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Jun 22 2015

Healing from Trauma and PTSD – Nine Reasons NOT to Talk About “What Happened”

Heaing from Trauma and PTSD - Nine Reasons Not To Talk About What HappenedI believe that the telling of one’s story of trauma can be a sacred and therapeutic act.

But the story might need to remain untold for years.

And, when it’s finally time to tell it, it might need to be told in a specific way and a specific context for the full therapeutic value to be experienced and for the sacredness to be protected.

Rule. When I began Somatic Experiencing therapy in 2010, I made an agreement with myself to not even think about the traumatic events (that happened in 07 and 08) until some very far distant future time in which I was stable and strong enough that doing so would actually be therapeutic. This rule I set for myself has truly been therapeutic for me, and remains in place today in the year 2015. (This rule was inspired by all I learned from my first SE therapist in California about the wisdom of not thinking or talking about traumatic events.)

Attempts. Recently I began worrying a lot about my blog, thinking that I should attempt to tell my story, to explain everything that happened to me, because I want to “legitimize” my writing. I also wanted to give a factual, scientifically measurable basis for my diagnosis in the name of science itself (I love science, so much so that I wanted to override my instincts to relate my story). I also felt like it would be nice to give a human, somewhat relatable story to PTSD. So I began attempting to write My Story (yes I was totally violating my Rule to do so).

Four essays came out of this attempt, but in not one of them did I actually tell my story. Instead, I ended up exploring all the reasons why I should not tell it. And in fact, why I could not tell it.

The day before yesterday I brought this topic up in therapy, and my therapist gave me even more reasons not to tell my story.

I began to realize that this is more serious than I thought. That trying to tell my story could not only be truly impossible to do but it could be psychologically damaging to attempt it right now. I realized that my Rule really was created for an intelligent purpose, and SE therapists have good reasons behind why they always help me know it’s OK not to bring “it” up when it’s clear I won’t be able to handle doing so yet.

Ancient City. You see, even the thought of telling my story sends me into complete terror. Why is this? Think of it like… like a city. An ancient city. Pretend a very bad monster lives in the middle of the city. On the very outside of the city is a moat. Then there is a very tall wall. Then there is an “Outer City” area and another, shorter wall. Then there is the “Inner City.” Then there is the “City Center,” with its own wall. Inside that is a Castle, with thick wooden doors locked shut. Inside the Castle is a Room. That is where My Story is. The monster.

PTSD memories are like a monster in a city

PTSD memories are like a monster in a city

My brain created this City for me, to help protect me. My brain was very wise when it built this city. It knew that if I just walked up to My Story, I might die. So it built all these beautiful walls to help me continue to live, to breathe in and out, to calm down and look around to see the world, to take some steps in the direction of my recovery and wholeness. Strangely enough, my brain is guarding that city so well that it won’t even let me know what is actually in there.

When I say to myself, “I think I should tell my story,” I’m basically saying, “I think I’ll just walk RIGHT INTO THE CENTER of the city, without any protection from the monster.”

That is lunacy. Somatic Experiencing therapists (I’ve been to two of them) have been trained in “titration.” “Titration” is a term from chemistry. The technical definition is:

“The process, operation, or method of determining the concentration of a substance in solution by adding to it a standard reagent of known concentration in carefully measured amounts until a reaction of definite and known proportion is completed, usually as shown by a color change or by electrical measurement, and then calculating the unknown concentration.” (source)

If you “titrate,” you have a flask of one substance, and you drip another substance into it. At a certain point there will be a reaction. Because you were going so slowly, and measuring everything so carefully, you gain an understanding of a property of the chemical (the concentration of something within it) that you would not have gained by just dumping one chemical into the other willy nilly.

titration: take it one drop at a time

Somatic Experiencing therapy talks about “titration” as an important concept for healing from trauma

The idea behind this, when it comes to human psychology, is to carefully introduce something, in this case the memory of trauma, in tiny drips, monitoring the reaction that this produces at every drip. In terms of the ancient city analogy, titration basically means you walk across the drawbridge over the moat and stand by the outer wall of the city. You are experiencing only the quantity of one “drip” of the entire city – so, you are experiencing what it feels like to touch the palm of your hand  to the wall for 5 seconds perhaps, or what it feels like to pick up and hold one pebble sitting next to the wall. You sense your Felt Sense – which is a way to comprehensively monitor your reactions. You do some different therapeutic exercises like Pendulation and various other exercises those SE therapists have up their sleeves. You work on finding a way to regulate your nervous system and reach a state of “calm alert” (the healthy, natural state the body is in when not in a trauma reaction). Then, you’ve monitored the reaction, you understand the “substance” much better and  you STEP BACK ACROSS THE DRAWBRIDGE to safety. You don’t storm headlong into the very center which would be like dumping the trauma memory all over yourself. If you did that you wouldn’t accomplish much besides maybe going into shock and having your beaker explode.

