Importance of an Empathetic Therapist for Chronic Traumatization

Finding a compassionate and empathetic therapist is a must to heal from trauma.

Vets, if we do not develop a connection with our therapist, it’s unlikely we will keep our appointments. If missing an appointment call to cancel, and reschedule, so another vet can take your place.

There is no time frame in healing from war trauma.

We may feel an urgent need to purge, or have a sense of never being able to talk about our experiences. Similar to running distances we need to pace ourselves in therapy so we do not retraumatize ourselves, and return to our old coping habits.

It might take a couple of therapists to find the right one, so it’s important to keep appointments even if your not feeling secure in sharing. If after three or four visits, a rapport is not developed with your mental health practitioner, ask for a Change of Provider form at the counter.

To increase the likelihood of approval, write lack of rapport or connection, and do not feel they can help. It may take up to three months to see another therapist.

Remember, your mental health is important. Keep your appointments, and find the right person to guide you through the process. An empathetic therapist is paramount to healing from trauma.

Our emotional and spiritual centers are damaged, to find our way through the wreckage of our minds, we need a guiding hand. A ‘therapeutic window’ is an empathetic connection between the therapist and client, enabling a safe place for exploration of traumatic memories and events.

Traumatic events shape our lives, and alter the way we process information. Especially chronic traumatization, our symptoms mimic depression, bi-polar disorder, and personality disorders. We can be misdiagnosed by a less knowledgeable and skilled practitioner.

Veterans with chronic trauma need an empathetic practitioner, knowledgeable in the latest treatment modalities to take our emotional hand and guide us through the wreckage of our minds.

It is helpful for therapists to understand the implications of structural dissociation as an undue division of the personality, how it manifests, and how it must be treated. They should strive to understand the importance not only for psychodynamic, relational and behavioral aspects of treatment, but also become proficient in assessing and working with the mental energy and mental levels of patients. Therapists need to analyze survivors’ mental and behavioral actions for adaptively. (The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, van der Hart, Nijenhuis and Steele).

The dissociative features of chronic trauma have a distinct set of emotional states we cycle through distinct from the others, the common symptom such as anger and rage to the less talked about emotional numbing to the different personas that can emerge from trauma states.

Preparing for Therapy

So you are ready for therapy but don't know what to expect. What's the difference between all the mental health professionals?

A psychologist has a PhD, they use a variety of therapies but do not prescribe medications. They usually run programs, in rank they compare to captains. A psychiatrist is a medical doctor who specializes in mental health, they use a variety of therapies and prescribe medication. They often run departments, they would be considered a colonel or appropriate rank.

Therapists would be the high-ranking Non-commissioned officers the military could not run without. They are usually clinical social workers with a master's degree and often have specialties. My therapist is a nurse-practitioner.

You may need a Marriage and Family Therapists for help with your partner and relationship. But, more than likely if you are reading this you will need a therapist who practices evidence-based therapies to treat posttraumatic stress disorder, military sexual trauma and traumatic brain injury. In therapy you will need an empathetic hand to guide you through the wreckage of your mind.

Empathy is the ability to identify, internalize and experience another's emotional state. It's imperative to find a therapist you can connect with. The nature and structure of trauma leaves internal conflicts; the kernel of trauma-based disorders rest in the most recessed parts of our minds.

The most important aspect of therapy will be an empathetic connection with your therapist, a therapeutic window between the therapist and the patient to reach the deepest compartments. To access this information safely, we must bond with our treatment provider.

To begin the journey of recovery we must find a therapeutic window into our minds substrate. Without developing a rapport with your therapist, therapy will not work. Read that again.

Become an advocate for yourself and learn some basic information on how the Veterans Administration works. You can fire any doctor or therapist in the VA by going to the counter and asking for a Change of Provider form.

Write the reason you don't want this provider and you don't trust them. Generally it will take up to 3 months to get a new appointment so make sure you want to change. Go to at least 3 or 4 visits before you decide to fire your mental health practitioner.

I fired a therapists because she talked about her issues and was more depressed me. I fired a psychiatrist due to her inability to discuss my medications with me or her unwillingness to listen to what I had to say. I've changed therapists because they were not certified in Cognitive Processing Therapy (CPT).

There are many kinds of therapy and the one you will probably engage in the most is psychotherapy or talk therapy. Talk therapy consists of sharing about psychological distresses, social, life in general and family issues. The therapist listens, gives feedback and psychoeducation on your condition along with teaching coping skills to manage symptoms.

Talk therapy focuses on maintaining equilibrium and balance in life. The most effective treatments for the mentally wounded with the diagnosis of PTSD, MST and TBI is evidence-based therapies. The front-line treatments are Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT) and Exposure Therapy (ET). Ask your mental health provider if they use these therapies and if they have certification.

We'll cover two, since they are the most used. CBT examines the relationships between thoughts, feelings and behavior. By identifying beliefs that lead to self-destructive behaviors the therapist can offer coping strategies to help change thinking patterns over time. The therapies will be problem-focused and goal-directed for symptom reduction. Expect to have homework and if you want to heal actively participate.

