Keep Pain in the Past. Dr. Chris Cortman

Чтение книги онлайн.

СКАЧАТЬ The VA, which is the biggest provider of trauma treatment, and National Center for PTSD, which is the biggest researcher of PTSD, both agree that medication never helps the underlying cause of the symptoms—the unresolved trauma. In fact, by successfully masking symptoms, medications may actually interfere with effective treatment, as clients may settle for a treatment that distances them from their emotional pain. Antidepressants and tranquilizers are notorious for masking emotional pain (emotional anesthesia), although they can prevent people from disintegrating into a puddle of tears. Most people enjoy that feature of antidepressants, and they often conclude that masking the pain is as good as it’s going to get.

      Ironically, one of the prominent symptoms of PTSD is avoidance, as noted above in Jim’s story. Consequently, let me state this as boldly as possible (I’ll even use bold print): Prescribing only psychotropic medication without healing psychotherapy may contribute to the client avoiding the problem, rather than addressing and healing it! In fact, while I’m out of a controversial limb, “medication only” treatment for unresolved emotional trauma can be tantamount to enabling the client to remain stuck in the symptoms of PTSD.

      Medicating clients’ suffering without addressing the place where they are stuck in the pain of the past supports them in remaining mired there without having to address and resolve the underlying issue(s). Moreover, if clients are numb enough to function (albeit unhappily), they can avoid facing their pain head-on, which is a requirement of effective psychological treatment. After all, people don’t tend to present for psychological treatment unless they are in crisis mode—in layman’s terms, not unless they’re coming apart at the seams. Alas, as the great Dr. James Framo4, a former professor of mine, used to say, “People don’t change unless it’s too painful not to.”

      If medication separates people from their pain, they are less likely to address their underlying issues. Allow me a crude but hopefully accurate analogy: If a client has a large, unpassable kidney stone trapped in the ureter, the pain motivates the client to find a doctor who can remove it. But if allowed generous amounts of opioids, that same client may postpone (i.e., avoid) the surgery indefinitely, as long as the pain is manageable. If the stone isn’t removed from the ureter, though, it will do long-term damage.

      I’m not opposed to medication; I’m only opposed to medication that prevents the root cause of emotional trauma from being addressed. The psychological community appears to be equally culpable in Jim’s forty-five years of misery. Let me illustrate: At a recent professional psychology conference, I listened to a capable presenter discuss the two “leading treatments for PTSD.” She shared that Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE) were the best treatments we had at this time.

      I sat there stewing, knowing she was wrong. But how could she have been so unaware of the much more effective alternatives to treating emotional trauma? Here’s how. Various psychological schools and practitioners, past and present, offer an abundance of training, research, and theories on everything from psychological development to personality theory to effective treatments for psychological disorders. There is no one paradigm or model from which to draw. Psychologists emerge from their training with the theories and styles that best fit each practitioner. That only makes sense, but it also guarantees that if you enter six psychologists’ offices, you are likely to receive six different (albeit potentially similar) therapeutic styles and treatment plans to address the very same presenting issues.

      One therapist, for instance, may operate from the belief that you the client have suffered enough trauma already, so the last thing you need to do is revisit the scene of the crime. What the client needs instead are coping tools. This well-intentioned approach, though, may help you cope but not thrive. You may be able to maintain a relationship and a job but probably never be able to enjoy either. Until you make peace with the pain in your past, you will never do much more than cope.

      Other therapists try to help you to rethink the traumatic event. These therapists might have tried to convince Jim that he’d had about three minutes to locate his two sons, rescue them from the icy water, and revive them, and that given the impossibility of doing so within this time frame, he should free himself from his guilt. They would provide him with other types of useful and realistic information to alter his beliefs about the trauma. This might help Jim to some extent, but it wouldn’t allow him to release the intrusive attacks of the undigested trauma.

      Some psychologists believe in using highly specialized approaches, such as eye movement desensitization and reprocessing techniques (EMDR), which requires clients to visualize the trauma while watching an object such as a pencil move back and forth. While the visualization of the trauma is necessary for healing to occur, the eye movement is extraneous and completely unnecessary. What is paramount, however, is the need to release the traumatic event permanently, which in my opinion, EMDR does not accomplish effectively.

      And there are therapists who base their treatment on a behavioral principle called “flooding”, which employs a technique called prolonged exposure (PE) where clients are asked to revisualize and re-experience the trauma continuously until they are habituated (i.e., stop responding emotionally) to it. While remembering the traumatic event fully is important (as you will see, it’s step one of the Fritz), simply remembering it over and over again is unnecessarily torturous, forcing people to relive the biggest horror of their lives repeatedly. This is cruel and unusual punishment, especially given that a single return to the trauma is all that is required to find peace with the intrusive recollections and stop the nightmares.

      Assess Your Own Treatment

      As you read about these various treatment types, at least one of them may have struck a chord with you because of your own journey. It’s worth assessing that particular form of therapy (or those therapies) and what went wrong; or what failed to go sufficiently right so that you could now be living a life free of the effects of your trauma.

      Take a look at the following questions and think about your answers:

      •What type of therapy did you use? What method did your therapist employ (assuming he or she disclosed this method), or from what therapeutic school of thought did your therapist develop his or her method?

      •How long were you in therapy? Did you stop for a particular reason?

      •Are you a serial therapy-seeker? How many different therapists or types of therapy have you had?

      •Have you been prescribed any medications to help you deal with the problems stemming from your trauma? What are the medications, and how effective have they been, both in addressing the short-term symptoms as well as in helping you heal and lead a fulfilling, successful life?

      •How much work on your issues have you done on your own? Did your therapist suggest you should be working on healing outside of his/her office? Did your therapist give you any tools or techniques to use on your own?

      •How has the emotional trauma you suffered affected your life negatively? Has it negatively affected you in terms of your careers, relationships, moods, or ability to enjoy life? Has therapy helped you deal successfully with any of these problems, especially in the long term?

      Analysis: Putting Your Therapy on the Couch

      •What type of therapy did you use? What method did your therapist employ (assuming he or she disclosed this method), or from what “school” of therapy did your therapist develop his or her method?

      If you don’t know what type of therapy or school of thought your therapist uses, you’re not alone. Your therapist may not have divulged this information to you СКАЧАТЬ