Burned!!!!!

One of the difficulties of working in the trauma field, and I suppose in the general counseling field is personal burnout. I'm experiencing that myself these days. I can honestly say that it does not come from the actual client work in which I am constantly engaged. Naturally, there are many challenging situations that get me thinking and studying in order to meet individual needs; but that does not wear me down. It is other aspects of working on the "front line." It seems that working with children in this realm puts one in a position of scrutiny and question. A disgruntled client will subpoena me to court, or make accusations against therapeutic choices or consultations. It is these outside sources that leave me with a sense of vulnerability--as if my very character is being questioned. This is an obvious issue that needs to be dealt with as it can lead to unethical choices and compromising situations. That is definitely not my intention as a professional! However, despite my educated and consulted choices, it seems that there will always be someone to scrutinize, point a finger, sling mud, and blame when working on the front lines. There will always be ethical guidelines meant to protect, but that can be interpreted in several ways. And though some may say, when scrutiny is present, "oh don't worry, it'll pass...use this as a learning experience...just weather the storm..." there is still the gnawing voice in the recesses saying, "what would you do differently if faced with it again?...do you really want to work on the front lines anymore?... are you really an effective professional?..." It's those final two that bother me. It seems that my own perfectionistic qualities and errors lead me to BURN myself, which is not healthy, but alas, only human.

Responsibility

I struggle with an issue in the trauma realm. Most of the clients I work with fit in the "victim" category. Many victims struggle with "learned helplessness." On top of that they experience intrusive symptoms that result in avoidant behaviors. Some of them experience so much emotional, physical, and mental pain that they can become nearly incapacitated (that is an overgeneralized statement, but I used it for discussion only). Many of them begin to "become" their disorder or symptoms, thus completing their journey to learned helplessness. Once they get to that point it seems that their accountability and responsibility is out the window. When does pain resolution in trauma work and responsibility meet?

You are what you eat....you are what you think

We have all heard the term, "you are what you eat..." More or less, it means that your body becomes what it absorbs through your diet. If you eat high fat diets the body has a tendency to hold on to more fat and you become obese. That's a no-brainer. Let's take that a bit further and look at "you are what you think." The law of attraction, according to The Secret and other similar beliefs is that you become what your focus is. If you focus on wealth and that you are obtaining it, you will have it. I have actually heard of a man with terminal cancer who treated with with humor and taking vitamin C. He surrounded himself with positive aspects of life and lived. It works the opposite way. If someone is surrounded by negative influences or allows them to be in their presence they are more likely to adapt and become negative themselves. Then, they actually will create a negative environment, change their thinking schema, and continue in their misery and negativity without outside help. I see this every day in my job. People who have become victims believe they are victims and helpless to it. Therefore, they become more and more helpless and cannot change. They give up their will to change to victim stance. This process is called learned helplessness.
To look at the other end of the spectrum, some people who focus on more positive things can also end out getting hurt. These aren't individuals who have been through traumatic experiences, necessarily; but, rather they have been afforded strong characteristics that end out hurting them. I have met people in both my personal and professional life who fall into this category. Individuals who are so confident in their ability to work with people that it ends out hurting them. They know their capacity to communicate with others and use their leadership skills that they end out focusing on it too much...and it hurts them. For example: some individuals (guys or girls) believe so strongly that they can attract someone of the opposite sex (and they can--even if they're not all that attractive), and get them to fall for them that they end out making moral mistakes that result in pain, heartache, and broken relationships. In talking with one such individual about this once, they realized that they had always known that they could "get anyone they wanted" to follow them, and it lead them down prideful paths and destroyed their relationship with their spouse and children. Another example even falls in the category of spirituality. I have met many people who present themselves as being spiritually powerful; with gifts from God to help others. However, that sense of authority lead them to make moral mistakes that resulted in negative consequences. These individuals could be called zealots. Another great example of zealots comes from the valley of Salt Lake City. Several years ago a group of young teenage boys who belonged to a local church decided they were going to try to promote strong resistance to drinking, smoking, using drugs, and abstinence. They started out with the hope to help others to not fall into bad habits. Their dedication became so strong, however, that it lead them to physically attack youth they found engaging in these activities that they opposed. All of it, to them, was in the pursuit of the common good. But, kids got hurt. These examples show, that too much of even a good thing can become destructive.
Now, returning to the initial topic...the negative effects of learned helplessness and focusing on the victim stance; some people take their mental health position and begin to focus so much on it that it exacerbates their circumstances and interferes with their progress. Some, as an attempt to understand their situation or condition better seek to study, read, and ponder on everything they can in the hopes that understanding will bring relief. Then, they share their information with others to help others understand their condition. It starts out as an educational experience, which is positive, but then they become a zealot of their own condition. Delving deeper and deeper into it and refusing to let go of it due to the sense of purpose it gives them. Their condition, which was usually forced upon them is accepted, embraced, and used to give them purpose in life...to continue being sick. Why is that? We are creatures of habit. Sometimes, even if a behavior is negative, we don't wish to let go of it due to its familiarity. We find comfort even in the things that cause us pain. Abused children wish to return to their parents, because it is familiar. They seek to find the desired love they feel is necessary in order to give further purpose to their condition. It has been my experience that the positive attention and love that they feel is necessary will not be attained through the abuser or through constant focus on their difficult circumstances. Deep down inside, the suffering person probably knows this, but refuses to acknowledge it and take the appropriate steps to continue progressing. If the individual continues to return to focusing on their condition and the causes of it, progress is halted and the pain will continue. Growth is stunted.
My focus on this article has been to educate readers (all 2 of them) that if your main focus is something that is negative, you will exude negativity and attract it as well. It will stunt growth and create unhappiness. If you find yourself stuck in behaviors that are familiar and comfortable, but have negative results...STOP! It will be hard at first, just as breaking any habit is. It will be similar to the chain smoker stopping cold turkey. The nicotine that served as an anti-anxiolytic will cause withdrawals, but will subside. The security blanket of negativity will dissipate and make room for growth. Remember, you are what you think...and you become what you focus on most.

