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

[sanmagic7]

hey, everybody,

as some of you know, i'm engaged in this ongoing debate with other emdr practitioners.  the subject has come up regarding c-ptsd and therapy, whether it's important during prep for therapy itself to have a stabilization component or not.

one of the clinicians has been citing research as saying stabilization for a c-ptsd client is not important, doesn't really help, and can therefore be "a waste of time and energy".  personally, i think it's important as it begins the entire therapeutic relationship, helps build trust, and allows the client to feel safer as they go into the minefield of truama therapy.

in my mind, this does not only pertain to emdr-based therapy, but any trauma therapy.  however, i would like to hear feedback from others as to whether they think time taken for stabilization is important, if it's helped them and how.  if people report that it has been helpful, i'd like to take this info back to the emdr community and let them know that we can't always rely on research alone to guide us when working to help c-ptsd clients heal.

i'd appreciate any input you'd care to give, if only for the sake of being able to make ourselves heard to those clinicians out there who are supposed to be helping us thru this.  thank you all.

[Blueberry]

OK this is slightly OT, but it interests me how varied the ideas on appropriate cptsd healing are by country. The mantra in this part of Europe is: stabilisation, stabilisation, stabilisation, have a peek at something, stabilisation, stabilisation, stabilisation, have another peek, stabilisation.... etc ad nauseam.

I have always learned stabilisation techniques in therapy before looking too deeply at anything, even before I was in official trauma-informed therapy. It's true, I don't always follow the techniques, but I learned and practised them in T. And when push came to shove, e.g. when I was so badly destabilised that SI came up as a seemingly spontaneous reflex, getting help - a form of restabilisation to get the SI out of my head again - was automatic because I'd practised it. 

Another mantra here in trauma T is: "the slower you go, the faster you heal." Really. There are no typos in that sentence! Therapists take the time to stabilise their clients and good ones teach their clients to do so for themselves. 

san, I think you know what country I'm in and for the purposes of your discussion with emdr practitioners, you're welcome to pass along my comments with country name. If not, pm me.

[woodsgnome]

Some stabilization practice might be useful. But the very nature of any therapy is dealing with destabilized trauma survivors and the discomfort for sure will likely continue even as some progress may be noted.

It sounds like many therapists nudge clients to jump right into their pet practice right away, as they (the T's) may have seen it work well for others. Some, however, are pushed to do so by the insurance/government bureaucrats whose primary interest is tilted towards producing on-paper progress instead of the living dynamic of therapist/client. Quality of care can't always be easily quantified.

I've never heard of any therapy that creates overnight miracles, so being open to a range of what-ifs seems advisable. I've long held to the notion that therapy is more art form than science when it pertains to outcomes. No guarantees, and definitely pre-stabilization will not necessarily create predictable results.

At least that's my perspective based on having run the gamut of therapy 'styles', from those imprisoned by their self-absorbed beliefs to those who are belligerent and top-down in their approach, and to those who are just passing time or bored. My current T is about as ideal as I've had--open to different modes, respectful of the client, and not hung up on herself.

The other side of that is the unrealistic expectation that T's will or should be perfect, that they're supplying a cure, like waving a magic wand (would that it were possible!). It will require not just the cooperation of the client, but patience on both sides as the help-seeker is in the process of a long climb out of a desperate state of affairs.

Thanks, San.

[Elphanigh]

In my experience stabilization is a huge step in this process. For me it gave me the chance to trust my current T, as well as to trust in my own ability to work through my Cptsd. The first T I had did no stabilization and I went into EF or visual flashbacks every time I left her office, it was truly unhealthy. We were digging with not sense of stability, she never helped to stabilize me and certainly didn't teach me. I think with the emotional disregulation a lot of us experience we need to know how to stabilize ourselves in a moment of panic, even if that is know when to reach out for help.


My current T spent about 5 sessions in get to know me and stabilization techniques. One of our treatment goals is that I knew and could effectively use ten different coping strategies that were healthy. It makes all the difference now to have those in my toolkit. We literally call it that as we were just building a set of tools to help me through emdr and the other healing methods we are doing. It gave us both a chance to get to know one another and find my own limits in healing.

