The following is an excerpt from a beautiful article by our Board Chairperson, Susan Pease-Bannit, LCSW. Shared in the Fall issue of Oregon’s NASW Nexus Newsletter, we received her permission to re-post it here to share with you!
Banitt is in private practice in Portland, Oregon. She is co-chair of the NASW Mental Health Council. Her book, The Trauma Toolkit: Healing PTSD From the Inside Out, will be published in spring 2012.
Nothing screams scary therapist like incongruence or neutrality. Perpetrators are often shut down, non-emotive and opaque. Well-meaning therapists who are trying to give their clients space to figure themselves out often do not realize how triggering the standard therapy face is to abused clients. Be direct, ask questions, try out hypotheses out loud. Use humor when you can, and self-disclose regularly if judiciously. If you are upset or shocked, say so. Your clients will appreciate your humanity and connectedness. They will feel safer and stay with you longer!
Always believe your clients’ reality
I don’t care if the story is that little green men from Mars gave a party in their bathtub (oh, that their stories were this fun!). There is always truth in what patients tell us. After four years on a child abuse hotline I can tell you that even with psychological training you may have little knowledge of what abuse people in our society actually experience as children; the media certainly doesn’t report it.
You do not have the burden of being a lawyer so there is no harm in believing your client until you have an excellent reason not to. Besides, can you know for sure there are no Martians? Maybe they were leprechauns! My gold standard is psychotic is as psychotic does. If a patient’s thought process is lucid and the content is strange, their story may be true. If the thought process is really deranged, the patient probably (but not always) has a psychosis blooming. Even then, there will be symbolic encoded truths in the delusions! Accept and run with the story; more truth will eventually emerge, and your client will feel seen, acknowledged and held.
Attachment, attachment, attachment
All trauma survivors have been profoundly betrayed in some way(s): by caregivers, by society, by their commanding officers, by God, by nature, by their own expectations. In most cases, these betrayals are actual and multiple, and they rupture a secure feeling of attachment.
Your first, major and only job in the beginning of therapy is to foster a secure attachment in the therapy situation. Even for experienced therapists this can be a tricky task requiring pristine empathy, great timing and repeated safety and stabilization work. Sometimes this process can be quite lengthy. One patient had recurring dreams about me abusing her for years. This person had no memories of ever being lovingly nurtured by a parent, and she had been subject to the worst kind of abuses throughout her childhood.
After several years she finally had a dream buy phentermine 37.5 cheap online about a loving mother whale with her pectoral fin protectively around her baby, and she could feel it, a true maternal introject. If we had focused solely on her abuse stories, she would have become quickly overwhelmed and hopeless without the necessary solace of a soothing relationship. Our traumatized clients need and deserve a secure place to stand in their work with us. Often this means reviewing early attachment and object relationship theory to assess where they are at and how we can safely move them to the next stages of development prior to working through intense traumas.
Always review medications and diagnoses
I’ve had a number of severely traumatized patients come to me under the wrong label of bipolar disorder, sometimes medicated to the point of incoherence. Keeping abreast of the latest research can be a powerful way to assist your client and move the therapy along. Did you know SSRI’s show no stand-alone effect in relieving depression in patients with PTSD (Harvard Mental Health Newsletter 2010)? Or that risperidone, a popular PTSD drug, shows positive effects for people with abuse traumas but not for veterans (Psych Central News Editor 2011)? Are you familiar with the non-psychotropic alternative of beta-blockers to reduce the escalation of rage and tension?
Social Workers Speak
The Nexus • Fall 2011 http://nasworegon.org NASW Oregon Chapter • Page 19
Do you know how your patients are self-medicating and in what dosages, or if they are taking supplements or herbs? What about street drugs? Be sure you notice and release any judgments about illegal substances so your patients feel safe talking to you about them. By staying on top of options and the latest information, you can make all the difference!
Always do a psychospiritual assessment
Traumatic crises usually precipitate spiritual crises. The saying, “there are no atheists in foxholes” is not true; sometimes atheists are created in foxholes. Losing faith is one more loss for a patient who may feel like they have nothing solid to hold onto. Therapists can be reluctant to get involved in spiritual discussions and may treat spiritual exploration as an avoidance of resolving trauma. This interpretation is a profound therapeutic error.
Often our clients do not feel like they have a faith to return to, or they are spiritual but not religious, or they are incredibly angry at God, or they are having spiritual non-ordinary experiences that they cannot talk about anywhere else. Truth be told, most trauma survivors have experiences in non-ordinary realities (e.g. out of body experiences) as a matter of course, but they are afraid they will be labeled crazy and do not speak of them.
When they find a therapist who will accept their experience and exploration, whole new vistas of support and hope open up. Ask frankly about your clients’ spiritual history. Remember that in many cultures there is no divide between spiritual life and daily life, so this assessment reflects mindfulness of diversity. Verse yourself in multiple cultures’ spiritual practices and traditions and encourage your patient to explore them, if they are willing. Even one profound spiritual experience can be a powerful antidote to years of PTSD.