feedback, please, on the importance of stabilization prior to therapy

[Sceal]

Hi San, 

*Trigger warnings*
I'm not sure if this constitutes as traumatized but I've had therapist tell me they dont want to hear or talk about my SI, as it didn't matter. My self mutilation wasn't something several of them wanted to adress - I later found out that they thought that by talking to me about this behaviour would signal to me that it was okay and that I should just continue with it, they thought that it would increase the risk of harm if they helped me with it. Ironically, them ignoring the problem made me continue more and more frequently.

I've also had a therapist tell me that I will never be able to work in the health-'industry' in any capacity. He crushed a very fragile dream, and my GP who was with me in that meeting had to pick up the pieces for a long time afterwards. (I also proved him wrong, I've worked in various capacities within the health department in various roles).

I was misdiagnosed because my therapists never dared to ask me the difficult questions, I very much needed them to ask the difficult and unbelievable questions because I had no language to let them know it myself. I still don't - After so many years I still can't actually say the words out loud. They should have asked, they should have dared - it was their job. A Therapist NEED to be able to ask the questions when the patients can't things out loud - our body language will give them the answer if its relevant or not. For me it took them 12 years before someone managed to ask the question I most needed them to ask.  - This has caused me alot of pain and trouble, being misdiagnosed is awful. You get reduced to a few words on the paper, you're no longer a person. Your thoughts, actions and fears is just a title. If you try to argue or tell them it's wrong, it doesn't fit, it's not right you get met with disbelief and "it's just the illness talking" and rolling with eyes.

I've had therapists laugh at me in a demeaning way, but I've also have them laugh at me in a caring way. The latter is always okay - because I realize that cPTSD comes with a bag of weird tricks and sometimes I say things or have a theory that is far out there and all they can do is laugh for me to understand that was a bit much. And that is okay. It's also okay to be told that I am wrong, or my thought-process isnt any good - as long as they tell me why, so I can understand and learn. Or take it to heart and see if I do agree with them.

*Trigger warning end*

If any of this is helpful for you to relay to them, then please do so. I can understand your frustration and tiredness that they are not listening to you.
You say you've told them you yourself has been traumatized - could it be that they now view you as a patient? I worry that I say this, because openness is the only way things can change.
And also, their lack of reply might not mean they aren't considering it, or aren't thinking/processing it all. Perhaps they could benefit from you giving them some reading materials?
There are some talk of destabilization of patients in The Body Keeps the Score, and I am certain there are research articles out there on this very topic as well that might be enlightening. Sometimes people just need to get the information multiple times and from various sources until they start believing. I think this is true both for people who has been traumatized and people who haven't.

Still, I'm grateful to you San, for the work you're doing.  I understand that it's hard and it can feel like you're butting your head against a brick wall.

[Blueberry]

Thank you for writing the letter, san, and for speaking up for us in a place where it might hopefully make a difference.

As I said, the mantra in my country is: stabilisation, stabilisation, stabilisation, have a peek at something, stabilisation, stabilisation, stabilisation, have another peek, stabilisation.... But that doesn't mean all Ts follow it. So I'm one of those who've been very badly triggered to completely destabilised on a good number of occasions by various Ts who wouldn't / couldn't listen. They apparently think they need to break through a patient's resistance. Not helpful.

[sanmagic7]

i'm reading what you all are saying, and i can't thank you enough.  this is so helpful and i'm so grateful for you all and your support.

if anyone else cares to add anything, i'm not going to respond to the other forum until tomorrow.  i'm going to find the definition of trauma and include that.  my heart is racing, actually, at the thought of confronting them with this.  the whole idea of believing that traumatization only comes from overt acts has to be changed. 

thank you again from the bottom of my heart.  i'll say it again, you all are beautiful.  i'll write more later.

[Hope67]