[Deep Blue]

I was in a similar situation as elphanigh.  I had a therapist who didn't do any stabilization with me at all and I had the same reaction.  I had panic attacks or EFs right after leaving the office.  It was a mess!  I got meds to sedate me instead of teaching me how to stabilize.

My current T first taught me stabilization techniques and they were very much needed.  Stabilization takes practice and I think it's a really good idea to begin with it. 

[Sceal]

I belive that if you jump right into the deep end of the pool before you can swim - you'll drown. You wont magically figure out how to swim.
And I think it's the same in treating c-ptsd and ptsd. You don't force the patient to tell you their most vulnerable, shameful, scary, frightening moments of their lives without any trust in the T or in the fact that they will survive the encounter afterwards.
Many of us fight tooth and nail everyday to resist the impulse to do something stupid, we use every skill in the book to simply survive. Pushing the patient into the deepend without warning or before he/she is ready, I believe is a recipie for catastrophy. It'd be like playing with the patient's life.

And on a personal note, my T has spent 1.5 year with me (which is a long time here for gov. approved clinics) to just stabilize me. To stop certain kinds of SI and drastically reduce the rest (I'm almost over doing all of them  ), to reduce my paranoia to a liveable level, to reduce my hyperarousal. Because if I'm in a constant fight of being above or below the tolerance window there's no room for me to take use of the therapy given to me. It's not important, because as long as I'm above/below the tolerance window I'm still fighting for my life, to simply survive.

Don't ask someone who has just lost their home to fire or a natural catastrophe to buy a fridge. They have no use for it, they got no where to put it.

[Eyessoblue]

I think stabilisation is huge in the beginning of therapy, unfortunately time scales don't allow that to happen, in the uk you only get a set number of sessions with a therapist and it's all very rush rush rush, ok that box ticked now on to the next topic, ok I think you're ok now, I'll discharge you but you can reapply if you're still not ok,! Then on to another waiting list......
Cptsd people generally have a lot of trust issues and it took me 6 of my 12 sessions to want to say anything about what has happened to me then I'm supposed to get myself sorted in 6 weeks, it just wouldn't happen in the real world!

[sanmagic7]

thank you all for your candor and willingness to share your thoughts, opinions, and experiences.  when i post to the other clinicians, who are located throughout the world, i will be generic as to presenting what you've wrote.  i completely respect all of you, and who and where you are will still be held in confidence (altho, blueberry, thank you for that permission).

i do believe this will be helpful in opening some eyes among the therapeutic community - every little bit and all that.  i think it's a step in the right direction.  unfortunately, the wheels of change turn slowly.  like i mentioned, this was the first time in over 10 yrs. that the idea of c-ptsd has even been given credence.

thank you again.  you deserve so much praise for your courage in letting your voice be heard.  love and hugs to you all.  i'll let you know if i get any feedback on this.

[Estella]

Hi San,

I wish I had some real wisdom to add to this post. Instead, I just have the personal experience of having been quite unstable and then making, what I consider to be, great progress. Perhaps Not everyone involved in my care would consider my progress as "good enough". I'm still waiting for therapy and feel like I've done so much hard work that it feels disparaging to still be waiting. I'm not sure what the long term effect of waiting for therapy are. Food for thought, maybe.

[sanmagic7]

here's the latest that i've written to the emdr community.  i've only gotten one response from a t who addresses stabilization and has her clients practice such techniques. others basically say they don't believe it's necessary, and that as the trauma is resolved (the destabilization comes from the trauma, nothing else) the need for stabilization techniques decreases.



Thanks, Liz,

What you are saying is exactly what I've been hearing.  Practice has been very helpful to people while out in the world between sessions.  Also, they've talked about how learning and practicing such stabilization techniques has helped them to trust their therapist more readily, believe that their therapist truly has their best interests at heart, and feels safer because it feels to them that the therapist understands the nature of C-PTSD. 