Cognitive Processing Therapy, an exposure therapy, focuses on accessing trauma memories, identifying and challenging faulty beliefs about the event and resulting over-generalized beliefs in self. According to Cognitive Theory, trauma impacts our belief structures and how we categorize the world.

That two types of emotions follow trauma, natural and manufactured. Natural emotions are universal such as fear, anger, joy, happiness, sadness and loss. They have a natural course to run unless we feed into them, then they can become stuck points. Manufactured feelings result from the way we interpret events and not fact based.

I know a combat medic with four tours and many medals, the purple heart included. She was unable to return to active duty because of extensive damage received from an Improvised Explosive Device. She's fighting the belief that she let soldiers down because she couldn't return to her Mobile Army Surgical Hospital and deploy outside the wire under fire where she belonged.

Cognitive Processing Therapy starts with psychoeducation about your condition and symptoms, then therapy goals and identification of stuck points, and then 12 sessions centered around challenging beliefs and meaning of the event.

The structured sessions center around identifying thoughts, feelings and stuck points associated with the event. They challenge problematic thinking and address safety, trust, power and control, esteem, intimacy and meaning. This is an exposure therapy, a writing component starts with an impact statement and then writing about the trauma again from each perspective safety, trust, power and control, esteem, intimacy and meaning. The therapist and patient will examine the writing together with worksheets and writing exercises. I've used this therapy and it's the best one so far.

Keep a therapy journal. Write a list of questions and reminders to keep track of what to talk about. Write about your insights and revelations.

Write about your feelings, thoughts and trauma. In doing so you begin to take back your mental health one session at a time. A journal will keep you from forgetting the issues you want to discuss and a place to share your inner self.

Trauma telling is an important aspect of healing, it enables us to re-contextualize our experiences and find meaning where we once thought was none.

Daily Dealings with PTSD

This week has been the worst in a while. I am in week 4of CPT. I am working 3 part time jobs to make ends meet as a single mom. I also volunteer some time as an editor and am taking two graduate classes.

If I were an alcoholic or on drugs, people would be right there with a program, sympathy, empathy, some kind of words of encouragement or helping hand. My addiction is filling my schedule and helping everyone else so I don't have the time or energy for flashbacks and nightmares. I numb myself with work and helping others. There is no 12-step program for that addiction. People don't look at me with the sympathy drink or drug addicts get. People respond to me with, "Are you nuts?" As a matter of fact, I am. I am also struggling to support my family.

I know I am in a bad place in my head. I requested Cognitive Processing Therapy would help me deal with the aftermath of being raped twice while in the Army. Now in week 4,  I wonder what I was thinking and why does VA jump all over this therapy as a cure. For the first time in years I have thought that death would be so much easier. Suicide is not an option for me, but death seems so inviting and easier than what is in my head. 

I look to the scars on my arms and wonder if I could explain new ones. while I don't mind being alone, it is a rare treat for me, I feel completely lonely. I see people with their friends and loved ones, particularly the ones who are in each other's arms for love and comfort and I die a little inside. Yes, I can find that comfort easily for a few minutes with some stranger or friend, but it is not the same as the nurturing and lasting love and understanding I long for and crave.

I am frustrated and angry because I was not always like this. Living with PTSD, I had my down days, but most were good days with at least one thing I could find to be grateful for. Since starting CPT, there are no good days. There are days filled with as much as I can pack in them to not feel the emptiness and loneliness and pain.

Two Weeks Into CPT

I recently attended my third session of Cognitive Processing Therapy. Week one was difficult as my assignment was to write about how my trauma has affected my life. I know that sitting down and thinking about the physical, mental, and emotional manifestations of my trauma will set me off. Immediately I went into self-preservation mode and struggled to figure out how to write this requirement without losing control of my emotions. The directions asked for one page. I hand-wrote one page. There were specific areas to focus on: e.g. relationships, security, physical, etc. To minimize my reaction, I wrote the page at work where my job will certainly distract me from getting completely sucked into a flashback or crying jag.

The assignment for the second week was to take my trauma and two other instances and examine what happened, what I thought, and how did I feel. Then I had to look at what I told myself and determine if those thoughts were realistic. In my case, I was told so many times by people in authority in the Army that because I was drinking, I deserved what I got. I believed for may years that if I had not been drinking, I would not have been raped. Is that realistic? Maybe I wouldn't have been raped if I was sober. Maybe I could have fought back if I was sober. Likely it would not have made a difference because my rapist was on a mission. Regardless, I did not deserve to be raped and I will never know if drinking or not drinking mattered. It is a struggle to remember that my drinking made things easier for my rapist, but likely didn't really make a difference in the outcome of those nights.

This week, Week Three, my assignment is to write about my traumas. I have already written about my rape in Aberdeen in 1993. This time I am supposed to focus on my rape in Germany in 1994. The second trauma is one I had only vague memories I didn't want to put together. After seeing Invisible War and years of therapy, I remember too much. That is the trauma I haven't faced and now am being forced to, in my opinion. One day after getting the assignment, I am fighting it. I don't want to remember despite being sick to my stomach, being more depressed, being more anxious, and the continuous smell of the basement I haven't been in in 19 years. I know those symptoms should lessen if I deal with this, but I can't deal with this. I don't have time to deal with this now.