Oil and Water--Legal System and Mental Health System

It has become apparent that the legal system and the mental health system don't exactly mix. At times they can work together well, but most times it is water and oil mixing together. Most of the attorneys and even some of the judges do not have a full understanding of the purpose of the mental health system--specifically psychological evaluations. We provide parenting and psychological evaluations for the court systems. They are in depth and comprehensive. the results of the evaluations are difficult for others not trained in it and can be misinterpreted. That can cause problems in the court system. I would recommend that attorneys have training in human development and psychological testing as it would be a positive service to clients.

Another aspect of the legal system and the mental health system is even simpler...cover your own butt. Even if you're providing services for another agency, care for yourself. Remember that no other attorneys other than your own can provide legal advice or representation. Representing yourself in legal matters can get harry, especially when you have not had legal training. Trust your own judgment, though. If you feel that you should not get involved in a legal case, then don't. It has been my experience that there are attorneys that will do what is necessary (no matter how dirty, dishonest, or immoral) to defend their client. Do not expect an attorney to understand the goings on in a therapy session, the techniques used, the modalities followed, etc. Many of them might not want to understand. If you find yourself on the stand in a court room, be confident and sure of yourself and your therapeutic judgment and process. You are trained to do this work. This is what you are. Be the therapist in the office and on the stand. Also, continue your studies to ameliorate your therapeutic position. Do not be surprised that your modalities will change as time goes on. Be open to various forms of therapy and not just on Western thought-based modalities. I've found that to be extremely helpful with my therapeutic repertoire.
Enough for now.

Trapped

I know that I have hit safety several times in past blogs. I continually run into further problems with it, which thus makes it difficult for trauma resolution to occur. Many of my clients are in constant emotional turmoil, and much of it is caused by family members or other close people. These situations increase their stress and sense of helplessness. They all seem to be trapped. The legal system does not seem to be able to help these clients, as there is no actual "physical evidence" presentable to protect them. Oh well, back to the drawing board.

Christmas Spirit...

What is the Christmas Spirit? Does the United States still have it? It seems that the word Christ or God in general have been deleted from even Christ's birthday due to the fear that it is discriminatory to those that don't believe in Christ as the Savior of the world. Santa Claus, who is the Father of Christmas is nothing more than a symbolic representation of Christ, bringing gifts and joy to the world. Separation has already happened with the school system, such as banning the Pledge of Allegiance. I remember growing up and holding my hand over my heart proudly reciting the Pledge of Allegiance to the Flag of the US. Now, kids don't know it. Next, I wouldn't be surprised to see Christmas songs/hymns such as "Joy To The World," "Silent Night," and other common songs to be considered disciminatory. Here's the funny thing about the U.S. It is supposed to cater to the majority. The majority is Christian who believe in God and a Savior of the world which brings hope, joy, and peace. The minority have other beliefs that are also hopeful, but may not believe in Christ. The Christmas spirit is just that...hope, joy, and peace. It's the same thing that clients seek when they're in my office...hope, happiness, and peace with themselves and the world. It seems only logical that the Christmas season's purpose could bring that if implemented correctly. Remember, that the point of Christmas is "peace on earth, good will toward men" which comes through hopeful beliefs, whatever they may be. Obviously, I have displayed my values as a Christian believer and that it is a celebration of Christ, the Savior's birth. Therefore, for me it is a time of joy and celebration. Whether you believe it or not does not matter to me, but should matter only to you (the reader). Worship how you wish and in what manner that you don't, be you atheist, Buddhist, Islamic, Jewish, Christian, Pagan, etc. And let all others worship as they may. That will bring peace on earth and good mental health.