Many of them, myself included, have been traumatized by therapists, adding another layer of trauma to what was already there.  Besides, often these clients are still in the throes of being traumatized if they have ongoing relationships with their perpetrators, including family members, and re-traumatization is often an ongoing dynamic. 

I remember reading here a short while ago about someone treating a teen-aged client for anxiety (i believe) but stated that there was no childhood trauma, only parents who neglected to validate the client's emotions as she was growing up.  I know that many of us have been taught about big T and small t traumas, but i can't tell you the number of people I have encountered who's major trauma was, and often still is, emotional neglect.  A big T trauma does not necessarily have to be violent to completely undermine the 'self' of people.

At any rate, most of these people have been seen by multiple therapists, and have been hurt over and over in the therapeutic relationships to the point where they've given up ever finding someone who will help them.  They now rely on this online support forum for healing.  The ones who have had therapists who have taken their time, listened to them instead of pushing their own agendas (ex:  if you don't give up your anger at your parents, it means that you don't really want to heal.  they were flawed and did the best they could), and continually showed these people that their own best interests come first have made the most progress in the shortest period of time.

It's a community close to my heart.  Forgive me if i sound preachy.  The stories I've heard about the hazards of therapy, including EMDR therapists, are very,very sad to me.  Heartbreaking, even. I just wanted to let you all know that EMDR as well as other so-called trauma therapy is getting a very bad rap with C-PTSD survivors.   Too much, too soon, too fast doesn't help them.  Thank you all.


so, i've done what i could, i think.  put the word out,  and it will either  be  heard or not. 

i appreciate all the feedback you've given me here.  thank you for your willingness to share.  you're all beautiful.

[Sceal]

Thank you, San!
For speaking to therapists on behalf of those who can't, or who wont be listened to because they are "after all just patients".
Thank you for trying to open their eyes to a broader picture.

[Eyessoblue]

Thank you san let's hope they listen, what you wrote was as if speaking from my own mouth, I agree with everything you wrote. Well done.x

[sanmagic7]

thank you sceal and eyessoblue.  i'm glad to hear that in your opinions i'm representing this correctly.

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 have a couple examples from my own experience, but if anyone else would like to weigh in on how they've actually been traumatized by therapists, it would be greatly appreciated.

same clinician to whom i responded above.  no one else has responded to this.  i'm getting tired.  they don't want to believe, is what it feels like to me.   makes me doubt myself, maybe i'm making too much out of this.  too personal.  i don't know.

thanks again for your help.   

[Deep Blue]

Hey San,
I had a therapist traumatize me on my first visit.   
***Trigger warning... self harm ***






Years ago I had been self harming everyday. (Cutting)  It was getting increasingly dangerous as I escalated in location and depth. My therapist traumatized me on my first appointment.  On the very first appointment she asked to see the marks.  I said no!  She looked angry with me and said "well you will have to show me eventually"

Her disgust with me not showing her mirrored my disgust for doing it.  The only effect of her threat was for me change the location so she wouldn't suspect.  I was happy the last day I saw her and had never showed her the damage I had done.
End trigger warning***

This therapist was too aggressive on our first encounter and her lack of understanding actually made my problems worse. 

Hope this helps San 

[Elphanigh]

San, I am so grateful you are taking the energy to try to explain this to people that might listen. I am lucky with my T now but my first therapist traumatized me, and I ended up really sick for months because of it.

I was in college and struggling so I finally went to the therapist the school has, she was my first one and I was terrified. At first things went okay, but she stopped paying attention or caring about my panic levels. She would have me tell her the details of my abusex even if it made me shake and feel uncomfortable. I recognize now she was not at all cognizant of me having a window of tolerance. So I left her office triggered and barely functioning every week.

Looking back forcing myself to retell my horrors before I was ready was really damaging to an already struggling college student. She madr things worse rather than better and it took me almost 3 years and a big breakdown for me to risk finding another therapist.