Another thought has come to mind to follow me everywhere. Who will I be without these constant reminders and relivings? Who am I without my traumas hidden away inside of me?

Suicidal Thoughts: Recovering From the Darkness

NOTE: I am in therapy and have an appointment in an hour and thirteen minutes and will be discussing the below. I have a safety plan called Smoke Break if the thoughts become persistent. When I can think of nothing else, it's time to check myself in to the local VA, for the 7th time if necessary.

If a veteran admits they have thought about killing themselves, then they mean yes, hell yes, too much and maybe even all the time. We talked about the compulsions to kill myself in the last post. Now I want to address the buildup to compulsive behavior; the compulsive thinking and the many reasons not to live rolling around in my head.

If you are feeling suicidal or homicidal, the National Suicide Prevention Lifeline has helped me several times over the years, so call 1-800-273-TALK.

I have few close friends locally and family comes around every so often; my dog and a few friends, that's it. I do not want to keep feeling this pain in isolation. Been fantasizing about how ending it would 'show them' or how 'they wouldn't care' while stoking my resentments and devising a list of who cannot come to my funeral. The obsessive thoughts of self assisted doom have been patrolling my mind to seize upon my life. There's no loved one or caregiver here, or resources for assistance for a non-Post 9/11 and undeserving veteran. I don't have a plan, just unmet needs fueled by distorted and delusional thinking leaving me vulnerable to the compulsions to kill myself. But, such is life.

Along comes detachment and numbness to replace the physical and mental pain, a different kind of anguish that makes us relish the void and can last for as long as life for some. It's another kind of hell to be cut off from the out going person I used to be, that deep down my desire to be among loved ones out in the world is buried under the fears of loosing my reality to the past, cyclical thoughts fueled by petal to the metal emotions raging on and on to loose myself. Or yourself if you are stuck in this pattern thinking. Below is how I get through moments of utter inner panic, most do not see it. But, those in the know do.

If you need a therapist in person or over the phone, click the Give an Hour picture above to get you in touch with mental health practitioners in your area free of charge.

Chronic traumatization causes our survival mechanisms to become hard-wired into our neuropathways; a veritable surgical steel Swiss Army Knife of fight, flight or freeze. A constant threat assessment on the battlefield was a lifesaving skill to master, at home it can manifest in distorted and delusional thinking, a major component of chronic Combat PTSD. The entrenchment of our evolutionary and primitive defensive mechanisms makes us prone to reactionary and compulsive behavior in civilization. The evolutionary defensive mechanism confound us with cyclical and repetitive thinking that may or may not be grounded in reality. Over time I have been able to become less reactionary by learning coping skills, education on my condition and triggers along with treatment. I can attest to the plasticity of the brain as per becoming a completely different person from 7 years ago, it has been exhausting most days but well worth the hard work.

Accept that you cannot prevent all of your triggering events and see them as a window into your suppressed self. 

The compartmentalized part of the mind acts as projections into the environment as seemingly inconspicuous triggers such as the unconscious sensory stimuli exchange of a tailpipe backfire for a battlefield bullet discharge. The damaged subconscious suppresses the ability to consolidate past and present memories thus giving birth to the dissociative features of Combat PTSD; a phenomenon we experience most days. It will make you question your own reality. During PTSD moments our arguments may have paranoid and delusional components set within circular arguments and backed by defensive mechanisms. As we learn our triggers, defensive mechanisms and look into what our subconscious is trying to communicate to us we begin to see a perspective from the out side of the chaotic, we begin to see more options. When we get caught up inside the circle and the battle is on. Anxiety and panic attacks can be coped with to where they pass without making us freak out. Meditation and pray have been my greatest tools to work through mine.

Meditation and mindfulness exercises like guided imagery can give you the sense of letting your thoughts go, or clearing your mind.

How? Imagine a body of water representing and matching your emotional level from raging seas to the calming stillness of a pond. Start with was an open body of water with the waves matching the level of your stress and anxiety. Visualize the waves calming to the point of stillness. This tool can be used to gauge internally your stress level and as a way to self sooth during these moments. Where there was no emotional gauge before, now if I am out of touch with my emotions accessing this image helps me gain perspective again. Coping skills such as guided imagery and other mindfulness techniques help by giving us a visual representation of our emotions so that we may better self sooth our anxiety and stress levels. Keep practicing and remember is not about perfection, it's about addressing our dangerously detached and compulsive behavior.

I ask God to take the power of it and practice letting go rather then holding onto.

Part of Prayer is asking God's blessing, an oft looked over piece is the sharing of the burden. We do not have too onerously endeavor, a trick of the Defensive State of Mind is to believe that we are alone. The sharing of the burden is living a prayerful life, venting to God and all who will listen is doing His work. Do you think the Apostles and saints talked calmly to God? By sharing your experience, you are the change you wish to see in the world. Your footsteps blaze the path where many will follow

Maybe it's time for us all to begin healing, if in your heart you feel the welling sense of hope beginning. Please, do not squelch this; you will be happy again given time. Also, accompanying may be apprehension and a sense of foreboding. This is a normal response, you were meant for more than you have been living and your being resonates this. You will become what you dream, if you dare to accept what is in your heart and act soon, if not now.

