Seeking Safety– You Are Not Alone

 

Seeking Safety is a manual driven treatment for PTSD and addiction, developed by Dr. Lisa Najavits. It was originally designed for use with all female groups, but has since been used with a wide variety of different populations.

https://i1.wp.com/www.affordablehousinginstitute.org/blogs/us/safety_net_small.jpgOver the last several years I have had the honor of being trusted by a group of women in a Seeking Safety group.  One of the greatest benefits they get from participating in this treatment is being with others who have experienced trauma and/or addiction. One of the greatest barriers to recovery that they have mentioned, time and again, is having other people in their lives who don’t believe they have a serious problem. “Snap out of it.” “Get over it.” “Stop being a whiner and a crybaby…”are some of the nicer things people say to them. These are barriers to recovery for most behavioral health problems, but particularly so for survivors of trauma. For these women, it feels good to get in a group where they are believed, both about the original trauma and its aftermath. It should be noted here that in this form of treatment, there is a strong emphasis on not telling one’s trauma story. This is because it can be too traumatic for both the teller and the other group members.  The goal of the treatment is to build the personal resources to deal with trauma symptoms and to feel safe in the here and now.

I am thinking about this now because of the reported skepticism about why a large number of accusers have come up in such short order accusing Mr. Trump. It reminds of me of a story about a group of women in treatment for drug addiction twenty or more years ago in a program in San Francisco called Moving Addicted Mothers Ahead (MAMA). This program took place at Glide Church in San Francisco, which then had a charismatic pastor named Cecil Williams. Cecil was known as a spellbinding orator, come sermon time, and people listened. He was also known for addressing the needs of his urban congregation and addressing recovery issues.

In one Sunday’s sermon, he was addressing the classic AA saying, “We’re only as sick as our secrets” and the way out of the sickness– being willing to disclose. A group of women from the MAMA program were there, and one suddenly stood up and interrupted him. “I was molested as a child,” she said, “and it has affected my life ever since.” Another woman stood up, then another. One by one, they disclosed that they all had been victims of sexual abuse, either as children or as adults. But it took the courage of one to lead it off.

Let me point out the obvious differences from current events here– they were not all saying they were victimized by the same person. There was no election going on and no question of any ulterior motive. They were all at the same place at the same time. But there was the same “bandwagon” effect, kicked off by one person speaking out. I believe this is because it was easier once each of the women felt that she was not alone, and that she would be believed. I also need to say that to me the story is apocryphal– I wasn’t there. But based on my personal and clinical experience it makes sense. The MAMA program was a program of the Haight Ashbury Free Clinics, where I worked at the time, and the story was widely shared, and it transformed our approach to what is now widely known as trauma informed treatment– recognizing that many people coming into treatment for both addiction and mental health problems have suffered from trauma and have symptoms that need to be addressed. It seems obvious in retrospect.

While politics are involved in this discussion, it is not my direct intention to involve this blog in politics. It is to shamelessly exploit the controversy in order to speak out for victims of trauma. As others around me have pointed out, men can be the victims of trauma, both sexual and otherwise, and not all trauma results in PTSD. But people are exposed to traumatic events all the time– hurricane Matthew, the recent flooding in Louisiana, urban violence (another political topic which I’m skipping), even car crashes, witnessing domestic violence. It’s a long list.

For some, a traumatic event is a bad experience from which they can recover relatively quickly. It leaves its mark, but doesn’t overshadow the rest of life. For others, it can leave a legacy of nightmares, flashbacks, depression, anxiety, difficulties in relationships, even missing time episodes multiple personalities and out-of-body experiences. People who are living with PTSD know what I mean. And if you have someone in your life living with PTSD the biggest thing you can do is to believe that the symptoms are real. The sense of isolation, not being believed, is one of the greatest barriers to recovery. But believe it: after all, no one can see your headache, and they don’t tell you to “just snap out of it.” If you are living with PTSD and haven’t participated in a Seeking Safety group, you might want to find one. You are not alone. You can get better.

image source: http://www.affordablehousinginstitute.org/blogs/us/safety_net_small.jpg

