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Prolonged Exposure For Multiple Incidents Of Csa & Exploitation At Various Ages (as Child & Adult)?
- Post starter Lola Nocheprieta
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- Post starter
- #26
Lola Nocheprieta
Diamond Member
Me, too. Thanks!
Lola-
A little pushing is good with therapists that you trust and are involved with when youre ready.
Watch your urge to divulge when it feels like the compliant behavior of an abuse victim to go along with it.
That just means you need to firmly tell them its time to slow down.Dont underestimate the destruction you might do as a rebound .
Tell them that and make sure they respect it.
Ive been there and done that, did horrible things because of great therapists. You just have to learn to trust yoursef with bad therapists and good ones, we never get out of that lesson until it is learned.
Slow down, pick the things that you know influence you, even if something else sounds like a bigger trauma to the T, then over time all of it falls ito place. :)
A little pushing is good with therapists that you trust and are involved with when youre ready.
Watch your urge to divulge when it feels like the compliant behavior of an abuse victim to go along with it.
That just means you need to firmly tell them its time to slow down.Dont underestimate the destruction you might do as a rebound .
Tell them that and make sure they respect it.
Ive been there and done that, did horrible things because of great therapists. You just have to learn to trust yoursef with bad therapists and good ones, we never get out of that lesson until it is learned.
Slow down, pick the things that you know influence you, even if something else sounds like a bigger trauma to the T, then over time all of it falls ito place. :)
- Post starter
- #28
Lola Nocheprieta
Diamond Member
Thanks, Coco. That makes sense and is reassuring.
- Post starter
- #29
Lola Nocheprieta
Diamond Member
I'm fortunate to have a great post-doc psychologist who is very attuned and with whom I feel more comfortable and trusting than I ever have with any previous T. The "pushing" works both ways, but I feel empowered and haven't ever felt pushed or challenged more than I could handle or that felt appropriate.
It was totally my choice where to start, in terms of choosing which memory to process first. I struggled only because of my own fear, and tendency to ruminate, perseverate, and over-analyze everything (I know you know what I mean, lol!)
Your words are a good reminder, not just re my relationship with my T, but my relationship with myself.
Thanks, my friend. :hug:
- Admin
- #30
anthony
Founder
To a degree, she should probably not tell her clients her personal beliefs versus the facts that validate trauma therapy discussion, getting out secrets and the impact that has on healing the brain, talking about events specifically that cause you conflict and that you seek understanding in order to process the memory so you can move on and beyond it.
MAPS has a very long list of the wealth and benefits of getting it all out, truthfully and honestly, by using MDMA under the guidance of a professional. The results from MAPS work add another 20% to that of the same therapies without the MDMA to relax the person and let them be honest.
This to me says... the therapy techniques are not the problem -- we are often the problem by not being honest, not fully disclosing, and even not fully knowing the circumstances of what happened (lost memories or never encoded).
IMHO, the evidence far surpasses what your therapists beliefs are in relation to healing trauma -- again -- they should not be imparting upon their clients in an attempt to indoctrinate them with misinformation based on personal belief systems.
- Post starter
- #31
Lola Nocheprieta
Diamond Member
So, an update on this post is in order, I think, and probably overdue. ;) I thought about giving an update several times, but would get overwhelmed and not know where to start. I think since I have been in the thick of it, it’s been hard to have perspective, sort of a forest/trees conundrum. If you remember, one of my biggest concerns (beside just fear of the unknown) was how would PE, which seems to make sense in the context of one (single-incident) trauma or one primary “index” trauma, would work for me, i.e., with multiple traumas throughout my life at various ages. We worked on only one memory, one memory from one year of my life, and so I still have questions about that.