Merry Christmas to all...

Reductionism and Foundation

Reductionism and Foundation

I had an interesting session recently that brought up some thoughts. I was talking with a particular
client who had been in a violent relationship. The name will obviously be omitted, however, the
gender will be included for the sake of the situation and the ease of writing. She had been with a
boyfriend for nearly a year when he attacked her. The situation resulted in her contacting the
police and his incarceration (though not for the crime, but rather for probation violation). She
ended out dismissing the charges, but he was still sentenced to a year in jail. She admitted that she
was the kind of person that goes back to their abuser due to insecurities. As we began talking she
opened up and admitted that much of the foundation upon which she built her self-worth had to
do with her looks and social skills (which were not lacking especially in high school years she
said). However, due to an unforeseen health malady she was robbed of those physical
endowments for several years. During said time she experienced a deep depression and a loss of
confidence and who she was. After that time of trial her health returned and she was able to lose
the weight she gained and was feeling "more confident" again. It was soon after, however, that
she met her boyfriend (now incarcerated) and began dating him, though she promised herself to
never date that type of a guy. She still plans on staying with him, though she knows that he will
not help her attain the future she desires. So, I asked her "what happened? What happened for
you to compromise your own standards and values?" She didn't know. Now, that is where we'll
begin this discussion on foundation--a personal foundation of values, character, traits, standards,
beliefs, etc. She didn't have one other than her physical traits. I asked her if it was a firm
foundation and she agreed that it was not. I asked her what it could be built upon--something
unshakeable and firm. She didn't know. I then suggested to her that she think about her purpose
for living as it is a place to start. She said she wasn't sure, but that it must be to learn and to
experience. I asked her why that would be important. She didn't know. After our conversation I
began thinking ab out reducing purpose and meaning to life down to its simplest form, which is
explained as reductionism. This paper is not going to necessarily focus on reductionism as a
principle, but I will describe it for explanation sake. The online Merriam-Webster's dictionary
describes reductionism as follows: 1 : explanation of complex life-science processes and
phenomena in terms of the laws of physics and chemistry; also : a theory or doctrine that complete
reductionism is possible. 2 : a procedure or theory that reduces complex data and phenomena to
simple terms. Simply put, it’s the idea that all things can be broken down into a simpler form. Not
only does it work with the scientific model, but with psychological problems as well–so I
discovered. I began with this client with one of her current problems and we broke it down to a
main problem that could be resolved. With her self-worth being based on looks and beauty we
used reductionism principles to get down to the core problem. It was simple as one only has to
ask “why” for everything until they can’t any longer. For example, if they have anxiety about a
certain subject, they can break it down as follows:
Q: What are you so anxious about?
A: I’m anxious about failing.
Q: What is it about failing that makes you anxious?
A: If I fail, then that would be bad?
Q: Why would it be bad?
A: It would mean that I didn’t know what I was doing?
Q: What’s wrong with that?
A: If I don’t know what I’m doing, then I fail.
Q: How do you know you fail?
A: I fail when I don’t do something completely right or I make a mistake.
Q: Again, how do you know you fail?
A: I just do.
Q: What does failure truly mean? Let’s look it up in the dictionary.
You then look it up in the dictionary and discuss the meanings of failure. Then ask,
Q: Do you fit the criteria of failure?
A: Well, no, not really.
Q: Then, who originally made the description of failure that you held to for so long, that caused
so much unnecessary anxiety?

Then, discuss the source of the description and why it is so important to them. Why they place so
much value on a description that is not complete. At times the client will even base it on a belief,
standard, or value that is shaky, incomplete, and not firm. I then talk to them about their values,
standards, beliefs, and the foundation upon which they place everything they feel is true (including
their definition of failure). We break it down to a foundation, usually, that is based on principles
that are untrue. As a definition, principles must be true which means that they are complete and
are not missing any important aspects. Principles are beliefs and standards that hold unshakeable
value to the individual. Meaning, it does not matter what kind of emotional upheaval or time of
prosperity the client endures, the foundation with true principles remains constant and
unchanging. Too often do many of my clients not have a foundation, therefore, they wander
without direction, purpose, or goals and thus become victims to their misery, helplessness, and
pity. Using reductionism one can arrive at their very foundation principles to address and modify
them as needed.
Many of my clients have a foundation based on religiosity or spirituality. They seem to recover
more quickly. In fact, some research indicates that individuals with strong active religious beliefs
and activities are more resilient to life’s difficulties and stressors. Though, as a counselor I cannot
recommend or pass those values on to one who is atheistic, similar principles can be found if one
digs deep enough through reductionism. Helping a client find their foundation and core values
helps them have something to fall back on during times of emotional upheaval or anxiety.

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...