psychotherapy

No escape: The pervasiveness of trauma and the ease of retraumatization

Over the past 4 years in my psychotherapy practice in a community mental health center, I’ve worked with lots of trauma cases–children and families with histories of neglect, abuse, abandonment, exposure to violence, and a host of other horrific things. When I left the agency 3 weeks ago in hopes of pursuing other interests and diversifying my experiences, I was enthusiastically sent off towards an anticipated less stressful, trauma-free life outside of community mental health. Though I was extremely sad and somewhat regretful about leaving the children and families I’d become so attached to and invested in, I did look forward to new freedom and less stress.

What I didn’t expect was for my exposure to traumatic experience to drastically increase or to almost immediately experience a direct trauma myself. I was quickly reminded that trauma is not exclusive to community mental health or is it a rare or unique occurrence that happens to certain people (though certain demographics are at risk to more exposure to certain types of trauma due to forces such as oppression, history, cultural dynamics. ex. Blacks have higher risk of witnessing domestic violence). Traumatic events are always happening and their presence is sort omnipresent. We’re constantly being exposed to traumatizing things through media and by simply living in this world, whether it’s turning on the T.V. to watch a natural disaster occurring or a war in action, or turning on the computer to see a post of a violent fight or police brutality in your community. In the same way the media and the world gives us pervasive messages that reinforce sexism, racism, classism, homophobia, transphobia, sizeism, etc., it also encourages and repeatedly displays trauma.

Due to the prevalence of exposure to traumatic events, these things have become routine and “normal.” And subsequently, many of us are or have been traumatized and don’t even know. Not all exposure to traumatic events result in a trauma response or diagnosis, but it is difficult to not have some emotional response to something traumatic. There are people moving through the world feeling fearful, distrustful, anxious, hypervigilant, angry, or depressed without knowing why. Others have found a way to cope with these painful things using highly developed defenses like denial, projection, acting out, and dissociation, among others. Both of these responses (reacting and defending) are logical and necessary ways of adapting to living in such an unpredictable and oftentimes cruel and scary world. These are ways we’ve learned to protect ourselves from experiencing emotions associated with being traumatized which can be intrusive and make us feel weak and powerless. However, in the long run these responses are harmful to our personal growth and healing, and to our relationships with the people and world around us.

Trauma is complex and experiences of trauma can vary significantly. Some people may experience one traumatic event in their lifetime like a bad car accident or natural disaster, while others may experience multiple traumas over time like consistent emotional or physical abuse or witnessing frequent community violence.

What is trauma?
Trauma is an emotional response to life threatening event like a rape, abuse, natural disaster, or accident. It can be experienced directly, or by witnessing, or being told about the event. Events like street harassment, neglect, emotional abuse, witnessing domestic violence, sudden death of a loved one, medical complications, bullying, or a humiliating or extremely disempowering experience can also be traumatic.

Types of Trauma:

Acute Trauma: Acute trauma occurs when a person experiences distressing emotional reactions within one month of a traumatic event. The emotional response can include dissociative symptoms (numbing, detachment), re-experiencing the event through dreams, flashbacks, and intrusive thoughts, avoidance of stimuli that remind one of the event, and increased anxiety/arousal.

Complex/comprehensive Trauma: Multiple and/or repeated exposures to trauma over a period of time, like persistent physical and/or sexual abuse and witnessing domestic violence and community violence would be characterized as complex or chronic trauma. Complex trauma can seriously impact a person’s development, especially a child. Early childhood trauma often significantly affects brain development, ability to regulate emotions, ability to form healthy attachments/relationships, impulse control, self-esteem, learning, and the ability to feel safe in the world. The effects of childhood trauma can be incredibly challenging for both the child and the caregivers of the child. Traumatized children often have learned to survive their traumas by using behaviors that can be difficult for others to understand or tolerate. When children are acting out or displaying troubling behavior, it is important to understand what underlies this behavior, as there might be some trauma or other emotional turmoil affecting them.

Generational Trauma: Some of us may not have experienced a direct trauma in our lifetime, but could be holding on to the wounds of trauma’s experienced by our ancestors or older relatives. Often times traumatic experiences are too overwhelming to process and work through, and the learned behavior and emotions associated with these traumatic events end up being passed down through. For example, as a result of longstanding systemic racism starting from slavery, some Black Americans have developed what is called Post Traumatic Slave Syndrome, a term coined by Dr. Joy DeGruy. This is multigenerational trauma that continues to be transmitted through families and communities who have not yet healed from the trauma of violent and complex oppression.