Vets Prevail: for Vets by Vets

Our veterans face a severe 30% shortfall of therapists and mental health practitioners in both the government and private sectors. It's estimated that 70% of soldiers and veterans needing help do not seek it. Our Veteran's Administration budget is strained and cannot handle the patients they have let alone address the on coming tsunami of help seeking veterans.

The Vets Prevail program is much different than the rest of the veteran's sites that only offer information in base form, such as this one. The interactive skills teaching aspect and the asking and answering questions section are paramount in helping to address the veterans and soldiers mental health problem. This program can get a soldier or veteran the skills needed to navigate life successfully. It can get the warrior fast tracked and ready for therapy and treatment by teaching them skills needed to process traumatic memories.

It's centered on proven coping and behavioral skills building concepts, values and emotive identification. All needed as a strong foundation for therapy and recovery from the Unseen Wounds of War. The interactive program is thoughtful, creative and a much needed tool for the veteran suffering in silence. Veterans can learn the skills they need to safely navigate their Combat PTSD in and outside the home.

Mental Health Emergencies

An overwhelming sense of hopelessness may lead a person to think of only one way out. I want to say that we all have errant thoughts of others being better off without us, but that's probably a symptom of something in me. Obsession is an often overlooked component of the hypervigilance portion of PTSD, coupled with the delusional aspects of traumatization cause the suicidal thoughts to be seen as a way to escape the emotional and physical pain.

Upon percolation the overwhelming and despondent thoughts often lead us too constantly resist compulsions to drive head on with a truck or off an embankment. Picking up a sharp knife to chop veggies for dinner becomes an ominous dilemma or looking out the window makes me wonder if the second story is high enough. When the higher thought processes shut down and give way to base emotional states we become susceptible to reactionary and compulsive behavior. In our hearts and minds we are torn between the vast chasm of the macabrous to spiritual enlightenment, of which in war we felt simultaneously.

Get help now, for your mental health emergencies. Don't sit alone waiting for months on end. Your life depends on getting treatment and reducing these obsessive thoughts.

PTSD: Get Over It

Ever been told to get past it? Or told to get over it and can't?

I wouldn't ask you to beat your noggin against that wall, my head hurts just thinking about it. But, working through it; that won't be as difficult. Our language says much. "Getting past it" or "getting over it" suggests it's something to be pushed aside or to get around all at once. To work through suggests that it can be managed, one trauma at a time, and one therapy session at at time. Outside of therapy you can start by learning from others who have been in your shoes through online social media sites; Facebook is an excellent tool to network Additionally I suggest learning coping skills, guided imagery to lessen anxiety, becoming familiar with your triggers, and mindfulness of thoughts and feelings to help process. Grounding techniques such as putting a rock in your pocket can help ease anxiety along with learning to pray and meditate. Journaling is a tremendous instrument in purging and self reflection, a tactile sensory expression of our experiences allowing differing perspectives on ourselves.

A Ruse Indeed: Wanna Be Therapists

Comment from a guy who originally placed on his Facebook education and work page that he worked for me here on this blog. I asked him to remove it, he apologized and gave me a huge line, I accepted his apology and gave him the benefit of the doubt. But then he makes this comment on my last article, this guy says he is a clinical social worker and I am sure he is. I was astounded when he referred to his clients as "wanna be's". Please plow through his wordage, at the end you will be rewarded as I tear him up real nicely.

Combat PTSD: A Psycho-Social and Spiritual Wound

America, I gave you my soul in 1991. I didn't know it then that I would receive a psycho-social and spiritual wound that not even I could see. Of late we have heard much on the common symptoms of Post-traumatic Stress Disorder or PTSD in the media and the soldier or veteran, you won't hear me talk about that much. I deal mostly in the chronic nature of Combat PTSD and it's many flavors and identities as it relates to me. I'm all about talking about the mental, physical, social and spiritual aspects of where going to combat can take us.

Along with the mental health issues where I perform the equivalence of aerial acrobatics in a paper airplane with an elephant pilot. Yeah, go read that again. I have recently started taking a new anti-depressant, Lexapro to help with the seasonal depression which buffers the chronic depression this last year. Since I have a "sensitivity" to such medications I get the distinction of trying novel and 'off label' usage of medications. Or I get to be first again, leading the way with taking new medications where hundreds of thousands of veterans will go!

The year 2011 was a year of grieving and mourning; I went into an inpatient PTSD program in Memphis, TN. Cognitive Processing Therapy (CPT) is a tremendous tool I was able to learn and apply to novel ways of processing my war trauma. Long story short, I was able to reconcile and mourn 5 marine deaths. In doing so it unblocked a flood of mourning for my grandmother, mother, father and friends who had died since 1991. The year 2011 was the year I took my soul back.

Other symptoms of the Combat PTSD Veteran? Toxic levels of stress hormones and chemicals in the body can cause muscle and nerve damage over years from constant flooding of the body. Stomach ulcers, acid re-flux, chronic bowel problems. Then there are the side effects from the medications starting with erectile dysfunction from the medications to treat chronic PTSD I take 9, down from 15 two years ago. If you or a loved you is not on top of your medications they can kill you!

