CBT and Relational Therapy

[Kizzie]

So early this year I tanked.  I was drinking all day (never drank before mainly because my F was an alcoholic), depressed (that I was used to but this time it was bad) and having huge panic attacks (never had them that bad before). I had been quite independent, responsible and all of a sudden I couldn't get out of bed some days.  I had to reach out for help. 

Looking back I realize a part of me said "That's it, stop the facade and get well already!" My H was able to come home a month early (he was finishing up his last posting with the military on the other side of the country - a BIG reason I lost my bearings), I stopped drinking the day he arrived -- cold turkey (very bad idea - there is medical help to do it without risk of seizures and the like) and off we went to my GP. I told her all that was going on and what a humbling experience that was for someone who rarely asked for any help from anyone.

Long story short after a few false tries getting on the right medication I ended up on Celexa which has done wonders.  I spent two decades on Prozac and within a few weeks of starting this med I began to feel comfortable in my skin for the first time ever.  I'm not drinking (didn't really enjoy it - just wanted to be numb and blot out the fear), I don't have panic attacks any more, and I'm reaching out/opening up  as much as I can to others - on this forum and two others, in a support group for mood disorders and with an addictions counsellor.  I have Social Anxiety as a secondary disorder to CPTSD so this last bit is amazing.  I was very isolating and insular except with my H although I did not appear this way to most people.

An way, it all really helps and I wish I had reached out in earnest years ago.  Part of the problem was that I did not have names for any of what I was  experiencing and in fact struggled to believe that I had been abused because my parents were not physically or sexually abusive. And, I just plain did not want anyone to know what lay beneath the facade I had constructed to get by IRL.   

The one big piece that is still missing for me is dealing with my CPTSD both through therapy and by coming here.  I understand now that there is a lot of trauma I have not acknowledged and worked through, and that it fuels anxiety and depression left untreated. Walker's approach of working on both the cognitive or thinking aspects through Cognitive Behavioural Therapy, and the emotional or feeling aspects through Relational Therapy seem like the right path out of the storm for me.   

[Annegirl]

I don't know what these therapies actually involve. My T does thought inquiry which is from the work of Byron Katie. She somehow knows how to ask the most triggering questions to me and then we work on those. I am finding it challenging but very helpful. I have never been on medication though.

[Kizzie]

Sorry AnneGirl - here's an explanation about the two types of therapy I mentioned:

Relational psychotherapy - By facilitating a safe and positive relationship in the security of the therapeutic environment, the client is armed with a stronger sense of self and confidence. The primary goal of this technique is to empower the client with the skills necessary to recognize and create productive and healthy relationships. The therapist strives to address any and all past and present relationship traumas or impressions that have served to create discord in the present life circumstances of the client.

Cognitive Behavioural Therapy - CBT is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.  The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. CBT helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented.

[Annegirl]

Thank you for that Kizzie, now I see my T is doing both those things in the sessions lol.

[hopeless]

Kizzie - you make me want to drink more and crash hard so I can make the progress you are! I could really *feel* a lot of what you said.  Thank you for sharing.

[emotion overload]

Your story is very familiar to me.  I drank heavily for many years.  And then I stopped a few years ago.  I always worried about going back to drinking b/c I didn't know why the cravings left me so abruptly, when I had tried many times to quit in the past with no success.  Pete's book gave me the answer - I had learned to put myself into the freeze (disassociative) state without the alcohol.  I knew I had drank to numb the feelings.  When I realized that I had just learned to numb without the alcohol, I could finally relax in sobriety.

I also suffered for many years because I did not have the language or words to tell the doctor what the problem was.  I just said I was depressed, over and over again, and I think he got tired of hearing it.  When I finally realized that my numbness was much of the problem, I was prescribed wellbutrin, which is an activating drug.  It helps with the numbness, but is no miracle.  I was on Lexapro/Celexa for the better part of 20 years, and I have no idea if it really helped.  I seem to feel worse when I go off of it, but it certainly doesn't turn me into the productive member of society that I want to be.  I am experimenting now with Zoloft per the new psychiatrist I am seeing.  Right now I am in the switching stage from Lexapro to Zoloft, and seem to be in a pretty bad place.  I am waiting it out to see if the Zoloft works after a few weeks.

Once I realized I had CPTSD, I sought out a trauma T.  We are doing EMDR and talk therapy.  I have done some CBT on my own, and it is useful as well.  I don't know anything about relational T besides what you wrote here, I'd be interested in learning more.  I'll google it.

[Kizzie]

Hey Hopeless - not a great way to start the recovery process believe me - it was that awful that I'm happy never to drink again, ever.  As EO suggests, alcohol was more a medication to numb myself which I guess is why I don't crave it now.  What really makes a difference is that I know what an EF is.  They used to scare me silly and they still do -- like getting anxious about a panic attack, but at least I know what's going on and I didn't before so started to drink.

