Category: Uncategorized

My experience working with PTSD is that you can recover from it. I have also found there are some who do not wish to give up their PTSD. There may be several reasons for this, one being they are part of a brotherhood of others who they went through events that gave them meaning. It may be they are afraid they will forget someone from the past. It is also true that most individuals living with the disorder have little hope of recovery. Recovery from PTSD means the criteria for the disorder are no longer met. It does not mean all of the challenges of PTSD have gone away. The work in moving past PTSD is hard. After recovery from PTSD other mental health challenges may exist but not PTSD.

An individual’s response to trauma is highly complex with multiple systems of the body affected. One of the defense mechanisms that allows individuals with PTSD to successfully cope with stimuli in the environment is dissociation. Dissociation supports resilience but it may also leave one fragmented, making it difficult to respond naturally to conversations and decision making. It takes significant effort trying to manage the multiple paths of communication coming into consciousness at the same time when parts are fragmented. Those who become dissociative as a result of severe complex trauma can get past their history and give up defenses that were necessary for coping when they recognize the former threat is not longer present in their lives. This distress caused by childhood trauma is les distressing.

Military personnel may fit into the category of those who are conflicted about giving up their PTSD. They have a bond with others with similar experiences; including the loss of comrades and other life and death experiences. They may want to hold on to their past and the trauma that went with it because it gave them meaning. They typically limit their contacts and support system to others with similar experiences. It is difficult for some to move on. It is common for them to want to return to the combat arena where they left their team.

I am not a fan of group therapy for individuals who have been diagnosed with PTSD where their traumatic event is discussed. It is difficult to manage the heightened subjective units of disturbance (SUD) in a group setting when being reminded of the trauma of others. If the level of distress nears its maximum limit the member will likely be retraumatized, making recovery more challenging. If the purpose of the group therapy is to establish tools for coping and managing they symptoms a support group work may be beneficial.

I have found and studies support that there is a high correlation between PTSD and childhood developmental trauma and experiences of attachment. If a feeling of security and safety was not experienced in childhood someone is going to go through life feeling unsafe unless attachment is experienced with a partner or through a healthy motherhood experience.

A significant stressor affecting mental health is the stress brought about by a job. Stress from a job is unfortunately taken out on those individuals who mean the most, the family. I have witnessed on more than one occasion where a new manager can take a rewarding and fulfilling job and turn it into a job where the employee does not look forward to going to work. Good managers are worth their weight in gold, both to the organization and heath of a community and should be rewarded accordingly.

The management of most companies and governmental agencies is underwhelming. In the organizations I have been part of, investigated, and where clients have struggled, it has been rare that effective management exists. A good manager can create an environment where employees are rewarded for taking on stressful tasks. I have found working with clients with high stress jobs the greatest stressor is often not the work, but their peers or management. An effective manager will see the problems that occur and take corrective action. Their primary objective should be supporting their staff and motivating those working below their potential to find the desire to perform at a higher level.

There needs to be a significant increase in reward to motivate individuals with the rare character assets required for leadership. Leadership takes unique skills in communication, sales, and vision for the future. There are many reasons someone might not want to be in management. The pay increase may not be worth the extra work and time expected of management. There may not be sufficient peer support at that level and job performance will be evaluated differently. If the promotion requires a move to a geographically undesirable location and when a family is making the move other factors must be considered. All too often the management job goes to the individual raising his hand, since no one wants the job and the headaches that go with it. Creating an environment where staff are willing to be supervisors/leaders and take on the additional and unique responsibilities of management requires significant support at all levels. And in the best organizations those skills will be exhibited and developed at all levels.