Posted in Addiction, behavioral health, belongingness, Emotions, Feelings, group therapy, hope, mental health, Recovery | Tagged , , , | Leave a comment

Take Your Placebos- They’re Good for You

http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo

I suggest using the following placebos, as needed:
1) Vitamin C supplements for colds, 500 mg every four to six hours;
2) Vitamin D supplements for depressed mood, 1000 units once a day (may be some clinical evidence in support);
3) Dark chocolate chips, a handful every 2-4 hours for stress, not to exceed one ounce daily;
4) Chamomile tea for anxiety and upset stomach (some actual clinical evidence);
5) Walking, 30 minutes a day or 10-15 minutes as needed for depression or anxiety (clinical evidence supports this).

As always, check with your doctor to see if there are reasons not to do any of these.

But the basic idea is: if you think you’re doing something good for yourself, then you are. I know lots of people who do vitamin C supplements for colds, vitamin D for depressed mood, especially in winter, and lots of people who do chocolate for stress– I suggest chocolate chips because it’s easy to take smaller amounts. The chamomile tea thing actually has clinical evidence, (and just stopping to take some time for yourself) as does walking (or yoga).

Let’s face it, in our rushed lives we all yearn for sudden, dramatic relief from our dilemmas, aches, traumas, etc. But doing the small good things on a regular basis can have a cumulatively large effect.

Posted in behavioral health, Depression, Distress tolerance, mental health, physical health, physical health, Therapy processes, Uncategorized | Tagged , , , , | Leave a comment

Save a Life– Either Your Own or a Friend’s.

There has been controversy over gun violence killing people, but one of the comparative statistics is that 11,208 people died from firearm homicide,(http://www.cdc.gov/nchs/fastats/homicide.htm)

while firearm suicides are double that– 21,175 (http://www.cdc.gov/nchs/fastats/suicide.htm)

Revolvers

One of the problems is that many who own guns really like their guns, and don’t want anyone taking them away– even a friend holding it for them until they feel better. I am not going to step into the buzz saw of that argument. Instead, I am going to offer a life saving tip that came from someone who owned a gun and was thinking about suicide. He didn’t really want to die, but he also didn’t want to give up his gun. As so often happens in cases like this, he was alone, isolated, felt that there was no one he could talk to, and it was the middle of the night. Then in a moment of inspiration, he took the firing pin out of his pistol and threw it out into the weeds of his back yard in the dark.

Soon thereafter he sought mental health care, and ultimately recovered from his suicidal mood. He presumably got a new firing pin for his pistol, but that didn’t come up in therapy. If this tip will help you or someone you know get through one of those long dark nights, please share.

image from grabagun.com

Posted in behavioral health, choices, Depression, hope, mental health, suicide, Suicide prevention, Uncategorized | Tagged , , | Leave a comment

A therapist is like a cab driver

I’ve been away for quite some time, still trying to be true to my original intent to post only original content that’s new here & not a rehash. I’ve broken the rule a few times when I thought there was something really worth it, but mostly not. And I have to admit that this is something I heard,not my own original content, but it’s so important that I just wanted to put it up.

Image result for taxi cab

The title basically says it, and I heard the saying at a training. The presenter pointed out that (good) therapists are like cab drivers– you can only take someone where they want to go. You can offer different routes, make various recommendations, but you can’t take someone where you, the therapist, want them to go– that’s kidnapping.

By the same token, you can decline to take someone to a place you refuse to go– say, if some parents come and want you to do “reparative” therapy on their gay kid, something all the therapists I know would reject. Or if you, the cab driver/therapist don’t know how to get there, for example, referring someone to a hypnotherapist if one is not trained in it & that’s what the client wants.

Is your therapist a good cab driver?

image from wikipedia.org

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What’s My Gender?

