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.

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.

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.

Inaugural Issue of the Trauma Newsletter

I’m excited to announce the arrival of the first issue of our newest publication, the Bernstein Institute Trauma Newsletter.  Each issue of the newsletter will contain helpful, practical articles on the subject of trauma, along with a personal note from me on a vital issue catching my attention.  My aim is to consistently provide accurate information and positive inspiration for everyone who has been touched by what I’m calling the “hidden epidemic” of our time.

This first issue includes two articles: “Financial Crisis, Trauma, and Reinvention”, covering the continuing, painful repercussions from our Great Recession; and “Military Suicides: Part One”, the first in a series exploring the facts and trauma-related issues underlying the dismaying spike in suicides by military personnel.  Also, in “From Peter”, my personal answer to the question, “What is emotional trauma?”

Soon, we’ll have a way for readers to subscribe to the newsletter through our website.  For now, please follow the link to download your copy today.

A Lone Star State PTSD Debate

In 2014, George Bush will run for the office of Texas Land Commissioner.  He’s campaigning already, according to a recent article in the Mid-Valley Town Crier, and, as a veteran, he has plenty to say about PTSD and other issues regarding military service.

Julie Silva’s Crier article first caught my eye for an obvious reason—is Former President George W. Bush running for Texas Land Commissioner?  After my double-take, I discovered that US Navy Reserve Ensign George P. Bush (and nephew to our former president) is actually the commissioner-hopeful.

The next reason for my interest in the Crier article is a debate about PTSD that arose during Bush’s visit to VFW Post No. 7473 in Elsa, Texas.

George Prescott Bush served in Afghanistan in 2010 as an intelligence officer.  On returning to the homefront, he explained to his VFW audience, his greatest concerns for fellow veterans were the high rates of suicide and unemployment, as well as providing increased access to education.

Bush created some controversy when he began to talk about fellow Texan and former Navy SEAL Chris Kyle, who was killed earlier this year on a shooting range, allegedly by a fellow veteran with post-traumatic stress disorder.  Based on his own experience with PTSD, Kyle had decided to create FITCO Cares, a foundation with the goal to help veterans overcome PTSD.  “He proved that PTSD is not something permanent,” Bush stated of Kyle.  “To me, this was a call to action, not only to my generation of veterans, but to all veterans.”

But a member of the VFW audience objected to Bush’s statement.  “Many times we have a hard time getting our benefits and the last thing we need is for somebody to say that PTSD is not permanent,” a Vietnam veteran responded.  “A lot of times PTSD doesn’t hit you until years later.”  Bush clarified his stance by explaining that he believes that the condition can be permanent if left untreated.

Whether PTSD is “permanent” is a thorny issue and I’m not going to go into all the background for taking one position over another in this post.  What I want to highlight today is a point I make in my new book, Trauma: Healing the Hidden Epidemic.  There is a crucial difference between “healing” and “a cure”.

In short, I believe there can be healing for post-traumatic stress disorder.  But there is no cure.

Let me quote from “To the Reader” in Trauma:

“Healing is possible.  We have witnessed such healing time and again at the Bernstein Institute for Trauma Treatment in Petaluma, California.  However, only by addressing the wounds lodged deep in our subconscious mind and, quite literally, in our bodies can true healing begin.  The process of discovering and developing a method of healing at this profound level is described in this book.”

Notice my carefully chosen term: healing.  Not cure.  I suffer from PTSD myself (you’ll discover the multiple sources of trauma in my life as you read my book).  And although I’ve done much work to heal my PTSD and the PTSD of my patients, I know there’s no cure.  Put me in a particular set of circumstances, in the “right” situation, and I can be triggered into a reaction of violence and rage.  And to their dismay and regret, this is true for my patients as well.  For them and for myself, getting triggered happens a lot less often than it used to, but it can and does happen.  Most of the time, I’m able to stop myself from acting on my violent emotions, but their intensity can still be consuming.

Let me say, briefly, that healing PTSD means being less frequently triggered into the past, less frequently confused and overcome with potentially destructive emotions and pain.  Healing means being more often in the present, enjoying the sometimes stressful challenges of a fulfilling life and relationships, with fewer debilitating intrusions from memories of the past.

No, there is no cure for PTSD.  But there is hope.  Our veterans can find healing.  And if you suffer from PTSD, so can you.

Would You Talk to a Virtual Therapist?

