Trauma Therapy – Boynton Beach Trauma Therapist
Trauma, Post Traumatic Stress, and Complex PTSD
Trauma – “Unwanted and unwilled overwhelming emotions in the face of helplessness or aloneness.” (Diana Fosha)
In my opinion, the aforementioned quote is the preeminent and most comprehensive definition of trauma I have heard. I will explain as we go why Dr. Fosha’s definition of trauma captures trauma most succinctly but is also the most scientific.
Few clients walk into my office and assert they would like to work on trauma. They arrive saying things like, “I’m depressed, but I have no reason to be,” or, “I had a great childhood; I was never abused.” To the former I respond a bit ‘tongue in cheek’, “Apparently there is because you are:)”, and the latter, “That’s interesting because of all the clients I have worked with who I would deem as having a great childhood, none of them ever say that.”
The clients who experienced emotionally secure attachment will give you a cohesive narrative with specific details of what they are referring to when they discuss their history. Each of these responses indicates the client has developed a pattern of dissociation. They may also look a little confused or spaced out as I begin to ask for more explicit details.
Limited Definitions of Trauma
Another reason people tend to discount or deny they have been through various traumas is they have a preconceived definition of what constitutes trauma. They only define trauma through the lens of what we refer to as ‘Big T’ traumas, such as sexual assault, auto accidents, war trauma, or severe physical abuse. However, as I will soon delineate sometimes the ‘medium T’ and ‘small T’ traumas can be even more destructive.
Take a single-incident sexual assault as an example. I will preface my comments by saying I am in no way minimizing the damage these type of events can have on an individual, and I have helped countless clients heal and recover from these types of traumas, so I am extremely sensitive and compassionate to the impact of such incidents. Nonetheless, if the assault occurs in adulthood and is not associated with any other traumas, I can help a person process this event pretty rapidly using several powerful, experiential therapies I employ. The main theme that needs resolved is reestablishing a sense of safety in the world.
Impact on Safety vs. Self
Now take a person who was chronically shamed by a parent throughout childhood and adolescence. This individual will grow up with a deep sense of unworthiness and inadequacy. The issue is associated not with safety but with self, which is more extensive and time consuming to resolve. This was the example I used earlier in which the person stated they had no reason to be depressed. What we discovered in their therapy was they were burdened with so much shame they could not experience life in any meaningful way.
Although each of these clients experienced different forms of trauma, which do you believe had a bigger impact – a short-term loss of a sense of safety or a lifetime of unworthiness. My point is not to compare but to broaden your definition of trauma. Allow me now to return and elaborate on Dr. Fosha’s definition of trauma.
Traumas Impact on The Body and Nervous System
Emotions are chemicals comprised of information and energy moving about the nervous systems orienting us to important survival and higher level needs and providing energy to respond to that information in an adaptive manner. However, if we cannot regulate that energy into effective action it will reach the upper brain and cause cellular damage. Dysregulated emotions are a survival threat.
Fortunately, nature has evolved ways to protect itself. There is a nerve coming out of the brain down the cranium into the heart, lungs, and stomach called the vagal nerve. There is an explosion of research over the last couple of decades and currently into the associations of the vagal nerve on trauma, the immune system, emotional attachment, and feelings of well-being.
In terms of dysregulated emotions, if the vagal nerve activates one pathway it will initiate an impulse to reach for connection of what we refer to as emotionally secure attachment. Another possibility is activation of the sympathetic nervous system and the fight or flight response. If neither of these options is accessible or adaptive for whatever reason, the vagal nerve will activate a different pathway and trigger a shutdown state of varying levels of intensity from going numb and detached, to feeling unreal or outside of one’s body, to blacking out. This process is referred to as neurological dissociation.
