Coping with Trauma

Again quoting from Coping With Trauma:

To relive trauma is to be retraumatized. Being retraumatized is bad enough in itself, but there is another danger: You can become sensitized. Each intrusive experience -- nightmares, flashbacks, emotional upheavals -- may lower your threshhold for the next. You can become mired in a vicious circle: Episodes beget episodes.

You cannot avoid retraumatization entirely. To be able to do so would be tantamount to rubbing out PTSD -- something we've obviously been unable to do. But you can lower the likelihood of such reexperiencing by taking care of yourself -- for example, by emphasizing safety and a secure base, by refraining from self-destructive behavior, and by avoiding traumatic relationships.

Here we encounter the perennial dilemma in the treatment of trauma. You need to remember and talk about trauma, but doing so may be retraumatizing -- making matters worse rather than better. In trying to find the right balance, I am inclined to err on the side of caution. Here's Kluft's maxim for the third (and last) time: "The slower you go, the faster you get there."
(Pages 305-306)

Choosing to Act

I heard an excellent presentation at church regarding the principle explained in 2 Nephi 2:14, 16, 26:

"...God...created all things...both things to act and things to be acted upon....Wherefore, the Lord God gave unto man that he should act for himself. Wherefore, man could not act for himself save it should be that he was enticed by the one or the other....And the Messiah cometh in the fulness of time, that he may redeem the children of men from the fall. And because that they are redeemed from the fall they have become free forever, knowing good from evil, to act for themselves and not to be acted upon..."

One important part of the plan of salvation is agency. We have been placed in a world in which there are real choices: real choices which include both the best that the Father offers and the worst that the human mind can imagine. (I believe that unless both possibilities exist there cannot be agency, but that is the subject for another post.) Having placed us here, the Father gives us the freedom to choose, real choices to make, and the atonement of Christ to redeem us from the consequences of our poor choices, if we choose to avail ourselves of that third gift.

That said, we are placed in the position to act. The importance of this can easily be missed. Particularly, I have noted that men who struggle with SSA are often paralyzed by indecision. This often occurs at the time the man is trying to decide what to do in the SSA struggle.

The following analogy may be useful. You are on a baseball team, and are a reasonably talented player. The team is playing an away game. In the 9th inning your team comes to bat, and you come to the plate with the bases loaded, your team down by 2 runs. The stands are full of less-than-friendly fans, who cheer every time you miss. The pitcher is an imposing, almost frightening resemblance of Randy Johnson. The catcher is whispering less-than-sweet encouragement to you. And you stand there, almost paralyzed by the pressure. What should you do? He might walk you, if you let him throw to you and wait. If you swing, you might strike out or fly out. And yet you know that the likelihood of a walk is low, especially if you stand and do nothing. Unless you choose to act, the end of this story will not be a happy one.

Many men I know seem to have spent much of their lives, particularly in the struggle with SSA, responding to outside influences, waiting to be acted upon, waiting for the pitcher to walk them. But in the passage cited above the message is clear that we are expected to act, and not to be acted upon. We can choose to act; we are free to act. If there have been prior mistakes, whose consequences bind and hold us captive, the atonement of Christ can free us from that bondage. We are free to act, and not to be acted upon. We have both the responsibility and the opportunity to choose and take charge.

Coping With Trauma

Extracts from Coping With Trauma: A Guide to Self-Understanding, by Jon G. Allen.
(Once again, footnote references in the original have been omitted.)

* * * * *

Given the broad array of problems, symptoms, and disorders associated with traumatic experience, it should come as no surprise that virtually all major forms of treatment are applicable. Because of the complexity of trauma-related disturbances, the many forms of trauma, and inherent differences among individuals, treatment must be tailored to each individual's needs and situation. Individual psychotherapy is usually the primary form of treatment for trauma-related problems. But persons who have been severely traumatized and who have chronic symptoms often need a combination of treatment approaches over an extended period of time.

This chapter offers an overview of major treatment approaches, emphasizing issues pertinent to trauma. First, a preliminary matter is addressed: establishing safety....

Judith Herman rightly declares: "The first task of recovery is to establish the survivor's safety. This task takes precedence over all other, for no other therapeutic work can possibly succeed if safety has not been adequately secured." I reiterate a few of the main points from her chapter on safety in Traum and Recovery -- a chapter I consider required reading for all who are in treatment for trauma. A paramount issue in the beginning of treatment, safety remains crucial throughout. Above all, progress in treatment depends on putting an end to ongoing trauma -- incest, battering, or any other form of abuse. Safety cannot be predicated on others' declarations that they will no longer inflict harm; rather, "it must be based on the self-protective capability of the victim."

