Trauma Therapist Podcast

Last week I had the very great pleasure of being interviewed by Dr. Guy MacPherson. Guy is a clinical psychologist and the moving force behind the West Coast Trauma Project, a website dedicated to raising awareness of trauma and helping trauma therapists thrive. “My goal with the West Coast Trauma Project,” Guy explains, “is to help other trauma therapists thrive – through providing actionable information, community building, inspiration and support.”

One of the resources Guy offers on his website is the Trauma Therapist Podcast, a series of recorded interviews with therapists in the field of trauma. My conversation with Guy provided me with an opportunity to share from my heart about my life and work. Follow here, to listen in.

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.

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.

Freedom on the Inside

In 1970, I left New Jersey for California.  This was not a decision freely made.  I was forced to leave because my life was at risk.

When I arrived in San Jose, I felt like a fish out of water.  Seeking some kind of familiar territory, I started working in prisons and juvenile detention facilities.  These were definitely not places where freedom “reigned”.

I had wanted to make a new life for myself in California, but the “New Jersey” in me wouldn’t go away.  I walked around with an armored exterior, always ready for battle even when there was nothing and no one to fight.  I couldn’t turn off my anger and defensiveness.  The fear and anger of my former life were in charge of me despite the fact that there was no need for them in my new environment.

Today, on Independence Day, I want to talk about the loss of freedom on the inside: the freedom to choose how to react or respond to events and people; the freedom to live in the present; the freedom to grow and change; the freedom to live without debilitating fear or destructive rage.

Do you ever feel trapped in your own skin?  That’s what I’m talking about.

I want to introduce a concept you may never have heard about that relates directly to a loss of internal freedom—reenactment.  I explain reenactment from several perspectives in my new book, Trauma: Healing the Hidden Epidemic.  Reenactment is part of what I call the stress response, otherwise known as the “fight, flight, or freeze” response to trauma.  Here’s a definition from my chapter, “Emotional Blueprints and Developmental Trauma”:

“Reenactment occurs when traumatized individuals try to recreate or relive their traumatic experience.  They seek out or even create scenarios similar to their traumatizing event in an unconscious attempt to complete the stress response that was interrupted so that they can resolve their post-traumatic disorder.  Similar experiences re-engage the stress response, the unfinished biological process that left them traumatized in the first place.  Victims seek opportunities to engage the stress response in order to complete it, most often unaware of why they are doing so.  The trapped energy [from fight, flight, or freeze] causes so much emotional and physical pain that the unconscious aspect of trauma victims’ brains will go to any lengths to release that energy.  Unaware of the process, they may even feel puzzled as to why the same painful events happen to them over and over again” [emphasis added].

Not knowing why we keep doing the same things over and over again, particularly if they are unsatisfying, dangerous, or destined for failure can leave us feeling more than “puzzled”.  Being trapped in the reenactment cycle can lead to feelings of rage, panic, discouragement and despair.

Freedom—to make new choices, to grow and change, to become the person we long to be—requires tackling our unresolved trauma and breaking the reenactment chain.  It is possible.  My life today, as a husband, father, and psychotherapist, is infinitely freer now than it was in 1970.  I urge you to read Trauma: Healing the Hidden Epidemic to discover how my life changed, and how yours can change as well.

The Season of Light

Two thousand eleven is drawing to a close.  For many of us – and I include myself – this has been a difficult year of losses, changes, and transitions.  But my 2011 has also been an important year of opportunities and growth.  I hope you have found this to be true in your life, as well.

In this season of celebration, I wish each and every one of you these blessings:

Faith – in someone or something bigger than yourself

For me, it’s God.  I was raised a Jew, and became a Christian.  My faith is the bedrock of all that I am.

Hope – for the future, for a better world, for a life filled with meaning and purpose

I urge you: never stop moving forward.  Find your calling and work to fulfill it.

Love – for the people near to you, for those who are hurting or in need, and for yourself

I firmly believe that close, loving relationships are a vitally important part of our lives.

Comfort – in that you aren’t alone, we are all imperfect and human and fallible, and help will be there if you reach out for it

Connecting with and caring for others, I’ve found, and accepting their support in return, is at the heart of healing.

Joy – in moments of heartfelt recognition that life is good, even in the midst of pain and difficulty

Joy is a feeling far beyond happiness.  It goes deeper, it feels stronger; it comes to us through struggle as something essential, right and true.

