Thursday, November 28, 2013

Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)
Founders: John and Helen Watkins
The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 
Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.
Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 
This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.
Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

PLEASE NOTE: The techniques described here have been integrated into PSITM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSITM is described here in more detail.  

More approaches to be continued

Tuesday, November 26, 2013

Self Empowerment: Actualizing the Power Within

To experience empowerment we must act on a sense of self worth, value and give voice to our own needs, and give equal validity to our own needs as to others'. As we develop a sense of empowerment, we begin to discover that a conflict of needs actually can present us with a creative challenge to imagine solutions that can empower all parties involved (rather than fearing that a conflict of needs must necessarily result in a "win-lose" battle).  I offer the following vignette as an example:
Mary does child care every night so John can go out with the "boys".  Mary becomes more and more resentful of John and their young children.  Finally, Mary initiates an assertive "conflict".  She says:

"I understand that you work hard all day and need time in the evenings to relax and unwind, but I've never pointed out to you that for you to relax and unwind by going out every night, you are counting on me to stay home with the kids, which is what I do all day.  So I don't get to relax and unwind and I become more resentful toward you and the kids and unpleasant to be around.  I need escape time too.  I'd like us to work out a way that we can both get what we need."
John agreed that Mary had become very unpleasant to be around (and didn't hesitate to tell her so.)  But after a number of arguments, they came around to agreeing on an experiment.  The experiment was that once a week John would go out while Mary watched the children, once a week Mary would go out while John watched the children, and once a week they both went out while Mary's mother watched their children.  The other two evenings they all stayed home as a family.  After two weeks of this experiment, not only did Mary feel better, but John felt better as well because he was feeling closer to his children and getting less resentment from his wife--and he still had time to see his friends.

The word "compromise" does not adequately describe the process of creating a "win-win" solution.  Compromise implies that neither side really gets what they want, whereas in "win-win" solutions, both sides get as much if not more than they wanted originally.  Assertiveness means acting from a place of respect – for self and other – and assuming equal value to the needs of self and other.  This presents many dilemmas that can also be seen as possibilities.  Power--the power of creative problem solving and acting--is mobilized rather than suppressed.

Traditionally power has meant different things for men and women, taking on more positive connotations for men.  Think of the following words, first for men and then for women.  Pay attention to the feelings they evoke:

1. Women have traditionally been expected to defer to men, and have internalized the dominant cultural expectations of females as submissive and powerless
 2. There is something wrong with the present system of power distribution for all people, which we, as women, may be particularly sensitive to, having so deeply learned to respect the importance of other people's needs.

 As we endeavor to compete with men as their equals, some of us feel there is something sour about climbing up a ladder on top of other worthy people's heads, something deceitful about the notion of inferiority and superiority in our fellow human beings. We see that to gain others must lose, and having been relegated to losing for thousands of years, we may not feel comfortable inducing that experience in others.

When some people have less power than others do because external forces (e.g. money, status, physical strength, military force) block them, many problems arise for both the "winners" and the "losers".  The "losers" become afraid to express their needs because they fear (often rightfully) that what little they have will be taken from them.  They then become afraid to even feel their needs, to admit to themselves that they want something.  They become immobilized.  And, in certain critical ways, they stop growing; cease to thrive; development (the Power from Within) is blocked. The "winners" then miss out on the experience of sharing with equals and become self-preoccupied.  Their development is also blocked.
Let's consider these questions:

1. How do we reclaim our rights to power and effectiveness in the world without doing so at the expense of others?

2. How can we, as women, integrate the profound knowledge we gain from mothering and being nurtured by our mothers -- i.e., that we are each special, unique, and worthy in our own right, into a culture where value is so often seen in material terms?

We may want to begin by developing our own vocabulary to describe our experiences and perceptions.  Without words to communicate our experiences, we are trapped and limited.  If power only means the power to force others to do our will, we will feel that power is foreign to us, awkward and unfamiliar.  But power means many things, and many aspects of power can feel right for us.
I offer the following words and phrases to begin reclaiming our own vocabulary taken from Simos 1987 - (see below*)

 Power Over: the ability to force others to do your will through physical or financial coercion.  The power inherent in social or economic positions, or physical size or strength, regardless of skill or ability.

 Shared Power: power whose goal is to uplift or teach others to bring them to parity, as with a parent/child, teacher/student, or psychotherapist/client relationship

 Referred Power: the power others give us because they value, respect, and/or are attached us

 Expertise Power: the power others give us because they count on our knowledge and judgment

 Power With: the power to be effective interpersonally, to persuade, to inspire (not “command” or force) respect

Power From Within: the power of growth and development inherent in all living things.  It is the power to change, to overcome obstacles, to face our own fears, to learn new skills, to fail, and to try again.

Power can be used to destroy or create, to belittle others and over-inflate the self, or to belittle the self and over-inflate others.  We may call the use of power to harm or belittle the self passive power, and to harm or belittle others aggressive power. In contrast, assertiveness can be seen as the use of power to enhance and respect both self and other.  Assertiveness training, then, can be a way for women to reclaim their rights to power and effectiveness in the world without doing so at the expense of others.

Recommend this on Google Plus  
 * new vocabulary words taken from Miriam Simos (Starhawk) Truth or Dare, Harper & Row Publishers, New York, 1987

 Suggested Reading

Jean Baker Miller, M.D. (1976). Toward a New Psychology of Women. Boston: Beacon Press
Pamela Butler (1981) Self-Assertion for Women. New York: Harper & Row Publishers
Margaret McIntosh () Feeling Like a Fraud a Work In Progress Paper of the Stone Center for Developmental Studies at Wellesley College, Wellesley, Mass., 02181

Miriam Simos (Starhawk) (1987) Truth or Dare. New York: Harper & Row Publishers