Safety includes not only protection from the maltreatment of others but also protection from self-harm. Many persons who have been severely traumatized continue to feel endangered by their own self-destructive impulses. This vulnerability reaches the extreme in dissociative identity disorder when the individual feels terrorized by dissociated suicidal states. Short of endangerment from abuse at the hands of others or oneself, Herman emphasizes caring for basic needs: finding safe living quarters, eating and sleeping properly, obtaining needed medical care, and providing for financial security. Another crucial component of safety is a social support network -- the wider the better. This network may include friends, lovers, trusted family members, self-help groups, and mental health professionals. The process of establishing safety as a foundation for treatment is not easy; Herman likens it to preparing to run a marathon....

The price of establishing safety can be extrememly high. Many individuals face the dilemma of being economically dependent on persons (parents, spouses, or lovers) who continue to inflict trauma. Herman eloquently describes the magnitude of these costs:

"Creating a safe environment required the patient to make major changes in her life. It entailed difficult choices and sacrifices. This patient discovered, as many others have done, that she could not recover until she took charge of the material circumstances of her life. Without freedom, there can be no safety and no recovery, but freedom is often achieved at great cost. In order to gain their freedom, survivors may have to give up almost everything else. Battered women may lose their homes, their friends, and their livelihood. Survivors of childhood abuse may lose their families. Political refugees may lose their homes and their homeland. Rarely are the dimensions of this sacrifice fully recognized."
(Pages 235-237)

The universal prescription for trauma: Talk about it. To whom? To any trusted person who will listen -- the sooner the better. This universal prescription works best in conjunction with single-blow traumas, such as a natural disaster, an assault or a rape. Even then, it is not always easy to "just talk about it." Talking about it may bring back the feelings of terror or rage engendered by the trauma. Shame may get in the way. As you begin to think or speak about it, self-protective dissociation may block the memory.

It's not always easy for others to listen, even when they are caring and eager to help. Trauma can be abhorrent. Listening to another person's horrific stories of trauma can itself be traumatizing. It can threaten the listener's sense of safety and security. Friends may urge you to "just get your mind off it" so that they do not have to think about it. You may need to impress on them the importance of your need for someone to listen. But the listener's feelings of fear and outrage can also interfere with his or her capacity to listen. A woman who has been raped may find that every time she tries to discuss it with her husband, he becomes so embroiled in his wish to kill the rapist that he can hardly pay attention to her feelings. In such cases, trying to talk about the trauma can make it worse, not better.

When talking through the trauma with others is not possible, you may need to turn to a psychotherapist. A psychotherapist not only can provide help with symptoms but also can help with the process of talking about the trauma. As Judith Herman puts it, the psychotherapist's role is to bear witness. Not that it's easy for the psychotherapist. Psychotherapists can also feel horrified and outraged. But their training, experience, and professional role afford a degree of objectivity that provides a safeguard against their becoming so distressed that they, too, cannot listen....
(Pages 237-238)

Trust forms the foundation of a positive relationship with a psychotherapist, as does a feeling of being accepted by the therapist. The feeling of trust should be based on your perception that your psychotherapist is trustworthy, reliable, and trying to be helpful. For a good alliance, your psychotherapist must indeed be trustworthy and capable of providing help. Obtaining a referral from a reliable source and checking out your psychotherapist's reputation can help provide a foundation for the alliance. But ultimately you must make a judgment on the basis of your own experience with the psychotherapist. It is important to find a good match; a psychotherapist whom someone else finds helpful may not necessarily be best for you.

A good therapeutic alliance also includes active collaboration. In psychotherapy research at The Menninger Clinic, we have defined the patient's collaborative role as making active use of the psychotherapy as a resource for constructive change. You should feel that you and your psychotherapist are working together toward common goals. You should be an active participant in the process. Probably every patient in psychotherapy wishes she or he could just be "cured" by the psychotherapist. Who wouldn't? Psychotherapists I know work very hard. But their patients must work even harder. Your psychotherapist should not be working harder than you are. You are the major contributor to the success of your therapy. Your psychotherapist's job is to provide the guidance and support you need to do your hard work. Talking about trauma is hard work. Coping with trauma is hard work. Like any other hard work, it can't be done continuously. You need breaks; you need rest; you need respite. But the ultimate outcome depends on your persistence -- over the long haul, if need be.
(Page 239)

Psychoterhapy is not a cure by love -- emotional or physical. Rather than belatedly attempting to provide the level of attachment and mothering that was missing at the time of trauma, your psychotherapist can help you mourn that lack of mothering, comforting, and affection. No amount of psychotherapy can entirely redress that loss....