On June 20^th, I attended the day-long “Brain at War” conference in San Francisco presented by NCIRE – The Veterans Health Research Institute, in cooperation with the San Francisco VA Medical Center, UCSF, and the US Department of Defense.  Annually hosted by the stately Marine’s Memorial Club & Hotel, “Brain at War” reports on the “ongoing examination of the physical and neurological consequences of military combat duty”.  Experts in medicine and science present “the latest innovations and emerging technologies” in the understanding and treatment of PTSD, TBI, and other brain injuries associated with combat experiences.

Some of the presentations were of great value.  Caroline Tanner, MD, PhD, the Director of Clinical Research at the Parkinson’s Institute, gave a fascinating overview of Parkinson’s disease and its possible relation to brain injury and exposure to toxic chemicals.  My father died from complications of Parkinson’s, and while I was familiar with some of the information Dr. Tanner presented, some of her material was new to me.

Robert Obana, Executive Director of NCIRE, graciously included me at a lunch table where I was able to meet several presenters and other important conference attendees.  We had a lively discussion on many topics, one of which included the day’s most thought-provoking presentation.

The presentation came courtesy of Dr. Albert “Skip” Rizzo, the Associate Director for Medical Virtual Reality at the Institute for Creative Technologies, USC.  Skip, who obviously loves his job, gave a fascinating overview of his work developing virtual reality applications for military personnel training and treatment.

Briefly, Skip’s work involves four areas: first, an intense, customized version of the Xbox game “Full Spectrum Warrior” for PTSD exposure therapy; second, a video resilience training program modeled on a “Band of Brothers” format; and third, a somewhat folksy, virtual-online PTSD mentor-coach, dispensing information and coping skills from across the table on a porch.

The fourth application involved the creation of a virtual therapist who conducts a Skype-style counseling session from a comfortable chair.  The program uses a fairly young, female image to probe for emotional dysfunction in her real patient by instantaneously tracking patient verbal responses while reading both vocal patterns of distress (by microphone) and visual body language (by web-cam).  The virtual therapist is programmed to then respond verbally and physically in real-time to the issues shared by the military patient.  “That sounds difficult”, she acknowledges when a veteran reveals a painful memory, and leans forward when her real-life patient leans back.

The therapists, social workers, and counselors in the room reacted strongly to this simulation.  I felt a visceral dislike for what struck me as a removed and cold treatment approach to the complicated issues and deep wounds of many of our traumatized combat veterans.  A “sensitive” machine is still a machine.  Won’t troubled service members feel belittled and dismissed if they assume they don’t rate face-time with the empathetic, skilled professional help of a real, live therapist?

This chilling prospect was remedied, somewhat, by Lieutenant Colonel Steve Countouriotis, US Army (Ret.), NCIRE Board of Directors, and fellow resident of Petaluma, in his closing remarks.  He brought humanity back into the day and touched me deeply.

So, on to the question of this blog post title: Would you talk to a virtual therapist?  There’s a possibility, I admit, that feelings of intense embarrassment or shame could make confiding in a virtual, not-real therapist seem safer or easier.  I would appreciate it if you’d weigh in on this one.  Could you see yourself participating in virtual therapy?  Or, do you see it more as I do, as an approach which could oversimplify and disrespect the complex nature of trauma and being human?

PTSD Awareness Day

The United States Senate has designated June 27^th as National PTSD Awareness Day.  Every day in my practice I’m doing what I can to bring more awareness to trauma and the “invisible wounds” that contribute to post-traumatic stress.

It isn’t just the military who suffer from PTSD.  Anyone and everyone who has experienced overwhelmingly traumatic events can find themselves suffering from hidden, emotional wounds.  Firefighters, EMTs, police, nurses, emergency room personnel, crime victims, abuse victims—all of these and many more are at risk.

I’ve tried to highlight issues and misunderstandings about PTSD in my recently published book, Trauma: Healing the Hidden Epidemic.  To further contribute to PTSD awareness this day, let me quote from my chapter, “A Note to Veterans and Their Loved Ones”.  What I’ve written in this chapter regarding veterans applies to all those suffering from post-traumatic stress.

“Post-traumatic stress disorder is just a name for a catalogue of symptoms that follow a stressful situation.  Veterans are not the only people on earth with PTSD.  Yet the term has a very negative connotation in the military world.  Veterans often feel that a PTSD diagnosis reduces the uniqueness of their individual reactions, feelings and struggles.  Or they may feel stigmatized, labeled, and devalued by their peers.