The goal of trauma work is to feel safe in present time. The same can be applied to anxiety, which I view as a learned experience related to a fear of identifiable adverse life events. If it were possible in the first session to get a client to know they are safe in the present moment the work would be done. This doesn’t happen because events from the past are revisited whenever a trigger of past events causes the physical, emotional, cognitive spiral of a stressor to escalate and cause distress. Trauma work in therapy is about rewiring the brain to avoid going into that spiral and to be able to view the present moment more fluidly; where observations, decision making, and communications are more effective. The rewiring of the brain is described by Francine Shapiro, as the Adaptive Information Processing (AIP) model. She created Eye Movement Desensitization and Reprocessing (EMDR) as a tool to facilitate the process. The amount of work and time necessary to feel safe in present time is typically dependent on whether the trauma is a single incident event or developmental trauma. When developmental trauma is coupled with attachment issues the process for feeling safe in present time can take significant time. What I find most fascinating is the resilience that some children have in their ability to create dissociative states to cope with the severest constant emotional and physical abuse in childhood where they often have a feeling of hopelessness. The ability to do so is the difference in someone being able to thrive and those who suffer mental breakdowns and self destructive behavior. The work of the therapist is to facilitate the client in separating the content of the trauma that has been compartmentalized from the dissociative state and allowing that part stuck in the past to recognize it is in present time and can stand down and be less vigilant. When this occurs it is much easier to cope with daily challenges recognizing that options are available that did not seem possible in the beginning. This is why it is necessary to routinely reassess what the goals of therapy are.

When assessing the potential for growth and compatibility of a couple I consider the level of trust and commitment that exists between them. If one of them is not committed to the relationship it has little chance of success. If there is limited trust between partners it is going to be difficult for the relationship to grow while working through the conflicts that are always present.

Normal relationships begin with levels of trust that is limited and it develops as the relationship evolves. A healthy person has a normal suspicion of others. If one of the partners has never been able to trust others growth is going to be a challenge. Those with attachment issues is going to be particularly cautious about trusting others. Being in conflict with a partner can trigger past memories and emotional upsets presenting vulnerabilities that people respond to in many ways. Being able to trust a partner in conflict provides the opportunity for individuals to know that their inner weaknesses will not be used against them. Being in conflict provides a window for resolution or compromise, which provides for long term growth.

I do marriage counseling, but I find myself doing more divorce counseling than marriage counseling. I was not aware of divorce counseling as a field of practice until I recognized how often I do divorce counseling and began doing research on it. I sometimes find the primary goal of clients is moving on and preparing to move on before, during and after divorce. Sometimes the client is preparing for a divorce and sometimes it is for the partner who does not want a divorce and is shocked when faced with it. While doing a search on divorce counseling I have noticed that most dedicated marriage counselors do divorce counseling. I have not seen training for it like I have marriage counseling, but I find the issues of divorce counseling are the same relationship and trust issues that most clients deal with.

Divorce is a major life event whether you are the one asking for the divorce or the one being forced into divorce. It changes those things that are most important to us. Most areas of a persona life is impacted. Relationships with children usually have the greatest impact and the factor that weighs most when contemplating divorce. Divorce without children is much less complicated.

Clients learn to cope with life and conflict based upon what life was like in the home when they were young. Protecting the children from the negative energy in a home filled with conflict, anger, addiction, or yelling will have a life long impact. Divorce is sometimes preferable for the children over staying in an unhealthy marriage where constant stress and negative energy overwhelms the household. I often have to process with clients their response to people having a loud voice where their typical childhood learned response is to shut down.

Unfortunately, finances are a major factor in the decision to get a divorce and a very significant stressor no matter how much money is involved. It is costly to get a divorce, where an attorney is almost always recommended, and duplicate living expenses are necessary. The unknown is always child custody. Even when a partner has a predisposition and history of maladaptive behavior one never knows what a family court will do in regards to custody.

Much of the work in counseling for someone around divorce issues is creating better boundaries and decision making, while dealing with overwhelming emotions. It is often necessary to address attachment issues. The loss of what what may have been or of what was experienced early in the marriage can be overwhelming. Grieving the loss of that trust and commitment can make it difficult to see a path forward. Grieving the loss of someone who is still living may seem more difficult than the loss of a partner who has died because of the continued hope that the relationship can be renewed. After someone gets past the divorce the fear of committing to a new relationship may be met with trepidation where one questions their ability to trust others.