Hi SanMagic,
I admit I've not read the contents of this thread, so apologies if I am jumping in here, but I have read that you're looking for feedback about therapy - and I have just read a paragraph from Janina Fisher's book, which I think makes some excellent points about someone's experience - so from p 38 and 39 of Janina's book I'll write out the quote, incase any part of it would be helpful for you to share with your colleagues:
"Gillian developed a fear of therapy and therapists in her early teens: as the family's identified patient, she was sent to one therapist after another to be "fixed".  None of them "got" what her behaviour was communicating about her mother's alcoholism or her brother's abuse and focused on strengthening her relationship with her family by getting her to be more compliant.  "Not being understood", "not being heard", or "no one getting it" are all very powerful triggers for traumatized individuals.  Without realizing it, the therapists' automatic assumption that this was a healthy but overly permissive family with a challenging child made them triggering stimuli and therefore dangerous.  Isolated from her peers, the "best friend" of her fragile mother, dependent on her father's financial assistance, and triggered by the helping professionals, Gillian regarded therapy as a dangerous place she had to navigate rather than as a source of help and safety.  Had she known that her fear was a communication from a young child part that longed for help but was triggered by the failure of former therapists to "believe her", Gillian would have been able to make a connection between the past and the present.  She might even have felt protective of this little girl and tried to stand up for "her".  She might have been able to reassure the child that, even if no one else did, Gillian believed her unquestionably.  Gillian knew what had happened.  She might even have been able to tell the little girl that not being understood or believed was hurtful but it wasn't dangerous - as long as she was in Gillian's care."

SanMagic, I don't know if that paragraph is relevant to the points you want to make to your colleagues, but I thought I'd write it - just incase.

Good luck with your meeting - hoping you get somewhere, and thanks for doing all you do.

Hope 

[snailspace]

Thank you very much Sanmagic for all that you do and for opening up this opportunity to comment.

I still find it difficult to talk about what happened when I was retraumatised in therapy but have tried to summarise it as follows:  My therapist created a new situation, a new reality, then blamed me for it when I became panicky and couldn't cope with therapy.  In some twisted logic she then suggested I forgive myself for the situation which she had induced.

Being the daughter of a narc mother it was a repeat of the situation I had grown up with, and sadly very familiar to me which is why I tolerated it for so long even though I became highly anxious and suffered nightmares etc.  All of which she blamed on my resistance and unwillingness to work with her.  I can't believe it now in the cold light of day but she actually told me to put my hand up if I wanted to speak, like a child in the classroom.

[Hope67]

Hi again SanMagic,
I am reading Janina's book today, and another paragraph seems relevant to what you may be discussing with your colleagues - so I'm just going to write it here: It's from p.44:
"But for clients with chronic, multi-layered trauma histories and severe dissociative symptoms, dysregulated unsafe behaviour, or chronic stuckness, the goal of stabilization can be elusive.  Years of treatment focused on self-regulation and avoidance of traumatic content sometimes leads only to small steps forward - or bigger steps forward followed by a setback after setback.  For fear of exacerbating the dysregulation, the therapist might inadvertently collude with the client's tendencies to ignore the trauma; or fearing empathic failure, the therapist might make the opposite mistake: allowing clients to say too much and, then having triggered themselves, become overwhelmed or unsafe.  Often, the therapist comes to feel equally overwhelmed by the conflicting challenges of helping the client stabilize while also feeling heard and validated and to resolve the past."

SanMagic - I don't know if you find that helpful, but I thought I'd put it out there, just incase.

Hope 

[Hope67]

Hi SanMagic,
Just found another section that looks relevant:
p.46 and 47
"Influenced by widespread belief in the "talking cure", the pioneers in the trauma field initially assumed that creation of a narrative and being able to "tell the story" to a witness were sufficient to process "what happened" and resolve the symptoms (Rothschild, in press).  A corollary assumption was that the worst effects on the individual would be dictated by the worst aspects or details of the trauma.  Therefore, one might think it important to process those "worst" memories.

These assumptions leave therapists trained to use the phase-oriented treatment model in a quandary: while it does not feel empathically attunded to ask clients to avoid telling their stories, the prioritizing of stabilization requires focusing away from traumatic events.  On the other hand, meeting the client's "need to get it out" is also risky.  The former risks empathic failure; the latter risks destabilization.  What does the therapist do when caught between "a rock and a hard place?"."

SanMagic - good luck with your talk today - hope it goes well.
Hope 

[Hope67]

This is my last addition here, as I feel I'm going 'over the top' - and probably saying things you already know, but this is a really helpful paragraph from p.48
"A Different Approach to Traumatic Memory"
and says this:
"In today's trauma treatment world, therapist and client have many more choices when it comes to treating traumatic memory.  We can choose what kind of memory to treat: implicit or explicit memory?  Memories of dehumanizing events or memories of ingenious survival? Memories as held by parts? Cognitive schemas? Incomplete actions? Or procedural memories of habitual actions and reactions? We can touch on memory by acknowledging it, naming it as a part's memory or as an implicit feeling or body memory.  The therapist can help the client observe how it continues to exert its effects through pathogenic kernels that may or may not have any obvious connection to narrative.  What is different is that the therapist no longer has to be focused preferentially on becoming a witness to the client's narrative regardless of its effects on his or her symptoms and stability.  Instead, the trauma therapist's job is to create in the therapy hour a neurobiologically regulating environment that enables the client's nervous system to experience greater safety and therefore an expanded capacity for tolerating both past and present experiences (Ogden et. al., 2006)"

