Trauma: Working Through It, Letting it Go, and Living with It

As a mental health therapist, I currently meet with people who have lots of different types of trauma. A few people who I meet with tell me that they chose me based on my background and training in trauma therapy. Choosing a trauma therapist can be challenging, so here are some things that may be helpful when choosing a therapist, particularly someone with evidence based training in trauma therapy.

When choosing a trauma based therapist, take into consideration what trauma is and our responses to it. Traumas are: What we have experienced, our bio-chemistry, our sensitivities, and our pre-dispositions which make us affected by social interactions and life events. As we all are trauma affected, I’m thinking of COVID here, we’ve all had different responses to it. All of us have experiences that have affected us in some way, and for many of us choosing mental health therapy is a way to work through trauma. There are several different types of evidence based practices which treat trauma in mental health therapy.

A meaningful training I attended as a trauma researcher and therapist came to the forefront at a Trauma-Informed-Care (TIC) train-the trainer workshop I attended in 2012. It was put on by the Federal Youth Service Bureau (FYSB, pronounced fizz-B), and was particularly meaningful to me as a participant.

At that time, I’d had a couple of experiences working in residential settings. One was an experience I had during graduate school. I was the van driver for a group home for adolescent boys who had either broken some sort of law or experienced some sort of abuse or neglect, rendering them unable to stay in their home environment. After being the van driver for a year or so, I utilized the group home for practicum experience and was a therapist to some of the boys who resided at the facility.

My second experience occurred while I was attending the TIC workshop. I was Director of the staff and programming for a Pregnant and Parenting Teen program, also funded by FYSB. We had one location for the 18 and under moms or moms to be. We also had apartments for the moms who were 19 and older.

The training confirmed some of my own biases and opinions that I had formed working in residential facilities with youth. I had always thought that it is important to take into consideration what trauma each of the residents had experienced, and to apply therapy which respected the participant. One thing I learned in the TIC training was about helping connect consequences to the behaviors, and recognizing how trauma can affect the person doing the behavior. For instance, a person may have a very large reaction to the lights being turned on when someone is going to wake them up. If they have trauma associated with lights being turned on and being removed from their home, this makes sense. Respecting the trauma response and waking someone gently with words can be a better route than turning lights on in this scenario.

It also confirmed family therapy I did with families who were affected by Child Protective Services when I did home-based work. Early in my career I was a home-based therapist for families involved with Child Protective Services or at risk for having abuse or neglect in their family. Utilizing TIC when working together with parents of children who had been removed from the home, or with the children who either had been or were at risk for being removed, was important to gaining trust with the families and children.

There are all kinds of traumas that people can experience; and as a therapist in the field for many years, I have been privy to hearing about quite a bit of it.

Some have experienced sexual trauma, others have lost a child, others have experienced abuse that was physical or neglectful.

There are some evidence-based types of mental health therapy that are specifically designed to work with trauma.

As people who are living with and through trauma determine what type of training their therapist has had, there are several different things to consider.

Number one, from pretty much all of the research I have read, is that therapeutic relationship. The therapeutic relationship is tough to know prior to making that first phone call, which is also going to be dependent on cost, availability of the therapist, whether or not they take your insurance or are a fee based (private pay) person. In addition, it is important to consider some of their trainings in areas that are important to the person participating in or facilitating the therapy.

One type of evidence based trauma treatment is utilizing a Trauma Informed Care approach. The TIC approach includes recognizing that trauma plays into interactions that we all have with each other. We can recognize that as we work together in the therapeutic relationship.

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is a trauma-informed approach that includes psychoeducation (teaching about trauma) and including a trauma narrative, which is the story of what the trauma is. It has more of a prescriptive approach to the therapeutic relationship, and has good evidence behind it.

Dialectical Behavioral Therapy (DBT) is an approach which recognizes that there are certain, specific techniques that can be helpful in therapy with someone who has experienced trauma. The training includes learning about these techniques and practicing using them in the therapeutic relationship.

ART, or Accelerated Resolution Therapy, is an eye movement therapy that helps the therapist and the person in session work through traumatic experiences. EMDR is similar to ART, but was developed first and is another evidence based eye movement treatment for those who have experienced trauma.

Of the types of training listed above, I am trained in all except for EMDR, which may be something I tackle next.

Motivational Interviewing is a type of evidence based therapy that I utilize frequently in sessions, where I am working to help the client be motivated to make changes through interviewing, or questioning.

Finding a therapist who utilizes evidence based treatment can be a real plus when working to make changes.

What qualities do you look for when you are finding a therapist?

How do you choose which therapist to contact? Do you look for someone who appears personable in their photo, someone who has a strong history of rapport building, or someone with trainings in evidence based practices? Or do you look for a combination of all of the above?

