforcer that is forced upon an individual against their will causing damage. Neglect is similar, however, it involves withholding a reinforcer that is necessary for the developmental survival of the individual. It is something that didn't happen that should have. Now, some cognitive behavioral theorists may say, "well, every individual has the ability to choose how to feel by thinking differently and addressing their cognitive distortions, changing their irrational belief system, or modifying their cognitive schema...then, the negative feelings will change." I agree with them, but it seems that there is a piece missing. If a client does not have the capacity to "reprocess" the abuse or neglect (the actual pain it caused) how can thinking about it differently cause it to go away? If in a situation where trust is required the client who has been trained in cognitive therapy can certainly think their way through the situation...but, what about the correlation that the current situation has with past abuse or neglect situations? What about the pain that is still present and surfaces during a trigger moment that doesn't seem to dissipate even when trying to rationalize through it? I am not supposing that cognitive behavioral therapies are not effective. There is sufficient research evidence that supports its efficacy. However, they are not effective alone in these types of situations (which are the situations in which I work every day). Other interventions are necessary that are non-traditional and focus on pain resolution, developmental restructuring, augmented by cognitive approaches. Not one approach, but all that are necessary to meet each client's specific needs.

Thoughts on Social Development...

Here's something to stew over in your mind. I was reading again in "A Psychology of Human Strengths" edited by Aspinwall and Staudinger. On page 39-41 roughly it begins talking about the importance of relationships to human beings and how evidence suggests that attachment with children begin in the last half of their first year of life. Also, that the relationships that adults seek romantically or with others function in ways that are common to that which they had with their caregivers. My question is this...what happens if a child is not given the opportunity to create that attachment and relationship? What will it do to their development and ability to create a bond. Part of my question was quickly answered. I will quote their quote of Siegel (1999) who "argued that infant's early social relationships 'have a direct effect on the development of the domains of mental functioning that serve as our conceptual anchor points: memory, narrative, emotion, representations, and states of mind' (p. 63 of Siegel); (p. 40 of Aspinwall and Staudinger). The editors go on to state that research shows that even slight deprivations in social relationships and contacts "results in abnormal neuroanatomical structures and impaired endocrinological sensitivity associated with stress" (p. 40). They also indicated one study that supported the same findings.
Now, the question is posed. If human beings must have social contact in order to create the positive neurological and endocrinological structures, what happens to a person who did not have those opportunities or was denied them in one way or another? The studies say that their actual brain structure and chemistry does not make the neurological connections that are necessary. Would such a person be able to meet others' needs if their needs were never met? What if they had children? Would they try to meet their own neglected needs through their children, thus continuing the cycle? My guess is...NO! Simply, because I have seen it go either way through personal and professional experience. Much of the differences had to do, I believe, with the individual's exercise of will and desire, as well as their willingness to look at possible deficits that they may have. What do you think?

On the weekend getaway....

Returning to past trauma definitions...I wonder if trauma could be considered sleeping in in a three man tent with a friend next to me that is comfortably snoring the night away while my extremities continue to lose any sensation due to the ever increasing freezing sensation and the steady drop in temperature. If it is trauma, then I'm a survivor.
I went camping over the weekend with my neighbor in the Oquirrh mountains in Ophir Canyon. Ophir is a quaint town, remnant of a past mining boom in the late 1800's. It's a beautiful canyon with a population of...well, I'm not sure it's been established.
We got there late on Friday night. While I pitched the tent on the snow my neighbor built a warm fire. We enjoyed tinfoil dinners as we huddled over the dying embers. Upon retiring to our tent, he was snoring within 15 minutes. I made the grave mistake in bringing a cot, thinking I might be comfortable. To my dismay, it was my undoing. The cold air circulated underneath me all night. I slept maybe an hour. Upon reaching the hour of 5:20 a.m. I finally woke up my slumbering friend and told him of my predicament. His first comment, to my utter surprise was, "Dude, we're not spooning." We then got into his Tahoe and stayed there for the next two hours warming up with the car heater and seat heaters (a must for a car I think). After getting another hour of sleep or so we made breakfast, broke camp, and took off for a hiking adventure. We hiked a little under two miles, yet climbed 600-700 feet in elevation. The sights were breathtaking, and so was the exercise. All in all, it was a good weekend getaway. For pictures and more comments of the excursion, click on this link. It will take you to Jason Hall's blog. http://halls.lug-nut.com/gallery/jayce/Camping/Oquirrh-2-07/