 

I’ve been attending a series of sessions on transgender issues over the last few months. It’s a feast of food for thought. Here’s a morsel– one study found that the typical transgender person knows they’re trans by age 8, but doesn’t tell anyone until age 17. That’s a long time– half a lifetime– to be sitting on that big a secret. However, there are families that are open and supportive where kids disclose to parents at a young age and get various kinds of support, emotional and medical. One possible step is to give a kid drugs that are known as puberty blockers. Say your kid is freaking out about being a boy in a girl’s body. The last thing he wants is to start growing breasts. So you put him on puberty blockers. But wait– what if he changes his mind, decides he’s really a girl after all, and you take her off the puberty blockers? Was there any damage from being on them? Not as far as we know, but there’s no real knowledge base. What if a girl feels like she must be a guy because she falls in love with girls? Fine, put her on puberty blockers.

I use the example of the budding trans-guy because there’s another interesting set of data. It turns out that boys who will grow up to be gay men typically know their orientation at a relatively early age. These are boys who know they’re boys & want to go on being boys, but who will fall in love with other boys. As for girls who will grow up to fall in love with girls, they typically don’t come to that understanding of themselves until late teens– after the age at which they could, for example, have sex reassignment surgery if that’s what they thought they wanted. Hey– lots of 18 year olds get tattoos they  don’t like later in life. What happens when you get sex reassignment surgery and later regret it?

One of the interesting factoids is that some people go one way, then another, then go back. AND– people who describe the original feeling about their gender is that “when I was a kid I knew I was the other gender are not as likely to change back as though who describe their experience as “when I was a kid I wished I was the other gender.

Interestingly enough the percentage of folks who get this kind of surgery (sex reassignment procedures of all kinds for both genders) & are unhappy with it later is lower than for people who get cosmetic surgery in general. Hey– whatever people’s gender identity, looks, etc., you can’t please all the people all the time.

So part of the seven course banquet in food for thought about gender is this– gender is, after all, a seriously cultural thing. Guys aren’t supposed to wear makeup. Women aren’t supposed to chew tobacco. Guys are supposed to know how to fix cars. women are supposed to know how to bake cakes. Make your own list.

So here’s my speculative question– are there times when the psyche is in a state of genderless awareness? If I’m sitting at a computer, typing, that’s not really a gendered thing, is it? If I’m driving a car (in the west, not In Saudi Arabia), is that really a gendered activity? Even if I’m doing something that might be associated with a particular gender, like cooking, do I necessarily do it as a male or female?

I posed the question to Julie, the presenter in the series, who began the series by saying she identifies as genderqueer (not pigeonholed), she said that there are times when she makes a movement or gesture that she feels is particularly masculine. My reaction was that I sometimes feel I’m cooking in a genderless way, and at other times may feel nurturing and feminine.

There’s another possible perspective on this analogous to the idea that fish don’t know about water. If I’m completely immersed in my gender identity and there are no incongruities, then everything I do is “just me,” but I am completely identified with a particular gender. Personally, I don’t think this case holds as widely as some people would like to believe.  I think people experience incongruity between their mental/emotional experience of self and their social presentation of gender at some time or another.

Bottom line, whoever you are, a lot of people find that “being me” can be difficult. This is just one of the more obvious areas of struggle.

Of course, the North Carolina HB2 flap has brought these issues to the fore. I think people who are overly interested in who potties where & how have a set of problems that they need to address within themselves, not in the state legislature.  As for the trans man whose photo appears at the top, I think it would be problematic for him to show up in the lady’s room. Not because I think he’d do anything wrong. Trans people tend to be aware of issues of compassion toward and safety for others. As a generalization, I’m sure it has its exceptions, but my guess is you can see how what they have to go through just to be themselves would promote that kind of awareness. Wouldn’t  it be nice if everyone, regardless of gender identity, had a high degree of compassion for others, and wanted to promote safety for everyone?

Photo at top: Shawn Stinson, trans man, champion body builder. Photo by K. Dae

From http://transvalid.org/portfolio/handsome-body-builder-shawn-stinson/

Posted in Gender Identity, happiness, mental health, Uncategorized | Tagged , , , | Leave a comment

Self Pity versus Self Mourning

Just a quick thought & a question– what is the difference between feeling sad about something bad in your life, and feeling self-pity? This came up recently in a session, where a client worried about sinking into self-pity. this is a person who, due to chronic pain in back & feet, has lost swimming, which he loved, and is limited in walking/hiking, which he also loves. That’s enough to bum anyone out, much less someone already diagnosed with depression & a substance use disorder (now in long-term remission, I’m happy to say).