Community or Societal Trauma:As mentioned above, trauma can be experienced not only individually, but collectively through some type of shared experience. On September 11, 2001, the United States was repeatedly shown the collapse of the World Trade Center, which was a terrifying experience. One did not have to be in NYC that day to be traumatized by the event. This is an example of how an entire nation can be acutely traumatized. Similarly, communities that are plagued with violence and poverty can also be traumatized. The collective experience of trauma by a shared group often establishes patterns and ways of being that sometimes become part of that groups “culture.”

Diagnoses that capture Trauma:

Post-traumatic Stress Disorder-Develops after experiencing, witnessing, or hearing about a harmful event. Symptoms last for at least one month and include re-experiencing the trauma through intrusive thoughts, dreams, and flashbacks, avoiding stimuli that triggers memories of the experiencing, and increased anxiety/arousal.

Acute Stress Disorder-Symptoms are the same as PTSD, but duration of emotional distress is less than one month.

Other diagnoses-Experiencing trauma can also lead to depressive disorders, anxiety disorders, attachments disorders, personality disorders, developmental disorders, and adjustment disorders.

Recovering from Trauma

Recovering from trauma can be a long, arduous process. If not dealt with, trauma can have devastating effects on healthy development and living; functioning in relationships, coping with emotions, and the ability to deal with day-to-day tasks will be compromised. To begin healing from trauma and move towards mental health and contentment, a therapeutic practice is recommended. Seeking a therapist can be helpful, but if therapy does not feel right for you, there are many other practices that can help work through trauma.

On the path to mental health and wellness. A list of 10 practices to try when therapy isn’t for you

As a therapist, I’m an advocate for talk therapy. Whether it’s family therapy, insight-oriented individual therapy, mindfulness-based group therapy, or any other of the many different treatment approaches, I recognize the usefulness and effectiveness of therapy as an agent for self-care, growth, and change. I’ve gone to therapy and made strides in my personal development and ability to be reflective about myself and my connections to the world. Furthermore, as a clinician I’ve been privileged to witness people work through traumas, change maladaptive behaviors into adaptive ones, and become (subjectively) happier and better people.

However, I realize that this is not everyone’s experience. I know some can experience therapy/therapists as difficult, intrusive, and even harmful. With roots in ancient Greece, and later in 20th Century Vienna with Freud, psychotherapy is historically a European practice. Presently the field has expanded its reach and though not fully, is more accessible and relevant to the masses. Most now see psychology and psychotherapy as tools to develop better understandings of ourselves, receive and provide help, and find strength and healing. Though these are the basic intentions of the field, it is also important to acknowledge that historically (and currently) it has also served to stigmatize, marginalize, and pathologize many groups of people. Whether intentional or not, the practice has historically harmed and limited the realization of true mental health for some. For example, women were once exclusively labeled as “hysterical,” queers were diagnosed with identity disorders, the poor and working class were excluded for lack of funds, and non-white people were misunderstood or not considered. These are just a few examples and are obviously large, general statements. But considering the historical context, it makes sense that we still feel and see the wounds that have been transmitted through generations as a result of misguided maltreatment in psychotherapy. For some, these wounds have lead to caution, skepticism, and even fear of the mental health profession. And as a result, therapy does not always feel like a safe or best practice for some.

Fortunately, the field has made great strides in becoming more inclusive, positive, and open. Today there are hundreds of treatment approaches integrating anything from existentialism, body awareness, social justice, spiritual practice, feminism, and the list goes on. As the field expands and diversifies, and clinicians from various cultural backgrounds and with unique interests and talents are practicing, the necessary understanding and connection between client and therapist is made easier, through reflections of sameness and shared experiences. As I said earlier, I’m an advocate for therapy and think it is a great tool. But I also know, that even with the advances in the field, it can still be triggering and hard to find a therapist who gets it, and gets you. So here is a list of alternatives (in no particular order) as you journey towards health and wellness, if therapy isn’t for you.

1. Spiritual/religious practice
There are many benefits to engaging in a spiritual or religious practice. It connects you to the world and greater power, it can add or clarify meaning in your life, and can relieve stress. Spirituality can be found in religious observance, nature, meditative practice, or whatever enhances the meaning and connections you feel in your life.