Peace – in this world, in our hearts, with each other

Let go of the past and the things that don’t matter.  Practice thankfulness.  Give of yourself and receive.  In surrender, gratitude, and selflessness we find peace.

Charis – grace – and Shalom – peace – to you and yours in this season of light.

And now, onward.  I’m ready.  I have big plans.  Bring on 2012.

Corvette Crash Course, Lap 2

Last week, I shared with you one of the most devastating traumatic events to happen to me in a long time.  On a summer evening two years ago, my wife Lynn almost died while I was virtually helpless to do anything about it.  The incredible men and women of the Two Rock Fire Department saved Lynn that night, she recovered very quickly, and my partner in love and life was restored to me.

I want to continue to share things I’ve learned in the aftermath of trauma.  Two weeks ago, following my post on an accident in which I totaled my Corvette, I mentioned five lessons I’ve been reminded of at somewhat great cost.  They are:

• I am not in control.
• I forget too quickly what’s really important.
• “The Tortoise and the Hare” is not just for kids.
• If I “know pain”, I can “know gain”.
• I am human and mortal.

Today I want to add five more lessons from Lynn’s traumatic emergency episode:

1.  Life is fragile.

It was clear to me, as Lynn lay unconscious in my arms, that it could all be over, that she might be taken to heaven and I would have to say goodbye to her.  In that potentially disastrous moment, I recognized again how truly fragile life is.  One moment we can be alive and have the people we love with us, and in the next moment they, or we, can be gone.

2.  We are all dependent.

I also was forcefully reminded of how dependent I am on Lynn.  I like to think of myself as a strong, capable, and independent person.  In many ways, I am.  But Lynn takes care of so many things for us, some of which I’m aware of, and some I’m not.  She works very hard at maintaining our home and managing our finances, which are important and complicated right now.  The day after she went to the emergency room, she was taking care of some business matters from her bed in the hospital.  I had no idea about all the things she was keeping track of and staying on top off for us financially.  I am very grateful that she is so purposeful and committed, as I am, to our life together.

3.  Our lives have rhythm.

This lesson is related to the lesson from “The Tortoise and the Hare” – we tend to try to live our lives too fast.  We tend to overshoot that core, basic rhythm that each of us has but may be unaware of.  When we’re moving fast all the time, we can stop being tuned in to the pace of life that works best for us.  It’s a pace that allows us to accomplish what really needs to get done, while still permitting us to take the time to make wise decisions, pay attention to and discern what’s really important, maintain our health, and sustain our treasured relationships.  A traumatic event can strip away all that fast-paced, driven quality that keeps us consumed with all the things we’re so worried about.  As we recover, we can regain the pace of life that restores our balance.

4.  It’s harder to watch.

When my Corvette skidded out of control on Springhill Road, I knew what was happening to me and how I felt in each frightening moment.  I could tell whether the injuries I was sustaining were major or minor.  Someone looking on could not have known that I was only suffering a bump on the head and a slight neck strain.  When Lynn passed out and collapsed into my arms, I had no idea what she was feeling or what was happening to her.  I had no way of knowing whether she was in pain, whether she was suffering a heart attack or stoke, whether irreparable damage was happening inside her or if she would be able to recover.  There’s a helplessness that accompanies watching trauma occur to someone else, particularly someone we love.  It’s not just that we may not be able to stop what’s happening, we also can’t always know the extent of the crisis.  This helps make the experiences of secondary victims of trauma – the observers – so potentially shocking, overwhelming, and intense.

5.  Surviving can mean dissociating.

Dissociating is the capacity to distance ourselves from present-moment events and feelings.  Our innate, built-in survival mechanisms include the ability to dissociate during highly dangerous and traumatic moments.  This concept is valuable to a real understanding of trauma and the process of healing from it, and so I want to devote my next post to a fuller explanation of this aspect of our human nature.

My hope is that these lessons learned from my traumatic experiences will help and inspire you to better navigate these hard times we’re in.  As I do with my all my patients, I want to reach out to you where you are hurting and in need.  I want to  let you know you’re not alone and you can have hope as you learn and apply some of these universal life lessons that I too have had to learn so painfully for myself.

Not in the Driver’s Seat

For the last two weeks I’ve written about a recent accident that left me slightly injured and totaled my Corvette.  I experienced trauma that day, with its classic symptoms and aftermath, and I’ve shared some of my thoughts and realizations following the event.