We didn’t come to a definitive conclusion in session, but we did spot some markers– one can legitimately mourn one’s loss while taking steps to deal with it, as this client has done by engaging consistently with the medical community and pursuing alternative therapies such as mindfulness based stress reduction and gentle yoga for the back. He has learned how to schedule himself & rearrange his day so that he doesn’t use up his tolerance for the pain before he gets his goals accomplished. These are not the moves of a self-pitying person.

Thinking about it now, the word that comes to mind is agency. There is justifiable cause for sadness in the person’s life– the losses are real, and the prospect of them being reversed is unknown but probably extremely small. But he continues to be the author of his fate, within his powers.

Self-pity, I feel, is more characterized by victimhood. When I (or you, or whoever) am experiencing self-pity, I have a feeling that there’s nothing I can do. There may be blaming, finger pointing, recrimination. There may be appeals for help in doing what I am capable of doing, no matter what my loss may be, or perhaps an appeal for help to do what only I can do for myself.

Fortunately, the person who brought up this issue is a 12-stepper, and there’s a tool in the 12 step tool kit that can work on this– the personal inventory. For those who are interested, the AA literature about this includes both the fourth step and the tenth step. As a brief digression, I will mention that these steps require no dealing with higher powers. Even the original AA literature on the fifth step, which directs the user to share the inventory with one’s self, God, and another person, emphasizes that it won’t work unless another human being is included. But taking time to do some writing, some thinking, some looking at causes and conditions, and looking at one’s own part regardless of anything else, can help sort out the difference between a genuine sadness and mourning for one’s losses, and a self-indulgent victim role.

As part of my feedback to the client who brought this up, I pointed out that it’s a rare person who doesn’t fall into self-pity at some time. And I don’t think that it’s possible to make it through a life filled with frustration, disappointment, loss– the thousand natural shocks that flesh is heir to– without feeling self-pity at times. After all, isn’t one of the aspects of self-pity the childish, even infantile wish for some kind of miraculous removal of all the problems? “Mommy, fix it!” (At least for those whose mothers were adequate in early life). If you’ve never felt that, you’re a more stalwart person than I.

But I think the key thing here is that one doesn’t stay with that magical thinking and that passive stance. One takes the role of actor, even if it’s the action of trying to find support people, meditating, or simply accepting one’s limitations. There can be tremendous sadness in this without there being a scrap of self-pity. This is where self-compassion comes into play, and for that I will direct people to self-compassion.org.

Posted in behavioral health, choices, Depression, Distress tolerance, Emotions, existentialism, Feelings, happiness, hope, mental health, mindfulness, Recovery, Renewal, Sadness, spirituality, Therapy processes, Uncategorized | Tagged , , , , , , , , , | Leave a comment

Work at being happy?

Briefly put, yes. Here’s a post from

http://greatergood.berkeley.edu/article/item/five_science_backed_strategies_for_more_happiness?utm_source=Newsletter+Mar+16%2C+2016&utm_campaign=GG+Newsletter+Mar+17+2016&utm_medium=email

Of course, if happiness just jumps out at you, relax and enjoy. but if it doesn’t, go get some.  If you’re depressed,  please remember that your depression will give you messages like “It won’t work,” or “why bother.”  Instead of acceding to the negative messages, take an evidence based approach– try doing things anyway. I went through a period of serious depression in my early 20’s and had good success with this approach, which at the time I thought of as distracting myself from being depressed. Well, it worked– when I went and did things, I frequently forgot to be depressed. I might have gotten depressed again when I went back to ruminating about all the bad things in my life– and there were several– but in the meanwhile, I really wasn’t depressed. so I can say from experience that it helps to do this stuff. does it make you “all better?” Maybe, but probably not. Does it make you feel better for awhile. Yes, definitely.

Of course,  if you’re not depressed, doing this stuff can take you from neutral to happy, or from happy to happier. Is there someone who doesn’t want that? I don’t know anyone like that.

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