I have complex trauma beginning with abuse early in my childhood. I've likely had PTSD since I was very young.
I've done CBT, DBT, EMDR, PE, as well as family systems therapy.
Since I have had multiple traumas, we worked on whatever was most distressing to me in the present. Targeting those traumas that were negatively affecting me in the present was a good way to go. I also got to pick and choose which ones I felt ready for and which I didn't. My therapists watched closely for signs of resistance, indicating that I wasn't ready to go deeper with that particular one yet.
I had to develop a really good self-care routine. I made sure to be getting enough rest and have nourishing food ready so I wouldn't have to cook for a day or two. We did the sessions at the end of the day so I just had to go home, do what I needed to do for the kids, and then go to bed early. Sometimes the symptoms were worse for 1-2 weeks, but as I practiced my grounding and self-care routines, the recovery time after sessions got shorter and shorter. Now, it's just a few hours if even that.
I did have full-on dissociation and flashbacks during it. My therapist would then help me come back into the room, and we used that time to practice skills to bring myself out of them. That practice has been invaluable because it works in my life outside of the therapy room now. No session is wasted.
I learned to allow the increase in symptoms to wash over me, knowing I had opened up a flood gate and just like all floods, the water recedes. I will say that I wish I had pushed myself to do this therapy decades ago. Why? Because every single trauma I've addressed extinguished the triggers to it, helped me change the adaptive behaviors I had picked up that weren't helpful now, and allowed the adult me see the events more clearly with far more compassion for myself. My self-esteem got a LOT better.
Also, every session left me with a sense of 'open space' in my psyche that wasn't there before. It hasn't been easy, but it has definitely been worth it. My life feels so wonderful to me now most of the time.
Nobody needs to do in-vivo alone unless you want to. You get to listen to yourself and your own needs, and decide what is best for you. You'll get suggestions, but you'll learn your limits. Every in vivo I've done has really opened up my world.
The therapists do help. We get to decide what we will talk about. They help us see things from an empathic, supportive adult's view to teach us when we are beating up on ourselves and how to stop that. My therapists and I determined how best to interrupt me when I was dissociated. I couldn't be touched. I needed just a gentle voice encouraging me to come back and drink some water or eat one of my mints. Then, I'd talk again and again about the experiences. Once I was able to talk about them - saying only what I wanted to - without going numb but with appropriate emotions being expressed, the trauma would recede into the past where it belongs. I still have the memories but they don't highjack my system and flood it with the emotions that happened at the time. Then, we'd spend time talking about what I thought at the time, and what core beliefs I picked up during/after the traumas that are harming me now. Once I was calm and grounded, though extremely tired, the session would be over and I'd head home.
During the trauma therapy, the first part is helping us deal with whatever issues are difficult in our present so those don't interfere when going into the past. Also, my therapists assess me to ensure I'm not too tired, hungry, thirsty, or ill to safely proceed. Once I'm calmed down in the room and the anticipatory anxiety has let down, then we'd find a target to go after. I'd talk about it while my therapist would do EMDR or just listening. If I was numb, processing couldn't take place so we'd take a break and just discuss non-therapy things, or I'd color with crayons, or we'd talk about funny things.
There were whole sessions I couldn't remember. They allowed me to record my sessions so I could listen to them later, which was immensely helpful. Even the things I don't remember, part of me does.
Unfortunately in my case, it turned out that I have DDNOS, or "dissociated disorder not otherwise specified." Meaning, my personality has a lot of fragments and while they aren't whole personalities, each one does present differently. Now I'm working on gentle communication between these parts so I can access my skills, knowledge, and memories no matter who is 'driving the bus' so to speak.
I am so glad I pushed myself to do this. I am proud of myself for allowing myself to finally express all the feelings I kept locked away. I am far more assertive now. I never feel victimized by life or other people. I have good boundries, and while I still get triggered, nothing gets me down for very long.
I have no regrets about any of it other than not doing it sooner.
