What We'd Like Medical Health Professionals to Know about CPTSD

[BeHea1thy]

Greetings!

This post is refers to desensitization techniques to those who are doing graduate work towards their Ph.D credentials. The prevailing thought about desensitization is that a traumatic event will 'lose' some of the potency and intense arousal of feelings if revisited repeatedly. This particular technique was applied by a therapist in training several years ago, with the best intentions for my recovery.

The first issue which determines whether a patient is 'ready' for this technique is how long they have had a therapeutic relationship and how well their history is known. It should not be attempted unless there are at least 6 months of ongoing appointments.

The second issue is to assess their overall functioning in the world, and if it is hovering at around 65%, don't do it!

The third issue which is perhaps most important is to elicit a short episode or identify from the patient's point of view what might be intense, but spanning a day or an hour which is particularly troubling. Experiences which span several months are too lengthy. Better to break these up in manageable chunks by people involved, or by one point in time.

All that being said, there is a fourth component, which would require an brutally honest look in the mirror. How compassionate are you?

My one and only therapeutic desensitization session was a learning experience for both myself and therapist. And because of the 'failure' of that intended outcome, I know that if given the opportunity to do it again, I'd pass. I don't harbor any anger or resentment, just a view that this was not helpful to me at the time it was approached. For people with multiple and ongoing traumatic experiences, the ability to cope with even a small part of processing it is so overwhelming and complex, it takes a superhuman effort.

Under no circumstance should the traumatic event be 'revisited' a certain number of times. My therapist believed 3 was the magic number. And worse still was the expectation is would happen within the 50 minute 'hour."

My suggestion instead is to take the theory of revisiting the traumatic event, and be willing to amend that or combine it with a mindfulness awareness. Always follow the patients lead and listen and watch closely for clues to whether they are 'fully present.'

Thank you for taking the time to consider this viewpoint.

[Kizzie]

When I tell you about my CPTSD please listen to me in a respectful and caring manner and then treat me as a partner in my recovery. If you don't know about CPTSD be up front and tell me,  I know a lot about it and can help you with that!

Please do NOT just hand me a Cognitive Behavioural Therapy (CBT) worksheet and send me off to practice thinking differently.  If you can't help me more than that, then refer me to someone who can. I need a professional who will help me process the trauma and integrate those parts of me that ended up stuck (developmentally arrested) in childhood. 

I was a terrified child alone in a big world with none of the support, nurturing or guidance that other children enjoy. But I survived so congratulate me, honour the wisdom and courage it took me to get to this stage of my life, and then do your level best to get me the most relevant and effective treatment possible so that I can become whole and live the full and joyous life I deserve.

Thanks for listening! 

[schrödinger's cat]

(reposted here on Kizzie's request)

I was diagnosed with PTSD over a decade ago, and had therapy. There were several points where PTSD therapy just didn't "fit".

My therapist assumed a "neutral", detached/aloof attitude towards me. I've since read that this is generally what therapists are supposed to do. However, if you've contracted CPTSD partly because of childhood emotional neglect, this might actually make the whole relationship feel subtly "unsafe". It might even be triggering. I was taught from a very early age to interpret a detached/aloof attitude as a sign that people wanted me to leave, to stay away, and be neither seen nor heard for the foreseeable future. Cool aloofness makes me want to escape - it's utterly counter-intuitive for me to react with trust and self-disclosure. In hindsight, I would have preferred even sporadic expressions of compassion, and a more "active" way of listening - anything that would have marked my therapist as a potential ally.

My therapist told me to "find a stable social support network", which is probably good advice for someone who had a more or less normal life (up until the traumatic event) and consequently has more or less normal social skills. For me personally, interpersonal relationships are precisely what traumatized me in the first place. What was so traumatizing wasn't a one-time event either, it was a whole series of small events that happened on a daily basis over the course of twenty years. My family of origin isn't a source of support, it's the reason I'm seeking therapy in the first place. Like many people with CPTSD, I'm rather isolated, and finding friends can be a tricky business - not just because my social skills stem from my experiences within a dysfunctional family, but also because social interactions can trigger me. To put it bluntly, simply telling people with CPTSD to "go find supportive friends" is like telling an injured man to go throw himself under a bus.