By the “beaker exploding” I mean that this fast approach could cause you to become dysregulated, incoherent, chaotic, dissociative and cause things like mental splitting and other reactions. It could cause weeks of nightmares and “mental flashing” which is something that has happened to me in which it seems lights are flashing in my brain as the circuitry attempts to deal with something it can’t. It can cause a huge mental and emotional meltdown. It’s more humane to respect your body’s natural way of defending itself, and work WITH your body around healing this monster and the city that’s been built around it. Titration is slow as heck, but it works without any experiences of re-traumatization.

Nine Reasons NOT To Talk about “What Happened” when Healing from Trauma

  1. Re-traumatization by Going Too Fast. Having things happen too fast is a characteristic of trauma itself. Pushing yourself to tell your story, overriding any part of yourself that feels unsure or unready, constitutes another trauma because it’s just another case of too much too soon.
  2. Re-traumatization by Breaking the Protective Barriers in the Brain. The brain encapsulates traumatic memories away from us for a very good reason. It’s not healthy to try to just break apart these protective structures. This could cause a lot of problems. If impatient, you could begin making up the story because you don’t understand why you can’t actually remember it. You could numb out so much you can’t speak with any coherency. You could become so disorganized all the pieces of the story come out like shattered glass, all in the wrong order. This could cause you to feel insane and embarrassed, and like a liar. You may not realize the brain has cut you off from the memories for a number of very good reasons and it’s trying to help you heal, not be a source of embarrassment and confusion for you.  It’s much better to honor the brain’s wisdom in putting the walls up. Breaking them is destructive. Healing should be gentle and constructive. There are many ways to heal traumatic memories without breaking anything.
  3. Re-traumatization by Reliving It. Telling could re-traumatize a person by forcing them to relive the trauma. Because of this forced re-living of the horror, just the idea of telling What Happened can be utterly terrifying. It can be totally, completely overwhelming. It’s not going to have any therapeutic value if it’s bringing about utter terror. Reliving past trauma is itself another trauma. If you are pushing yourself through terror, this is not about your own healing anymore, it’s about some part of you that is being forceful and hurtful with yourself, or trying to please another person.
  4. Re-traumatization by Being Too Vulnerable. Telling one’s story could traumatize a person by making them too open and vulnerable than what is healthy. Some trauma victims are used to being too vulnerable and do not know how to protect themselves yet. Even if nobody ends up criticizing what they have to say, just the act of opening up about what happened could constitute a reliving of the experience of being overly vulnerable and too open to being abused. This could re-create the unhealthy pattern of others forcing too much vulnerability on them. It reinforces habits from being abused in the past.
  5. Traumatization by Being Attacked. Telling one’s story can open oneself up to people saying it’s not true, questioning it, criticizing it, picking it apart, trolling, abusing. Having details of your story attacked, your character belittled in some way or being outright not believed, when you are actually telling the truth – these kinds of things constitute an additional set of traumatic events to deal with.
  6. Telling of one’s story could traumatize other people. This is something I had not thought about at all until my therapist pointed it out. If we care not only about our own psychological health and well-being but that of others, we would exercise some caution when putting things into the world that might end up traumatizing other people. I may think carefully about the context I am putting it in and really make sure it’s what people are expecting to read about in that context. Of course, a trigger warning is important to help people understand that it may have difficult content and then they actually take responsibility for reading it. I think it’s very important  and healing to engage in creative or other forms of self-expression around trauma, but it does make sense to at least spend a little time considering the context and the impact a story of trauma could have on others before sharing it and make sure it comes with a warning. If the telling of the story has therapeutic value for others who have been through the same thing, then you can weigh the therapeutic value with the potential traumatic impact and then think about whether the traumatic parts are absolutely necessary in order to achieve the results you want (they could be crucial – every case is a unique case).(Note that this is in reference to the public, friends and family – you don’t need to be cautious when you tell your therapist because they are trained to listen to every detail of whatever you need to express to them and regulate themselves if they need to.)
  7. If you were not believed in the past, you could also be terrified due to the trauma of not being believed. If your story is quite unusual, or if you were (for all reasons listed so far) unable to make it make any sense to others, you may have experienced the very real trauma of not being believed. Perhaps you revealed something to someone you thought you could trust and that someone broke your trust. Not being believed is an additional trauma. It would make sense to focus some time on healing the emotions related to this trauma of not being believed before you get into the trauma story itself because whenever you think about telling your story, this additional trauma will rear it’s ugly head and stand in your way.
  8. If your trauma involves something socially negated, a social stigma, your risk is higher. If your story involves something taboo, not socially acceptable, something people don’t generally understand or condone, something generally rejected or ridiculed, this can make it take longer to feel safe and find a safe person to talk to. You actually do have a higher risk of being condemned or misunderstood in this case.
  9. If your story is incredibly long, spanning many years, you may be unable to tell it. In my case my story is very long. Having a very long story is another reason it can be hard to tell one’s story because it’s technically a book (or several). It’s not “a trauma” but a giant landscape of thousands of traumas. I know I’m telling a bit of my story here – but it feels relatively safe to me since I’m leaving out any details so there is nothing gory or graphic; rather it is a brief, surface, intellectual telling which focuses primarily on the math. I have to make peace with the fact that I won’t be understood from this brief telling. But I do want to explain how the length of a trauma story can make it almost impossible to tell. Anyway, in my case, my body was being destroyed for approximately two months (one in 07 and one in 08). The body has hundreds of systems, each system has hundreds of components that can be broken and fail. During the first one and a half years or so, every hour of every day was different. One 24 hour period could take up to 20 pages to describe accurately in terms of both the complexities of what happened physiologically and the psychological impact. I was rehabilitating for 3 years (technically I still am but systems are stabilized now). Say it takes an average of 5 pages to describe each day, over 3 years – that comes to 5,475 pages to give an accurate description of what happened – and this is only for the two medical accidents/injuries/incidents. Then if you add on top of that 18 years of childhood trauma issues, and sexual/relationship related trauma, it’s like – a very long document. 10,000 pages? What is that – like 5 books?
    I can imagine this is the case for many people whose trauma spans months or years. How can you explain all of that accurately and truthfully when it covers so much time? How can you make sure that your truth will be heard, when, in order for your truth to be heard, you would need 10,000 pages because with any fewer pages you would be leaving out something that you feel would be crucial to make sure you won’t be misunderstood? So there is this problem — my story requires 10,000 pages for me to tell it right, but I’m trying to tell it in a few paragraphs? Or in one hour? This will not work out at all. There is an inner knowing that – I WILL not be understood because I CANNOT tell this story entirely within the space and time allotted, and this adds another level of terror – the terror of not being understood. The terror related to forcing yourself to enter into a situation in which you know people will not be able to understand you. Then on top if it there are all the other problems, such as the brain trying to stop you from remembering things. With all this, getting the story communicated clearly will be pretty much impossible.