Divorce is a regular occurrence in our society and brings many clients to therapy that otherwise would not have considered doing so. It gives them the opportunity to find a path forward that they might not have imagined after the shock and stress of change is dealt with.

Normal life requires that we create methods of coping with life’s challenges. When l was nine I had Perthes disease and walked on crutches for over nine months. I fully recovered from the disease but had adapted to having the crutches be part of me. I would not walk without them after I had been told I did not need them. I even crawled into the house after my mother took them away from me in the back yard. At the next visit to the doctor’s office I was told I could not leave with the crutches. I walked down the hallway and never used them again.

I wish I had the authority of that doctor with my clients. When I see clients fully recover from PTSD, DID or other negative belief from the past, they still use the crutches that are no longer useful. Crutches prevent us from being able to live outside the bubble people place themselves in to try to control their environment. We refuse to take off the armor one wears to protect ourselves from threats that no longer exist. It is odd that when one recovers from an identifiable mental health issue, which I see happen with my clients, the significant work is to adapt to being normal. Habits that have been created over a lifetime are not easy to let go of. It is easy to assess when they are able to feel safe being themselves in present time. They are able to sleep more restfully and wake more alert. They have an easy smile and are excited to talk about their life , whether it is about something they did, an experience with others, or something they are passionate about.

I have been recognizing lately how often it is necessary to grieve the loss of a child, parent, or spouse who is still living. The family member may be lost to addiction, mental illness, a cult, a possessive spouse or a spouse who has found someone else. It is complicated by the existence of hope that recovery or common sense will prevail. I’m often told that it would be easier to deal with if the person had actually died. There is always hope that the addicted member will find the ability to find a path back towards a future rather than the chaos they are entangled in. A family member who becomes psychotic and loses touch with reality creates incredible pain for those who love and care for that person. It can become even more distressing if the family member is a threat to them. I find too often that parents lose contact and relationship with a child because of a spouse who is too possessive and threatened by their family. I often hear people say “I never saw it coming” when a spouse or significant other leaves them for someone else. The endearing memories from the past feel like only yesterday and one wonders how could this have happened. A support network of friends or a spiritual faith can be helpful, however, the grief that one feels is real and painful. Accepting the loss can be just as real as if the person died and often my perception is that it is worse.

I commonly work with the ego states of clients. Ego states are the dissociative states of individuals, usually identifiable by the age at which they became active. I view individuals with complex trauma on a continuum of dissociation. Those who did not want to be in the stressful environment in which they were raised are going to find the need, if they are resilient to dissociate for the purpose of managing the unhealthy environment. With highly traumatized clients who are highly dissociative those ego states create an experience of having a mind that is fractured, with a seemingly constant input of data coming in at the same time from different sources. The work of those ego states in therapy is to recognize they are safe in present time and that it is no longer necessary to maintain the constant responsibility they have been engaged in since their creation. They allow a person with a traumatic past to manage the stability of the self while managing daily activities. Once they recognize the adult self is able to manage daily life in a safe environment the ego state is allowed to be less engaged and be quiet and eventually integrate into the adult self. Most highly dissociative individuals believe that when this occurs they will be finished with therapy and all will be normal. I caution them that there is more work to do. It takes time to adapt to being “normal” and some previous trauma needs to be processed in present time, particularly if it has been placed in a “container” when working with the ego state. Their relationship with everyone around them changes and both the client and those they interact with have to adapt to the change and learn to trust that the change is going to be permanent. Significant people in their life often have difficulty with the change. Life can be challenging to those who have learned one way of coping with stressors, mood swings, emotions, and everyday events when they find they not longer are affected by them in the same way. Communication with others changes when they find themselves reacting to situations differently than thwy would have previously. Relationships are transformed and sometimes a partner does not like the change. Boundaries with others changes. New possibilities are presented and goals are redefined.

