Research Are You Getting Exposure Therapy? Just Testing The Grounds...

[Nicolas Connault]

Thank you Cat! Please bear in mind that I'm not yet sure I will be conducting this survey, it will depend on ethics approval. It gets quite messy when you try to access clients for questionnaires :(

 

[PTSD sufferer]

My first psychologist was a young man who did a degree with honours and then was on supervised practice which I was not informed of. He did not have a Masters. Seems like the rules differ between states ?

The Act (revised and passed as federal legislation in 2009) and NRAS is national/ federal legislation, therefore, there is no difference across states. However, there may be additional state laws relating to health, but Federal law always takes precedence over state law. I may be wrong about the Masters qualification requirement, I haven't looked at the NRAS for quite a while...so I'll take a look and re-clarify this as soon as I can.

I would say that 'ethically' psychologists should disclose that they are on 'supervised performance' and their number of years of experience should be information made available to patients if requested, but 'legally' they don't have to disclose this...

In cases where a trauma is singular, I think exposure therapy is likely extremely useful. My traumas are multiple, include family members, aquaintances, strangers, and persons of authority, include gang rape, beatings, robbery/rape, statutory rape (repeatedly), in my childhood home, in school, in town, at college, in my adult home. I get triggered by so many things on a daily basis, it is like I live exposure therapy.
.

Hi Girl, I agree with you. I think both therapy and patients are organic in nature, and it may not be the 'best time' to do EMDR, or it may not be the best treatment for everyone. In my mind, the patient needs to take precedence - the patient's history, what they can handle, what's best for them, and so on.

I had to agree to try EMDR, and it came with some very honest warnings from my T, which I appreciated.

Doing EMDR on 'everything' when there are multiple traumas may not be the best idea. Sometimes its better to to work on specific traumas with EMDR. Or other exposure techniques might be better because EMDR can be quite distressing...if I was to address all of my traumas with EMDR, I'd have a pen permanently attached to my forehead ;)

I didn't do EMDR on 'everything', it was carefully targeted at specific things. I do other exposure work (desensitization like you do) on addressing specific triggers....added another trigger to my list yesterday - "old man language and attitudes" (is that the weirdest one yet on this forum??:confused:). It's a long journey isn't it...

 

[Fan Blender]

"The limit is them, nothing else." Anthony

I have to say that I am TERRIFIED of Exposure Therapy. I'm pretty sure that when I was in my early teens, I had a couple of therapists who tried that form of treatment with me. EMDR especially; but it always came to a very abrupt end because I phsycially, emotionally and psychologically couldn't handle it. They could only nudge me so far (which wasn't far at all) and I'd completely lose it and then would never want to go back.

I do regret not following through with the Exposure, but I was very young and the trauma was so fresh and built up over my entire childhood. Often I feel like the reason why I am so dibilitated now is because I didn't go through with the treatment. Often I give myself crap: "shoulda, woulda, coulda", but that gets me nowhere too.

I agree that exposure is needed to heal, I just get flooded with panic and fear by the thought of having to do it.

Does anyone know if there is a way to ease into it or "prep" for it? PTSD has been a life-long struggle (which I have recently come to know) and it is taking a major toll on not only my mental health but my phsycial health as well. I don't want this illness to kill me. That would mean that my abuser wins and that sickens me.

 

[PTSD sufferer]

I think that the preparation is done in therapy by talking about the traumas, how they made you feel and which part of the trauma upsets you the most.

You need to really trust your therapist, and if you are not trusting, don't feel you are in a safe environment and unable to let your therapist have some control, then you will not get the benefits of EMDR. Even if the trust issues are around previous therapists, this could make it a bit harder (not impossible) but it may take longer and you definitely need to talk about these residual fears and address them before you commence EMDR.

Can you put your full trust in your therapist? Or do you need to talk about these fears from past therapy a bit more?

Sometimes the reason we 'negative self talk' is because we have lost the ability to apply rational and logical thinking. This is what EMDR is designed to help with, by using bilateral methods such as eye movement and/ or tapping, we are softly encouraging our brain to begin using its natural ability to logic and reason again, and doing so helps to reduce the level of anxiety associated with the most upsetting parts of the trauma (by calming the emotional connection to the brain). You are always conscious when EMDR is performed, and you are always feeding back information to your therapist, and your therapist is always guiding you to focus on the trauma and the bilateral movements (eyes or tapping). Your T does not leave your side at any point.

I like to call it a brain massage, sometimes not comfortable, but the relief after is well worth it...;) Does any of that sound scary?