Secondary Trauma

As many have noticed from the news, there was a severe tragedy occurred yesterday at Trolley Square in Salt Lake City, UT. An armed gunman opened fire killing five people and injuring more. I heard on the radio that four or five that were injured were in stable condition, although they were watching them heavily in the ICU. Our hearts go out to them and their families and friends. Our hearts also go out to those that witnessed the atrocity, or were involved in any way. It is possible that they will suffer from secondary trauma. Primary trauma occurs when an individual is the actual victim or experiences personally the trauma. Secondary trauma occurs to a witness. Let's review what trauma means. Webster's online dictionary states: 1 a : an injury (as a wound) to living tissue caused by an extrinsic agent b : a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury c : an emotional upset.
Obviously the first definition is primary. The second and third can be either primary or secondary. the unfortunate aspect of secondary trauma is that it can have the same or similar psychological effects as the primary victims. Flashbacks, paranoia symptoms, fear, nightmares, high anxiety, avoidance behaviors, etc. It can happen with any trauma, but doesn't necessarily mean that it will.

Back In Action

After having taken a break from writing for a time I'm back in the saddle and ready to ride. Still working hard with many clients and even more paperwork. I have several clients who are beginning to improve and some that continue to struggle. The situations that bother me the most are those that are avoidant or resistant. They come in all ages and from all kinds of circumstances. The common characteristics is their resistance to change, or avoidance of addressing the core problems. These clients are simply not ready to be in counseling for themselves. Many times they are being forced by the courts, an upset parent/caregiver, or a loved-one to be in counseling. It goes against their free-will to be here, thus canceling the single greatest power for change--CHOICE. Some parents bring their children in who are acting out behaviorally and say "FIX THEM!" Usually, the problem is not one that can be fixed on an individual basis, but rather a family basis. It is usually the parents with the problem and the children are the symptom. At times it is the parents that are resistant to change, thus the children don't get any better. Or, due to behavioral modeling the children begin to follow in mom and dad's footsteps--forging a path of deviant behaviors. Deviant, meaning that it deviates from the norm and is self-destructive. I'm perplexed at how to address this population, because there are so many. I know that it is not possible to force my will on to them and make them change and see the light, so to speak. How can the avoidant and resistant clients change? With time, hopefully.