We’re hearing on the news about how important therapy is. I watched Saturday Night Live last week, and multiple skits included the topic of therapy.

The stigma of participating in therapy is lessening, and more and more therapists are getting trained in the field of therapy, at least here in Texas where I live.

I hope you find a quality therapist. One you can trust, one you can talk with, and one you find helpful as you work through whatever has brought you to therapy.

Understanding Instincts: An ADHD Therapist’s Perspective

Daily writing prompt
Do you trust your instincts?
View all responses

So… should I actually trust my gut? That’s a solid question!

As a mental health therapist, I rely on my instincts during the sessions I have with clients. It is imperative that I trust what I have to say; but it is even more imperative that I LISTEN to what they say, because listening to words, body language, and expressions are how I gauge what someone is saying to formulate a response. .

As a teen and early twenty-something-year-old, I had a lot of confidence in my instincts. School came easily to me, so my instincts were reinforced with high grades in high school and in college; and then again in graduate school.

As I have aged, that confidence has probably lessened to some degree.

For about 5 years, I worked for an organization that was not a great fit for me. It had a long history of bureaucracy, which was totally new to me.

I was raised in a farm community (Tipton, Indiana) where we valued all roles at all times. We valued the soil that is one of the richest in the nation, and we valued the work we did in the corn fields to detassel the corn. In fact, at the time I worked at the bureaucratic company, Bureau was part of the name. They have since changed names to a more egalitarian sounding company, but I digress.

I learned while I worked there to tell my direct supervisor anything that was important to me. Previous to that role, I had reported to the President, or Executive Director, so being a Middle Manager was hard for me. I am the second of three children, so being number two was definitely in my comfort zone.

I also learned to question myself, which has been difficult to unlearn. I learned that my instincts get me into ‘trouble’, or can be met with disdain. I learned, or at least was told, that the executive director did not like email. Email was at that time my preferred way to communicate

I also learned how to function in a bureaucracy. I learned it the hard way, and have since moved on to another position. I report to the Director, who owns the practice where I work.

I have learned again to trust my instincts, as they are generally accurate. I have also learned to ask questions of those around me again. I had stopped doing that for a period of time during my transition from Indiana to Texas.

Texas is a whole different world from Indiana. We like to be independent, have little to do with the police unless a crime is committed, and generally like to be left alone unless we need help.

I would say, to answer the question as it was originally asked, that I do in general trust my instincts. I live by motivational-ly interviewing my clients who allow it, and sometimes guess wrong. Lucky for me, talk therapy includes non-verbal communication. I can get an idea if I guess wrong and the person is hesitant to verbalize that.

As you reflect today on your instincts and the degree to which you trust them, I urge you to consider the individuals who provide you with support in your life.

Who do you turn to when you are unsure if your instincts are accurate or not?

What do you do when an instinct leads you into an inaccurate response?

I encourage you to trust yourself, and to have a strong sense of self.

I’m encouraging my clients to watch ‘Inside Out 2’. It has a great description of sense of self, as well as doing a great job of explaining Anxiety, Ennui, Disgust, Nostalgia, and the characters from the first one; Joy, Anger, Sadness, and another one or two I am currently forgetting.

Let’s all work to have confidence in ourselves in moderation, as it promotes a strong sense of self and helps us to succeed in our roles

Mental Health and ADHD

Do you enjoy your job?

I love my job.

I’ve been trained as a mental health therapist since 1995, and have been with the private practice I’m with since 2020. I did a lot of non-profit work between ‘95 and 2018, and enjoyed lots of pieces of that as well.

It has always been important to me to make a difference.

Currently, I’m specializing in working with people who have ADHD, depression, and anxiety. I particularly specialize in ADHD.

My undergrad was a BS in Psychology, where I learned all about the brain. Then I went straight to get my MA in Community Counseling at the University of Cincinnati, where I found my niche of working as a mental health therapist.

I love lots of pieces of my job. I love to read, and really enjoy reading research based works and learning about evidence-based practices. Currently, I’m reading a book to help me work better with children who have ADHD and can struggle with following rules. It is called ‘Your Defiant Child’, and while I’m not a huge fan of the title, the information is very much strength-based.

At my last full time non-profit employer, I was frequently told by my boss and the president of the company that I reminded them of an outpatient therapist. This was interesting to me, because although I had provided therapy in many settings, being an outpatient therapist was something that my job title had only briefly included.

My history was in home-based therapy, where I was able to see the entire family system. When I was at Promising Futures, I provided outpatient therapy toward the end of our time as a stand-alone non-profit before we merged with the Children’s Bureau.

Today, I am working on my writing skills, which my job allows me to do with the schedule that I have. I have seen clients this morning, will participate in a consultation training at 1pm, and then will see clients until late afternoon.

I have a one hour break in there where I will either continue working on my writing skills, or read more of my book.