Meds are a bit of a crap shoot aren't they EO?  Wellbutrin ramped my anxiety up so high, as did Ativan and Clonazepam, but Celexa?  In a word, wow. I hope you get your meds sorted out, they really helped me but they're not for everyone.  If I could do this without meds I would but for me I don't think that's going to happen.

I also tried EMDR and had a major panic attack after each - to be fair that was in the throes of my downhill slide and I did not tell the EMDR T that I was having as a bad time as I was - another "don't' do this" lesson lol. How do find the EMDR EO? 

Relational therapy is just talk therapy really, but with a focus on the relationship between the T and you - s/he is a model for a healthy, open relationship that you can try in IRL once that all important trust is built(and of course that usually takes some time because of the trauma).  This is from Walker and other articles I've read by the way, I'm certainly no expert.  Anyway, the T serves as part of the "reparenting committee" and helps to build trust and advocate for you and your right to grieve, be anger and heal (as I understand it).  Are you finding you're comfortable with your T?  So many of us have difficulty finding just that right T because of our distrust.

[Butterfly]

Every time I read of or try CBT it just brings feelings of anger and I'm not sure why. Need to explore this more.

[Kizzie]

Perhaps because CBT can be interpreted as "You are the reason for your pain?"  I know that's how I took it at first, that CBT is a blame the victim approach.

The other BIG part that's missing for me with CBT is that it pretty much bypasses all of the emotions associated with the trauma that we have buried, and imo need to remember and grieve;  otherwise that "residual goo" as Globetrotter calls it keeps fueling our emotional flashbacks, inner critic, etc.

What I do now appreciate about CBT is that it does help us to look at whether my present day fears are realistic or not, or are perhaps a throwback to when I was a child and did not have the means to fight back, escape abuse.

[pam]

Relational therapy is definitely the one for me. And luckily for me I have a "good enough therapist" most of the time anyway. He might not understand CPTSD, but we get along pretty well so that alone is helpful. I understand what you are saying about the positive aspect of CBT Kizzie, but isn't that just the ability to look objectively at a situation and use logic to solve it? I just don't see why that was ever made into a whole branch of therapy. I see it as just a skill that can be (and is) taught within any other therapy. Sorry, CBT has always rubbed me the wrong way, lol.

Butterfly, One of the things that angered me about CBT was the whole "forget your past" attitude. "That isn't happening now, so it doesn't matter." Oh yeah?  >

I like to have the corrective experiences within a relationship. I can learn a skill at home on my own and I expect more from a T than that. Especially for the $ they get. 

[Butterfly]

Kizzie, I was raised on stoic thinking cbt uses that we control our thoughts and therefore our feelings and I believe this to be true. However, that's not going to address what I've learned are emotional flashbacks. There's no logic and yes, my adult knows I'm in control, but the wave of panic that sometimes rushes in defies logic. I'm new to CPTSD but from what I've learned so far when that happens my mind is bringing my feelings back to childhood even though I'm not there anymore. It's when I feel trapped and even though I know I'm not presently trapped something haloed to trigger those feelings and I want to hide in my closet or other dark place. Not that I do that but that's what I feel. I used to hide in the closet or basement crawl space for hours even in summer when kids should be out playing in the sun.

Pam, yes I'm not certain cbt addresses the past and I've got a fairly good handle on current situation, maybe not if I'm flashing back. The thing that triggered this whole thing was a recent very serious health episode and mum actually bullied me while I laid in the hospital bed quite weak physically and mentally. I wound up agreeing with her ranting twice just to shut her up and then I ended the phone call. I was angry with myself for not just hanging up the phone.

From Pete Walker:
"At the same time, those who have only tried a Cognitive-Behavioral Approach [CBT] to healing their trauma may feel great resistance to hearing that cognitive work is important. If you are like me, you may have been introduced to it in a way that promised more than could be delivered. Cognitive tools are irreplaceable in healing cognitive issues, but they do not address all the levels of our wounding. They are especially limited in addressing emotional issues"

On a completely unrelated note I wanted my forum avatar to be a butterfly with tattered and broken wings, dark, because that's how I feel here on OOTS, but it made me sad so I chose one coming out of fire and made of fire. Still dark but not as sad. On OOTF dealing with the present I feel strong but here I feel very broken.

[Kizzie]

From Pete Walker:
"At the same time, those who have only tried a Cognitive-Behavioral Approach [CBT] to healing their trauma may feel great resistance to hearing that cognitive work is important. If you are like me, you may have been introduced to it in a way that promised more than could be delivered. Cognitive tools are irreplaceable in healing cognitive issues, but they do not address all the levels of our wounding. They are especially limited in addressing emotional issues"

Couldn't agree more  Pam, Butterfly (and Pete  ) CBT does not get to all that core trauma; it takes that therapeutic relationship Walker talks about. As he suggests though cognitive work is an important part of the recovery process, it just can't deliver the whole of the goods for CPTSD.

