Good Parent, Bad Parent

Last week I wrote about reparenting in psychotherapy. I’ve used it as part of my practice since the beginning, about 45 years ago. Reparenting places a sizable burden of responsibility on a therapist, because it means committing in every way to being a loving parent to often deeply troubled people.

My patients have often grown up in families with neglect or abuse of one kind or another. In crucial ways, they didn’t get the help they needed to become capable adults. They carry around pain from their childhoods combined with pain from their troubled current lives. When I reparent them – become the “good parent” they never had – they have a fresh chance for something better.

With reparenting, something interesting happens. I get to see how my patients were as children. I get to see how they were treated by their parents and the ways they protected themselves, as best they could, from neglect and abuse. Because I take on a parent role (even though I’m the good guy) they get confused and end up thinking I’m just like their true parents were. It doesn’t feel good sometimes, but it’s an important part of the process of healing that they bring this confusion out with me.

Just last week, at the end of a session, I had a patient say, “I know you’re mad at me.” No, I wasn’t, I explained. Why did they think so? “Because I didn’t work hard and I made no progress,” they said. It was clear to me in that moment that as a child, my patient had needed to earn their parent’s love. Most of the time, nothing they did was ever going to be good enough.

So I had the opportunity right then to genuinely acknowledge my patient’s efforts. I stay with the truth. I’m not going to give false praise. My patient is working hard and doing their best. More importantly, they are a person of value and worthy of love and support. I was glad for the opportunity to give them that message.

Trauma/Healing I

Trauma . . .

. . . is a visible or invisible wound.

Healing . . .

. . . repairs the wound, but there will always be a scar.

Reparenting

I think the best description of how I approach being a psychotherapist is to say that I “re-parent” my patients.

When I was training in psychotherapy in the 70s, reparenting was part of the classic model. I believe our profession has moved away from taking on this role but I can’t imagine doing what I do in any other way.

The people who come to see me usually have significant problems. Their traumatic issues and experiences cut deeply into who they are and disrupt their lives and relationships. I would say that every one of them suffers from seriously flawed parenting. Growing up in their families of origin included either harsh discipline, neglect, alcoholism or drug use, or some type of physical, emotional, or sexual abuse.

The people my patients loved and trusted and depended on for their lives – their parents – significantly betrayed them in some way.

There are important things they didn’t learn; they weren’t able to grow up in the right ways. They want their lives to be good but things keep going wrong for them in ways they sometimes understand and sometimes are completely confused about. They need to be reparented.

And I want to say, right off, that this role is a huge one to shoulder. To do it right, with integrity and humility, is very, very hard. The burden of responsibility to reparent my patients is as awesome a responsibility as being an actual parent of a child.

It was in the role of a parent with one of my patients last week that I needed to share one of the most difficult experiences of my life. My patient was at a critical turning point and needed to be able to learn from my example, like a good father helping his kids learn from his mistakes. Believe me, I thought about this very carefully. I don’t like sharing this story and I need to be absolutely sure that by sharing it I’m really going to help someone.

I decided to go ahead. As usual after telling this story, I ended up sweating, drained, and shaking inside. I had trouble sleeping that night.

I hope my patient heard me. Now I’ll see where he goes with it.

Lost

Families of service members killed in the line of duty have suffered the ultimate loss of their loved ones. Their sons or daughters, husbands or wives, fathers or mothers, will never come home. Their loss and grief are real and tangible.

But many families of service members who do return from active duty also feel that they have “lost” their loved one. To a lesser degree – but still significantly – the service man or woman they knew before deployment has changed beyond their recognition.

Military families understand that the experience of combat changes people. They would be concerned if their loved one returned from deployment exactly as they used to be, as though nothing had happened to them. But many families and loved ones are unprepared for the stranger who at long last walks through the door.

Loved ones expect a time of transition. But when time goes on and on and their veteran doesn’t readjust – or is possibly getting even more troubled – they wonder what to do. They can feel pain for the lost relationship, frustrated over how to get help, and worn out at the burden of care placed on them.

Military personnel are changed by their service . . .

. . . physically – by wounds and injuries, and the lingering disabilities they may produce

. . . emotionally – by anxiety, depression, rage, terror, and shame

. . . mentally – by changed attitudes about the world and the people in it, or by the side effects of psychotropic and pain medications prescribed for visible and “invisible” wounds

. . . spiritually – by a loss of hope and faith, by anger at God, by shame for violating deeply held principles of conduct in a hellish theater of war

The Bernstein Institute for Trauma Treatment, with the support of nonprofit Sonoma Coast Trauma Treatment, is in the process of forming a support group for loved ones of veterans struggling with the traumatic effects of their service. If you or someone you know needs our help at this time, please get in touch.