“In truth, veterans experience a wide range of reactions following deployment, and the symptoms can be minor or severe.  Instead of using this name as a label, it is important to reestablish post-traumatic stress disorder as merely a collection of possible symptoms caused by trauma.  It is not limited to war veterans, and those suffering from PTSD may not be permanently damaged; they can heal with proper treatment.”

Let me say that again: PTSD is not a permanent condition.  With help, it can be healed.  That is the essential message of my book, a message of hope.  Of all the awarenesses that could occur on this National PTSD Awareness Day, let that be the overriding one.

Military Suicide and Military Families: Part 3

Military suicides happen far too often.  Alarming statistics from studies of suicide by active duty service members and veterans both paint a tragic picture.  The years of combat in Iraq and Afghanistan, the multiple deployments, have taken their physical and emotional tolls.  Over the last few months, I’ve kept this issue in the forefront of my blog posts.  Lately, I’ve highlighted a side to military suicide about which few studies have been done and statistics are largely unavailable: suicide by military spouses.

I’ve drawn heavily from the words of two military wives:  Ms. Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, and Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation.  I’ve reviewed the symptoms of post-traumatic stress (including suicide and suicide attempts), and the inadequate mental health treatment currently available to military spouses.  Today I’m going to go into more detail about the stresses experienced by military families.  I’ll conclude with Deborah and Kristy’s suggestions for ways the Departments of Defense and Veterans Affairs could better serve the mental health needs of military families.

In January, 2011, Deborah Mullen addressed the Military Health System Annual Conference.  She opened with a direct quote from a letter by a young military spouse.  “It is infinitely worse to be left behind,” she read, “a prey to all the horrors of imagining what may be happening to the one you love.  You slowly eat your heart out with anxiety and to endure such suspense is simply the hardest of all trials that come to an army wife.”

The letter’s young author?  Libby Custer, wife of General George Custer, writing in May of 1876.  “The nature of war changes,” Ms. Mullen observes.  “Weapons get smarter . . . tactics get sharper . . . breakthrough medical advances save more and more lives.  But the stress and the anxiety felt by those who are left behind NEVER changes.”

Besides the agony of waiting, other sources of stress for military spouses and families include reintegration and reunion challenges, Deborah explains.  “A combat tour may last a year, but the effects of that tour on the service member and family may last much longer.”  Spousal and child abuse cases are rising in military families.  Families of service members who’ve sustained serious physical injuries may endure long-term relocation to receive treatment, and children “may be left at home with family or friends”, breaking the immediate family apart.

Or maybe the returning service member has suffered the signature wound of our Iraq and Afghanistan conflicts: an “invisible” wound from PTSD or TBI.  Spouses and children “don’t understand why their parent looks the same, but isn’t the same,” Deborah continues.  And “for those children whose mom or dad died – either by the enemy or by their own hand – this war will never really end.”

How can the DoD and VA better serve the mental health needs of military families?  Deborah Mullen and Kristy Kaufmann, writing for the New York Times, make the following key suggestions:

1. Really listen to military families, look at things through their eyes, to better understand their special needs and challenges.

2. Provide “home-centered” assistance for families in crisis, in which counselors and other assistance personnel come directly into the home to provide needed support.

3. Do a better job of following up on the results of programs currently in place.  New programs are being created all the time, but too often they aren’t reviewed and modified, as necessary, to become truly effective.

4. Develop a more holistic strategy that integrates military families and community support.  Society has a crucial role to play in helping keep military families strong and healthy.

“Ultimately,” Deborah concludes, “spouses tell me they don’t need another program, they don’t need more training.  What they need – what they want – is time.  Time with their spouses.  Time together with their family.  Time with a counselor or a doctor or a minister.  They want time to explore and understand what is happening to them . . . and the patience and understanding of loved ones, friends and the system itself.”

“If you have a broken family,” Kristy warns, “chances are you’re going to have a broken soldier – and vice versa . . . . It will take a nation working together to keep us strong.”

As a young Marine wife told Ms. Mullen, “It doesn’t matter if it’s the first day they’re gone, or the last day before they return home, you’re scared all the time.  You pretend to be happy, but you’re living in fear.”  And, Deborah urges, military spouses should not have to face that fear alone.

Through my work, I’m committed to the health and well-being of our nation’s service members and their families.  I don’t want them to be left alone to struggle with their issues of emotional trauma and post-traumatic stress.  I encourage you to join me, in whatever way you can.