How Primitive Defenses Create PTSD
Dissociation is the human equivalent to what is referred to as tonic immobility in the animal kingdom. When an animal is pursued by a predator and has no possibility of escape, its last line of defense is to collapse into a catatonic state. There are different survival-based reasons for this action I won’t articulate at present. However, if a predator becomes distracted or for any reason the animal has the potential to flee, it will reactivate its adrenaline, escape to freedom, and once safe shake its body for a period of time, discharging all the unused energy and resetting its nervous system.
When humans dissociate what they cannot regulate we typically fail to go through this intuitive process of discharging and resetting our system. This is due to our large and advanced neocortex, our thinking brain. We neurologically dissociate, split off what we cannot regulate into an isolated implicit memory network. Implicit memory is the body’s memory; a felt sense with no images or conscious thought. It is also stored in a part of the brain that is the brain’s threat detector.
Implicit Memory Networks
Furthermore, it has no sense of linear time and cannot differentiate people, place, or setting. It will activate in the body with any association of the original event no matter how tangential or remote or whether one is conscious of the trigger or not. A smell, color, sound, time of day, day of the year, phrase of speech, photo, etc. is sufficient to trigger the implicit memory in the body making it feel like it is happening in the present even if it occurred decades ago.
This is how various forms of post traumatic stress (PTSD) and traumatic symptoms are generated. In essence, PTSD is a memory disorder. A part of the brain does not know the event is over. It keeps responding as if the event is occurring. Individuals can experience intrusive thoughts, images, memories, dreams, somatic reactions, etc. Moreover, the person will tend to also experience chronic hyperactivation of the sympathetic nervous system leading to anxiety symptoms or recurrent activation of the parasympathetic nervous system causing emotional numbness, detachment, chronic fatigue, depressive symptoms.
Undiagnosed Epidemic of PTSD
What makes Dr. Fosha’s definition so comprehensive is that anything that fits her description will trigger some level of dissociation resulting in chronic symptoms of some form. A great deal of what is diagnosed as depression and differing anxiety disorders are actually symptoms of post traumatic stress. People’s first thoughts when someone mentions the words post traumatic stress are soldiers, police officers, firemen, or other first responders. Population wise, these individuals are a small segment of society.
It is my experience as a trauma specialist that the vast majority of individuals suffering with PTSD are the average members of society that don’t even realize they have PTSD. It is an undiagnosed epidemic. People continue to get diagnosed with depression, anxiety, anger-management issues, addictions, eating disorders, OCD, Panic Disorder, Generalized Anxiety Disorder, Relationship and Personality Dysfunctions, etc.
Symptom Management vs. Symptom Resolution
What I am asserting is that underlying the majority of these diagnosis is actually forms of post traumatic stress. Moreover, let’s say for sake of argument you would need a 7 on a scale of 10 on an intensity scale to qualify for a PTSD diagnosis. What about everyone who is under a 7 on the scale? It’s the same neurological process as the people a 7 or higher even though the symptoms they are experiencing may not be as intense as those at the higher end of the scale.
As I’ve written prior on depression and anxiety disorders, the vast majority of the mental health communities approach is symptom management from medications to cognitive behavioral approaches. Individuals receive symptom diminishment at best or develop somewhat effective means to cope with their symptoms in a more effective manner. I am all for providing symptom relief for clients. However, these approaches do not address the underlying cause of the trauma symptoms and resolve them.
The Thinking Brain is The Problem
In addition, cognitive and insight-oriented approaches perpetuate the problem. The cognitive brain is blocking access and discharge of the energy associated with the trauma. The more you activate cognitive parts of the brain, the more it will block healing. Fortunately, we have discovered and developed various experiential therapies that can gain access to parts of the brain and activate implicit memory networks in the body that are holding the traumas, initiate the body’s natural healing capacities, and release the energy associated with the trauma and reset the nervous system.
