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Trauma

Parenting Styles

I’m seeing several families in my practice now with adolescent sons. Adolescence is a challenging time for kids from even the healthiest of families. It’s a time when teens begin to separate from their parents and establish themselves as individuals. To successfully transition into adulthood, teens need to learn how to take on the tasks of adult life, including job skills, relationship skills, and self- discipline.

These can be almost impossible tasks for teens from families with misguided or deficient parenting. Poorly-parented children tend to act out, rebel, isolate, or get self-destructive. The stakes for these kinds of behavior are much higher during the teen years. This is the time families show up in my office because they are in crisis. There’s plenty I can do to help.

I want to talk briefly about parenting styles, which I learned about early in my professional training and included in my typewritten thesis (this was forty years ago). Time may have passed, but these profiles are just as valid today as when I was an intern.

There are three classic parenting styles: authoritarian; permissive; and authoritative. The following definitions come directly from my thesis.

  1. The authoritarian parent attempts to shape and control the behavior and attitudes of the child in accordance with a set, absolute standard of conduct. They value obedience as a virtue and favor punitive, forceful measures to curb a child’s self-will where the child’s actions or beliefs conflict with the parent’s.
  2. The permissive parent attempts to be non-punitive and accepting towards the child’s impulses, desires, and actions. The parent consults with the child about policy decisions and makes few demands for household responsibility or orderly behavior. The parent offers themselves as a resource for the child to use as they wish.
  3. The authoritative parent directs the child’s activities in a rational, issue-oriented manner, encouraging verbal give and take, and sharing with the child the reason behind their policy. The parent values the child’s unique abilities and cultivates a balance of autonomous self-will and disciplined conformity.

The authoritative model of parenting creates healthy families. Most people accept that flawed parenting styles like authoritarian and permissive will lead to problems for children. What many people don’t understand, however, is that kids from both authoritarian and permissive types of families can end up with very similar attitude and behavior problems. The outcomes for authoritarian or permissive parenting can be equally severe and destructive, especially for teens.

That’s what I’m seeing now in the troubled families in my practice. There’s been harshness and neglect, or pandering and overindulgence. The bottom line? Tragic difficulties for all involved.

“Ten Things I’ve Learned About Trauma” – by Catherine Woodiwiss

List articles are popular on the internet, some more helpful than others. Catherine Woodiwiss’ “A New Normal: Ten Things I’ve Learned About Trauma” from the Sojouners website is better than most I’ve found on the subject. Catherine has done a good job of translating her experiences with trauma into wisdom and insights worth taking in. Below, you’ll find her first point, “Trauma permanently changes us.” Follow the link at the end of this post to read her entire article.

1. Trauma permanently changes us.

This is the big, scary truth about trauma: there is no such thing as “getting over it.” The five stages of grief model marks universal stages in learning to accept loss, but the reality is in fact much bigger: a major life disruption leaves a new normal in its wake. There is no “back to the old me.” You are different now, full stop.

This is not a wholly negative thing. Healing from trauma can also mean finding new strength and joy. The goal of healing is not a papering-over of changes in an effort to preserve or present things as normal. It is to acknowledge and wear your new life—warts, wisdom, and all—with courage.

Read the full article here.

Self-Pity and Grief

I had an almost identical word-for-word exchange with two of my patients last week. Both of these patients experienced significant early childhood deprivation and abuse. Both continue to be haunted by the pain from their distant pasts and yet they cut themselves off from feeling that pain.

This is not unusual. Disconnecting from pain—what I call dissociating—happens frequently with trauma survivors. No one likes to be in pain, particularly if they feel like there’s nothing that can be done about it. Or that if by feeling the pain, they might fall apart or not be able to function.

One way people use to avoid feeling old pain is to claim that they don’t want to indulge in self-pity. Both my patients told me that. Now I’m one of the first people who would agree that self-pity is an indulgent, useless state. Nothing good comes from it, certainly no constructive progress toward a better life. But what I was asking my patients to do last week was not to indulge in self-pity, but to allow themselves to grieve.

Grief is a healing process. Grief acknowledges that someone or something valuable has been lost. It recognizes that this loss must be felt—fully—so that the grieving person can let go and move on. I’ve seen patients trapped in protracted grief, and it’s a painful, lonely, hopeless place to be.

If my two patients were able to grieve for their losses of love and nurture during their early years, they would be more able to embrace the opportunities for love and fulfillment in their present-day lives. I know this idea is not obvious to most people, particularly hurting people. It’s important, though, to clear up the differences between self-pity and grief so that healing can take place.

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.

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, 11th, 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”