Now, in order to give you a fuller understanding of the experience of trauma, I want to share another, much more serious traumatic incident that took place in June of 2008.  That may sound like a long time ago, but my memories of that night remain overwhelmingly vivid.  On this occasion, I was not the primary victim of trauma – not the person directly experiencing the crisis.  I was what is called the “secondary victim” – the person who observes someone else’s suffering – and who is connected to them either as a professional first-responder, or as a loved one or bystander who may be reduced to watching helplessly as horrific events unfold.

Late on a Wednesday evening, after coming home from a business meeting, my wife, Lynn, and I were relaxing in front of the television.  Lynn got up to leave the room and then returned shortly after, stumbling and semi-conscious.  As I sprang up to catch her fall, she collapsed into my arms.

As with so many traumatic events, it all happened so quickly.  One moment Lynn was fine, the next moment everything was completely out of control and I could tell she was near death.  I was terrified.  There was nothing I could do except hold her and love her in what I thought could be her last minutes of life.  The intensity of fear I felt inside was like normal fear times a hundred.  The velocity and intensity of my emotions felt like an engine that was racing with absolutely explosive power.

In that moment, I felt the full, overwhelming impact of the trauma.  I went into “hyperalert”; I didn’t disassociate, I didn’t mentally go away or numb out.  I needed to get help.  I couldn’t do everything myself, couldn’t both hold her and get to a phone and call 911, all at the same time.  I shouted to my son, who made the phone call, and within three minutes some fabulous people arrived to save us.  These fire and EMT personnel saw us in that naked moment, in our most vulnerable state, with tremendous compassion.  They did a wonderful, sensitive, and professional job of stabilizing Lynn and getting her to the hospital.

I believe in miracles, because Lynn came back to me as quickly as she started to go.  She went through all the tests at Petaluma Valley Hospital’s emergency room and she was fine.  What happened was just one of those freak medical episodes.  She recovered quickly and I felt such intense relief and gratitude to have her alive and with me. To this day, Lynn and I are very close friends with the Two Rock volunteer fire department crew who came to our rescue and who told us how very touched they were by the love and commitment they saw Lynn and I share.

Lynn’s emergency was a much more significant trauma than my car accident.  There is really no comparison.  But I want to use both these experiences – one in which I suffered the trauma, and one where I could only look on helplessly – to share some of my understandings about primary and secondary trauma and its victims.  I have other lessons I want to share from this earlier, most frightening and intense crisis.  I’ll make some of these insights part of my next post.

Corvette Crash Course

On the morning of April 16^th, I lost control of my Corvette on the back road into Petaluma.  I was only slightly hurt in the accident – a bump on the head, a small neck strain – but my car was totaled.  As I stepped out of the wreckage, I stepped into the state of shock and loss that follows in the aftermath of a traumatic experience.

Like the calm after a storm, the time after a crisis ushers in a time of reflection.  It’s a natural sorting-out time, when deeper awarenesses and awakenings can emerge.  After our world turns upside down, we have the opportunity to decide if we want to turn it right side up again in exactly the same way.  It’s a natural time for choices and changes, for new goals and directions.

But the aftermath of trauma doesn’t feel good.  As great an opportunity as crisis provides for positive change, it’s still uncomfortable and scary to tackle putting the pieces of your life back together again.  Some people respond to the challenge with paralysis.  Some are able to go into action.  I want to share with you some thoughts and realizations, some things I’ve learned and relearned, that have come to me in the wake of my recent accident.

1.  I am not in control.

I only like to think I am.  I like to assume that I can predict the outcome of my decisions and actions.  I will take this turn, call this person, say these words, sign this paper, write this check, and I believe that rationally certain things will follow.  I will take this quick trip into town in my Corvette and be back in time for my staff meeting.  I can fool myself into believing that what I expect to happen will happen.  Sometimes what I expect does happen.  But there are no guarantees.  Control is an illusion.

2.  I forget too quickly what’s really important

Like being alive.  The things that really matter are the things you can’t replace easily, or maybe even at all.  The so-called “simple things”, like people and relationships.  Like health and moments of joy.  I could grieve the loss of my Corvette, but what I really miss are the moments I spent driving it, the freedom I felt rounding curve after curve.  I need to remember that the exhilaration and aliveness I felt doesn’t depend on the car.  I can feel that way again without it.  I can feel a thrill in just being alive, being in love with my wife, and embracing the next challenge.

3.  “The Tortoise and the Hare” is not just for kids.