I love the idea of relational therapy too, of having a T like Walker who bears witness to my trauma and advocates for my inner child.  I've pined this for oh so long now but couldn't express well enough what I knew I needed the few times I've gone to therapy.  Now that I've read Walker's book I understand just how important relational therapy is in the recovery process, how essential.  So many T's are going with CBT now I guess because it's straightforward and fairly simple that it's hard to find someone that fits the RT bill (and is affordable - that's a big barrier in my life).

I really like your avatar Butterfly - I think it fits really well with your journey out of the storm. Sorry to hear your M took a swipe at you when you were ill in the hospital and so vulnerable.  My M did that to me last year at a really bad point and it brought me to my knees - triggered the worst EF ever.  So, getting your M off the phone -- probably the best thing you could have done for yourself in that situation.  There will be other times when you're back at full strength you can back her off with all that you've learned at OOTF. 

I'm also sorry to hear you feel broken when you come to OOTS Butterfly. I think of us as being injured and able to heal with the right treatment.  We may have some residual pain that we have to manage, but the key is that we can manage it rather than be overwhelmed by it. In any case the EFS are so very difficult I agree, I actually have gone in the closet so I could shut out noise, light - like a burrow where no-one could find me.  I didn't know then that I was having an EF, I just felt like I was falling apart.  Now that I know I feel much more hopeful that Walker is right and they will decrease in both intensity and duration as I learn to stare them down by caring for and protecting myself in healthier ways. 

"Expressing yourself in ways that your parents forbade typically triggers intense flashbacks at first.  This can cause you to lose sight of how this practice gradually reduces the chronic pain of remaining invisible.  We can encourage ourelves to face these growing pains by conceptualizing them as therapeutic flashbacks.  We then choose to weather these flashbacks to stop the past from holding us back, to reclaim the fundamental human rights that our parents denied us, and to finally own what is rightfully ours for the taking" (p. 77)

[Butterfly]

Thank you so very much. It's like OOTF deals with the present and OOTS is helping me overcome and deal with the past trauma. It's like the final piece to my healing journey.

[Kizzie]

I feel the same way Butterfly - maybe by coming here we won't have to hide in the closet anymore {{hugs}}

[Kizzie]

I copied a bit about Relational Therapy from Walker's site as it's important to understanding this thread I think:

Relational Healing in Complex PTSD

By Pete Walker (See http://www.pete-walker.com/)

More and more traumatology pundits see attachment disorder as one of the key symptoms of Complex PTSD. In the psycoeducational phases of working with traumatized clients [outlined in my article: "Managing Emotional Flashbacks in Complex PTSD"], I typically describe attachment disorder as the result of growing up with primary caretakers who were regularly experienced as dangerous – dangerous by contemptuous voice or heavy hand, or more insidiously, dangerous by remoteness and indifference. Recurring abuse and neglect habituate children to living in fear and sympathetic nervous system arousal, which over time creates in them an easily triggerable abandonment melange of overwhelming fear, shame and depression.

A child with parents, who are unable or unwilling to provide safe enough attachment, has no one to whom she can bring her whole developing self. No one is there for reflection, validation and guidance. No one is safe enough to go to for comfort or help in times of trouble. There is no one to cry to, to protest unfairness to, to seek commiseration from for hurts, mistakes, accidents, and betrayals. No one is safe enough to shine with, to do "show and tell" with, to be reflected as a subject of pride...to even practice the all-important intimacy-building skills of conversation. In the paraphrased words of more than one of my clients: "Talking to Mom was like giving ammunition to the enemy. Anything I said could and would be used against me. People always tell me that I don't seem to have much to say for myself."

Those with Complex PTSD-spawned attachment disorders never learn the communication skills that engender closeness and a sense of belonging. When it comes to relating, they are typically plagued by debilitating social anxiety, and social phobia when they are at the severe end of the continuum of PTSD. Many of the clients who come through my door have never had a safe enough relationship. Repetition compulsion has compelled them to unconsciously seek out relationships in adulthood that traumatically reenact the abusive and/or abandoning dynamics of their childhood caretakers. For many such clients, we are their first legitimate shot at a safe and nurturing relationship; and if we are not skilled enough to create the degree of safety they need to begin the long journey towards developing good enough trust, we may be their last.

As the importance of this understanding ripens in me, I increasingly embrace an Intersubjective or Relational approach. I believe that it is the quality [rather qualities] of the clients' relationship with me that can provide a corrective emotional experience that saves them from being doomed to a lifetime of superficial connection, or worse, social isolation and alienation. Moreover, I notice that without the development of a modicum of trust with me, many of my PTSD clients are seriously delimited in their receptivity to my guidance, as well as to the ameliorative effects of my empathy. In this regard then, I will describe four key qualities of relating that I believe are essential to the development of trust and subsequent relational healing. These are Empathy, Authentic Vulnerability, Dialogicality and Collaborative Relationship Repair.