So if the telling of one’s story can be a sacred, healing, therapeutic act, but there are so many reasons not to tell it – what do we do? Well, from my perspective at this time I see two roads. The first is to slowly become stronger and talk about tiny pieces of what happened in a therapeutic context. (I focus on SE therapy because that’s what I know, but there are probably additional therapeutic modalities that I am not familiar with that have ways of ensuring safety and integration while leading a person back to the traumatic events). The second way is to engage in some kind of creative expression in relation to small parts of the traumas, when ready.

Inner Resources. In terms of getting stronger, we can focus on building ourselves up so that we have so many inner resources we can handle more and more pieces of the story. We need to build the felt sense of what “safe” is, within our bodies, and never allow something to happen that violates that feeling – even if it’s with a therapist. We need to build up inside ourselves a bodily experience of “titration” and never ever violate that again by running headlong into something “too much, too fast, too soon.” We need to allow the brain to find it’s natural states of organization, almost a re-forming of the brain from scratch, through making the sincere effort to frequently self-regulate. After all this we can begin taking little bites out of our trauma story. Over many years perhaps, all the tiny bites eventually end up impacting the whole cake.

Somatic Experiencing therapy is one kind of therapy we can do to build all these internal strengths. Somatic Experiencing avoids creating scenarios that either bring about too much shutting down or too much activation.

Many therapists ask for your story without being aware of the consequences. I went to regular therapists who did “intakes” in which they had me go into the center of all my traumas within the course of an hour. This is really terrible! It felt like getting scalded by boiling water over and over again until falling apart completely.

Somatic Experiencing therapists do NOT ever ask for your story. They get a brief idea of what happened and then they stop you from messing yourself up by telling it because you might be thinking, “That’s what I’m supposed to do in therapy, right?”

