Over at my other site, www.globaltraumarecovery.org, we now have part II of Dr. Langberg’s talk (March 2013) on dissociation. This video covers the concepts of Dissociative Identity Disorder (DID) and complex trauma. She ends with 10 principles and cautions for therapists working with clients who dissociate and/or who present with alternate personalities and identities.
Check out the video here. If you missed the first video or want to find other free resources, click around on that website.
For those of you who love or are helping PTSD or complex trauma victims, you may find this video link helpful. Dr. Diane Langberg (after an introduction by me) explores the experience and process of dissociation, or “leaving” the present. She discusses why it happens and what is going on when a person dissociates. At the end of the video, she explores a few helpful ideas for helping to ground the individual in the present.
Filed under Abuse, counseling science, counseling skills, Psychology, Uncategorized
This summer, Jim Owens, PsyD will be offering a one weekend class (Aug 23-24) entitled, Essential Psychopharmacology for Counselors. Jim is a board member here at Biblical and has extensive training in psychopharmacology. In fact, he is board certified by the Prescribing Psychologist Registry. He will review traditional and alternative medicines commonly used today as well as best practices for engaging prescribers. In his course description he says,
The ever-growing use of medications, both traditional and complementary, to treat mental health problems, has both helped and harmed many people. Approximately 80% of all psychoactive medicines are prescribed or recommended by non-specialists, who frequently have little time, training or experience to accurately diagnose the person’s condition. Therefore, trained counselors and psychotherapists are in a crucial position to aid their clients in getting appropriate treatment. This involves knowing some basics regarding which available talk therapies as well as medications are most likely to be helpful for those struggling with certain problems. It is also important to know how to interact with your clients’ physician(s) and other health care providers.
Get CEs!
The course is 1 graduate credit (includes some pre and post course work) OR, 9 CE hours for counselors. Biblical is an approved provider of CES for counselors by NBCC. To read more on costs and other CE approved courses this summer, click here.
You will find the theme of sexual abuse all over the news these days, from clergy sexual abuse to teacher-student improprieties. This level of public discussion allows some victims to feel empowered to speak about past abuse. Hopefully these same individuals find the courage to seek out a counselor to address ongoing struggles with memories, shame, and self-doubt.
But will just any counselor do?
How can you know if the counselor you’ve picked is the right one? Are there questions you can ask to determine whether you are getting good care? Check out the following questions.
How does my counselor handle my disclosure of sexual abuse?
It takes great courage to tell another person about violations of body and soul. Victims fear not being believed, blamed, or worse, having their secret told to others. Thus, when a person sets aside those fears and speaks of what has been hidden, it is a great honor to be blessed with that story. Consider these questions to see how your counselor rates:
A quality counselor will also talk to you about the typical 3 phase model of trauma recovery. They will educate you why it is important to develop good self-care strategies and to eliminate harmful behaviors (addictions, cutting, risky behaviors) before entering into the work of processing memories. They will tell you that safety and stabilization phase (first and ongoing) is about finding ways to stay in the present and to reduce dissociation. When you do tell your story in greater detail, the effective counselor always leaves room in each session to help you leave the office well.
Your Questions?
I have just touched the surface on a few questions. You might have many other questions you’d like answered. Feel free to suggest questions here and I will attempt to answer some over the next few days.
Filed under Abuse, Christianity, counseling science, counseling skills
A former student (HT Armando!) sent me this link today about a woman who experienced PTSD like symptoms after receiving an out-of-the-blue text from her husband telling her he was leaving and divorcing her.
She experienced flashbacks, nightmares, became hyper-alert to dangers, unable to sleep and other such symptoms that are common to PTSD. She did not have an actual or perceived threat on her life–a necessary requirement for the current diagnosis of PTSD. However, she did seem to respond to the surprising evidence that her husband had deceived her for some time as having been “sleeping with the enemy.”
This question for you is whether you think it harms those who suffer classic PTSD (i.e., those who do experience a threat on their life) to lump them together with those who have similar symptoms from non-life threatening trauma. Yes? No?
I have observed pastors in significant conflict with church leaders exhibit PTSD like symptoms. I have observed individuals who learn in late adolescence or adulthood that their parents were actually adoptive parents. It appears that some of the same symptoms exhibited by those who experienced rapes, car crashes, or war trauma show up in some individuals whose world is turned upside down by another’s deception and duplicity.
So I ask the question again: What is gained or lost by expanding PTSD diagnosis to include those with similar symptoms but without the threat of physical injury or death?
Here’s one gain and loss for someone having this kind of divorce reaction. Those who have the symptoms without the physical threats may find some comfort in knowing their reactions are had by many others. However, I would imagine that most of these same people may find their symptoms abate more quickly than that of those who see actual death and destruction. Thus, a diagnosis of PTSD may end up hurting them due to an over-estimation of recovery time needed.
Filed under counseling science, Post-Traumatic Stress Disorder, Psychology
This recent New York Times Opinion Page essay is written by Law Professor, Elyn Saks. She tells a bit about her diagnosis of Schizophrenia years ago and her fight against those who thought that she would not amount to much. While we shouldn’t assume that everyone who struggles with delusions and hallucinations will rise to Dr. Saks level of accomplishments, we should take note where we give in to hopelessness when someone we love receives such a similar diagnosis. Such hopelessness will surely hamper our loved one’s prognosis for recovery.
There are two important factors that predict both recovery from mental illness and future recurrence of symptoms.