From Janina Fisher's book "Healing the Fragmented Selves of Trauma Survivors"

That's my final reply here today - as I am going to put the book down now, and step away.      I just wanted to include that, as it seems very hopeful and a good model - and relevant to the 'importance of stabilization' within therapy.

Hope 

[Eyessoblue]

Hope; I really enjoy reading the snippets that you give us from this book, it all makes total sense to me. I must purchase this book. Thank you for sharing.

[Blueberry]

i checked today, and am being questioned as to my use of the term being 'traumatized' by therapists, with the clinician asking if another term, such as being 'very upset' or some such would be more accurate, and would like details. 

I thought that might come up. Yes, I have been very upset by something Ts have said, but there were I think it's fair to say 4 times where I was severely triggered to completely re-traumatised and the T in question plus inpatient place couldn't see they'd done anything wrong. They just kept going at me like a dog with a bone. I'll see this weekend if I've ever written on here or anywhere else in English about it and could copy it in here for you. It would be too upsetting for me to try and explain the situations again.

[sanmagic7]

just a quick thank you to everyone for all your efforts.  i loved your snippets, hope, and find them completely validating to my perspective on trauma therapy.  blueberry, thanks for looking for that, but if it's too much for you, don't.  take care of yourself first, ok?

still too upset to go further with this today, so i'm resting again.  but you all are so wonderful, so supportive - i've never found this in real life, certainly not from colleagues for the most part, but i want to say that i find your input more valuable than all the literature and theory quotes i've heard from clinicians.  you know, they don't, and a lot of them are guessing wrong.

i'll address the rest of you at a later date.  i want you all to know how much i've appreciated every word written here by everyone.  love to you all.

[Blueberry]

Hope; I really enjoy reading the snippets that you give us from this book, it all makes total sense to me. ... Thank you for sharing.

The snippets are really telling somehow. It's always good to learn more about the process of healing I think and not just rely on the T knowing, which takes us back to the original topic on here - some of us clients know as much of what's going on in us as the Ts and it would be good if Ts could appreciate that and accept a "NO!" when they hear it.

[sanmagic7]

just want to let you all know that i just posted on the emdr list.  it was a long post, but i think it covered everything necessary.  thank you all once again for your support, for sharing your stories, and for making this possible. 

the head mod there had posted that she'd had questions from clinicians as to whether emdr protocol or other changes were going to be made in light of the discussion about c-ptsd.  she was openminded and said that she didn't know of any changes, but thought it was important that we as a community continue to evolve by looking at fresh information.  that gave me the heart i needed to post what i had to say.

so, i don't know if there will be any responses or what kind.  i did include that it took me so long to respond to the question because i'd been questioned before in a humiliating way and this question triggered anxiety and an ef for me.   i know sceal had some misgivings about whether i'd be looked at as a patient or not, but as i was writing, i didn't care.

i felt strong, felt like an advocate for a worthy cause, and felt a bit numb as well, just typing without much feeling behind it.  i knew it was what i needed to do to get thru it, so i was ok with it. i've had plenty of pos. feedback from t's on the list over the years about suggestions or perspectives i've offered when another t had a problem, so they know me, know that i've been in the field for many years.

as far as i'm concerned, they can look at me any way they want.  i just hope that at least one reads t what i wrote and has a good long think about it.  i'll share it here another day if you want.  otherwise, know that all types of therapy was covered, including inpatient and outpatient.   you were all very generous in giving me so much information about your experiences.   thank you all so much.  you are such wonderful,caring people. 

ok, the exhaustion is beginning to set in.  taking the rest of the day off.   love and hugs all around.

[Elphanigh]

San, I hope you are getting that much needed restful part of your day  Thanpk you for taking so much time and energy to advocate for us, it is wonderful to know some of this is being discussed

[sanmagic7]

i just found out that my emdr posting is being reviewed by the mod cuz it was so long.  don't know yet what will happen with it, but it hasn't been posted to the list yet.  guess we'll see what's gonna happen.  just an update.