Wildfire Recovery and Healing

Wildfire has devastated our community. Lives have been lost, homes and businesses destroyed, and individuals and families dislocated. Firefighters have labored in high-risk conditions. Law enforcement personnel have protected our neighborhoods. Community organizations and countless individuals have stepped forward to offer refuge to evacuees. My heart goes out to everyone in my community who is suffering in the traumatic aftermath of the Wine Country wildfires. Their impact will be felt for years to come.

I’ve worked in the field of trauma recovery for over 47 years. I’ve seen that after a crisis passes, the steps to recovery and healing can begin. While recovering from trauma isn’t simple and will take time, I offer five suggestions for starting the process:

1. Allow yourself to grieve.
Give yourself permission to feel and express your grief. Grief includes feelings of loss and sadness, but also of anger, distress and frustration. Shortcutting the grief process postpones your recovery from trauma. Buried feelings don’t go away, they fester. Grieve your losses.
2. Deal with reality without succumbing to fear.
Traumatic experiences involve threats of danger and loss of control. Fear is a natural response in such situations but allowing your fears to take over will only make your situation worse. Discipline yourself to focus on taking one step at a time. Don’t obsess about the past or the unknown future. So much can seem chaotic and unpredictable now. Ask yourself, what is the next constructive thing I can do? Then act, keep moving forward.
3. Look for new opportunities.
During dramatic upheavals, it’s easy to lose sight of new opportunities. What have you been hanging onto which it would be better to let go of? In what ways would it be better NOT to go back to “the ways things were?” I have seen that trauma produces not only post-traumatic stress but also post-traumatic growth. Change can be for the better.
4. Find things to be grateful for.
What can you be grateful for? I’m not suggesting that you feel gratitude for pain and loss. If you and your loved ones survived the fires, be grateful for the chance to rebuild and start again. If you were evacuated and received support, be grateful for that. If you helped hurting people in our community, be grateful for the opportunity to make a difference in their lives.
5. Help others.
Probably the quickest way to temporarily set aside your own pain is to help someone who is suffering, who may have had a harder time than you. Or, reach out to our first responders who have worked hard to protect us. Continue to care for others and you’ll find your own burdens will feel lighter.

In my years as a therapist, I’ve seen all kinds of trauma – combat, crime, abuse, violence, even our recent financial recession. I’ve helped many people get through traumatic life experiences. I know it can be done. It’s urgent to start the process of recovery as soon as possible after the immediate crisis is over. My staff and I are committed to helping our community to develop resilience, heal and find hope. Let’s reach out, come together, hold each other up. My heart is with you.

Psychotherapeutic Boundaries

One of my lifelong priorities has been to demystify the language of psychotherapy. Academic terms and jargon more often make the therapist sound impressive rather than help the patient get better. “Make it simple and down-to-earth for me,” is something I say a lot – to fellow therapists and to my patients, as well. Vague confusion doesn’t do anyone any good.

So today I want to demystify two terms in the psychotherapy profession. These thoughts come straight out of my thesis of 38 years ago. The terms I’m talking about are the external boundary and the internal boundary.

Part of a psychotherapist’s job is to set and control the external boundary for their patients. This means – as simply as I can put it – that it’s my responsibility to create and maintain a safe and beneficial space for my patients. This setting will give them the best chance to understand and resolve their challenging personal issues. Part of the space is my office. Patients must be able to feel physically safe. This includes the promise to complete privacy and confidentiality.

The other “space” that’s part of the external boundary is the structure of the therapy I provide. Working within their budgets as best I can, I determine how many sessions, lasting how long, and happening how often, are needed to give my patients their best chance for success. I also set up scheduling and payment methods to help my patients be more accountable for their progress and success.

The internal boundary of psychotherapy, however, is less directly under my control. It is more like a delicate partnership with my patient. Patients cross the internal boundary to reveal to me their pain, wounds, struggles, and fears. They reveal their traumas from the past and the present and their hopes for the future. These revelations allow me to get to work – helping them address issues, resolve pain, and create a better life and relationships.

But crossing the internal boundary can be complicated by many, many things. Patients can feel shame and have trouble being honest. Patients can want to blame others or events and deny responsibility for themselves. Patients can be in denial, or disconnected, or just plain don’t know how they feel or why they keep making a mess of their lives.

Over my years in practice, I’ve developed ways to help people cross the internal boundary, discovering and revealing their most deeply held pain and secrets so that they can heal. I believe this is where psychotherapy goes beyond having a toolkit. Yes, tools are necessary, but there is an art to using them. In this area, I can always improve.

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.

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.

Trauma/Healing 4

Trauma . . .

. . . can be an isolating experience.

Healing . . .

. . . happens most fully in relationships.

From “A New Normal: Ten Things I’ve Learned About Trauma” by Catherine Woodiwiss

Trauma/Healing 3

Trauma . . .

. . . is a hidden epidemic.

Healing . . .

. . . is possible.

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.

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.