2. Exercise
We’re often encouraged to work out to lose weight or to help prevent and treat physical health issues. Along with weight loss and health benefits, which can be important desired outcomes, exercise can also impact psychological health, including lift your mood and self-esteem. Focusing on physical outcomes of exercise can overshadow its influence on mental health, but research shows a strong link between exercise and mood. Do something you enjoy and pay attention to your mental state as you do it and after. The neurotransmitters running through your body will make you feel good and just doing something you enjoy will add to that feeling. So if you’re dancing, hiking through nature, playing pick-up basketball, do what you like to do to get the endorphins flowing.

3. Community/connections
Positive relationships and connections with others is largely documented as a strong protective factor against the risk of mental illness. Connections and relationships can be with family members, friends, collective spaces of like-minded or similar intentioned people, community spaces/organizations, teams, etc. Any relationship that feels safe, supportive, and understanding can be helpful. Relationships are vital to the human experience and existence, so call your mom, take a walk with a friend, or join a group/space that fits with you to promote wellness.

4. Food/nutrition
I’m sure we’ve all heard the cliché saying, “you are what you eat.” What we put into our bodies can affect our present moods and our physical and mental health over time. In America there are an abundance of processed foods, with high levels of saturated fats, sugars, and preservatives. Research shows that the consumption of large amounts of these types of foods can directly and indirectly contribute to the development of many different psychological stressors (ADHD/hyperactivity, depression, dementia, low self-esteem). In short our bodies and minds are healthier when receiving the nutrients from foods that are more natural for humans. http://www.sciencebrainwaves.com/blogs/biology/food-for-the-brain-how-diet-affects-mental-health/

5. Personal reflective space
Space is important. Finding a quiet space and time to reflect on your thoughts and feelings can be an essential step in moving towards healing and wellness. It may help if reflecting is one of your first steps, as being able to look at yourself and identify and acknowledge your needs and desires, will give you direction on your path. Taking time to identify and acknowledge your values, beliefs, ideals, expectations, dreams, ways of relating, among other things can bring a sense of grounding and self knowledge that can make it easier to move comfortably through the world. Whether you find your quiet space during a meditation retreat, writing in a journal, or while listening to music on your morning commute, this space is crucial. Spend time learning yourself without influence or validation from anyone or anything else.

6. Traditional healing practices
Western medicine often excludes traditional healing practices, which sometimes offers healing through less intrusive and more organic, natural processes. Some ancient practices include aromatherapy, acupuncture, the consumption of plants and herbs, and shamans and other magical and spiritual healers. Some of these practices are still used and can be effective in treating physical and mental health issues.

7. Helping others/Altruism
“Altruism in all its forms—kindness, generosity, compassion, volunteering, and donating money—has the potential to reward the giver as much or more than the recipient.” Acts of kindness foster compassion, boosts our image of ourselves, and can provide something meaningful for others. Be careful and thoughtful about how you choose to give to others, as to not perform altruistic acts that primarily benefit you, which is a trap we can easily fall into. The happiness and esteem we feel when helping others is good, however it is important to be intentional and reflective about the meaning and the impact your acts might have. http://www.pbs.org/thisemotionallife/topic/altruism/altruism-happiness

8. Learning
When we learn new skills and information it shows that we care and value ourselves and can improve cognitive capacities. Taking up a new hobby or investing time in learning new information gives us a sense of mastery, usefulness and also releases the same endorphins that make us feel good when exercising. Try reading more, taking a course on something you’ve been interested in, or visiting a museum or area you want to know more about.

9. Arts
Artistic expression can be a way of making connections with ourselves and with others. The act of creating, the finished creation, and the witnessing of the creation can all have transformative and healing effects. Through art, we can teach and inspire through the use of our bodies, thoughts, voices, and other tools. Art is a medium of self-expression and expressing ourselves is an agent of healing.

10. Asking for help
Asking for help is one way we assert our needs, though it seems to be quite difficult for some of us. Since asking for help can communicate vulnerability and dependence on another, we sometimes postpone or fail to have a need fulfilled for the sake of appearing self-sufficient and contained. In reality, we all need help sometimes and asking for it also communicates strength, assertiveness, and self-care. Allowing another person access to your vulnerability or insecurity is a step in the direction of healing and care.