A PTSD Scenario – and a Support Group

A veteran and his wife sleep side by side in their darkened bedroom. The man moves restlessly under the covers. The woman, long familiar with his insomnia and night terrors, is somewhat conscious of his rising agitation. Something happens. It might be a sound from the external world – a passing car, a gust of wind – or a shift in the internal dream world of the man. Suddenly he is on his feet, dragging his stunned wife out of bed. He grabs the knife on his nightstand and braces his wife forcefully against the wall. She knows him as her husband, the man she loves, a troubled veteran with PTSD. But the veteran doesn’t know his wife. She is the enemy. As she pleads with him, he slowly recognizes where he is, who she is. He releases her, flooded with remorse and shame.

A dramatic scenario, I’m sure you’ll agree. Something you might see in a movie, such as the recently released American Sniper. But it’s also a true scenario, as it happened to me. I was that veteran.

My first wife and I are not alone in experiences of that kind. Many patients and people I’ve met over the years share similar stories. Many veterans and their spouses or partners make the decision to sleep apart – many of them eventually break up – because veterans with PTSD often have great difficulty with relationships and intimacy.

Intimate relationships are characterized by vulnerability. With a loved one, we drop our defenses and expose ourselves and our feelings. For veterans struggling with PTSD and other military-related traumas, vulnerability can be terrifying and intolerable. Their partners, paradoxically because they are beloved, become dangerous threats to be avoided. Veterans can fear losing control and hurting those they love. Sometimes they even sufficiently lose touch with reality to believe their partners really are the enemy. Everyone suffers, including the veteran’s loved one.

That’s why I’m in the process of forming a support group for loved ones of veterans struggling with PTSD. I’m reaching out to spread the word that the Bernstein Institute, in partnership with nonprofit Sonoma Coast Trauma Treatment, has help and hope to offer. If you or someone you know is in need of this kind of group, please contact us at 707-781-3335.

Support for Veterans’ Loved Ones

Three weeks ago, my commentary on peer counseling for combat trauma – and the connection to American Sniper and former SEAL Chris Kyle – appeared in the Santa Rosa Press Democrat’s Close to Home column. A reader responded: Yes, many veterans suffer from PTSD and other emotional challenges and need and deserve help. What about the partners, spouses, and family members of struggling veterans? We’re suffering, too, in our own ways.

This loving partner of local veteran is absolutely right. I won’t reveal her name, but she has really hit the nail on the head. Loved ones of veterans and service members struggling with behavioral health issues need information and support. They need help to take care of themselves so that they in turn can take care of the veteran in their lives and any other family members depending on them for care. My respondent asked: Did I know of any support groups for loved ones of struggling veterans?

I’m a man of action, and now I’m acting. I’m in the process of forming the kind of group this loving partner needs. I’m also involving our affiliated nonprofit, Sonoma Coast Trauma Treatment (SCTT) to help make this group a reality.

Part of SCTT’s vision is to provide emotional trauma-related services and support for local veterans and their families. This new support group fits squarely into their mission. It also fits squarely into my passion to give back to the military men and women and their families who have sacrificed so much for us and for our country.

We are now forming the Support Group for Loved Ones of Veterans with PTSD. If we can help you, or if you know of someone who could use our help, or if you would like to contribute financially to this outreach, please contact us. You will have my deepest gratitude.

For more information about SCTT and our new support group, please contact either myself or group coordinator Hilloah Levy, at 707-781-3335.

Shortages – Of Mental Health Providers and Real Healing

A recent Wall Street Journal special report on health care included a revealing article titled “Where Are the Mental-Health Providers?” Reporter Louise Radnofsky presents convincing evidence and sounds the alarm about the increasing difficulty of finding much-needed mental health care in many regions of the United States.

Radnofsky quotes statistics from a recent study by Mental Health America, a patient advocacy group. The study found that while 42.5 million adults in the United States have a mental illness (18% of the population), the ratio of mental health providers to people in the US is just 1:790, while only 41% of people with a mental illness report receiving treatment.

“That’s prompting a sea change in attitudes among mental health advocates,” Radnofsky writes, “who are starting to look at solutions that are broader than just training more psychiatrists.”

It’s about time. In this month’s article and book excerpt, I explain my thinking on the Dr. Jekyll and Mr. Hyde nature of trauma treatment by psychiatrist-prescribed medications. I will stress again that there is an important role for psychotropic drugs in effective therapy. But—too often—drugs are presented as the complete answer for trauma sufferers. Nothing could be further from the truth.

Chemically locking away traumatic memories may help people temporarily, as I’ve outlined above. But I firmly believe that the hope for healing lies in unearthing and resolving the painful past. Drugs can make this process all but impossible when patients have great difficulty accessing their memories. And, over time, serious and life-compromising side effects of medication pile up.

Well-trained psychotherapists play a vital role in our nation’s mental health. I’m all in favor of greater recognition of this serious gap in our mental health system.