These factors are found in nearly all forms of mental illness, but especially pertinent for depression, mania, and psychotic disorders. When a person accepts the existence of a problem and commits to a treatment strategy, they are likely to be more cognizant of the signs and symptoms re-appearing and therefore willing to seek additional help. When medications create irritating side effects, the committed person will either find ways to tolerate these irritations or work with their doctor to find alternative treatments.
The absence or minimization of family stress requires the family or community to not behave in ways that exacerbate the problem. The family must also accept the limitations and not act in ways that place unrealistic expectations on the patient. This of course requires a great deal of sacrifice–on top of existing grief and loss over relationships that will not be what they could be (e.g., caretaking a spouse with mania, supporting an adult child who needs a sheltered environment). This means releasing the demand for the patient to reciprocate empathy or have insight about their impact on the family. Still further, when we loved ones maintain a hopeful perspective–identifying a patient’s value, capacity, and possibility for a future–we offer that person the greatest chance for success.
For some, success may mean being able to hold down a steady cashier job. For others, success may mean staying out of the hospital. Still others may rise to Dr. Saks level of success in academia. If you have a family member who suffers with mental illness, work hard to see them beyond their illness and evaluate their current capacities (rather than by their best or worst day). Oh, and be sure to find someone to talk to. Your family member isn’t the only one who needs help coping with a difficult world!
Filed under counseling, counseling science, Psychology
Thanks to a friend I read this essay today about a possible way to model PTSD formation–by considering what does or does not happen in the trauma victim’s social environment after the trauma experience. The article discusses 2 different studies, one animal and the other human.
The animal study concludes that kidnapping a mother rat from her pups for more than 15 minutes will result in anxious activity upon reunification in the same cage where the trauma happened. Mother and pups will continue to be over-reactive well beyond the event. However, if mother and pups are reunited in a new environment, the trauma reactions (racing around, stepping on each other, aggressive behaviors) seem not to be present. Might it be that they have a shared job of exploring the new environment?
The human study points to the importance of having reunification symbols or rites of re-entry when bringing child soldiers back into the community. This appears to have value over just quietly pretending that nothing happened.
In preparation for the start of our introductory Global Trauma Recovery course here at Biblical I re-read Richard Mollica’s Healing Invisible Wounds book (see previous posts about the book here and here). Mollica reminds us that there is a healing way to tell one’s trauma story…and there are destructive forms of telling the story.
Destructive forms of storytelling?
Trauma victims do need to tell their story. They need to be heard. But some forms of telling do more damage than good. Signs that the telling may not be helpful?
Facets of healthy trauma telling?
Mollica suggests 4 facets of good story telling
Notice that the storytelling is not just about what happened. It is also about the significance, looking from God’s perspective (on self, other, world, etc.) and identifying new connections, skills, resiliencies, etc.
Mollica gives these questions for counselors, family, and pastors to help guide a better story. I find them very helpful if one accepts the caveat that they are not all asked in one sitting nor would we demand articulate answers from victims:
Here’s video of Dr. Diane Langberg musing about what she has learned from listening to trauma over the years. (link here) She made this presentation as a part of a larger evening of trauma counseling training at Biblical Seminary, November 12, 2012.
Enjoy. More to come soon.
Likely, you are participating in the current national soul-searching after the latest tragic school shooting/mass murder. In our angst we ask, “Why God?” and “What can we do to try to stop this kind of senseless killing?”
It is the second question that is on my mind right now.
Political debates will abound about gun control measures or the right to bear arms. In my humble opinion it is time to move beyond that debate and address the treatment of those who are most at risk to engage in mass killings. I have no idea about the mental status of this most recent killer but that shouldn’t stop us from trying to figure out how to better care for such individuals.
Who is at risk? A complex matter
Violence risk assessments have morphed over the years from clinical judgment (turns out our intuition wasn’t very accurate!) to an actuarial approach looking at factors like: active psychotic symptoms, family problems, history of aggression/domestic violence and or criminal behavior, social withdrawal/skills deficits, and substance abuse. But of course, there are many who have positive indicators on several of these factors who are in no danger of becoming a mass murderer. Still others meet none of these risk factors and yet become killers. [Read Randy Otto’s short paper on violence risk assessment and discussion of the historical, clinical, and environmental factors of violence risk]
One possible (partial) solution
Right now mental health professionals and educators are required to report possible child abuse. In addition, we counselors have duties to warn and protect when our clients indicate they are an imminent (meaning, immediate) danger to self or other. Sadly, many adults in high risk categories are not likely to be in treatment (due to costs, treatment availability and refusal) and may have enough sense not to make threats to those who are obligated to report.
So, what might we do to help those who do come in contact with at-risk individuals? In some states, all civilians are required to report potential child abuse. What if we develop a reporting mechanism for civilians to report those who are making statements about violent acts?
To make this procedure work, there are some additional changes we would have to enact (some of which are not simple)
Some need a rescue
Soon after the Connecticut shooting, The Huffington Post ran an op ed blog post by a mother of a mentally ill young man. It went viral as it was “a gorgeously written piece” by a mother whose son’s behavior terrified her. She well described the isolation and inability to find proper treatment and care for a son she loved but could not control. Almost as soon as her piece went public, others outed the writer as a person with mental illness who publicly blogged about wishing to strangle her children (see above link for that story). Despite her lack of judgment in prior writings, the original piece reminds us that there are many families suffering without avenues to help the ones they love. If we are going to make progress in quelling mass violence, we had better start building better mechanisms to treat the mentally ill and to support their family members.
Filed under counseling science, Psychology, Uncategorized
Musings on Faith and Psychology 