It’s a job I love, and I’m so proud to be a part of a group practice that has multiple locations to serve the North Dallas area.

What do you like about your job? Are there pieces of the schedule that you like?

Do you like being retired from a job you may or may not have loved?

Are there more things you dislike about your job than things you like?

Either way, I hope you are able to enjoy your day today and tomorrow as well.

Pilates

What are your favorite physical activities or exercises?

So when I was little I really wanted to be a gymnast.

I watched gymnastics on tv, I endlessly practiced doing a handstand unsuccessfully, and I successfully practiced headstands.

Fast forward to the summer before my 50th year, and I moved to Texas. My childhood friend was a Pilates instructor, and I had learned about a condition known as Ehlers-Danlos Syndrome, better known as EDS.

I began doing Pilates. Pilates works the core, and in many ways is like doing gymnastics or dancing on your back.

I realized that with my ligaments being unable to keep things like my shoulders in place, and my abdominal muscles being very weak from having a hysterectomy in 2018, that Pilates provided a lot of help.

I learned, through a trauma training I participated in, that movement and talk therapy work together to help us function as well as we can. I find the meditative aspect of Pilates helpful. Like many therapy sessions, a pilates class is 50 minutes long.

Core strength helps with back pain. We do a lot of footwork, which helps with ankles which tend to turn easily. The work we do in Pilates supports the mental health therapy we can get by helping our bodies stay in tune.

I recommend Pilates to many people in my personal life. My niece and my sister have started doing it as well.

As you think about what helps you to function as well as you can, what do you think about?

What are your favorite exercises that you like to do?

When you think about the mind-body connection, what helps you to calm down, relax, and exercise your muscles?

I encourage all of us to find some way of moving our bodies. That may be aerobic exercise, running, pilates, yoga, or many other things. As we end this year and get close to the holidays, what are you thinking about to help yourself to get or stay physically fit?

I hope your holidays are as peaceful as possible. I will be home in Texas on Christmas for the first time this year, and am looking forward to spending time with my family.

Changing and Staying the Same

What is one thing you would change about yourself?

Today’s prompt is the question you see above; what is one thing you would change about yourself.

My immediate thought was that i would change my flexible joints. They are a part of who I am, and enable me to squish my hand into a tiny fist, but also cause quite a bit of pain.

Today though, I’m thinking about anxiety.

My imagination works quite well, and with that comes a fair amount of anxiety. I would lessen my anxiety, although it has helped me to have success in school and work.

This weekend, we are heading to Indianapolis to celebrate my son’s graduation from law school. This has taken a bit longer than anticipated, due to an illness he had during fall semester of last year.

You have a few goals when you have kids, and one of them is to launch them.

I went to grad school immediately following undergrad as well. We were ridiculously poor, and the future income of a mental health therapist is not as high as I would have liked for it to be.

We knew, as I was accumulating loans, that paying them back was going to be tough. My husband was in retail at that time, which was not a high paying role for him. I studied, worked at a group home for boys, and spent a lot of time entertaining myself with very little income.

He worked approximately 70 hours per week. He was an assistant manager at a Footlocker, which was similar to Finish Line. He taught me about multiple sales, and I taught him about some of the traumas that the boys had experienced where I worked.

We have been together since we were 20/21 (me being the older one), and have been with each other all of that time. We worked together through our poverty, and have lived through more than one recession.

Our children were born on the same day, but currently have a lot of differences between them. One of them has worked since graduating from college in 2020, and the other is completing law school and will be joining the workforce in September.

I am looking forward to his graduation dinner, but am also fairly anxious. I can’t wait to celebrate him, and our accomplishment in having a child who is launching from school to a career feels good as a parent. I get overstimulated fairly easily, so having a dinner at a restaurant with 19 family members feels a little overwhelming.

I find myself talking about him to people I know OK well. I tell them about the upcoming job that has been offered to him.

They congratulate me, and I smile and indicate happiness to them.

I would change my anxiety about a trip filled with excitement and family to just looking forward to getting together.

One thing I’ve noticed, since working in the mental health field prior to and during COVID, is that anxiety drives a lot of us.

We want to do well in school, and study hard to get the positive reinforcement that good grades bring.

We want to follow rules, and trying to figure out which rules we were wanting to follow caused quite a bit of stress to a lot of people during COVID and continuing to today.

One of the diagnoses that I work with is anxiety in others. We work together to come up with positive ways to decrease their anxiety and to have some results that lower their feelings of angst.

I encourage each of you to enjoy this holiday season as much as you can. It can be tough, with members of our families who used to be with us missing family gatherings for multiple reasons.

Whether our family members are missing due to death or a change in holiday traditions, it can be hard as we celebrate the holiday season.

I hope you find something to enjoy today and as we get closer to Christmas and the New Year.