Speaking of family and loved ones. We have the propensity to push everyone away and many of us will alienate the ones we love. Combined with a sense of loss of community, no wonder we are still loosing veterans at a rate of 18 a day. I have the gift of hindsight for all the good it does me in repairing some relationships, if I can manage to keep dodging those land mines! Yeah, the flashbacks. We don't talk about those for two reasons; one because they scare the hell out of us and two, most of us don't have the language to describe it

I do, drop me a line.

30 Confirmed Kills: Surrender Hill Part 3

Healing is not fluid. Sometimes it happens in jagged forms; one step forward and three giant leaps back. I have part 3 of one of my war time trauma accounts to share with you, Buddha said, "Do not believe what I say just out of respect for me, but test it out yourself, as if you were buying gold." This resonated within me for reasons I have recently surmised; for a combat veteran with chronic PTSD we feel as if we must test everything in our world. It is in how we test ourselves that we may find the best use for our most intimate encounters in life.

Note: This trauma account is not heavy combat yet.

My notes pick back up from April 15, 2011:

Our 3rd vehicle opened fire strafing the hill. This was our first contact with the enemy, I was horrified that we had just taken lives, but also relived that we had not taken casualties ourselves - my god - I felt pride in doing my job, that I saw or was the first to see the enemy [this has got to be part of the core of this issue, the pride I felt at being first and saving our guys - which was what I did - saving my guys from the fate of the marines from the day before]

More to come on what all this means and the connections I make today...

Hello, I'M BACK: Cognitive Processing Therapy (CPT)

I have been away for awhile...I'm ready to talk about it again. I'm ready to add the Memphis Chapter where I am back from a six week stay at the Memphis VA. I gotta say from the start, it was a great program. I was able to work through some more stuff and I am grateful for what I have learned. I saw some tremendous work from the staff and gained a new way to frame my trauma.

Cognitive Processing Therapy (CPT), I gotta say it does work. I endorse the inpatient program, but not the hospital. The hospital was pitiful, it reminded me of the Louisville, VAMC 20 years ago. I thank GOD for my local VA services. That said, I also want to scold the other f'ing side. Seriously, Louisville does not have inpatient PTSD services for residential patients? And VA over all...I waited four (4, if you read that wrong) months to get help I needed? Seriously? How many hours does one have to wait before another veteran takes their life?

As you well know I can only talk about my experience. So I will begin with typing out my therapy letters, notes and thoughts reworked here.

Playing Videogames Can Protect Gamers from Nightmares

If I could have THE video gaming device? Are you serious? Uh...well if I didn't have to worry about the cost or anything and the VA was going to pay for it (what)...did you say?

Over at GameSpy, Mike Sharky Reporting,

And it's only Wednesday. On Monday, we heard from the a UK therapist that said two hours of gaming produced the same effect as snorting a line of cocaine. A Harvard economist wondered aloud on Tuesday if the nation should thank videogames for its dropping crime rate. Today, a Canadian psychologist suggests that playing videogames can protect gamers from nightmares.

As MSNBC reports, Jayne Gackenbach, a psychologist at Grant MacEwan University in Canada, studied lucid dreams for years before becoming curious about her young son's infatuation with videogames. After initial research, she began to find "several surprises, although suggestive associations rather than definitive proof."

Some of those suggestive associations include: lucid dreamers and gamers appear to have better spatial skills and are less prone to motion sickness. The two groups also demonstrate a higher level of concentration and focus.

Based on her initial findings, Gackenbach began more detailed studies and discovered gamers were more likely to experience lucid dreams than non-gamers. She was able to duplicate the results in a number of different studies and found that gamers were also better able to control their lucid dreams than non-gamers.

Curious what her research meant in regard to nightmares, Gackenbach conducted another study with 35 males and 63 females. More on the study from MSNBC:

[Gackenbach] used independent assessments that coded threat levels in after-dream reports. She found that gamers experienced less or even reversed threat simulation (in which the dreamer became the threatening presence), with fewer aggression dreams overall. In other words, a scary nightmare scenario turned into something "fun" for a gamer.

"What happens with gamers is that something inexplicable happens," Gackenbach explained. "They don't run away, they turn and fight back. They're more aggressive than the norms."

According to MSNBC, Gackenbach hopes to continue her research and discover if videogames can help veterans suffering from post-traumatic stress disorder [PTSD]. Combat veterans with PTSD [Combat PTSD] typically experience dramatically higher rates of nightmares, and Gackenbach thinks videogames might be able to help.

Uh....Playstation 3 of course.

Sentencing Alternatives for Veterans

One county over from where I live, there is a special Veterans Court which offers a second chance to current and retired service members who commit crimes while struggling with war-related psychological wounds, notably PTSD and traumatic brain injuries. The aim being to identify and treat veterans before they get deeper into trouble with the law and their crimes become serious and violent.

The defendants accept treatment and regular monitoring in lieu of jail time however if they don’t comply with the conditions of their treatment program they land in jail as the judge can revoke the suspended or reduced sentence they received. Anyone with half a iota of common sense, should realize this is a huge step in the right direction.