You might think of psychotherapy as a stepping stone to other relationships in which your natural and healthy needs for intimacy and physical comforting can be met. As Bowlby stated, the need for attachments, for a secure base, and for comforting -- including touch -- is lifelong. Optimally, psychotherapy is but a way station that fosters a capacity to depend on others even more deeply and intimately.
(Page 246)

Fortunately, while legions of psychologists and others have studied the various forms of distress that befall us, a few have worked to understand positive emotion. We should be devoting at least as much energy to learning about feeling good as we do to learning about feeling bad.

It is easy to appreciate the biological significance of "negative emotions" like fear and anger. Fight and flight can save our skins. But positive emotion is just as biologically necessary. While pain and negative emotions tell us what to steer clear of, positive feelings tell us what to head for. Positive feelings go with activities that satisfy our basic needs, such as hunger, thirst, and sex. Positive feelings go with activities that lead to growth, development, mastery, and accomplishment. Positive feelings also accompany the healthy forms of relatedness. Neurophysiologist Jean-Didier Vincent puts it plainly: "This choice [between pleasure and pain] helps the species to adapt. What is good for it causes pleasure and what is bad causes displeasure." Our brains come with billions of possible connections, and we have to hook them up on the basis of our experience. Good feelings are a guide: Hook this up! Do it again!

Unless you know what it feels like to feel good, you don't know how to get there. As a start, you must learn to identify your positive feelings. Look for them. Notice them. Pay attention to them. Then you can use various methods to cultivate them. Make them a more prominent part of your experience. Make good experience a habit, a daily routine. Ultimately, you can gain a sense of choice and feeedom about your feelings. You can learn to change unnecessary distress -- to bring it within more tolerable bounds and to shift into more positive experience. Beware, however, that you cannot necessarily change quickly from negative to positive feelings. Anxiety, fear, and anger create a blast of transmitters that remain in circulation -- in the brain and in the rest of the body -- sometimes for a long while. The switch can be turned on in an instant but it can be turned off only gradually.
(Pages 270-271)

Selections from "Coping With Trauma"

The following are quotations from Coping With Trauma: A Guide to Self-Understanding by Jon G. Allen. For simplicity, his source references have not been reproduced.

While these passages were written in the context of helping a person cope with trauma (child abuse, molestation, rape, war, and so forth), they also provide insight for the person whose trauma has been unwanted feelings of SSA.

* * * * *

I think the "secure base" is the single most useful concept in understanding trauma. Bowlby explains, "A central feature of my concept of parenting [is] the provision by both parents of a secure base from which a child or an adolescent can make sorties into the outside world and to which he can return knowing for sure that he will be welcomed when he gets there, nourished physically and emotionally, comforted if distressed, reassured if frightened." The importance of having a secure base cannot be overstated. As Bowlby says, our survival as a species has depended on it....

The secure base is a launching pad for independence. In addition to serving the biological function of ensuring safety from harm, it serves a psychological function: The secure base provides a feeling of security. the secure base is a home base from which the youngster feels confident to explore the world. Attachment and exploration are in dynamic balance. Ideally, life is a series of "excursions" from the secure base. Having a secure base, the youngster feels free to explore, always with a sense that security and safety are close at hand. When the child feels frightened or threatened, the attachment needs are activiated, and the youngster returns to the secure base. When trauma impinges on this sense of security, exploration, initiative, and autonomy are undermined. Traumatized youngsters may be unable to avail themselves of the rich environment needed to foster healthy development.
(Pages 37-38)

