What Is A Trauma Therapist?

[Hashi]

This is so true.

One of the questions I asked potential therapists was "How do you keep things safe?" and left them to interpret and answer that however they liked. I didn't have any particular answer in mind, I just wanted to get an idea of their approaches. Their responses spoke volumes about how much they understood about trauma and PTSD. It was also obvious whether they'd read it in a textbook or were talking from experience.

Responses to open questions (ie they can't just answer yes, no or with a fact) can tell you a lot.

 

[Sunrise]

To sterre
No matter how nice your T is and no matter how much you like her, I suggest that at the end of the day it is only about how far you’ve come towards getting better. Once she starts to blame you for the lack of progress it is time to find another T.

 

[anthony]

Once she starts to blame you for the lack of progress it is time to find another T.

Not exactly true, especially with PTSD.

Call it blaming, call it a therapist being honest with their client. At the end of the day, if a client isn't doing assigned homework, isn't pushing themselves and motivating themselves to actually help themselves, then yes, the client can be at fault.

Yes, the therapist can be at fault as well. Clients are not innocent in therapy... a good majority of people with PTSD don't push themselves during therapy. This is known.

 

[mamachick]

I think sometimes we all need are feet held to the fire. I know therapist's who have fired their clients. If the client does not follow any recomendations, does the "ya but..." about everything, doesnt do homework, etc. the T has told them that they have a waiting list and if and when the client is ready to work......

It is an injustice, IMO, to let someone come to therapy and not make progress. It gives a bad name to the field and helps nobody.
A good t will tell you from the get go that you are in this together, the therapist cant make anyone better no more than the dietician can make someone thin.

 

[anthony]

Technically by ethical standards, a therapist is to let a client go until such time as the client wants to commit to therapy.

Its actually unethical and could border legal consequences in some circumstances, if you continue to see a client who does not progress and work effectively at their own treatment.

Most people may not know that, but its the way therapy ethics and laws exist.

 

[mamachick]

Thats right. Some people would feel insulted knowing this, but it is unethical. The code of ethics is there to protect clients interest and from being taken advantage of.
There have been times in my life that I have needed a big shove, and I appreciate that.

 

[Sunrise]

thanks Ant n' brat17 for good responses..

Without wishing to over simplify, just to make one point: what you do outside of the therapy room depends on how the trauma is being handled. CBT (which really refers to several cognitive therapies) works from the outside in (my opinion). Meaning that you use the logic of what you are being told, to cognite on how you should be going about managing say, a symptom and you use the force of your will to constantly impress on the subconscious that things have to be done differently. Once you are convinced and motivated it takes determination and repetition and the damn subconscious can take a bit of convincing.

So the homework has to be diligent and constant.

However, approaches like TIR and some others that I would argue, work from the inside out, that is they address the central reason/cause that we have the symptom in the first place. If you removed a chunk of lead from your shoe, you would immediately walk more freely, you would very quickly become accustomed to this new freedom and there would be no reason to practice walking – no homework needed. A problem here is that CBT holds such sway that not many people have experienced the other approach and so cannot speak from experience to compare. Other approaches that could be seen as working from the inside out might be hypnotherapy, somatic experiencing, EFT and EMDR. Those of you who have had success with these approaches will know what I mean.
Where an approach like this is used, activities outside of the therapy room - especially going over traumas solo - can actually be counter productive.
Love to all,

 

[anthony]

CBT should actually work from the inside out, not the outside in. CBT should always start with cognitive, being exactly what you mentioned, identify the problem, review the problem, understand the problem, identify solutions and methods to achieve the result, then apply those solutions to find the one that works best for you and achieves the result.

CBT has always been that way. If its not done that way, then the therapist is doing it wrong.

 

[Sunrise]

I don’t want this to get drawn out.
The oft used phrase in CBT is that the method is used to “change your thinking.”
To “help client’s adjust their self-defeating thinking and discover more rational ways of approaching problems.” [DLMURL="http://www.cbtcambridge.com/how-does-cbt-work/"]http://www.cbtcambridge.com/how-does-cbt-work
[/DLMURL]I know that many have been helped with CBT.
What I am alluding to is that getting the sufferer to see that their thinking is not rational is very different to methods that do not ask the client to think “about” their thinking, but instead get the “victim”* to explore an incident to see it more clearly.
To illustrate, if I was asked about an incident/argument I had with someone I would come up with all kinds of thoughts about the event. My evaluations, feelings about what I said, what they said to me, what they did, what I did etc.

Irrational thinking when it is automatically triggered can be destructive from the point of view of the harm it does and from the point of view that it is automatic, that is, out of control.
But if I was guided back, went to the incident and safely but closely reviewed it and was asked what I experienced, how I felt about it would logically come up but would not be pivotal and could change the longer I examined what went down. Eventually, if I clearly observed what was holding the thing there I might feel great relief and leave it behind, like getting the lead out of the shoe. Once you are freed of the drastic hold the deep nastiness of an ugly event has had on you, what you think about it or whether we are being rational or not doesn’t matter a bit.