As for the rest of resource work - it would have been helpful if my therapist had been open to my feedback about the techniques. She told me, for example, to write down twenty things I liked the smell of. I did that, and it was fun to do, but I couldn't for the life of me see how this was supposed to help. When I was having flashbacks, reading about how I apparently like the smell of oranges doesn't make one bit of a difference. And when I'm feeling good, I don't need that list in the first place, since I know by heart that oranges smell nice. The whole exercize was very confusing. - I read a book on PTSD later, and found this theory that such resource work is supposed to help you reconnect to the resources, attitudes, and general inner strength you had before the traumatic event. In my case, the traumatic event happened when I was one year old, and it lasted twenty years, with ongoing effects that led to at least one retraumatization and constant triggers. I would dearly love to have a previously strong, unharmed state I could reconnect to. Instead, I'm having to build that up from scratch, usually by myself. My working theory is that this is why resource work never really worked for me.

Visualizations didn't work for me either. Or rather, the only ones that worked were the very basic ones that are mostly just mindfulness meditations. My therapist handed me a sheet of paper with a visualization exercize on it, which I was then supposed to learn how to do. It was about visualizing a "safe place". I tried, repeatedly. Whenever I was getting somewhere, this safe place was always invaded by danger, and destroyed. It's very possible that I simply lack the primal trust that would have let this work. The same thing holds true for other visualizations, e.g. the one where you're supposed to imagine that you're a tree. I tried, and I was a tree, and it didn't make me feel a bit safer or stronger. I suppose this exercize was meant to put me in touch with some inner core of primal trust that I simply don't have. I'm not saying that such exercizes never work at all, but I'd have loved it if my therapist had shown me how to find something that worked for me.

If you practice EMDR, it might be of interest to you that many people with CPTSD don't get any "typical" flashbacks. What we're flashing back to isn't necessarily a specific event, but a general state of affairs that lasted for years, maybe decades. Our flashback may not have even the slightest visual element, instead comprising thoughts, feelings, and sensations. Emotional flashbacks are hard to recognize. Your patient might not even realize she's having one. How then can she alert you to the fact and ask you for help? It's possible that you unwittingly trigger her really badly, and she only notices this once our allotted hour is over - in which case she'll be left to cope with her flashback all by herself. Personally, I would never ever consider doing EMDR again unless
-- my therapist has repeatedly shown herself open to feedback, ideally asking me every now and then how I am doing and how her methods are working for me;
-- resource work has really started working for me;
-- my therapist and I both know what precisely a flashback would feel like, and how we can each of us recognize it when it happens;
-- my therapist and I both know what to do in case a flashback hits.

As things were, my therapist told me: "If you have a flashback, tell me. And later, soothe yourself with the visualization exercize from the worksheet I showed you." My flashback was really bad and lasted for three days.

One thing I found in books, and which helped tremendously, is validation for my way of life. Let me explain what I mean. Many people with CPTSD have "always been that way", as it were. For people with PTSD, their lives go like this: normality --> traumatic event --> PTSD. But for people with CPTSD, life has always been like that. This is how we've grown up. This is simply what we're like. For this reason, it's an enormous relief when someone
-- normalizes my symptoms (for example by calling them a normal response to an abnormal situation),
-- validates my feelings and reacts with compassion to my struggles (since I, like most of us, have grown up feeling terrible, but having to function as if nothing at all were the matter),
-- reminds me that even the most bizarre symptom can have started out as a coping strategy (things like dissociating, self-harm, etc).

I hope this doesn't sound too negative? On a brighter note: I'm getting the impression that yes, many people with CPTSD have HUGE trust issues - but we're also so used to people acting in damaging or harmful ways towards us, there's a chance that you can amaze your patient simply by being an ordinary, decent human being.