If you have been traumatized, you know what it's like to be without a secure base. There are patterns of attachment that fall short of the biological idea of safe proximity. We have learned a lot from research on these different patterns. Bowlby's collaborator Mary Ainsworth developed an ingenious method to study attachment patterns in infants. Because she wanted to observe attachment behavior in action, Ainsworth created the "Strange Situation" to study infants' and mothers' reactions to separation and reunion. The basic scenario is this: The infant and mother are brought into an unfamiliar but comfortable room filled with toys. A stranger enters, and the mother subsequently departs, leaving the infant in the room with the stranger. Then the mother comes back into the room, pausing to allow the infant a chance to respond to her return. After a while, the stranger leaves the room. Then the mother leaves the infant all alone in the room. The mother then returns a second time and picks the infant up.
(Page 38)

Secure attachment is the antidote for trauma. Secure attachment characterizes the majority of infants studied in the Strange Situation. Securely attached infants are highly sensitive to the mother's presence and keenly aware of her leaving the room. Depending on their temperament, securely attached infants may be more or less distressed when left alone with a stranger. They may protest or try to follow their mother. Regardless of their level of distress, they rely on their relationship with their mother for comfort. They rapidly seek proximity when she returns; they may make eye contact or approach and greet her. They are easily reassured. There is a smooth alternation between exploration and proximity seeking. When threatened or distressed, securely attached infants seek proximity and find comfort; when security is reestablished, they return quickly and confidently to playing and exploring their environment.
(Page 39)

...Attachment also goes through major changes over the life span. As securely attached youngsters grow older, they are able to tolerate longer separations over greater distances from their mother or primary caregiver. Their sense of security no longer rests on proximity or the physical presence of a caregiver. Rather, they develop a sense of trust and confidence in the reliability and endurance of attachments.

In addition, attachment with a primary caregiver gradually evolves into a wider range of attachments. In the nuclear family, an attachment to the father develops alongside the attachment to the mother. Patterns of attachment to the mother and the father are independent; the quality of the attachment to the father may be the same as that with the mother, or it may be different. Of course, the pattern of attachment to the father that evolves will depend on the father's behavior.

The infant's range of attachments is contingent on the composition of the household and the caregiving arrangements. Generally, attachements cover an ever-widening sphere, developing with nonparental caregivers, siblings, and peers. Given the variations in contemporary family composition and caregiving, it is fortunate that attachment behavior is so flexible.

The finding that the infant's pattern of attachment depends on the behavior of the caregiver is extremely important. For example, the infant who has an insecure attachment to the mother may nevertheless form a secure attachment to the father. Or the reverse may be the case. Keep in mind that the infant is biologically disposed to form a secure attachment....Even in the presence of pervasive family violence or abusive experience, the infant and youngster will often form relatively secure attachments outside the family, for example, with peers, teachers, coaches, grandparents, neighbors, or clergy. It is rare for a person to arrive at adulthood without some capacity to form a positive, close, and secure attachment.
(Pages 43-44)

So just as trauma disrupts the secure base and basic trust, it also disrupts physiological regulation. There is often a kind of "double whammy" here: The traumatic experience generates hyperarousal (fear, panic, pain), and the individual is often abandoned or neglected after being injured and aroused. There is arousal beyond normal bounds, and there is a lack of soothing or comforting. This uncontrollable arousal is especially problematic when the primary caregiver is abusive or when the trauma is hidden and kept secret, precluding restorative comforting.
(Page 47)

Having a safe place is necessary to feel secure, but it is not enough. Only through secure attachments with others can we gradually internalize a sense of safety and learn to regulate arousal. If workable attachment patterns were not developed in childhood, they need to be developed in adulthood. Of course, individuals who have been hampered in forming attachments need more than just the mere availability of a good "attachment figure," such as an understanding friend or a reliable therapist. They must overcome distrust, avoidance, resistance, and ambivalence. Much of the work of coping with trauma entails understanding and surmounting these obstacles in order to restore secure attachments. This process can be a tall order, especially if the foundations of attachment were distorted in childhood. Even when the trauma occurs in adulthood, secure attachments may not be easy to reestablish. Traumatic experience in adulthood (assault, rape, spouse abuse) can profoundly undermine the foundations laid in childhood.
(Page 48)

How are new models learned? They are learned from and with other people. they are taught, not didactically as in a classroom, but through relating and interacting. For good or for ill, others tend to shape us into the molds of their models. Abusive models are taught in relationships and interactions. So are nurturing models. Models of others as reliable and trustworthy are obviously learned only over a long period of time. One must find good teachers -- persons who are kind, trustworthy, and reliable. Abusive relationships set up a vicious cycle: The more you are mistreated, the more you feel devalued and the more mistreatment you tolerate and feel you deserve. Healthy relationships turn the tide, creating a benign cycle: The more you are treated with kindness and respect, the more you feel confident and worthy, and the more you will assert your needs and be treated accordingly.