The Loss of Robin Williams

Excerpts from Trauma: Healing the Hidden Epidemic, by Peter M. Bernstein, PhD

On Monday, August, 11^th, Robin Williams took his own life. Robin was a brilliant, gifted actor and comic who struggled with addictions to alcohol and cocaine. He admitted to experiencing episodes of depression and displayed manic tendencies in his work. Personal experiences of trauma, I believe, left their mark on his life in recognizable patterns. His death is a tragic loss for his family and fans.

After the suicide of a friend or loved one, people often ask themselves if there were signs that they missed of the individual’s intent to suicide. In some cases, the troubled individual does exhibit warning signs, which can be subtle or obvious. In the following excerpt from my book, I provide guidance and suggestions for finding and recognizing signs of potential suicide.

“First, be observant when dealing with a traumatized individual. Loved ones of suicide victims often recognize too late that there were warning signs. Understand the possible warning signs of suicidal behavior. If you suspect a person may be contemplating suicide, trust your judgment.

“Suicidal behavior results from many different traumatic experiences, from sexual abuse to a disabling accident to the death of a loved one. It can also be caused by seemingly less serious life situations that are uncontrollable, such as a successful professional’s job loss or an exemplary student’s experience of poor grades. As this book illustrates, almost anything can lead to trauma if the event is unexpected and the person has a negative reaction to the experience, particularly if she has suffered developmental trauma in childhood.

“Look for specific, telltale behaviors in your loved one, such as the following:

• Crying and withdrawal
• Recklessness
• Quitting activities and lack of interest in former activities
• Loss of appetite
• Lack of interest in appearance
• Diminished physical energy
• Frequent minor illness
• Sadness, hopelessness, guilt, loneliness
• Scattered thoughts
• Drug or alcohol abuse

“Pay special attention to any individual with a previous history of suicidal behavior or suicide attempts. And certainly, take action if someone close to you begins talking about suicide or shares plans of suicide. At this stage, professional help is absolutely necessary and should be sought as soon as possible. If you feel your loved one is at a very high risk of suicide, don’t leave him alone; call help to the scene.

“Drastically elevated moods after a long period of deep depression can also be a warning sign that a suicide attempt is imminent. Once a person has resolved to commit suicide, he or she may exhibit behaviors that seem almost euphoric. The shift is usually sudden and without any change in life circumstances. The change can distract loved ones and friends from the victim’s condition, giving them hope that things are turning around. In fact, such a dramatic change in behavior is a smokescreen for the increasingly dark feelings and can be a sign that a suicide attempt is just days or even hours away.

“Many family members of suicide victims wish their loved one had shared their despair and plans with them. If so, they feel they could have stopped it. But most people contemplating suicide keep their plans to themselves. Therefore, it’s up to those around them to stay in tune with their behaviors. If you are suspicious, ask the other people in your circle what they have noticed.

“Even if you aren’t convinced that your loved one is contemplating suicide, reach out to her and show you care. Be open to hearing what she has to say, but also tell her what you have noticed in her behavior, referencing specific actions and incidents. Then, ask direct questions about her current state. Don’t be afraid to say the word suicide. Talk to her about her plans, previous attempts, and thoughts about suicide, if applicable. Listen, talk openly, and let her talk. Try to be understanding and open-minded about her thought process and feelings. This is the time to determine her risk for suicide.

“Most important, try not to become upset or over-emotional during these conversations. Becoming upset might discourage at-risk people from talking to you again about their situation, and you want to keep an open dialogue so you can continue to monitor them. By mitigating your reaction in this way, you pause your own feelings and emotions about the situation in the moment. Remember, you must deal with these emotions at some point, allowing yourself to experience your feelings when it’s more appropriate. Ignoring your feelings indefinitely or overriding them for an extended period will only do you harm, and you will likely become a secondary trauma victim.

“Finally, offer hope and solutions to those at risk. Discuss the option of seeking professional help to deal with their pain. If they are resistant, help them imagine what life could be like without pain and despair. Let them know that such a life is possible for them with the right help and support, including that of friends and family, and counselors and therapists. Resolve to find help for your at-risk loved ones even if they are resistant. Be firm and diligent about your intentions to get help for them, even if they refuse to get it for themselves. When the danger signals are present, don’t wait for confirmation of their plans to seek professional help; move forward on your own if at all possible. (See chapter 6, “Seeking Treatment.”) They might ask you to keep your conversation secret. Don’t. Secrets can be deadly.

“There is hope, and there is a solution. We have learned a lot about the effects of trauma in recent decades, and even more about the process of healing from it.”

