Communicating With Physical Therapist About Trauma Issues

[Chava]

I'm thinking of printing out some of those studies showing the differences in brain changes between "regular" PTSD and the dissociative PTSD subtype(s) for the PT.

so if a PT has little knowledge in advance of this stuff but can read a scientific study with fMRI evidence, I think it likely that scientifically educated folks would more fully accept it than it being "my experience"

But still, you will need to relate this to your experience to make it valid for you. The evidence, imho, honestly isn't as powerful as your direct experience of symptoms and being able to articulate how they slow you down. Also, I tend to be extremely careful about looking like I'm schooling anyone because it would be easy for me to do. But I'm also coming from the perspective of not needing external voices and materials to justify or explain my experience or symptoms, because they speak strongly enough. And when they don't (like I'm not having a panic attack in the doctor's office), my explanation of how they affect me in my daily life is what gets her support and guidance.

So that's where I'm coming from. YOUR experience is more important...finding a way to articulate it in a simple but clear way. And then maybe have some well-chosen and not overly heavy information available if the PT is interested. Do you think you have the kind of PT who would be open to reading articles you bring? Or would you explain your experience and just offer the articles as more information if they are interested in reading more...leaving it up to them. ??

I'm also coming from years of PT on and off myself, but I think since I have a body psychotherapist (SE, etc), this stuff didn't factor into my PT too much. But I think more because I knew when I hit a plateau and deserved a break. If you are making steady, though slow, progress, why would they yank it away from you? Have you asked your PT if it looks like you can continue or if they see strong goals for you into the future? Are you going into all of this based on fears without sort of feeling out where things are at and if they are still on your side? You mentioned something about reading expressions and making catastrophic conclusions (I do the same thing). So do you feel the PT indicated this work isn't going anywhere, or did you feel they were frustrated or losing interest/hope, etc?

Also, I hear you've felt burned and invalidated. I know not everyone understands. I tend to just stick with those who do. But have you brought articles to professionals before and found that to be helpful? Now we do know a lot more about the dissociative experience. You absolutely can talk about your very own experience, and maybe have some resources that back you up if you get the feeling it is completely foreign territory to your PT. Just be careful not to come across like you are trying to justify yourself, if you know what I mean, but that you trust your reality (even if you don't sometimes) and your articles are simply there for the PT if they'd like to know more. It's all about self advocacy and at times you do have to trust your reality first, or others will feel suspicious. Trust what you do know and work to articulate it (writing it out first helps me a lot because I stumble and get nervous speaking)...and then support that in a way that comes across as helpful but not schoolish. Like, "Here is an article that explains PTSD with dissociation" if you are interested in more information..." ???

(sorry I often have more questions than answers)

 

[DogwoodTree]

Without that I have had too many people for too many years, apparently think I was not trying to work on issues.. the not-directly-abusive family members minimized my experience.

I just ignored the feelings and detachment, the sense of feeling more real was rare anyhow, so I guess I just assumed at some level that that was normal, or I never even thought about it much?

This has been my experience as well. Because I don't seem to experience/express things in the ways that people seem to expect, they don't recognize the legitimacy of my experience. And my feeling so disconnected to begin with...it's only been in the past couple of years that I've slowly started to realize how different my experience of the world is from the ways other people generally experience it (even though I'm in my 40's). It's nearly impossible to describe what's different when my experience is the only one I know, you know? It's not like I have a "before" and "after" to compare it to, so that I could describe what's changed. It's just always been like this.

Also I couldn't cry and get support with pretty much anyone, couldn't stay with my emotions around them... all safety problems that I had no words or help with until recently. It didn't really occur to me that it was a problem either because the worlds were so separated for me. Well, that makes no sense... unless you have read about dissociation stuff I think... the world with the abuse in it still seems doubtful to me when I'm walking down a sunny street sometimes, other times the happy people seem like aliens.

I can't cry, either, especially around other people. My emotions get completely locked down around others. If the emotions start to be come unmanageable on the inside, then my whole self locks down...shutdown mode...and I can hardly communicate. I can project a functional facade on the outside, or I can be conscious of what's on the inside, but I can't seem to do both at the same time. It's too large of a gap between those realities.

all safety problems that I had no words or help with until recently.

What are you doing that's helping so much?

YOUR experience is more important...finding a way to articulate it in a simple but clear way.

It's all about self advocacy and at times you do have to trust your reality first, or others will feel suspicious. Trust what you do know and work to articulate it

I can't speak for the OP, but I'm not really yet aware of what parts of my experience are so different from other people's to be able to point it out very well; I just experience shock and confusion when they don't understand my perspective or when they don't respond in ways I expected.