First, let me say that, predictably, I felt worse before feeling better. I felt worse than I thought I would, initially. And the difficulty has persisted longer than I thought it would. I have at times had intense FBs, intrusive and overwhelming memories, increased episodes of dissociation, and increased self-harm urges. At the same time, these FBs & memories were not entirely random and unexpected, and that is a good thing. I had FBs, overwhelming emotions, intrusive memories & self-harm urges *before* starting PE. I have worked with my T to reframe the dissociation & FBs as evidence that I am doing hard work, I am confronting my demons (poking the bear, she calls it), and NOT evidence that I am getting worse or somehow “failing” PE (which makes me think of high school, ditching PE to get high and have sex under the bleachers, lol!) When I catch myself dissociating or missing time at work, instead of beating myself up for it, I simply say “Welcome back, Lola.” When I have FBs I try to stay present, grounded, tell myself, “Come back, come back,” and then try to praise myself for managing such painful emotions. This reframing has been good, helpful.
It was so hard, that first imaginal exposure! So raw and painful, and the unknown was terrifying. Would I dissociate? Would I break down? Would I be completely unable to access any emotions and be all monotone or sarcastic? Predictably, I vacillated between getting trapped in the memory (very slightly dissociating), and feeling overwhelmed by the feelings, memories, and trying to talk about it in the present tense. My T was awesome about keeping me both present, “in the room,” and fully able to feel and describe the memory.
I rarely felt numb during PE, just felt more or less intensity of emotions. The hardest thing but the thing where there has been the most demonstrable progress, is the physiological arousal. Before, even just thinking about what happened would cause my heart to race and my breathing to change. The first several sessions were just about tolerating the intense physical feelings and emotions, and being able to relax more while talking/recounting the memory.
We’ve worked on one memory, of my choosing, for all the sessions. We did 5 sessions of telling the whole memory, end to end, then started focusing on “hot spots” as my SUDS went down around certain areas of the memory. We did 4 “hot spots” retelling, and the first time was hard, just focusing in on one part, but then it got easier. I have only one session left. Next Friday I will once again recount the whole memory, end to end. I expect it to be much easier than it was the first time.
I was also surprised that just 15-30 minutes of processing after the imaginal exposure was actually enough. Of course, we had already checked in, discussed homework, etc., for about 15-30 minutes before the retelling, so it was a concentrated 15-30 minutes. My T is very focused, and able to both follow my lead but also keep me on track.
We did not get as far into the in vivo exposure as I thought we would. I still struggle with a lot of things, my SUDS are still high for certain exposures. BUT I am avoiding those things less and less (despite it still feeling difficult or being triggering.) I guess I could say that fear of the FBs and dissociation are not stopping me as much. Some areas of avoidance we thought would be a pretty easy place to start and we could then quickly retire that HW turned out to be hugely difficult. In fact, it brought up a whole different memory, something we are not concentrating on. What to do? Well, I have kept at it. If I stop that exposure, I risk reinforcing that it is something too scary to approach. But, we are not yet addressing that whole other set of memories. That is the big, bad, really awful, scary stuff. We will probably do another round of PE on that stuff after a few months break (going back to general supportive counseling.) I am in a holding/distress tolerance pattern with that exposure, but other things have gone well.
One of the main areas of in vivo exposure we have worked on during this time has been being in my body, moving my body in certain ways that I want to, without always getting so triggered. Mostly, this has been around yoga. For example, using the yoga strap to stretch open my hip flexors makes me feel extremely vulnerable and fearful, and brings up body memories of being tied spread eagle.:( NOT easy to do that pose in a room full of other people! I have been working on that pose and others in the privacy of my own home, with just my wife also doing yoga. That still makes me feel vulnerable and causes body memories, but is much more bearable. Yesterday at yoga I was able to do the pose, WITH the strap (which I often avoided), with only minor fear/anxiety and minor adjustments to the pose itself. AND I really was able to stay present for the entire time, including during the resting pose (savasana, aka corpse pose) when my hypervig usually kicks into high gear. I even allowed my yoga teacher to do an adjustment (she just touched my feet a bit, and I didn’t kick her.) Yay, me! :tup:
Anyway, I have one final PE session, then the following week we have a “mopping up” session for checking in and treatment planning before the winter break. I know she will still work with me, but I’m a little worried about how frequently I’ll get to see her. Damn Kaiser HMO! ***shakes fist at sky*** If I’m lucky, I’ll get to see her every other week or every three weeks; if I’m unlucky, it will be exceedingly hard to get in to see her and I will only get to see her like once a month or less. It’s ridiculous. But I have to admit, I am A LOT better off than I was when I first started seeing her a year ago. By the time we break for the holidays I will have been free from self-harm for about 3 months. Fingers crossed I can keep that up without the fear of being “kicked out” of PE as a deterrent (no self-harm was a condition for undertaking PE in the first place.)