In This Corner We Have...2

This is a continued post from the last regarding determination and WILL. I will no longer use the term free-will as I do not see it as being free. If it were free then nobody would ever become a slave to an addiction. It seems that will comes with a price. That price is the ability to make positive and correct choices. If we make choices that are not in-line with continued self-actualization (see Maslow's Hierarchy or Carl Roger's explanations on self-actualization) we give up a small portion of out choice ability. Therefore, it is in our benefit to make those positive and growth promoting choices. I do not have an actual psychological algorithm that would ensure a constant positive outcome. Everyone has to do that on their own using their own value system and morals; but, that is not what this paper is about. Rather, I want to focus on choice and how one choice isn't actually one choice, but a series of smaller choices leading to a final choice.
Let's begin with personality. My thoughts on personality are fairly simple. Any individual who has raised more than one child knows that at birth each child is different than the other. Not only in appearance, but in their mannerisms, etc. Each child already begins with a unique and different personality. As the child grows it seems that many of those original characteristics stay, some become dormant and others are integrated into the personality schema. I will describe a personality schema as parts of a whole. A personality is made of small parts, roles, sections, etc. that when combined create the entire personality. If you look at a whole personality as a soccer ball then the parts and roles are the six-sided sections that are combined to make the ball. Only, in a personality the sections are three dimensional. Some common roles to personalities are: a person is an 1. individual; 2. a son/daughter; 3. a brother/sister (if not an only child); 4. a friend; 5. a student; to name a few. As a child grows their personality integrates new roles. Each role carries out a certain job or expectation. A student has different expectations than a policeman, for example. If we wanted to become even more complicated, we could take one role and break it down into smaller roles. The same senior high school student is not the same as they were in the first grade. Role definitions are changed, modified, and molded through experience, environment, culture, cognitive beliefs, personal choice, society, standards, morals, rules and regulations, etc. I am sure that we could add more to the variables that can influence personality structure, but it would become far too complicated and unnecessary at this time. However, another important aspect has to do with the strength of a role or part within the schema. It would make sense that the more a specific role was utilized and reinforced, the stronger it would be within the system. It would almost grow in size, strength, and authority within that schema. How is this important to choice and will? Let's suppose that will is simply an already integrated part or role within every person's personality schema. The ability to reason and choose is already there. What would happen if we did not exercise that role? It seems to me that it would atrophy. Just like my six-pack abs have weakened due to lack of exercise, overeating, and an affinity for Mountain Dew and carbohydrates, so can our strength to choose decrease if we do not exercise it. Why would someone wish to stop choosing? There are many reasons that I'm sure we could come up with; however, it comes down to small choices that lead to the larger choice of giving up one's will and becoming a victim of experience, environment, culture, society, standards, cognitive beliefs, etc. I do it. I know I do. I'm sure that you do it as well.
Now, I will discuss how a large choice comes from smaller choices. If someone makes the decision to do something that is detrimental to himself or others, it didn't happen all at once. For example: infidelity in marriage. A spouse that is unfaithful did not all of a sudden decide that he/she was going to be an adulterer. There were small choices beforehand. It starts with little thoughts such as "I wish my husband was home more often. He works so much" or "I wish my wife wouldn't spend so much time with her friends when I'm home. They're more important than me." Those kinds of thoughts may seem harmless. However, they can grow into judgments against a spouse. All the thoughts are CHOICES. We choose to think them and continue thinking them. We can choose to stop them as well. How? By becoming aware of what we do, think, and feel. A good gauge to begin changing it is by noticing how we feel in general or in certain situations. Our emotions are there to teach us something. There's no need to think that you shouldn't have them. We need them. If something is upsetting you, figure out what's going on in your head. Are there judgments that are being made about others or yourself? Are they true? If they are, what does that mean to you? If they are true is the world going to end? Once you figure out the judgments, act on them; replace them; dispute them; do what it takes and what works for YOU. Take responsibility for your own feelings, thoughts, and actions. You're the only one accountable for them. If they're not that important, let them go. It takes courage to do all of these things, but the more you do it the easier it becomes and the stronger your will becomes. The fruits of your choices will positively reinforce your new behaviors and continue to strengthen your will.
That is all I have to say about that for now...
Except for one sidenote. If an individual has mental deficits that are caused by a truly diagnosable physiological condition, then the above information is more than likely not applicable. If you read this and say, "well, I have this mental/emotional disorder that makes me do this or that and I have no control over it" then I'll say to you the following--seek medical and professional counseling help. Your will is probably not gone. It's too small for you to make a decision or you're too afraid to try. If that is the case, start out with small choices. If you're stressing over buying Charmin or some sand-paper-like toilet paper, try the one that you normally don't get. Just make the choice and move up from there. Do it every day. If you're really feeling courageous or want to feel courageous, do something even bigger. Pass gas loudly and proudly in a crowded line at Walmart. That takes guts. Do it for yourself!

In This Corner We Have...