I come from a correctional background, working in a jail and seeing veterans incarcerated without the proper treatment they need is a national disgrace. I was embarrassed to be a part of a system that couldn't pull it's head out of its ass for veterans yet offered Sentencing Alternatives and multiple treatment options for Sex Offenders.

There are barely twenty veterans courts around the country, a woefully inadequate number yet still encouraging when compared to two years ago when the first one was started in Buffalo, NY.

The Buffalo court has had a zero recidivism rate, surely those kinds of results and the potential tax dollar savings will encourage more of these courts to spring up around the country.

I stumbled across this PBS News Hour Veterans Suspected of Crimes Swap Guilty Pleas for Rehabilitation report I thought was worth sharing.

Wartime Trauma Versus Childhood Trauma

For the last year or better whenever I am stressed or have highly emotional experiences I find myself being brought back into my wartime memories, flashbacks, emotions and perspective.

I was having a conversation the other day with someone close to me about the possibility that my wartime trauma may be getting in the way of healing from my childhood traumas. She suggested that I have a pattern of submerging myself within my wartime trauma to avoid healing from my childhood trauma. I talked to my therapist yesterday about my childhood issues and as we talked she commented that it appeared I had done a lot of work in that area. I was pleased to have her discern the 18 months of therapy that I spent on the topic. I do have more work to do in this area, but I think that my wartime trauma gets in the way of my recovery today.

My therapist and I made a deal to begin processing my wartime trauma with Acceptance Commitment Therapy and EMDR in conjunction.

(After reading this I realized that I spent too much time on my childhood trauma lately [before a couple of months ago] that I was unable to test reality against each other because I would get false positives out of it. In that, had I tested reality against others around me. I couldn't do that well with others in my family because they also carry the triggers of war...I battled on

I hear the chatter on the intercom of the division radio within my BFV, when I put on my new hearing aids I was transported back in combat, I had my headset on, I looked around to check if it was real...and it was....till I realized the hurting in my ear and remembered that my new hearing aid was probably hurting. But the Veil of Combat did not come down until I removed the hearing aid....)

Finding a Therapeutic Framework for Trauma-Based Disorders

I received a comment last night from Jeannie and thought that this would have a wider application to those of us who seek treatment for our trauma-based disorders. Talk therapy is an extremely useful tool when utilizing a proper framework with a trauma-based philosophy, which is beyond the scope of this posting. So, intimacy in a therapeutic framework is where I want to go. Without establishing this environment with a therapist we could run the risk of intellectualizing our trauma and not actually internalizing it. To internalize our trauma and absorb it within our consciousness is to finally find freedom from a foreboding foe.

To all of you who are seeking help with ptsd keep on working at it. My years of sexual abuse hapened over 50 years ago (I'm 62 years old) and I have lived my life with more then my share of ad bad choices, bad decisions and worse choices in relationships.

I would like to mention that finding the right right therapist and the right treatment is like tring to find the right pair of jeans. If the fit between you and your therapist isn't working it's not your fault...the fit just doesn't work. Please don't give up. Seek referrals and don't be hesitant about requesting an informational interview.

PTSD therapy is about as intimate soul bearing as it gets. It is imperative to find the right person to help you through the process.

EMDR - just had my second treatment and I am truly amazed. If the light bothers you then you can close your ears and just listen to the beeps.

My comment,

Jeannie is absolutely correct. It is imperative to find the therapist that you can connect with. The nature and structure; the kernel of trauma-based disorders rest in the most recessed parts of our minds. We will not be able to access this information properly if we do not bond with our treatment provider. To begin the journey of recovery we must find a therapeutic window into our minds substrate. Without developing intimacy between your this would not be possible. This could take several appointments, please be patient you deserve it.

Where Seconds Become Days and Hours Become Eternity

I received this comment today on a post about Eye Movement Desensitization and Reprocessing (EMDR) treatment from an anonymous reader. As always I welcome all questions, negative or otherwise. It seems that the commenter has some grieving to do and to identifying some resentments toward the Veterans Administration (VA).

I don't mean to insult you, but my father served in heavy combat in Vietnam for 8 months, and he suffered from severe PTSD all of his life until he died of a stroke. If I posted his experiences, everyone would puke. I read a post about something you said that you missed feeling alive in combat. This is not and never was a part of his illness or what caused it in the least. I just don't think that eye treatment would have helped him. It's not something the VA offers, as he was actively being treated by the VA just 3 years ago before his death.

My comment,

I am not insulted at all. Not every combat veteran experiences the same phenomenon while serving in a battle zone. Additionally, the veterans reactions to unimaginable situations could be polar opposites.

I do not expect everyone who reads my material to have a complete understanding of my combat experiences and reactions. Further, some people do find my writings difficult to read and troublesome. I have included a warning disclaimer at the top of my blog for this reason.

When I wrote the article about missing the feeling of aliveness. I was describing a psychological and phyisological change within myself. This altered consciousness shifts the brains entire focus on the immediate arena of experience. All the rambling thoughts that we incur in normal life cease to exist and all of the minds faculties automatically focus on interpreting sensory input. All of the senses sharpen exponentially and time suspends its rush toward the future, where seconds become days and hours become eternity.