Remember the fable?  The hare quickly goes out in front, but the tortoise wins the race.  I’ve been trying to live my life way too fast.  When I put myself under a lot of pressure and try to get too many things done at once, I can make mistakes or miss things.  I’m unable to give sufficient attention and time to important matters.  I can’t force an elephant through a keyhole.  I can’t ripen green tomatoes overnight.  Trying to get too much done in too little time is just like that.

4.  If I “know pain”, I can “know gain”.

If we give ourselves permission to go through our crisis and heal, we can be transformed in the midst of our trauma experience.  I can choose to respond to my accident in one of two ways: with resentment and bitterness, or by embracing change and growth.  I can remain stuck, angry that my Corvette is totaled, scared that if I get another Corvette I might crash that one too (and possibly suffer significant injuries), or I can go on from here into the unknown future, where there’s a whole lot more in store for me.  Where my story continues.  I want to embrace my life by going through my trauma, not going around it or stopping cold in my tracks.  I want to emerge a stronger, better person.

5.  I am human and mortal.

My life could end at any time.  An event like my accident urges me to remember that no one’s immortal.  I feel my humanity and vulnerability more now than I have in many years.  I don’t have that same feeling of security – physically or financially – that I took for granted for a long time.  And, just as quickly as it might have happened to me, someone I love could be hurt seriously or die.  I’m only human; I have no control over that (see Number 1 above).

I want to propose a somewhat radical picture of the lasting legacy of trauma.  I see the wound of trauma as a friend.  It is an uninvited, unexpected friend, to be sure.  But if I accept it and build it into my life, my life will be transformed in ways I can’t begin to imagine.  If I accept it, and share that with others – that this part of me is acceptable and so therefore this part of you is acceptable – we are drawn closer together.  We see we’re all the same: human, mortal, without control, but with strength and depth and intrinsic value.

This is living in what I call “extraordinary reality”.  It’s a quality you see in the lives of people like EMTs and other first responders to traumatic events.  Their experiences and the sacrifices they make in serving others make them different people to be with.  As a psychotherapist, I am a kind of “first responder”, too.  I help people survive and heal from trauma.  Experiencing trauma firsthand – as I did when I spun out of control on the way into town one recent fateful morning – and then embracing it, will only help me become more compassionate and skillful at the work which is my calling.

Little Red Corvette

Little red Corvette
Baby you’re much too fast
Little red Corvette
Honey you got to slow down
Cause if you don’t you gonna run your
Little red Corvette right in the ground

© Prince Rogers Nelson, Controversy Music

Slow down . . .

I’ve been hearing this message a lot lately: from my family and my employees, as I push for progress on many projects all at once.  From myself, as I pour on the pressure to accomplish more in fewer hours.  From my neighbors, as I speed back and forth from town with less and less time between appointments.

But this time I actually wasn’t speeding.  Early on the morning of Friday, April 16^th, I was driving my Corvette into Petaluma to a quick appointment before a staff meeting at my institute.  I came to a portion of the back road into town that had recently been patched and was still somewhat uneven.  I slowed down through the rough part and before I could resume my preferred, speedy-but-still-legal speed, I hit a wet patch of pavement.  All of a sudden, I was out of control.

Because these difficult financial times are affecting me, too, I’d put off repairing the Corvette’s stabilizer system. I had decided it was a nonessential expense that could wait another month or two.  But as I felt myself go into a 360 spin, I realized the car wasn’t responding as I needed it to.  I skidded across the lanes (at that early hour there was thankfully no oncoming traffic), glanced off a power pole, slid under a fence, and came to a stop at a steep angle in a field of pasture grass.

It all happened so fast.

One moment I was in control and the next moment I wasn’t.  The sense of suddenly losing control, feeling like everything is being taken out of your hands, thinking that there’s no way to stop this thing, are all classic reactions to a crisis event.  A lifetime of work as a therapist helping people resolve trauma didn’t shield me in that moment.  My feelings at that time were no different than anyone else’s would have been.

I was very fortunate; not much happened to me physically.  I remember thinking, “I’ll just get out of the car and everything will be all right”.  But when I opened the door, stepped out, and saw the wreckage that was once my beloved Corvette, I realized I too was really shaken up.  I felt dizzy and disoriented but grateful to be alive.

In the aftermath of the accident, I gathered my senses together fairly quickly, which is not always possible so soon after a trauma occurs.  I discovered that I could now somewhat imagine what our service members in Iraq and Afghanistan must feel after experiencing an IED explosion.  While the car had spun, collided and slid from the road to the pasture, my brain had done the same things within the walls of my skull.