A question was posed the other day to me by a family member. She asked, "how can some people from a terrible background still end out so well off...?" It was something to that effect. I will get to my thoughts on that towards the end of this article. First, I feel it important to address determination vs. free will. A good definition of determinism is as follows: "Determinism is the theory that all human action is caused entirely by preceding events, and not by the exercise of the will." (http://mb-soft.com/believe/text/determin.htm). In other words, cause and effect or stimulus and response. Things happen as they will due to their preceding events. Free will is more or less being able to act in a way that one wants or chooses. It doesn't entirely negate determinism, but certainly appears to be contradictory to it. Rather than delve into a philosophical discussion of the two, which could be quite lengthy, let's just assume that both exist. One non-behavioral (human) example of determinism is what happens when a tennis ball hits a wall. What does it do? It bounces back. The extent to which it bounces back involves other variables such as the density of the wall, how much air is in the tennis ball, how hard it was thrown, etc. However, the response will be for it to bounce back. It is a natural response. The same thing would happen if you threw a tennis ball at somebody's head. The tennis ball would bounce back. It has no choice. There are physical laws that "make" it respond in such a manner. Let's assume that the person who was hit retaliates and socks the thrower in the face while saying, "you made me mad...you hurt me...you deserved it...you made me do it...it's your fault, etc." Were his actions a result of physical laws (determinism) or an exercise of will? He said "you made me," but did the alleged assailant truly physically "make" him retaliate? It doesn't seem so. Between the time of getting hit and retaliating, the individual made a decision to attack. At lightning fast speed he made the decision. It took less time for him to make the decision than to double his fist, pull his arm and shoulder back, and launch it at the other guy's face. It certainly seems that WILL was a factor. Let's take it a step further. Some might say, "well, the guy who was hit by the ball might have been having a bad day...might have been abused or neglected as a child and not know how to cope with difficult situations...might have the wrong friends who have influenced him in a bad way...might have a chemical imbalance due to heredity that makes him unstable...might have been bullied a lot at school, therefore, only knows how to fight back with his fists...or has a bad attitude about everything...wasn't breast fed long enough...might have been high or under the influence of something...might be posessed with an evil spirit...might have cognitive distortions that affect rational thinking..." Well, which one is it? If you notice, not one of these is placing the responsibility of the action back on the person. To me, it seems that the "reasons" are giving license for the negative behavior. Sure, it might be fascinating (and I find it to be) to understand what brought the individual to make such decisions, but does it change anything? Maybe not. The truth is, he made the choice to retaliate. Nothing more. We could go even further with this when it comes to "why we do what we do?" It is possible that an individual is raised in a situation that is abusive, neglectful, and violent. It happens a lot and I see it frequently in my job. Just because a person is abused or exposed to violence does not necessarily mean that they will carry on the tradition as they grow older. If it were like that, then all of us would be carbon copies of our parents. We would act and be just like they are. But, we're not. We make choices and change as we live. We exercise our WILL to change and make choices. Why is it that some people from abusive/violent situations end out being abusive and violent? CHOICE! There are choices that they make that continue the negative behaviors.
I recently attended a conference on domestic violence. One of the speakers spoke of a study that he did on domestic violence perpetrators. They interviewed known perpetrators, their families, and friends to discover if there was a correlation between their environment and their violent behaviors. The results were somewhat staggering. They found sibling groups, all raised in the same environments--exposed to the same stimuli (abuse, neglect, violence) that did not end out carrying on the negative behaviors. Some of the perpetrators have siblings that were strong and non-violent citizens. What was the difference between the perpetrators and their non-violent siblings? CHOICE! Over time, the people made poor choices that resulted in perpetration. I am not saying that it was just one choice at one time. It makes sense that it was many choices over a long period of time. Can their environment be influential on their ability to make choice? Sure it can. But, it does not determine the end result. If that were the case, then none of us could make our own choices. I do feel that there are aspects about our physical human existence over which determinism maintains control. But, one universal truth (I believe) is that there are both determinism and WILL. There are things in this world that can be "acted upon" (determinism) and others that can "act" (will). I am sure that I will go more on this in the future. Until next time...

"If I were the king of the forest..."