On the whole, I think the PE has helped, at least with this memory, and with trusting my T with the details of my abuse. I have never in my life told anyone this level of detail about my past, what actually happened to me, even prior therapists. I think overall my PTSD symptoms (FBs, body memories, dissociation) have gone down over the past 2-3 months. The hyperarousal and hypervigilance has gone way down. The anxiety has gone down. The avoidance has improved in some areas. What has stayed constant, maybe even a little worse, is the depression. :( Unfortunately, with my depression tends to come a lot of avoidance, feeling like I can’t face the day. Sleep coma; calling in sick to work. But, there’s no magic bullet. I’m hopeful that over time the depression will eventually start to lift, and I’ll feel more like participating in life, being able to get work done, feel enthusiasm for doing artwork again and having fun.
Thank you all for your support. :) One final question, if anyone has actually done PE with a therapist: did you go back and do PE again for a different memory, different trauma? What was that like? For those of you who may have only done one round of PE, but have multiple traumas, did you find that the benefits of PE generalized to other traumas? Thanks!
First, let me say that, predictably, I felt worse before feeling better. I felt worse than I thought I would, initially. And the difficulty has persisted longer than I thought it would. I have at times had intense FBs, intrusive and overwhelming memories, increased episodes of dissociation, and increased self-harm urges. At the same time, these FBs & memories were not entirely random and unexpected, and that is a good thing. I had FBs, overwhelming emotions, intrusive memories & self-harm urges *before* starting PE. I have worked with my T to reframe the dissociation & FBs as evidence that I am doing hard work, I am confronting my demons (poking the bear, she calls it), and NOT evidence that I am getting worse or somehow “failing” PE (which makes me think of high school, ditching PE to get high and have sex under the bleachers, lol!) When I catch myself dissociating or missing time at work, instead of beating myself up for it, I simply say “Welcome back, Lola.” When I have FBs I try to stay present, grounded, tell myself, “Come back, come back,” and then try to praise myself for managing such painful emotions. This reframing has been good, helpful.
It was so hard, that first imaginal exposure! So raw and painful, and the unknown was terrifying. Would I dissociate? Would I break down? Would I be completely unable to access any emotions and be all monotone or sarcastic? Predictably, I vacillated between getting trapped in the memory (very slightly dissociating), and feeling overwhelmed by the feelings, memories, and trying to talk about it in the present tense. My T was awesome about keeping me both present, “in the room,” and fully able to feel and describe the memory.
I rarely felt numb during PE, just felt more or less intensity of emotions. The hardest thing but the thing where there has been the most demonstrable progress, is the physiological arousal. Before, even just thinking about what happened would cause my heart to race and my breathing to change. The first several sessions were just about tolerating the intense physical feelings and emotions, and being able to relax more while talking/recounting the memory.
We’ve worked on one memory, of my choosing, for all the sessions. We did 5 sessions of telling the whole memory, end to end, then started focusing on “hot spots” as my SUDS went down around certain areas of the memory. We did 4 “hot spots” retelling, and the first time was hard, just focusing in on one part, but then it got easier. I have only one session left. Next Friday I will once again recount the whole memory, end to end. I expect it to be much easier than it was the first time.