I do not expect you to understand this unless you have encountered a life threatening episode. Please, go back and reread the post and try to get past the line you described. The entire article should be absorbed to appreciate my reaction to an unimaginable situation. I did not think that the killing was beautiful; I was in awe of the massive tank battles, the Apache Helicopters rain of hellfire missiles, the Bradley Fighting Vehicles missiles and cannon, and the A10 Warthog airplanes strafing of the enemy.

One has to distance themselves from that kind of carnage to do what needs to be done to survive and win the battle. Some use anger to create an "othering effect" where they assign a monstrous value to the enemy in order to justify killing them. In my case my experience converged on omnipresence.

The VA does have EMDR therapy at many hospitals. I believe that this therapy is new to the VA, so your father may not have had access to it. I have read some on EMDR and the research has proved many successes using this treatment. I am in the PTSD program at the VA in Louisville, Kentucky and have been considering going through EMDR treatment. I want to stress that not all therapies will help everyone. Thoughtful consideration on choosing a therapist will maximize the benefits on deciding what treatment(s) will the individual profit from. It has taken me three years of extensive treatment to obtain the level of independence that I command today.

God bless you and your father, may you find peace.

Review: Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans

Silver, Rogers and Russell (2008) outline EMDR as an “eight-phase therapeutic approach” based on the Adaptive Information-Processing (AIP) model to treat combat veterans. The foundation of EMDR resides in the clients “neurologically based information processing” (Silver, et al., 2008, p. 948) center and employs an “adaptive resolution” mechanism from the neuroprocessor to resolve traumatic memories by utilizing the two underlying cognitions of adaptation; accommodation and assimilation. Accommodation involves the modification of our internal representations to adapt our normal operating schema. Assimilation involves utilizing an old schemata in a novel way.

When the individual traumatic experience such as combat, the mind begins to lose concordance with the internal operating system and equilibrium begins to unravel into trauma induced sequelae. EMDR seeks to reconcile the traumatic memories into a more collective consciousness within the individual by unblocking the portion of memory that has become entrenched. The combination of EMDR coupled with the AIP model corrects maladaptive behavior and cognitions through an adaptive resolution of the triggering stressor and the unprocessed memory that cause abreactions within everyday living.

The authors provide a brief overview of each phase in relation to the clinician’s main goals and expectations of the combat veteran. The treatment begins with a client history centering on the presenting problem(s), expressively the history of stressors and triggers. During the second phase the clinician prepares the client by educating her in what to expect, the clients role in treatment, information of EMDR and stress reduction techniques. An assessment follows in the third phase, concentrating on a goal-directed triggering of the patient’s affect through the client talking about the major stressors. The client has been given directions to deliberate on imagery, negative emotions and thoughts, and corporal sensations thus leading to the desensitization process.

During this step the practitioners expound on a key tenet of the procedure; the patient controls the therapy sessions and can at anytime halt the treatment. The fourth phase represents a fluid exchange between the client and the clinician where initially the patient is directed to speak of experiences shared in the history and assessment phases. The client has been informed that they do not need to disclose detailed dissections of the memories; a superficial discussion of the memories holds enough salience to stimulate eye movement. The practitioner employs a technique known as bilateral stimulation; a combination of eye movements, sounds and physical tapping to induce information processing to combine associated memories. This process proceeds until a complete resolution has been achieved. In phase five the helper helps the consumer to consolidate a new self affirmation in relation to the original stressors and formulate a novel experiential connexion to replace the trauma driven script.

The next step seeks to check bodily sensations to explore the need to reverse direction in phases or to go forward. Phase six involves a “body scan” whereby the client is directed to concentrate on the presenting problems and the newly associated positive perceptions. Bilateral stimulation can be implemented during this phase when bodily sensations do not match congruently with the recently identified cognitions. As with all therapies a closure needs to be ensured. The seventh phase addresses unfinished processing, covers the use of stress reduction and the probability of possible processing between sessions. The eighth phase includes a reevaluation and assessment to see if additional sessions would be needed to continue unprocessed memories, sensations, emotions and imagery.

In the article the authors chose to leave out two of the techniques in bilateral stimulation, the use of sounds and physical taps. I found this to be concerning, but not surprising as to the historical handling of the bastard child of psychological etiology of somatic disorders and related sequelae. Other considerations I encountered were their conclusions that EMDR therapy was “especially useful during combat situations” (Silver, et al., 2008). The article spent much of its time explaining the therapy and only one paragraph to state the argument in one of the main points in the abstract; that homework would not be necessary for using EMDR and would prove useful in a combat zone.

Considered an evidence-based practice, EMDR has weathered the storm of critics and naysayers and has attained the approval and endorsement of governmental and private entities including but not limited to the Veterans Administration, the Department of Defense and the American Psychological Association. Since the treatments inception in 1989, the efficacy has been proven to a high standard. Silver et al. (2008), reports of research on combat veterans has resulted in remission rates as high as 77% of PTSD patients. After 3-month and 9-months follow-up testing were reported to maintain the positive effects of the treatments.

