Category: Specialties

What does exploring trauma look like in therapy?  Many therapists have different thoughts and approaches when working with trauma.  I have had many clients initiate trauma focused therapy with me because of frustration that they felt no substantiative relief from past talk therapies.  I has extensive training in trauma and trauma-informed approaches.  I know, as Dr Peter Levine states, “Trauma is in the nervous system, not in the event.”  I trained in many techniques and therapies that can hone in on beneficial starting points for trauma treatment, work to activate the body to move toward adopting new ways of feeling, thinking, and sensing of past triggering events.

There are different types of trauma including singe incident, complex, and developmental trauma.  Single incident trauma are such events as accidents, natural disasters, single abuse/assault incidents, sudden loss, witnessing violence, or illness or medical issue.  Complex trauma includes histories with on-going abuse(s) or neglect, domestic or community violence, bullying, war, betrayal, or abandonment.  Developmental trauma is always complex trauma.  Developmental trauma is especially focused on the 0-5 years old range with hurts or omissions from caregiving sources.  Many times, this trauma is not exactly what happened but what was missing in childhood such as, not have feelings or situations validated as traumatic, not having a sense of connection, love, or protection.

All traumas can lead to poor self-identity and shame.  Understanding the underlying core beliefs (negative self-talk) is an important piece of working through trauma.

How long trauma therapy can take depends on a lot of factors and cannot be predicted.  A past client post 9/11/2001 asked, “How come some of my colleagues are going back to work and I can’t leave my closet?”  My reply was to not compare apples to oranges.  Different people’s life experiences (past traumas), brain make-up or chemistry, support system, etc. can play into some of the factors that determine length and complexity of treatment.

Some single incident traumas can be resolved or neutralized in trauma focused therapy in 3-10 sessions.  The more chronic the trauma was experienced the longer trauma treatment can take.  But in the long run, making the investment in trauma treatment can help you be able to feel physical and emotional relief, be less triggered in present day situations that may have some of the same themes/nuances, and learn to be kinder to yourself.

The big HEADING of anxiety includes PTSD, Panic, Agoraphobia, GAD, OCD, and Social Phobia among others.  Mostly anxiety is about the fear of loss of control.  And, for the most part, to treat anxiety is to face your fears, systematically.  The loss of control can be represented in fear of flying or driving if you are not in the driver’s seat, fear of another panic attack at the grocery store or while driving, anxiety that if not super busy negative thinking will be overwhelming, avoidance of anything that can bring unpleasant and distressing symptoms, etc., etc.

I enjoy treating anxiety disorders and am able to see dramatic reduction and recovery of these symptoms.  Many times, we begin with doing initial assessment evaluations of symptoms so we can track progress over time.  Much of the work though is for you to practice behavioral and self-talk strategies outside the therapy office.  We will continue to work to build your toolbox of skills that work for you and develop these tools into a regular practice.

Anxiety is the number 1 reason people seek therapy as the physical symptoms can be very uncomfortable and cause a lot of disruption in your ability to live your best life.  Yet, anxiety can decrease considerably with dedication and good coping skills and resources.

Most of the time people do not have depression without anxiety, or anxiety without depression.  Many times one will cycle into the other.  Also some people only experience a single episode of depression and some (due to brain chemistry or past experiences) experience regular dips of mood that can be quite debilitating.  It’s good to watch for patterns with depression or other mood disorders to predict what some early symptoms are, what helps and what doesn’t help when experiencing an episode, and have a plan for how your support system may help.  These subjects are typical when someone comes to see me due to depression/mood disorders.

Mood disorders can include dysthymia, major depression, bipolar I or bipolar II.  Patients can experience a single episode or recurrent episodes.  Many times genetics play a big factor.  About 1 out of 4 U.S. adults will experience a mood disorder at some time in their lives.  Some episodes can last weeks to months and symptoms can differ from person to person.  Most experience motivation issues and isolation tendencies.  Some experience inability to find life pleasant anymore, disrupted sleep, intense irritability, intense swings of emotions, crying episodes daily, loss of focus, or thoughts of death or just wishing life could end.  These symptoms are issues I have worked alongside clients to manage for many years.  I lean on my years of teaching DBT (Dialectic Behavior Therapy) skills groups and offering CBT (Cognitive Behavior Therapy).  Research suggests CBT is the #1 treatment for anxiety and depression.

Many times, meeting with a therapist and developing weekly plans to make small steps in the right direction can lead to great improvements.  With great strategies and an accepting mindset, your next depression episode’s duration and impact can be reduced.  You do not have to suffer alone with these symptoms.