I love working with snowflakes. I have been working with teens and young twenty somethings more often. Most of the teens I work with come from middle class families; therefore, their lives have been rather easy, with all their basic needs taken care of. They spend to much of their time in their rooms, particularly during covid, using social media and playing video games. Besides having most of their basic needs taken care of they have created rather bad habits that are not conducive to growth and social support. They go outside much less than before, they isolate from family, and worry about what they are going to do when they leave the home. Anxiety is often high. Occasionally they are asked/told to come to therapy by a parent. Just as with any client, I will not see them unless they choose to be there and participate in therapy. Recently, young clients choose to be there and have been highly engaged. Some stop after a shorter number of sessions than most clients. My work with clients is aggressive and it may be to much for their developmental stage. I often label them as being snowflakes, not a diagnostic identification in the DSM-5 of course, but a description of those who have never been challenged by real life. It is surprising how much they identify with the label and the impact it has. It is characterized by a lack of resilience, since they have rarely been challenged to deal with responsibility for themselves or others. They are highly insecure socially; although, I have often found them to be better communicators verbally than I expected. They are naive to basic developmental changes of teens and sexually naive, with significant false information about their peers. Identifying them as snowflakes has supported them in taking more responsibility and placing less blame on their parents or guardians. The benefit of working with young people is that if they are engaged change can happen quickly. If they get on the right path when they are young they have the ability to thrive much earlier and have a greater impact with those they interact with. They can take on greater challenges where more risk is acceptable and leave the snowflake label behind.

The secret to being successful is being grounded in the present, be passionate about your task, and taking reasonable risks. Life becomes much easier when you are not carrying the past with you. Past trauma, anxiety, need for attachment, addiction, distractions and disregulation require energy to repress them. It takes energy that makes it difficult to focus on present tasks. Being able to focus allows one to process, problem solve, communicate, analyze, or create as needed. If you are successful at these tasks you are much more likely to have the confidence to follow your path towards your goals. Because there is such a large part of our society that is not able to be in the present the opportunity to succeed is there for those willing to focus their attention on tasks presented to them. With all the opportunities that exist today and the extraordinary need for talent, there are opportunities for success in every direction in the fields that are desperate for talent and people willing to work.

One of the most difficult challenges to being grounded in the present is the increasing problem with addiction. Addiction is becoming an acceptable mode of functioning. The use of cell phones is no longer for person to person communication. It has been corrupted by social media, gaming, and the constant notification from news organizations and contacts providing the most recent emotional stimulus. The development and design of digital content is to bring about immediate reward. A necessary part of a psychological assessment today is to identify the amount of time clients spend daily on their “cell phones” or with gaming. Self reporting for cell phone usage is just as unreliable as self reporting for quantity of alcohol consumed. All addictions inhibit the ability to be in the present, to have a balanced life, and consequently the ability to succeed.

The use of marijuana is becoming socially acceptable in our society and is readily available. Here in Alaska it is readily available in your neighborhood cannibas store, through friends and the common local dealers. It has become so acceptable that many professionals are not concerned with the effect it has on their ability to function. It is not unusual to see consumers leave their identifiable business vehicle to enter a cannabis store. The need to meet the needs of an addiction overrides all other needs and drives. Habitual use of marijuana has a significant effect that has not been sufficiently examined, It has been my experience that habitual cannabis users have significant difficulty processing past elements that are necessary for change and I am not interested in having habitual users of marijuana as clients.

Todays workers have many addictions. Addiction to social media, gaming, marijuana, alcohol, pornography ; all, make it much more difficult to carry out the functions necessary for success in the workplace, creative endeavors and in relationships. This provides a multitude of opportunities for those who are grounded in the present to succeed with little competition.