From Chapter 8, “Danger Signals and Trauma First Aid”

Traumatic Reenactment

Excerpts from Trauma: Healing the Hidden Epidemic, by Peter M. Bernstein, PhD

Today I want to introduce the concept of traumatic reenactment. Reenactment is a process that includes compulsively repeated thoughts, attitudes, and patterns of behavior. The goal of reenactment is to resolve and heal a past traumatic experience or series of experiences. Reenactment arises out of our past and can seriously disrupt our present lives and relationships.

In a further excerpt from my book, I offer the following example of reenactment:

“Children who were abandoned by a parent or who went through the divorce of their parents may also reenact this experience in future relationships. They will often set themselves up to be abandoned or abused by seeking out friendships and romantic attachments in which they are destined to be left, discarded, or rejected.

“Men will become attached to women who are certain to leave them, or they will adopt behaviors that drive women away. Women will form attractions to men who are unattainable, abusive, or noncommittal. They approach life with the mentality that they are always doomed to be abandoned and create real-life situations in which that belief is validated.

“Another patient, Lucy, for example, grew up in a home in which her father left her mother for another woman when she was a little girl. Her parents divorced, and Lucy was raised by her mother who did her best as a single parent. When Lucy was old enough to date, she developed a pattern of pursuing boys who weren’t really interested in dating her. She would manage to persuade them to date her for a while until they finally, inevitably, broke up with her. She would be devastated every time.

“As an adult pursuing more serious relationships, Lucy continues to be involved with men who don’t value her, who cheat on her, and who eventually leave her. She doesn’t understand why her dating life is this way. Lucy attributes it to the immorality of men and to her worth as a woman. The truth is that there are plenty of men in the world who could love and cherish Lucy, but she is blind to these individuals because of her experience with her father. He was supposed to love and cherish her, but instead, he left her behind. Lucy doesn’t know how to build a healthy relationship with a man. She only knows how to experience the pain of her father’s leaving over and over again. 

“It is important to remember that reenactment does not occur on a conscious level. Rather, these patterns surface as a result of the pain and turmoil felt on a subconscious level. And because we do not actively choose these patterns, we are unable to actively choose something different. For the most part, reenactments rarely succeed in completing the energy discharge so desired; instead, they cause additional despair and pain in our lives. Usually after much pain, we discover they are false solutions.”

                        From Chapter 2, “Emotional Blueprints and Developmental Trauma”

Bureaucracy, Trauma, and the VA

Newspapers and media outlets are carrying daily revelations of serious shortcomings in the Veterans Affairs healthcare system. Those who have served our country, with honor and sacrifice, are receiving far less than their due for their medical and psychological needs. In 2010 and 2011, I provided resilience training to VA combat crisis treatment teams in the VISN 3 network—case managers, nurses, social workers, psychologists, suicide prevention coordinators, and other staff in eighteen medical facilities in the New York and New Jersey area. My firsthand experience with the VA system during this year-long contract, combined with experiences of my patients and friends, matches and confirms much of the recent reporting. Unfortunately, I’m not surprised at the level of bureaucratic dysfunction in our Department of Veterans Affairs.

Bureaucracy can have its own brand of trauma. Certainly, the VA treatment teams I worked with named “the bureaucracy” as their number one source of trauma on the job. Considering that these health professionals served a high-needs, often highly-traumatized population of Iraq and Afghanistan war veterans, this was a disturbing finding.

Bureaucracies, by nature, are hierarchies. Each level of the hierarchy possesses a level of power and authority over those levels below it. These positions of authority are proscribed, and by that I mean that the authority belongs by definition to the job position, not the person. The organizational chart dictates who has power and control over whom. When people who are natural authorities—skilled, mature, capable leaders in their fields—are also those with the proscribed authority, all can go well in a bureaucracy. When less-qualified professionals take positions of control, mistakes and abuse can follow. Poor leaders with proscribed authority can be capable of cutting corners ethically, making unreasonable or impossible demands on front-line staff, and creating both dangerous and even toxic work cultures and deficiencies in delivery of services.

This is what we’re seeing now at the VA. My heart breaks to witness it. Corruption has crept into a system that some of our finest men and women depend upon for their very health and well-being.

While working with the VISN 3 treatment teams, I found many highly dedicated, skilled, and compassionate professionals providing care to the best of their abilities, within some significant constraints of time and resources. As caregivers, they worked long hours, often donating their personal time to meet the needs of veterans and their extended families in ways the VA system couldn’t or wouldn’t provide. Pressure from above to meet quotas and keep up with voluminous paperwork were actual sources of trauma for them. While some already knew effective self-care techniques to stay resilient, too many of them were also close to burning out.

Losing effectiveness of the job and watching their home life deteriorate was the last thing these health professionals wanted to have happen to them. They wanted to continue serving in a calling they loved and were committed to. I think of them now—how hard they worked and how much they cared—and hope that real reform in the vast bureaucracy of our Veterans Affairs will happen soon. Veterans, and their caregivers, deserve better.