The experiential therapies I have found most effective for achieving resolution of the various forms of trauma are as follows:
- Internal Family Systems
- Accelerated Experiential Dynamic Psychotherapy
- Somatic Experiencing
I utilize these modalities in an integrative manner determining in the moment what will have the most impact on the client in session. Psychology is now biology. With the advent of neuroscience, attachment theory, neurobiology, and interpersonal neurobiology we have a much greater and ever expanding understanding of how to access the body’s innate healing capacities. Moreover, the body and brain have to follow these laws. Therefore, everyone no matter what you have experienced is capable of healing.
Trauma can come in many forms from attachment trauma, relational traumas, traumatic loss, single-incident traumas, to long-term neglect and abuse. These types of experiences will manifest in a diverse range of symptoms: overwhelming emotions, maladaptive behaviors, post traumatic stress, addictions, eating disorders, rage episodes, relationship conflict, etc.
However, one of the most challenging forms trauma can take is what is referred to as complex post traumatic stress (cPTSD). PTSD can develop at any point in one’s life. A single-incident trauma can result in PTSD symptoms or chronic exposure to a stressor, such as a toxic workplace or an abusive relationship can lead to development of PTSD.
What make complex PTSD so disruptive to a person’s life is it occurred during development so its impact on the brain is more extensive. Type 1 trauma is the single-incident one I have referred to earlier. Type 2 traumas are chronic, recurrent, and relational. These take place primarily from late adolescence down to birth. An individual experienced chronic abuse of some form, emotional, physical, sexual, or significant neglect.
These experiences result in a broader impact than single-incident traumas:
- Difficulty regulating one’s emotions
- Somatic symptoms – Chronic fatigue, Irritable Bowl Syndrome, Fibromyalgia, Low immunity, Trauma-induced asthma, Trauma-Induced Migraines, etc.
- Structural Dissociation
- Innate feelings of shame and worthlessness
- Inability to develop and maintain emotionally secure attachment
Individuals who have experienced Type 2 traumas typically receive the following diagnosis:
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Panic Disorder
- Borderline Personality Disorder
- Obsessive Compulsive Disorder
- Dissociative Identity Disorder
They also tend to have significantly higher rates of substance use, eating disorders, or various compulsive behaviors due to an inability to internally regulate the overwhelming intensity of energy released when traumatic symptoms are triggered.
Until the last few decades there was a lack of understanding in the therapeutic community regarding the differentiation of Type 1 and Type 2 traumas. The result was many individuals who sought out therapy for assistance ended up being retraumatized. As a trauma specialist, one of the first things I reassure my clients is we break things up into small pieces and intensity is not the goal.
A Softer Way Through
I initially build up my clients internal and external resources prior to accessing any traumas and do so in a slow and thoughtful manner. Trauma processes much better when it is controlled and regulated. What we refer to in therapy as one’s emotional window of tolerance. We focus on remaining in the window of tolerance throughout the process both in sessions and outside of them.
Whatever form of trauma, abuse or neglect you may have experienced take hope and encouragement in the fact that both neuroscience and my experience working with thousands of clients shows everyone can heal. Every one of my clients who has remained in treatment has succeeded. Moreover, both Bissan and I are clients as well as healers. We each have experienced our own personal traumas and had developed post traumatic stress disorder and many of its associated issues. We can also personally attest to the power of experiential therapies to heal.
Healing and Undoing Aloneness
Each person’s experience is unique. However, we each have an intimate understanding of what the healing journey is like and what being a client attempting to heal from trauma consists of. This allows us to achieve a greater level of empathy and undo aloneness in the moment with our clients. The antidote to trauma is emotionally secure attachment. We teach our clients how to connect deeply with their Core Self and provide an emotionally secure relationship from which to do so allowing them to heal emotionally, relationally, and spiritually.
If you have experienced any form of trauma from ‘Big T’, ‘medium T’, or ‘small, recurrent T’s’, I want to encourage you to obtain the support you need to heal, whether through us or any qualified practitioner. There are many paths to healing. You are capable, worthy, and deserving of healing. Don’t allow trauma to rob you of the life you could be experiencing. Please contact us today.