The hardest thing about EMDR is building the picture of the primary trauma, pulling up those emotions, and knowing that you will be increasing your anxiety for a little bit (to try to reduce it). Sometimes the first session is the worst and can drudge up all those memories again, but you need to be honest after the first session and tell your therapist if you still feel any residual body stress after EMDR, take your time with this. The residual stressors can be worked on straight away to ensure that all stressors are dealt with around that one flashback. Or it could be used as the basis for the next session if you are not up to it. You do feel a little groggy after and gradually as you feel less groggy, your anxiety should reduce.

If you are dealing with daily flashbacks at the moment, then it is just like these flashbacks. It is just as distressing as those flashbacks, because you are pretty much encouraged to re-create a flashback of the the upsetting one. Sounds scary I know, but could it be anymore scary then the flashbacks you have? You have the added benefit of being with your trusted therapist when this happens, so at least for me, that made it a bit less scary.

Remember to breath and ground before and after. And, talk to your therapist about any trust issues because that needs to be addressed before you go down this path.

PS xxoo

 

[Fan Blender]

Hi PTSD Sufferer,

Thank you very much for your reply. It is encouraging.

I don't have a T at the moment. We can't afford one. Although I have been called to see a councellor or someone at a free family service in my area. My first appointment is in March. I'm not sure how I feel about this, but I will go. You mentioned having trust issues. Yes, I could say that I have some reservations about how much I can trust anyone, let alone a T. I am a childhood incest "survivor", who, well hasn't really survived it yet, even after many many years of it stopping. So, I guess my trust issues are very deeply rooted as I never knew how to trust even where I should have been the most safe; at home, with my parents.

I like how you call EMDR a head massage. That makes me smile and laugh a little. Thank you.

I do have daily flashbacks. Terrible ones, which are obviously not controlled, I don't have the tools yet to deal with triggers. I do my best to avoid potential triggers; like not watch television, or certain movies. I try to minize things that stress me because those make it worse too, but now I find myself isolated and that combined with the flashbacks and body memories are becoming dangerous for me. I'm pretty sure it's a matter of life or death now. Either from all the chronic stress taking a toll on my body, or because of thoughts of violence towards myself are frequent. :cry:

So, after weighing the pros and cons now of EMDR, rationally, I think I could really benefit from it. I will seek it out.

Again, thank you for the encouragement and I like your suggestion of breathing anf grounding. I try to do this in my home as much as I can and it does help me. :)

Oh and PS
xx back at you. Thanks for the love

 

[anthony]

Exposure therapy is a progressive introduction, it should never be all or nothing, regardless its application.

Yes, there are plenty of idiots out there in the therapy industry with no real knowledge of PTSD and applying exposure therapy to people completely wrong. No different than those with EMDR. EMDR has come a long way in the last 5 years... vastly a long way. Again though, you would be crazy to have EMDR with anyone who is not well experienced with trauma, depending on trauma severity... even then, it may still be too much depending on trauma severity. There may be a requirement to lead a person first, to tackle smaller issues that quickly become larger.

EMDR's main use is with singular traumatic events. It can be effectively used in longevity abuse, though you need to weigh the experience of the practitioner if you have extensive trauma duration. DBT approach is usually a better one with longevity of trauma... which is a leading CBT therapy opting to concentrate highly on relaxation and grounding before any trauma itself is gone near. It is about teaching control before trauma.

Put anything in the wrong hands though, and you are going to get mixed results. The therapists personality has more to do with therapy than anything else. Qualification & therapy experience means nothing if their personality and personal experience isn't there to truly understand trauma.

 

[Fan Blender]

Anthony,

Thank you for this posting. I had never heard of DBT until now. I will certainly read up on it because the length of my trauma is quite extensive. It marked my childhood.

It it so good to hear that not everyone with therapist "status" are equipped to guide certain people through this kind of healing. I also completely agree with the personality aspect and truly beilive that when put into the wrong hands, mixed results can occur.

Sometimes I feel like it's easy to be placed in a "box" and forget to assert my needs, boundaries etc.

I do deserve treatment that is right for ME; and I can take the reins/responsibility in trying to recover by educating myself on what's out there, and getting a feeling for wether or not something fits me.

So thanks again for the tid bit on DBT. :tup:

 

[Sunrise]

Nurses who do additional studies (Masters in Nurse Practitioner on top of the three year undergrad) can become a 'Nurse Practitioner' in Australia, the UK and US. This means that they have a certain amount of additional privileges, or an expanded role if you will, relating to assessment, ordering tests, diagnosis and treatment of 'certain conditions'. Not sure how far it stretches in the mental health community for diagnosis and prescriptions.

etc SNIP

Just want to add to what was said about regulating counsellors etc
This is pasted from the AAHTC counsellor association website.