One of the most interesting aspects of EMDR was the capacity to treat concurrent diagnosis such as depression and anxiety disorders in the same sessions with no distinctions made. Another feature I found that entice my interest to learn and master this therapy was empowering the client to control the procedure, mirroring a fundamental principle in social work, the strengths perspective. The final characteristic that has attracted me was the ability to maintain a safe distance from vicarious traumatization and avoid compassion fatigue that permeates the treatment of trauma based disorders.

Silver, S. M., Rogers, S., and Russell, M. (2008). Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans. Journal of Clinical Psychology: In Session, 64(8), 947-957.

Reflections of Self: Bridging Differences with Similarities Between Clients and Myself

In the treatment of combat related trauma, the latest research reveals that a union of therapist and client can and will eventually bring about a healing process. Whereby upon establishing trust in the clinician, the combat veteran or soldier can begin to recover compartmentalized portions of the personality and regain a sense of normalcy. Prior trauma, such as childhood neglect, abuse and sexual abuse can and will have an impact on combat trauma (Van der Hart, Nijenhuis and Steele, 2006).

Seeing as how I have connected all of the dots here before inked, I will have to take great care in safeguarding myself from becoming triggered and interacting with the client on the outside of the therapeutic window. In doing so I will need to find a mentor who I can process with and who will be able to counteract any maladjusted behavior I may exhibit. Additionally, I am in the process of receiving exposure therapy in an attempt to reintegrate my childhood memories, my combat experiences and string together a more compete autobiographical history of self.

According to Tyson (2007), working with clients who have trauma based disorders can greatly impact and “transcend the mirroring of their client’s PTSD symptoms…” thus affecting the practitioner’s expressions of self-identity and leak into every aspect of their lives. With continuing therapy, I will find myself further integrating my past trauma experiences and finding breathing room upon facing the fires of facilitation within the realm of the treatment process. Should the field of combat trauma therapy consume too much of my psych, I must endeavor to find a different avenue to help my fellow veteran.

I have such a passion to help those who I fully identify with, to help them out of the dark and into the light of recovery. The closer I attend to receive my degree, I find myself having a growing apprehension and need to “fix” myself. I do recognize the false belief here, in that I am broken, or less than. These schemas and operational tendencies I face every day and take great measures to identify them as I live them. To alleviate these fears I have decided that if the stress is too great then I will help in other areas with our veterans, such as educational benefits. I received the help of a professional social worker in gaining the benefits that I attend school with today.

With a centered focus on self, self identifying in the moment, utilizing a mentor, engaging in continued therapy and further studying of trauma therapy I will be able to safeguard the clients well being and cause no further harm to an already fragile mind. I also plan on placing objects within my office that represent my principles and values that will shape my practice and ability to reflectively engage the client rather than defensively react. I behold the gift of cynosure and have viewed the revelation of my purpose; my faith and spirituality will be the sign posts to my continued journey.

Resources

Van der Hart, O., Nijenhuis, E. R., and Steele, K. (2006). The haunted self. New York, New York: W. W. Norton and Company.

Tyson, J. (2007). Compassion fatigue in the treatment of combat-related trauma during wartime. Clinical Social Work Journal, 35, 183-192.

A Cocktail of Therapies, Does It Help Our Soldiers and Veterans?

A cocktail of therapies. The thing is that many practitioners themselves stop at coping strategies and basic psychotherapies. Chronically traumatized persons will respond to these therapies and receive much needed relief from major--presenting--symptomology. By not addressing the underlying dissociated parts of the personality that drove the presenting symptoms, the survivor will be left with forever coping with and managing the structural dissociation and intrusive mental machinations.

Without appropriate interventions and therapies to address the structural dissociation, such as the Phase-Oriented approach, this can lead to post traumatic decline and periodic relapses of crisis and revictimization. The Phase Oriented Treatment modality concentrates on first, the aspects of cognitive restructuring and attaining the necessary skills to weather the stresses and resistance of reintegration of the personality.

A diagnosis of PTSD, or complex PTSD, becoming a diagnosis and broaching on borderline personality disorder. The chasm has left us with a dissociated understanding of the underlying processes driving the insanity of the one with PTSD, and branded by a fragmented trauma terminology base within the profession further impedes treatment.

Misinterpretations and a misconstrued understanding of the nature of Trauma Based Disorders, which lies on a spectrum where simple PTSD (primary structural dissociation), Complex PTSD (secondary structural dissociation), Dissociative Disorder Not Otherwise Specified (DDNOS, a more elaborated form of secondary structural dissociation) and Dissociative Identity Disorder (tertiary structural dissociation) which comprise the diagnostic criteria in relation to the Theory of Structural Dissociation of the Personality. Feeding into this confusion, the DSM-IV schedule separates the diagnosis’ in differing categories with seemingly no associations or connections.

Intrinsic in this spectrum of maladaptive behavioral defensive complexes, the true nature of combat or complex PTSD rests in a structure of adopted defensive mechanisms from the evolutionary primitive portion of the brain which becomes fragmented, thus limiting the individual from accessing differing aspects of identity and complicated further by prior trauma as precipitating factors.