Tag Archives: EMDR

My First Podcast 2 of 2

Part 2 “How to Heal” of my 11-6-15 podcast with therapist Jeff Friedman:

Allan Schore 2What books and resources would you recommend for trauma?
I really recommend Dr. Allan Schore’s Sept 2014 Oslo speech video “The Most Important Years;” on my Resources tab, see the subtab on Audios & Videos.  Dr. Schore (left) explains that babies are born screaming in pain because we’re designed for an adult’s emotional brain to show us “Someone cares, I can relax.”  Mom’s love actually creates the neural networks in a baby’s brain needed to calm down, Schore wrote in the’ 90s. Now, in the last 5 years, brain scans have proven him correct. But with infant developmental trauma and attachment disorder, no adult showed us how to calm, so we never did. Infant emotions are still crying painfully deep inside us, says Schore. We’re unaware of it, but that is the cause of our anxiety, fear, anger, and misery.

Several healing tools are really helping me now. Links to all these below are on my Resources tab, sub-tab Healing Tools.  I’m sorry to keep mentioning my website but I was forced to build it when I couldn’t find all this centralized anywhere else. My home page has almost 40,000 hits; my book tab over 12,000 hits and there are 4 more tabs. It gets hits because there’s a large amount of content on my pages.  Here are the healing tools:

Neurofeedback is a computer program therapists use to train clients to calm brain waves. We with early neglect and abuse have disorganized brains and fear circuits dominate.  Neurofeedback can calm this by growing new neural networks, the way a mother grows a baby’s neural networks. I was moved to tears by Sebern Fisher’s recent interview “Neurofeedback in the Treatment of Developmental Trauma” on ShrinkRap radio, as she described how necessary love and attachment are to the creation of a human brain.

EMDR can resolve trauma using bilateral eye motion, bilateral sounds, or even tapping on either foot. When a therapist moves a finger from side to side before the patient’s eyes, it guides the eyes to move naturally as in rapid eye dreaming. That’s where we process most trauma. That means, we move traumatic memories out of short-term memory banks where it feels like a terrifying flash happening “right now,” into long-term memory banks where we feel it’s past, and we’re “over it.

Tapping: For years I’ve used tapping, aka Emotional Freedom Technique (EFT). We use fingertips to tap a few times on 9 of the body’s acupuncture points. It’s a fantastic aid in calming down, or even just getting to sleep at 2 am.  I used it again just this morning to release a pile of anger.

Meditation: Meditation is where we ultimately need to go to fully heal, but it can be terrifying for us with infant trauma. To get started, we can work with our therapist on it, and meditate in groups. Please check Dr. Tara Brach’s “Basic Elements of Meditation Practice” videos on youtube; it’s also on my Resources tab, sub tab Audio & Video.

Books:  on my Resources tab, look for the subtab on Books:
–“The Grief Recovery Handbook”  by John James & Russell Friedman
–“A General Theory of Love”,  Thomas Lewis, Richard Lannon et al; 2000.
–“Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” Peter A Levine
–“Changes that Heal,” Dr. Henry Cloud
–“The Body Keeps the Score” Dr. Bessel van der Kolk, MD

Didn’t you say recently that there’s a lot of trauma in high places?
Yes, in part because emotional abuse is really hard to spot.  Emotional abuse alone can be just as damaging as overt abuse, but I didn’t know I had trauma the whole time I was a high-functioning business gal with a math degree, working with rocket scientists.  When I found out I had trauma, I used to say, “Nobody beat me or raped me.  What’s wrong with me!?”

What’s wrong was, I had a huge left thinking brain, but an infant’s right emotional brain that took a lot of damage.  As Allan Schore says, when the mom doesn’t grow the infant’s right brain, the child’s left brain often over-develops in an effort to control the emotional chaos.  My mom didn’t hold me as an infant or show me “it’s safe out here so you can stop crying,” to grow my right brain. So it remained an infant right brain.  Instead, I learned that “it’s dangerous as heck out here, the world is scary.”  I probably didn’t stop crying until my left brain grew myelin and began to think at 2 1/2 and I realized, cognitively, that if I didn’t shut up, they’d swat me.

I’ve been told: “Most people with what you have take it to the grave because they’re so intelligent, no one imagines anything’s wrong.”  One thing motivating me to finish this book is: I’m betting that 20 to 40% of smart people in high places have infant or child trauma hiding inside where no one can tell, just as I did. Maybe my book can help them wake up.