Sometimes parents (or households) with good intentions can still lead us to have relational issues as adults.  And sometimes parents were clearly poor role models for healthy relationships.  Clients seeking help with boundaries or codependency tend to avoid any confrontation, struggle with self-esteem and assertiveness, see over and over that they allow others to treat them poorly, and/or get disappointed and exhausted regularly from over-giving of themselves.

Some of the early experiences that give rise to issues with boundaries or healthy relationships include:

• living with a family member with a serious mental illness
• growing up in a family with addiction or an ACOA (adult child of alcoholic/addiction)
• growing up in high conflict/dysfunction families
• being parentified (placed in a role to caregive others) as a child
• witnessing emotionally or physically abusive relationships
• not being protected from an abusive sibling or another important person
• being a child of highly critical parent

Issues with confrontation, assertiveness, self-esteem also flow into relationship patterns at work, friendships, raising our children, etc.

Many times there is some backlash when we begin to put ourselves and our needs first.  Sometimes there is resistance when relationship dynamics change even in slightest ways.  Not all relationships need to be kicked to the curb, but usually many will experience re-evaluation.  Sometimes relationships withstand changes and sometimes we have to work to invest efforts where reciprocity and health are encouraged.

I enjoy working with women and men on boundaries and codependency issues.  I enjoy seeing client’s ability to set new expectations for themselves and others as we see their depression decrease and self-esteem/self-worth improve.  These shifts can be a bit emotional and reactive in the beginning but lead to much more stability and health in relationships over time.  As the therapist said to Lori Gottlieb (in her recent book) “the nature of life is change and the nature of people is to resist change.”

I realized when grades started to really matter that when others could read one chapter and understand the material, I had to read a chapter 3 times to grasp everything.  I’ve never been tested for learning disability or attention/focus issues but can relate to many of the characteristics.  I also have a special softness for those that have felt different, unable to keep up, lost, or left out.

I feel strongly everyone has strengths and weaknesses and many times ADD/ADHD also brings many strengths.  Just as Ray Charles is depicted in the movie when he was losing his sight as a boy his hearing become heightened, I believe we all need to find ways to compensate for weaknesses.  We can figure out our strengths or learn tools to adapt.

ADD/ADHD does impact life more than most acknowledge.  Amazingly enough, even after all our schooling is finished, we are settled into our profession, and have solid relationships, we can still have attention or concentration issues and impulsivity that can greatly impact us.  Examples can be:

• Y0ur partner complains that you do not listen attentively
• You struggle to do one thing at a time with full concentration.  You get sidetracked too often or don’t finish projects.
• You get in trouble for avoiding tasks you have no interest in
• You struggle with honesty or being upfront about not completing tasks
• You miss deadlines
• You have a bad memory but can’t keep up with writing things down because you’ll lose the notes
• Your have poor organizational or executive functioning skills so spaces are messy, you can’t get places on time, lose things on a regular basis, or can’t find items regularly
• Your marriage or long-term relationship is starting to feel like more parent-child than a true partnership

I have worked with many women, men, and couples to help compensate for issues like those above.  We all need to recognize areas that work against us and those areas we can fine tune.  Don’t let pride keep you from looking for strategies to be a better you.

When fight or flight instincts are not achievable, dissociation is a protective response to the overwhelming experience(s).  We all dissociate.  When we are driving in a car or in the shower and we cannot recall if we passed a road or put in shampoo already, we are dissociating.  We can dissociate by becoming fully absorbed in a television show.  There is a continuum of dissociation from typical dissociation tendencies to depersonalization/derealization and farthest on the continuum, dissociative parts of the personality.

All ages can experience depersonalization, derealization, and dissociation.  And dissociation symptoms can take place temporarily (like in major hormonal times in a person’s life, flashbacks, or extreme anxiety) or regularly, which typically stem from ongoing trauma experiences.  Grounding and mindfulness exercises can be very helpful.

I work with clients to recognize the cues and programming of the nervous system.  Therapy can involve recognizing triggers and reactions, expanding your emotional toolbox and tolerance, and adapting the dissociative tendencies that as a child was so helpful in very overwhelming times, that may not be so helpful as an adult.  With clients that dissociate, I can work with you to help you understand your inner experiences, like your inner child, critical voices, or parts that can feel very distinct.

Together we will work to understand your dissociative tendencies and help you have more control to use the skill or not.  We will also work to understand the internal, complex system developed and discuss ways to meet internal needs or unburden traumas in a paced way.