"If I were the king of the forest..." Most of us recognize that line from the Cowardly Lion in the "Wizard of Oz." The story goes that Dorothy and the other characters of Oz find the lion who is yearning for courage, but is afraid of his own tail. He travels to the Wizard to receive courage, but only finds that he had it all along. He just didn't know it. How often are we the same, because we're even too afraid to try. It will have more meaning as you continue reading this article.
Lately I've had the opportunity to begin writing my own treatment program. It began about two months ago and was inspired by a young boy. The goals and purpose of the treatment won't be discussed in my blogs, yet. It is still in the developmental stage and suppose that it will continue like this for some time. Already, the program is blossoming into something that it was not when I began it. I began to feel frustrated with myself as I was writing it and testing some of the ideas. Something was missing until yesterday I stumbled across an idea that I feel will be pivotal with the program and the general population we serve. It's courage. Nothing more. What is at the base of trauma, anxiety, depression, and many other mental health disorders? Fear! Fear feeds a lot of the mental health disorders and keeps the cycle going. At the base of trauma treatment, as I stated before, is safety. One does not feel safe when they are in constant fear, turmoil or paranoia. Safety is null and void and trauma resolution or reconnection (which I have not explained) is not achieved, nor can it be. So, simple courage training is an effective intervention. Let me explain something about courage. It is not the opposite of fear. That's impossible. There will always be fear whether it be of something that one can experience physically (five senses) or mentally/emotionally. Many times we fear ideas or constructs--things that can't be experienced with our five senses. Some of these can be fear of failure, success (yes, we even fear success at times), rejection, our own emotions , our own thoughts, judgment of others, God's judgment, etc. Webster's online dictionary states that fear is: to be afraid of : expect with alarm <fear the worst> intransitive verb : to be afraid or apprehensive <feared for their lives>. Notice that it gives no bounds to fear which means that it can transcend any possibility. Now, let's look at courage: mental or moral strength to venture, persevere, and withstand danger, fear, or difficulty. Notice that it says nothing about being the opposite of fear. It actually is the ability to endure it and grow from it by facing it. Part of facing fear involves becoming more knowledgable of what our fears are--especailly when they are at the root of emotional and mental upheaval. Ignorance can cause fear. Therefore, one must build the courage to know oneself. That takes work as courage involves action and endurance. It also involves making mistakes and allowing for imperfections. It promotes growth and healing. It also seems to be a core element of many other notable virtues such as confidence/self-esteem, responsibility, morality, integrity, faith, hope, etc. They all involve courage and seem to be a type of courage. Therefore, courage building exercises will become a new focus in my treatment program development. The exercises will be mainly psychoeducationally and experiential based (in other words--a little bit of talking and a whole lot of work and experiential training). To me, courage building is essential. It takes courage to want to work on and overcome depression; because the core of depression involves hopelessness, which is also a derivative of fear. It takes courage to overcome anxiety (worry-wart syndrome). I think you get the picture.
I think I've said enough on this. Ate mais...

Just A Thought....

The work that I do in the trauma field is unique. It was also noted by my boss that a study in 1995 demonstrated that non-traditional therapies are most effective with trauma over the traditional therapies. Therefore, I have a lot of freedoms to study, think, and try things to meet each client's needs. I love that part of my job. I also am currently developing a program for youth to help them 1. build a strong foundation of character traits; 2. overcome emotional traumas; and other goals which I will not go into. As part of it there will be, as planned, an increase in clientele to the clinic and an expansion of our clinic in general. Part of the expansion will be to develop a substance abuse program that is based on trauma resolution. The premise is that trauma treatment will be much more effective with substance abuse due to the nature of the drug and alcohol addiction. Trauma is a part of the drug community. As I'm sitting here thinking about it, the definition of trauma keeps going through my head. "Trauma is any event that causes you to feel helpless and terrified." That is the definition on our company brochure. The Webster's online dictionary states: b : a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury.
Is it actually possible that the very nature of substance abuse is trauma? The effects of substance abuse result in a disorderedmental, emotional, physical, behavioral, and social state of an individual. Is it possible that this is a new approach that could have new results in substance abuse treatment? I have not seen a treatment approach for substance abuse that is based on trauma resolution principles, yet. It will be interesting to see what happens as I work on this project. Until later...

Guilt, Guilt, and More Guilt...