Another example might be that I am avoiding you and thinking negatively about you ever since a nasty exchange we had. Every time I see you I am flooded with negative feeling and every thing you say or that happens around me is interpreted by me as negative.
Talking about it helps very little as I am always talking about how rotten I feel and how wrong you are. I avoid confronting you and the incident head on till one day we get stuck in a lift and we have a talk. You let me know a fact about that terrible day that I had completely misunderstood. Now that I have confronted the issue I am tremendously relieved and with my clearly seeing the incident without any avoidance my bad feelings toward you dissipate on the spot. Next time, the sight of you coming toward me no longer triggers that flood. Trigger null, symptom gone. It is only a light example but may serve to show what I mean. Examining the incident like that is what I mean by 'inside out' as opposed to examining one’s thoughts, reactions, opinions, etc etc
*I don't like the word "victim" but it is fair to characterise one as such at that point.

 

[anthony]

You have quoted an interpretation from a psychologists personal website business.

"Paul is a Psychologist who specialises in the treatment of Depressive and Anxiety disorders."

I would cite that the wikipedia's statement of CBT is more accurate and less personalised to this persons specific business model, being:

Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present.

EMDR is a CBT therapy, which you cite against CBT, and it achieves the exact same thing in a different manner.

CBT is a model which works like most therapies, being present tense, because empirical data has found that little is achieved by taking a person in the past.

However, therapy models also typically dictate that in some cases a person must still be guided back into the past in order to process a problem, but you don't let them dwell there, instead bringing them back to the present.

You raised TIR as an example of inside out, yet from the TIR association they state the same principle as for what the majority of trauma therapies cite:

When something happens that is physically or emotionally painful, one has the option of either confronting it fully and feeling the pain, or trying in some way to block one's awareness of it.

Confronting any type of trauma is called exposure, and TIR replicates more PE than any other therapy model, which is one part of a complete CBT approach.

It would actually be difficult nowadays to honestly tell what model a therapist is using, because there are literally so many rolled into one, what do you really call it? Bitza Therapy? Trauma therapy really is bits of this, bits of that. The moment you engage a client using reflective listening, you're using Person Centered and its gaggle of names used depending on location in the world, and not CBT. If you coach them in a life skill, then technically that falls into NLP, being business oriented coaching / communication skills.

I think its hard to really identify a specific name nowadays, and I think its more why CBT is merely used as a term more than really the adage 12 session therapy model it theoretically is.

Give TIR to 5 different therapists and I guarantee you will get 5 different interpretations of how they want to deliver that therapy model. One or two may get it right, all five may get it right, all five may get it wrong. No different to any therapy model. Do some reading here on people's bad experiences with dodgy EMDR practitioners. The model is sound and proven. Put it into a therapists hands who has decided to add their own personality to it, and suddenly they're screwing people up worse than when they came in the door.

Moral of the story. There is no sound, one solution fits all approach in treating trauma. DBT is a CBT therapy, yet touches little on the trauma and focuses heavily on emotion regulation and dissociation grounding techniques for BPD.

The facts though, is that there are four proven effective therapies for the treatment of PTSD, which are: Cognitive Trauma Therapy, PE, Stress Inoculation and EMDR. These four have proven without a doubt the best treatment options for PTSD symptom reduction longevity. No quick fixes... they all target the long term, not the short term.

Short term therapies (quick fixes) are not a viable solution for PTSD.

 

[Coda]

Culture is quite significant with PTSD... as stated, Australia is less talk, more do. America is more talk, less do. The actual equilibrium is an equal combination of both, being talk and do. Both cultures have flaws with trauma therapy.

One thing I am concerned about is the fact that I am Chinese- American, grew up in Los Angeles, and I myself am struggling to find the lines that divide the (sometimes oppositional) cultures that make me who I am today.

It's hard because Chinese people don't talk about certain things, and I was taught (on my semester abroad) in China that's it's actually a cultural quality to be "awkward"- that is, not straightforward or frank- and instead, to mask information or make subtle references or metaphors to address something.

My entire life has been a puzzle, and I'm also not used to talking about things with people. How can a therapist who is unfamiliar with the cultural differences help me with my relationship with my parents? Could it be possible that my parents do and say things that are considered "normal" for their particular group/class/generation of Taiwanese-Chinese, but really harmful/ hurtful to American standards? (For example, physical beatings as a way to discipline a child.)

And as far as I know, the whole situation with mental health is totally different in China- largely repressed, I think... but I guess I'll save that for a different thread.

 

[anthony]

And as far as I know, the whole situation with mental health is totally different in China- largely repressed, I think... but I guess I'll save that for a different thread.

That would be tough to deal with... I can understand exactly what you are talking about the situation you are within. Quite unique and troublesome, all within itself, due to cultural indifferences.