Telling the story in SE therapy might only happen after many years have passed because of how long it takes to approach each of the walls of the city and make sure you integrate them and reach calm alert at each wall. If the telling of your story makes you accidentally go through a wall forcefully and get dysregulated this actually reverts your progress from a therapeutic standpoint because you did not spend any time getting to calm alert. After processing and integrating and reaching calm alert, one naturally feels aliveness and calm in relationship to resolving that piece of the story/part of the wall. The life force that was held behind that wall is restored into the present time. As the wall naturally loosens up and falls away in that spot, the numbing effect of self-repression is reduced. It’s a delicate process. Over time, the story becomes less activating, and eventually the entire story can be expressed. But there is no hurry. If you die with your story inside you, that’s your business. It’s OK to never be ready.

Eight Criteria For Telling Your Story

  1. Be Ready. Make sure you feel certain this is the right time in your recovery to do this.
  2. Be Resourced. Be at a place where you have learned some skills to handle getting triggered, or be with a therapist who can lead you through finding your inner resources.
  3. Have absolute, embodied certainty of safety. Decide on what is a safe context to do this. Make sure you feel internally safe in the chosen context. Make sure you have already built inside yourself, in your body, a way to monitor and defend your own safety. Have the ability to speak with any and all parts of yourself that do not feel safe first in order to help them feel safe, and only then proceed. Have the ability to stop everything the minute you sense you feel unsafe.
  4. Make sure you are focused on your own needs. If the context is safe enough, you can be self-centered and listen to what exactly it is YOU need out of this. If something is repressed within your system (energy, emotion, action, vocalization), you should have the safety and freedom to express it. Make sure you are not doing this for anyone else. Nobody needs to know your story for any reason. (Of course this is different if you are involved in legal proceedings which is a whole different topic on how to tell your story when you’re being forced to.)
  5. Totally understand the experience of titration inside your body. Make sure you have had the internal experience of titration enough to know when you have gone too far. Figure out how to tell if this activity of telling your story will help integration of the past event, and make certain that is what you are doing – integrating. Know how to avoid getting triggered or getting caught up in the drama for drama’s sake.
  6. Trust your body. Work with your body. The idea of slow integration respects the integrity of the way the body has decided to store the traumatic memories and respects the body’s reasons for doing so. The idea is to trust the body and brain to be on your side. There is no reason to “bio-hack” one’s own physiology. There is no hurry.
  7. Have an “OK” level of brain organization. Make sure your brain has reached a level of organization so that it won’t just go into chaos and dissociate if you talk about what happened. You will know this because it’s like you aren’t drowning anymore when you reach this level of organization. Instead you are able to think clearly and rationally. There is a distinct shift. But because for many years you can go up and down, just make sure you have shifted into mental organization and use of the higher, rational mind for most of the time for at least a six month period, I would say. (I’m not there yet, I go up one week and down the next, but SE therapy is helping)
  8. Find your creativity. And – If you aren’t mentally organized enough yet to literally talk to someone about your trauma story, Creative Expression, such as journaling, creative writing, poetry, music, film making, art and dance (done in a safe environment or context, one that you truly feel OK with) also makes it safe to tell your story (and is incredibly therapeutic) and I will explore that in another post.

I’ve found a couple therapies that are healing for me: Somatic Experiencing and cognitive therapy (REBT /SMART Recovery) really work for me. Creativity is also good for me. I know that if I just focus on those therapies and get stronger, one day I might feel truly, internally, in my body, ready to tell a small part of my story to my therapist. On that day it will be the perfect timing for my system. It won’t re-traumatize me because by then I will have enough resources in place to know how to approach it. It won’t be premature, because I’m not doing it for anyone but myself and I’m listening to what my system is asking for. Eventually, the entire story can be told if the body wants it to be. In my case, right now I am not ready because I am way too disorganized still mentally to handle it. But maybe next therapy session, or the one after that, a part of it will be ready to come out. And I will sense into it. And I will know that now, I am, body and mind, ready to talk about that little piece.

And I am happy to say my Rule is now re-instated. I am again not allowed to even think about the traumatic events until some far distant future time when I’m ready. But I am allowed to create art, poetry, and creative writing to my heart’s content.

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There is an article in the New York Times – After PTSD, More Trauma – in which the author, David J. Morris, describes how “talking about it” during prolonged exposure therapy didn’t work for him very well. I appreciate anyone with the courage to stand up against the current paradigm and just tell their truth about their personal experience with a treatment modality, like Mr. Morris did.

I also found a great blog post (copied below) by a veteran named Elijah that is like a mirror of my own experience with therapies that ask you to “talk about it.”

You can tell that, like me, this veteran probably does not have enough mental organization to handle talking about the traumas yet. But, also like me, he does well with creativity. I tend to draw and create poems and he does creative writing. But for both of us, our brains go to hell if we are forced to try to talk about the traumas in front of others.