This next blog was inspired by a friend of the family who seems to struggle with these issues. It wasn't just her, though. It is a common issue that I see at work on a weekly basis with clients and even with myself. Now, however, I've come to a conclusion that seems to work and make sense regarding guilt. Guilt is something that we all seem to feel when we do something we wish we hadn't; when we don't live up to a perceived, subjective, or actual expectation (see how complicated it can be?). A perceived and/or subjective expectation is one that we have judged to be of value or importance. We place a value on it. If we do not achieve that expectation then we "guilt" ourselves by saying to ourselves that we are "terrible, awful, bad." A real or actual expectation has more to do with a decreed law that is irrevocable. We do the same thing when breaking that law. Now, to continue on to the nature of guilt
First off, there actually seems to be two types of guilt. The first one is actually not even guilt, but is remorse. I will give my definition and purpose of remorse and then the dictionary's definition. I see remorse as motivating sorrow for an act that we committed against the expectations we have (see above for expectations). Remorse is a positive motivator to change our behaviors that do not work or promote positive growth. Remorse is highly value laden as the individual can only feel remorse if they have broken a perceived value. Remorse does not involve shaming or demeaning oneself in any manner. Webster's online dictionary states remorse as: a gnawing distress arising from a sense of guilt for past wrongs. It's possible now as I read it that a definition of sorrow would be more appropriate for my interpretation of sorrow. However, for the time being I'll continue to use remorse.

The second type of guilt is--well, it's just plain old guilt. Guilt, in this case is a self-demeaning action that is done to shame oneself for having broken an expectation (my interpretation). Now for Webster's: 1 : the fact of having committed a breach of conduct especially violating law and involving a penalty; broadly : guilty conduct
2 a : the state of one who has committed an offense especially consciously b : feelings of culpability especially for imagined offenses or from a sense of inadequacy : SELF-REPROACH
3 : a feeling of culpability for offenses
I find it interesting that the first definition involves the placing of a "penalty." Guilt, as I see it, is placing a negative and overly harsh consequence on oneself. Being that it is demeaning and results in a greater "sense of inadequacy" it doesn not seem to foster self-actualization (Maslow's Heirarchy: see http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs), self-worth building, or healing. In fact, it does the exact opposite. What I see in my job and personal life (friends and family) is a lot more of the second guilt than the first. It is hard to say why we all seem to fall into guilting ourselves, but my perception is that a majority of us do it. The second guilt is almost in competition with the first and mocks growth and development. They are opposites and compete for dominance. I'd say that the second is doing quite well, especially in the mental health industry.
Why do we do the second more often? Each therapist, depending on their preferred model might have differing opinions. I will not attempt all of the models of thinking. I will just say this. We always do something for a reason. If we guilt ourselves for a reason and it is not working, replace the behavior with one that will. If you want to "peal the layers" to find out "why" you do what you do, go for it. The increased self-awareness will be helpful in figuring out what isn't working. Much of the reason, I believe, has to do with an individual's self-worth. If one does not feel much self-worth, then it is easier to be negative as it feels more real. Then, as this is the case, one must begin the process of change by just "doing" what will work. Not thinking about it. Just DO IT! If you normally put yourself down, do the opposite. Build yourself up! It really doesn't take much. All you have to do is start with simple silly things such as saying in the morning, "I like myself." If it is difficult to do it, then just do it anyway. Your mind will follow suit. Guilting oneself can become a habit. We do it for a payoff and a reason (negative). So, just change it. Change must be hard in order for it to stick and be worth it.
Well, that's all for today. Catch ya on a re-run...

A little on relationships...

This is more of a fun blog today. As part of my job I see all ages and situations. One of my favorites is couple's counseling. I get the chance to see how a couple interacts and how each individual's characteristics and traits combine and clash. One of the biggest things that causes problems that I see in relationships is just plain old contentious patterns. The definition of contention is as follows according to dictionary.com.
1.
a struggling together in opposition; strife.
2.
a striving in rivalry; competition; contest.
3.
strife in debate; dispute; controversy.
4.
a point contended for or affirmed in controversy.