I was also surprised that just 15-30 minutes of processing after the imaginal exposure was actually enough. Of course, we had already checked in, discussed homework, etc., for about 15-30 minutes before the retelling, so it was a concentrated 15-30 minutes. My T is very focused, and able to both follow my lead but also keep me on track.
We did not get as far into the in vivo exposure as I thought we would. I still struggle with a lot of things, my SUDS are still high for certain exposures. BUT I am avoiding those things less and less (despite it still feeling difficult or being triggering.) I guess I could say that fear of the FBs and dissociation are not stopping me as much. Some areas of avoidance we thought would be a pretty easy place to start and we could then quickly retire that HW turned out to be hugely difficult. In fact, it brought up a whole different memory, something we are not concentrating on. What to do? Well, I have kept at it. If I stop that exposure, I risk reinforcing that it is something too scary to approach. But, we are not yet addressing that whole other set of memories. That is the big, bad, really awful, scary stuff. We will probably do another round of PE on that stuff after a few months break (going back to general supportive counseling.) I am in a holding/distress tolerance pattern with that exposure, but other things have gone well.
One of the main areas of in vivo exposure we have worked on during this time has been being in my body, moving my body in certain ways that I want to, without always getting so triggered. Mostly, this has been around yoga. For example, using the yoga strap to stretch open my hip flexors makes me feel extremely vulnerable and fearful, and brings up body memories of being tied spread eagle.:( NOT easy to do that pose in a room full of other people! I have been working on that pose and others in the privacy of my own home, with just my wife also doing yoga. That still makes me feel vulnerable and causes body memories, but is much more bearable. Yesterday at yoga I was able to do the pose, WITH the strap (which I often avoided), with only minor fear/anxiety and minor adjustments to the pose itself. AND I really was able to stay present for the entire time, including during the resting pose (savasana, aka corpse pose) when my hypervig usually kicks into high gear. I even allowed my yoga teacher to do an adjustment (she just touched my feet a bit, and I didn’t kick her.) Yay, me! :tup:
Anyway, I have one final PE session, then the following week we have a “mopping up” session for checking in and treatment planning before the winter break. I know she will still work with me, but I’m a little worried about how frequently I’ll get to see her. Damn Kaiser HMO! ***shakes fist at sky*** If I’m lucky, I’ll get to see her every other week or every three weeks; if I’m unlucky, it will be exceedingly hard to get in to see her and I will only get to see her like once a month or less. It’s ridiculous. But I have to admit, I am A LOT better off than I was when I first started seeing her a year ago. By the time we break for the holidays I will have been free from self-harm for about 3 months. Fingers crossed I can keep that up without the fear of being “kicked out” of PE as a deterrent (no self-harm was a condition for undertaking PE in the first place.)
On the whole, I think the PE has helped, at least with this memory, and with trusting my T with the details of my abuse. I have never in my life told anyone this level of detail about my past, what actually happened to me, even prior therapists. I think overall my PTSD symptoms (FBs, body memories, dissociation) have gone down over the past 2-3 months. The hyperarousal and hypervigilance has gone way down. The anxiety has gone down. The avoidance has improved in some areas. What has stayed constant, maybe even a little worse, is the depression. :( Unfortunately, with my depression tends to come a lot of avoidance, feeling like I can’t face the day. Sleep coma; calling in sick to work. But, there’s no magic bullet. I’m hopeful that over time the depression will eventually start to lift, and I’ll feel more like participating in life, being able to get work done, feel enthusiasm for doing artwork again and having fun.
Thank you all for your support. :) One final question, if anyone has actually done PE with a therapist: did you go back and do PE again for a different memory, different trauma? What was that like? For those of you who may have only done one round of PE, but have multiple traumas, did you find that the benefits of PE generalized to other traumas? Thanks!
- Admin
- #32
anthony
Founder
Well done for taking the leap of faith with vulnerability. Huge congratulations.
- Post starter
- #33
Lola Nocheprieta
Diamond Member
Thanks, @anthony!
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