"Counselling in Australia is a self-regulating profession. This means that professional standards for counsellors are not set out in any State or Federal legislation. Instead, it is up to professional Associations to establish standards that apply to their members.​

​

Within Australia there are two national organisations set up to establish professional standards for the counselling profession - the Australian Counselling Association , ACA and the Psychotherapy and Counselling Federation of Australia, PACFA. There is complete agreement between these bodies on appropriate standards of professional practice and so there is, in effect, a national Code of Practice.​

​

Membership of an accredited professional association is generally a prerequisite for counsellors to obtain professional indemnity and public liability insurance. Members of the AAHTC qualify for professional insurance provided through Australia’s principle provider of insurance to the complementary health profession."​

 

[anthony]

That last part of the quote, is complete nonsense on the behalf of the AAHTC, and purely there to help them drum up business.

The reason many industries in Australia are not regulated, is because Australia already has such strict laws in place at both Federal and State levels, that already cover pretty much all aspects of job roles when it comes to doing wrong. So instead of trying to manage and regulate laws applicable to specific industries, they instead have laws that cover people buying a good or service period, which cover all professions.

You can get indemnity insurance at the same price through most providers here for counselling, without being a member of any association, as they have no legal authority. They like to claim they do, but they actually have no legal authority. I know, because I have already made said enquiries.

Me personally, I have no intention of joining such associations here once qualified, again, they have no legal purpose and if anything, they're really blinding the public by giving them false belief they have any powers on behalf of consumer protection. The most they can do is take a persons money and no longer allow them to be a member of their association. That is it... they have no legal powers to do anything further.

Associations are a great marketing ploy... they do that well. Until the Government ever says, "Ok, we are going to regulate the counselling industry" then anything else is useless until then. I doubt it will happen any time soon... as stated, laws already cover consumers and punish practitioners for unethical behaviour if found guilty in a court of law under existing laws for the provision of goods and services, under misleading and deceptive behaviour, and other such headings.

 

[old blue]

I recently started therapy, maybe 6 weeks ago, and it's CBT, and the therapist encourages me to revisit events, but I don't really manage to, I just cry. So I have no idea if I'm receiving the therapy you're talking about?

You might find some of the info about re-evaluation co counselling interesting. I was close to non functional when a friend introduced me to it over 20 years ago. (Dad's suicide 30 years before caught up). We met others and pretty much bootstrapped our way back to high functioning without much other help. That would describe crying/tears in a good counselling situation as " a reliable outward sign that grief is being re-evaluated"... ie healed. If the listener has "discharged" enough of their own old grief to be able to remain warmly relaxed and to shut up and gently welcome the crying until the "client" is eventually finished. That might take anything from 5 minutes to many many hours and several sessions, depending on the case. But once it is finished it is finished. The "problem" can be that few people can actually listen well enough and welcome the messy process. Two people who take turns though can manage for a few minutes each which allows each to listen a bit more and then a bit more. Ditto re shaking and sweating etc while clearing recorded terror, yawning away pain and boredom, laughing for embarrassment, energetic non repetetive narative for untangling confusion.
Worth a look.

 

[cat]

Thanks Happy Head, maddog and PTSD sufferer for your interest, it's quite encouraging!

PTSD sufferer (please let me know if you use a shorter nickname!), I'm wondering if the recent massive funding for CBT therapists in the UK (IAPT) has had an influence on the treatment type and quality you have been receiving? I've been reading up on this mass-training of low and high intensity therapists, and I wonder how many of them are actually getting trained in exposure therapy. My concern is that therapists can be great at making clients feel good in the short term (between sessions), but can miss the lack of long-term progress that might help a person become independent of frequent therapy and/or medication.

I quite agree. When I was diagnosed (by my GP) I was offered counselling weekly for 6wks. Luckily for me as time went on my counsellor told my gp that she was out of her depth with me & CBT was not working. ~

Then came the real problem, to see a psychiatrist for diagnosis there was a 6mth waiting list, afraid I would have completely lost it by then my GP suggest I see a private psychologist - in UK GP's are not allowed to recommend one so I took pot luck & thankfully fell on my feet.

My psych has been wonderful, she was trained in the US. We used a mix of many therapies including EMDR to address my most traumatic memories.

 

[cat]

I'll be happy to complete the survey.