Basic relationship problems seem to stem form all four. However, opposition and strife as well as general contention seem to be a huge cause of it. Then the real fun begins when we delve deeper into what "causes" (and I use that word lightly--I do not believe in determinism and I support agency and free will) opposition, strife, and contention in a relationship. Some may say that it is due to incompatible personalities. Others to stress. If we were to add stress into the picture, we could also peal away the layers to find out what is the root or core of the problem. Before I go further into what the root is, I would like to explain my view on its importance. If a new disease showed up that had various adverse symptoms a medical doctor/scientist would not only attempt to treat the symptoms, but to discover the virus or bacteria that was causing the symptoms. Once the source was discovered they would attempt to eradicate it through whatever treatments or therapies were available or developed. Thus, by eradicating the source the symptoms disappear. It seems, at times, that knowing the root of a relationship problem would also be helpful. Rather than treat a symptoms (such as stress--which I view as a symptom) it would be more beneficial to address the core issue. It makes sense to me. Some therapies attempt to do just that. REBT, which was coined by Albert Ellis focuses on discovering the irrational beliefs behind neurotic emotions; and then disputing and changing them. Other cognitive behavioral approaches do similar things. It requires a desire to peal away the layers of negative behaviors to discover the stinky core. Many times, it seems, that the stinky core is plain old fashioned selfishness. Wanting things your own way. Expecting your partner to change rather than looking at yourself. Once one begins pointing their fingers at others it can be (but is not always the case) a good indicator that the problem is your own. Webster's online dictionary states that selfishness is: 1 : concerned excessively or exclusively with oneself : seeking or concentrating on one's own advantage, pleasure, or well-being without regard for others
2 : arising from concern with one's own welfare or advantage in disregard of others selfish act>. Refusing to look at oneself and placing blame and responsibility on one's partner is selfish. Regard for your partner is out the window and pursuing your own advantage replaces it. That does not seem to appear to work in most relationships. There is the occasional exception to this, but at times it requires one person to be naturally overbearing and the other somewhat subservient. They do not see or perceive it as a problem. Some may say, then, that there is no problem in such a case. I will not delve into that subject, for I am not a philosopher and relationship rules, morals, and guidelines can become hazy for some. Returning back to the point at hand. If there is a problem in a relationship it is wise to exercise a level of self-awareness in order to discover the core issue--selfishness being one that is common. Self-awareness and humility can help address the core issue as it is discovered. It is hard for most of us to look at the natural tendencies that we have that just don't seem to work well. We did them for a purpose and developed them as a part of our behavioral repertoire. Why would we want to change them? The answer is simple--if they don't work anymore, replace them. That takes work. If it seems as if the old behavior isn't working, then remember something that William James said (this is not the exact quote, but it is close)--"It is better to act ourselves into thinking differently, rather than thinking ourselves into acting differently." I know it's not the exact quote, but you get the picture. Just follow the old Nike motto--"Just do it!" Sometimes we just have to do things rather than think about them. We may find if we just do it then our thinking will follow suit.
I may continue more on this at a later time, but it is late. Until next time...

Safety Continued...

For the few or none that have read this blog, I will continue writing more on psychological safety. This is more for my own benefit as I have a lot of thoughts on this matter that are manically running through my mind. Let's start with a definition of general safety. "The condition of being safe from undergoing or causing hurt, injury, or loss" according to webster's online dictionary. As is the case with many individuals who have experienced any type of psycholgical trauma, feeling safe is an ongoing problem. As is the nature of PTSD symptoms, many have a sense of insecurity, fear of the unknown, and at times paranoia of being harmed again. It can lead to compensatory behaviors such as avoidance. Therefore, does it not seem pivotal to to establish a sense of safety in treatment before attempting any trauma resolution? What can be done if just the thought of the traumatic incident causes severe fear even in therapy? How can the trauma be resolved? How can the client achieve emotional relief? It seems only obvious that the treatment regime must be planned to meet the client's needs in the way that they are able. Therefore, it seems only logical that the therapist/counselor be trained in several treatment modalities ranging from the traditional (i.e. CBT, REBT, talk therapies in general) to the non-traditional (i.e. play therapies, sand-tray, EMD/R, art, music, thought field therapy, experiential therapy) approaches. Thus, the client's needs can be assessed and resolution can be made by implementing an effective treatment that promotes safety. The goal, once safety is established and maintained is to decrease the negative symptoms and effects of PTSD sufficiently so that retraumatization is less likely to occur. One problem that I have run into with clients is retraumatization--not in the therapeutic setting, but in their normal environment and social interaction. They are still subjecting themselves or being subjected to situations that are associated to the past traumas. Therefore, the focus of the treatment changes from trauma resolution to establishing safety for their situation. This may mean that the battered woman must be empowered to refuge resources to avoid continued harm. It could also mean that the adult male or female who was abused by a parent avoid speaking or having contact with them as they are completing treatment. Essentially, safety is cornerstone in the trauma treatment.
I have also found that safety comes in levels and it can change throughout the treatment. There may be times when safety has been established with one step of the treatment and must be modified later on. Therefore, treatment progress seems to ride on safety.