The long-term effects of the accident were both physical and emotional.  My neck was sore and slightly strained; my head ached for a day or two.  Emotionally, I felt confronted with my lack of control, not just of my car but of other things as well.

My life had been going too fast.  I was trying to get things done too quickly, to deal swiftly with a number of things that needed more time to resolve and reach completion.  The shock of my accident forced me to slow down and simply appreciate that I was still alive, and I re-focused on the things in life that really did matter.  Things that weren’t so important fell away for a while.

The damage to my little red Corvette far surpassed the slight damage I suffered physically.  I discovered a few things about myself, though, in the days following the accident – days when I missed my car like a lost part of myself.  In my next post, I’ll share some of my thoughts and discoveries – precious realizations that cost me dearly to learn (or re-learn) on a Friday morning I’ll never forget.

Ten Things I’m Thankful for This Thanksgiving

Thanksgiving is one of my favorite holidays.  I spend the day at home with my immediate family and maybe a close friend or two.  I slow down, rest, and enjoy good food and intimate moments with the people I love.  I remember all the things I have to be grateful for.  Here’s my “top ten” list for 2009:

1.  My phone has been ringing

I’m busy.  My schedule has been full for several months now.  Money is coming in.  I’m immensely grateful for this alone.  I’m also grateful, though, that I’m not living in a bubble, insulated from the crisis so many people are going through.  I can relate to my patients and their painful difficulties because I’m affected by this financial meltdown, too.

2.  I’m following my passion and finding great fulfillment in my work

Not only am I busy, I’m busy doing the work I love.  Every morning I get up and go to work at my own business.  I’m my own boss, and what I do makes an enormous difference for good in the lives of people who are hurting.  As hard as it can be some days, this is still my dream job.

3.  I have a staff I can count on

My staff, including my wife, is committed to the work we do.  They work long hours, they give unselfishly of themselves, and they are dedicated to growing personally and professionally.  When I need them, they’re there for me.

4.  My health is holding up, in spite of the long hours I’m working

Next month I will turn 64.  Many people my age are thinking about, or already “enjoying” retirement.  I can’t imagine ever quitting.  I take care of myself physically, emotionally, mentally and spiritually so that I will be able to continue to work all the days God gives me.  So far, it’s paying off.

5.  My family is well, and after years of paying his dues in the wine industry, my son’s business looks like it’s on the verge of taking off

Last year, my wife Lynn had a serious health scare.  She’s doing fine now, but the memory of that wake-up call stays with me.  I cherish her more every day.  My son is growing and learning how to be a man and survive and succeed in a very tough business.  I’m immensely proud of him.

6.  I’m closer to my mother now than at any other time of my life

Mom and I haven’t always gotten along well.  My childhood was extremely difficult for both of us.  She has matured dramatically in the past year and sets an example for the grace and wisdom that comes with age.  I’m so grateful she is alive now, and that we have this time and opportunity to build a new and precious relationship together.

7.  I live in a beautiful part of the world

Northern California, and Petaluma in particular, is a wonderful place to live.  The landscape restores me both daily and through the change of seasons.  If the Bay Area only had a warm, tropical beach, this would be paradise.  (You can guess where I love to vacation.)

8.  I can ride my horse during breaks from work

My first thought here is almost a complaint – I wish I had more time to ride – so I’m only human.  But I’m glad that when I have the time, I can trailer my horses and head out to the beach or American Canyon.  In a time crunch I can take to one of the trails on my ranch.  Time spent on the back of my horse is time away from it all.

9.  The pastors of my church are there for me

Rich Cundall and Andy Sodestrom of Hessel Church are truly men of God.  They’ve counseled and encouraged me through some rough times over the years.  Their compassion and support for me and for my work has given me renewed strength and hope.  They have come along side me as true examples of obedience and service to God and to others.

10.  God is with me

He carries me, he protects me.  He promises He will never leave me or forsake me.  I am not alone, no matter how I may feel when hard times come and I have moments of fear and doubt.  I am loved by God, He has saved me, nothing happens in my life which is out of His plan or beyond His control.

Practicing gratitude isn’t just for Thanksgiving.  Remembering to be thankful is an act of emotional and psychological health.  I encourage you this Thanksgiving, and all through the year, to stay mindful of the blessings in your life.  Commit yourself to acknowledging the really wonderful people and events you’ve been privileged to know and experience.  A deep sense of gratitude can lead to positive humility and the desire to share with others in need.  Your opportunity is waiting.