Traditional talk therapies, EMDR therapy and Rapid Resolution Therapy were all negative experiences for me.  I know they work for many people but for me, at that specific point in my recovery and with the particular therapists I saw, they sent me into dissociation, chaos and dysregulation for days. After failed attempts at these therapies, I was self-destructing in 2010 but luckily found Somatic Experiencing when I did which turned me around. Unfortunately I moved away from CA after only 1 year of SE therapy so again in 2014 things were bad, I wasn’t getting anywhere with talk therapy, and I started SE again and things started to turn around for the better a second time.

I am working on an article that explores my negative experiences with talk therapy, EMDR and RRT. Note that I believe these are good, beneficial therapies full of wonderful healing mechanisms and tools but something simply went wrong in my case.  I had a wonderful experience with EMDR in 1996, many years before I had PTSD. Because of this I am considering various characteristics of myself as a client and characteristics of the therapist as causing the negative experience at the more recent sessions.

It is possible that people who have very acute PTSD symptoms will, for a period of time, not react well to any therapy that revisits the traumas and it could have to do with the level of organization of the brain prior to beginning treatment (and tendency to be dissociative). In a few years, those same therapies might be very beneficial for me because my brain will be more organized and have crossed some kind of percent-of-brain-that-is-organized threshold. The threshold would mean that enough of my brain is organized and because of that fact, rather than become dissociated my brain would organize the opened up memory in a superior way than it was organized before and I would experience a more regulated nervous system and relief from symptoms, just like I did when I went to the EMDR therapist I saw back in 1996.

Also, any modality can have inexperienced or incompetent therapists who have simply not yet learned the proper timing to guide a person through the technique in a safe way, and therefore the negative experience could be due to the level of expertise of the therapist and not the modality per se. As a therapist becomes more experienced and pulls more skills into their own toolkit, the likelihood of re-traumatization by simply following a technique diminishes.

These modalities could possibly use more ways to assure safety, however, by assessing the client’s state more thoroughly and having ways to make sure that even newer therapists do not go too quickly.

OK back to Elijah. Another thing I have in common with Elijah is I also feel like I am totally removed from life, like the fabric of life was destroyed. I have a profound sense of not belonging, of not being in time and space in the same way as before. Like, as he says, a “cog that slipped out of place.” A cog that is just floating around without a machine to be a working part of, without a floor or ceiling, with nothing. Nothing except creativity, I guess.

I really appreciate his writing this so I’m going to share it here:

Therapy: Doesn’t always work

from the blog Living with PTSD

by Elijah Pepper

“This is a subject that to this day remains in limbo. There are more than 600,000 veterans with PTSD, you are not alone in this fight.

“600,000 is a big number. It is a big enough population of people for me to safely say this: Therapy does not work on all of them. Myself included, for me the only this scarier than having PTSD, is talking about it.

“Since I got back, everyone always says, “You should get some help”, or “You should see someone about that”, and inside I am screaming like a small frightened child. My inability to talk about PTSD is so great, I can’t even read my blog posts out loud. What people don’t realize is PTSD is manifested and made real when you talk about it. Some, yes some, people can go to therapy and support groups and find all the help they need. But those of us that can’t talk about, we need a way of connecting with others to know that we aren’t alone, that we are just one more person dealing with things that make us human.

“This blog is my way of doing that. My friends who served with me, read this blog, and we talk about it. They are all the same, we are all the same. Lost, confused, feeling like monsters where a man once stood. We all feel like the world moved on without us like we were a cog that slipped out of place, and the world just ticked on by.

“Therapy does not help all of us, it helps some, but others are left to fend for themselves in a world we no longer fit in, in a world we no long feel part of. For those of us that feel like this, therapy is a 6 letter word for hell on earth. Just the IDEA alone, of walking into a support group, with men and women with missing arms and legs, you know the real super soldiers who gave more than anyone alive. And sitting there talking to them. that frightens me to the core. Not because I feel I will be judged, they did way more than I ever have, but because I will be trapped in a room, forced to relive all those things I fight on a daily basis, in an unknown location, with people I don’t know and don’t trust.

“At least when I am home, I am in a safe place, a place I made safe. Full of people I could and can trust, to a degree.

“My words can be a poison on my mind, but when written down they become like an I.V. bag slowly dripping the cure into my lifeless heart reactivating the person I hope I am. Someday when I reach the end of this journey I hope to find out who I am really am, when I am not fighting this demon 24/7.”

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Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.

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Note that this article is reflects my own opinions based on my experiences recovering from PTSD.