Thus far I have talked about safety being established in trauma situations to avoid continued traumatization. Now, I will explain an even more difficult situation regarding safety. With many traumas, the source of it is an isolated event or series of events that occur over time. It is as if they "leave a mark" on the individual's psyche. I will compare traumatization to a rotten buffet. An individual is forced to go to a buffet and is forcefed rotten moldy food against their will. They do not know when the feeding will occur or for how long they will be forced to eat. Therefore, it is a pain that is caused to them against their will. (One type of trauma in this case would be parental abuse which I will use during this part of the blog). How does neglect come into play in trauma? Neglect, if it were compared to a buffet would have a different aspect to it. Rather than being fed rotten moldy food, the individual is being denied basic foods and water that they need to survive. They are being starved rather than forcefed. Neglect, on its lowest level stunts psychological development, such as starvation would cause failure to thrive in small children. Maslow's heirarchy of needs explains it well. The lowest level of the needs pyramid is physiological needs--shelter, food, water, medical needs, etc. As that is established the next need is safety. Let's assume that an individual is safe from physical harm, but is not given the needed structure, nurturing, love, and attention that they need. They are left to learn for themselves and to develop without help. How can safety truly be established when their emotional, mental, and psychological foundation is not being cultured? It only seems logical that the individual is being denied basic needs. Without it, self-actualization is not possible and will not be possible until that foundation is built. It seems to me, thus far in my limited career, that building a foundation with someone who has attempted to self-actualize without it is much more difficult than resolving trauma. It is like trying to place a foundation under an already built home. Therefore, trauma resolution does not seem possible as that foundation must be built.
Thus far I have discussed briefly the concerns of safety in trauma treatment. This is only the surface of safety and I expect to continue more safety concerns, as well as possible explanations of how it can be established.
Until later...

Initial Thoughts

This is for anybody and nobody and is my first attempt to publish blogs. The focus will obviously be on issues of mental and emotional health. Yes, I do have an idea of what I am talking about. Much of it will involve the speciality that I work in--psychological trauma, much of which is manifested in posttraumatic stress disorder or like symptoms. As an initial blog I'll explain, to no one, that trauma is any event or situation that someone is a victim or witness of that causes a sense of hopelessness, helplessness, fear, and vulnerability. It can be physical or emotional in nature; and you don't even have to be the actual victim. You can be watching it, such as children witnessing domestic violence. Although I will not go into the full Diagnostic and Statistical Manual definition of PTSD, I will state that it can have long-term emotional, mental, relational, and behavioral effects. It can, at times, appear to be depression, anxiety, sleep, addiction, or behavioral disorders (among a few). If the trauma occurs many times and continues over several years (depending on the age and development of the individual) it can also result in dissociative symptoms; even to the point of dissociative identity disorder (formerly known as multiple personality disorders). Now, trauma-related disorders can be treated and there are many different modalities that are effective and beneficial. Every professional therapist or counselor will have their favorites. The important part is that it be done in a safe environment where the client will not be retraumatized during the treatment. It is possible to be retraumatized by focusing on the frightening images, feelings, or sensations that the person experienced during the actual event(s). Thus, if you know a person who purposely avoids talking about something traumatic, there is a strong reason for it. Safety, therefore, is the first step in the treatment. The second is trauma resolution--in other words, decreasing the emotional upheaval that is associated with the event/incident. Finally, once that is achieved the individual would benefit from reconnection to their family, friends, and society as trauma can result in personal isolation. So as not to continue babbling I will end this introduction now. Further blogs will include my thoughts and other professional's thoughts on therapeutic approaches with trauma as their targeted population--and some.