Also, my experience of reality has been so deeply invalidated for so long by nearly every significant person in my life from my childhood, that I don't trust my own experience of reality enough to put words to it. I'm always looking for external validation that I'm supposed to be feeling this or thinking that or experiencing this...I know this is bad, but I don't know how to fix it. The past year and a half, especially, have been a discovery adventure of sorts as I'm slowly identifying things about me that are different from other people, and as I learn what "healthy" and "functional" actually mean, because they are not what I thought they were.

 

[greenleaf]

What are you doing that's helping so much?

A number of things have been helping for me. Those scientific articles, oddly enough. They are putting some experiences like mine on paper, where I can go back and read them in the "real world" anytime I want. I can be somewhat more connected to the old reality, here in a room with no people, but the articles are still there. For a long, long time I didn't understand that the old reality "vanishing" when I was with other folks is a safety issue. The idea of "dissociated parts" also helps explain it. So, I learned to rely fairly strongly on my cognitive abilities to stay safe as a kid; having cognitive explanations for the old stuff, in the current real world , gives me a strange feeling that I'm looking out of a room with stale air. Maybe this is like what some people here call co-conscious, but it's really intermittent. But the stuff I read here helps similarly.

I got very used to hiding effects of the trauma as best I could in the "outside world"; reactions were generally bad, no understanding; reactions from non-abusive relatives were unhelpful, minimizing, blaming me sometimes, and I assumed the "outside world" must be much worse, since they weren't even family. I guess I can't know really if they thought I acted oddly; I remember some elementary school cafeteria workers saying what a "good" kid I was since I never ever talked at lunch.

However I have to write down feelings and old stuff if I want to talk to my T about much of anything; I totally forget things that were bothering me a lot when I'm with other people and "acting normal". Having an anxiety attack in front of people like you mention, @Chava, would make me feel so unsafe that I think I dissociate and totally numb out instead; not happening as much recently. (Being upset used to bring on more severe attacks from my brother, he would get pretty sadistic about that, so I learned the numbing, then learned at some point to "act normal" while numbed so I could escape and go to school.)

The ability to numb stuff and "act normal" sometimes feels like a trap, because it's very automatic now, and I think it has kept me and trustworthy other people from noticing many issues I've had for decades. I suppose people who don't hide as much haven't gotten good treatment a lot of the time either though.

Physical therapy is helping a lot, esp. since I've been able to talk some to the PT and her reaction has been supportive; body language etc. tells me she wants to help me, and some of that has filtered down to those separated-off-parts. I was simultaneously surprised but my current functional self sees that as the kind of thing everyone should do for each other; I think I would want to help another person similarly. There is a huge mismatch there that I'm really good at ignoring. Also I ignore that I ignore it. So, bringing together the perceptions / assumptions from the old world, with the much more supportive current reality, is helping. I also have lots of physical stuff that is very connected to the old world, so I think the fact that she is helping me with that, helps get through to some of the closed off stuff. :wideeyed::alien: I guess I like the word "stuff", it's helpfully vague. :whistling:

 

[DogwoodTree]

I have to write down feelings and old stuff if I want to talk to my T about much of anything; I totally forget things that were bothering me a lot when I'm with other people and "acting normal". Having an anxiety attack in front of people like you mention, Link Removed, would make me feel so unsafe that I think I dissociate and totally numb out instead;

Yes, I have to do this, too. If I don't write it out, I often can't even remember that it's an issue, or I tell myself, "Well looks like I solved that problem already...shouldn't bother the T about it."

It always feels like I'm making this stuff up, though, when I can't get in touch with any of it around anyone.

learned the numbing, then learned at some point to "act normal" while numbed so I could escape and go to school.)

The ability to numb stuff and "act normal" sometimes feels like a trap, because it's very automatic now, and I think it has kept me and trustworthy other people from noticing many issues I've had for decades

Allowing any weakness to show whatsoever would make me the target of all kinds of attention saying "You're crazy and screwed up and we have to fix you NOW! (...because the family won't survive if you have problems!)" When I was a kid, I experienced a couple of pretty severe physical injuries while playing. But even then, I wouldn't accept help. I walked home every time even though the events happened a long walk from home, and then was taken to the ER. It never even occurred to me to sit and wait for someone to come get me and help me.

 

[void]

I know many many PT's very well and I know their education.

They lack sufficient training and experience to understand triggers, dissociation, and other PTSD symptoms.

You will have to educate them on your specific status and if they are professional they will seek to incorporate your specific needs into the therapeutic approach...if they don't...FIRE them.

Good luck.