Nothing is foolproof, and this scenario is not flawless. No one is a perfect judge of character; we are all susceptible to being deceived. Self-protection is possible to a degree, but anyone can be overpowered. Rescue is not possible; helpful relationships are. Rescue is an ideal; all helpful relationships are flawed, limited, and disapointing to a degree. Conflicts wax and wane; closeness and distance ebb and flow. This is why Winnicott proposed the concept of the "good enough" mother. We need good-enough friends, good-enough mates, and good-enough therapists.
(Pages 164-165)

In thinking about a healthy balance between self-development and relationships with others, the concept of self-dependence is useful. Since its inception, American society has placed great value on "independence." But aspiring to independence can be problematic, particularly for individuals who have been traumatized. Independence comes to connote "not needing anyone" and, as such, becomes confused with isolation. Attachment needs are lifelong, and isloation is not viable. Psychoanalyst Joseph Lichtenberg defines self-dependence in a way that balances autonomy and attachment. To be self-dependent requires that you be able to have a sense of continuity in your relationships. You must be able to remember and imagine your relationships with those to whom you are securely attached. Once you develop this capacity, you do not need to be in the continuous presence of the other person to feel secure. In Lichtenberg's words, "To be self-dependent is not to be independent, without reliance on the attachment. Rather, to be self-dependent is to be able to rely on the self to evoke the other in a period of absence, to bridge the gap until reunion or restoration of the attachment." The actual reunion then serves to renew, refuel, and maintain the sense of secure attachment while fostering autonomy and self-development.
(Pages 165-166)

Another Perspective on this Issue

Last month I finished reading Der Weg Zurueck by Eric Maria Remarque (The Road Back, available at Amazon.com). This author also wrote All Quiet on the Western Front, for which he is more well-known. The book tells the story of a group of German soldiers returning from the first world war, and of their efforts to become reintegrated into a disfunctional society.

As I read the book, I realized that I was reading a detailed account of what is now called Post Traumatic Stress Disorder (PTSD). PTSD became more commonly known after/during the Vietnam War, among former participants in that conflict.

The striking aspect of this book was how hauntingly similar PTSD symptoms seem to be to the symptoms experienced by those who struggle with SSA: detachment from others, inability to relate to others, despair, discouragement, alienation, preoccupation with past trauma, and so forth.

I referred to another work: Coping With Trauma: A Guide to Self-Understanding by Jon G. Allen, Ph.D. He writes:

"Why read about trauma? Avoidance is such a common reaction that it's a defining feature of posttraumatic stress disorder. If you've been traumatized, you're likely to steer clear of anything that reminds you of the traumatic event. Thinking about traumatic experience stirs up painful emotions. Avoidance is utterly natural, but it can keep you stuck. Blotting the traumatic experience out of your mind can prevent you from coming to terms with it. To cope with trauma and to get past it, you need to think about it....Many individuals who struggle with a traumatic background are extrememly frustrated with themselves. They are highly self-critical, adding insult to injuries. They fail to take account of the serious impact of their traumatic experience, and they do not make sufficient allowance for the limitations of their all-too-human nature. Many feel that they are 'crazy.' The thesis of this book is that, rather than being crazy, persons who have been traumatized are responding in ways that are natural and understandable, given their previous experience." (pages 3-4)

His subsequent analysis of trauma lends support to the thesis that SSA is a form of trauma. Perhaps the person who struggles with unwanted feelings of SSA has been traumatized by repeated exposure to the incorrect idea that his sexual orientation is "wrong". Couple this with the emotional development issues described by Nicolosi and other reparative therapists, and the result is emotional chaos. The developing child is detached from his father and his peers, he feels inadequate in his gender role. His detachment from the groups which should be providing him with emotional support and friendship leaves him outside of the developmental circle; he has fewer opportunities to learn those masculine skills he feels he lacks. His fewer developmental opportunities accentuate his perceived estrangement from his peers. And now, adding insult to injury, he is repeatedly traumatized by the idea that his sexual orientation is "wrong". No wonder he struggles.

In this regard, there may be benefit in dealing with SSA issues in the same way a person deals with issues of abuse in childhood, with rape, or other trauma.