That’s why our corporations, governments and so forth make a lot of un-compassionate decisions.  No one showed them how to do compassion as kids.  That’s why wee spend over $80 billion a year to drug school kids into being quiet, but there’s no funding for serious therapy for children.

Maybe my book will help people see reality. Allan Schore said in his Oslo video that UNICEF put out a report in 2013 saying society needs a massive shift of resources toward making sure at least the child, from conception to age 3 at least, and families with young children, get major public support to try to stop child trauma at the source.  $80 billion would sure help.

Any closing thoughts?
Sebern Fisher hit it on the nose: the real answer to trauma is love.  Babies need our mothers to love us, to even just have the brain cells for emotional well-being. “We need to know that the Big Person who’s taking care of us, loves us,” says Dr. Henry Cloud, and then gradually a baby learns to grow “love inside” he says.

Or Not.  What if I didn’t get love as an infant?   Then emotional chunks of me are an infant’s emotions, and I need to find out about that.  Then I need to go where I can get that part of me loved!  Not to new parents, but I do need to feel the kind of love a good parent gives. And not to romance; we don’t want an infant or toddler on Match.com.  Instead, I need to learn that I can receive platonic love from a really fine therapist, and that I can love them back.  I need to learn that I can do deep platonic love with my Grief Partners and platonic friends at church or in small groups or yoga or meditation groups. I need to feel and give unconditional platonic love.

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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Comments are encouraged with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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My First Podcast, 1 of 2

Jeff Friedman 2I’m excited to have just done my first interview on attachment trauma with therapist Jeffrey M. Friedman, LCSW of Aventura, Florida (north of Miami).  Jeffrey (left) interviewed me  November 6  for his new “Trauma-Informed Podcast,” a series on the prevalence of trauma – so we can stop passing it on from generation to generation. Click here to listen: https://soundcloud.com/east-coast-trauma-project/kathy-new-edits?utm_source=soundcloud&utm_campaign=share&utm_medium=facebook

Kathy on Friedman Podcast 11-6-15The interview summarizes my work: my trauma history, what I’ve done to heal with good therapy, and my sorry adventures into what does not work, such as sub-par therapy. We noted the prevalence of child trauma, how it’s likely affecting a high percent of government and corporate leaders, and the need to educate and help them. Here are interview excerpts:

What is a quote that inspires you that is related to trauma?
“Too many Americans are spurred to achieve, rather than to attach,” says A General Theory of Love; that’s at the core of  our society’s illness.  We’re rushed to compete and get the grade from age 5 or even Baby Einstein age, but there’s little talk of how to learn to attach compassionately to other human beings.  But we are mammals, and we literally need attachment to other mammals, physiologically as well as emotionally, just to live. The book, which is by three psychiatrist MDs, demonstrates that unless we reverse this priority, our society can only get sicker.

Where are you from and what type of work are you doing?
I’m from the New York City area, then lived 20 years in the Washington DC area. Now I live in Orange County, Southern California.  I run a website with resources on attachment disorder, AttachmentDisorderHealing.com , and I’m writing a book about how I only discovered my severe attachment trauma after I hit age 50, and how I’m healing.

What is your story of trauma and recovery?
I was  a high-performer who’d barely even heard of trauma. Suddenly I was divorced from a 27-year marriage, bankrupt, and homeless. “I married a bad man, now I’ll find a good man,” I thought. But I only found more abusive men, and it hit me: the common denominator is me!  Something’s wrong with me. Then both my parents died in 2008, but when my Dad died, I couldn’t cry. “Wow, I’m really sick,” I said, and took myself to therapy.  But I found 3 poor therapists who made me sicker, almost to the point of suicide.  So in 2009 I quit therapy.  What does not work is bad therapy.

Then I got something which does work, the Grief Recovery Handbook, which instructs us how to read letters to a Grief Partner about what’s hurting us emotionally. I wanted to heal from my marriage so I could date, so I read letters about my 27-year marriage to my partners for two years. But I didn’t feel better; I only found more pain. Reading about my marriage regressed me back to about when I met my ex at 18, but still more pain. Then I read letters about my Dad that regressed me back to age 5.

I removed 40 years of denial like rocks off my soul by releasing the anger and sorrow.  But I didn’t have anything under the denial; the further back I went, I just found more pain. Then I read letters to my Mom that regressed me back to infancy.  It’s all on AttachmentDisorderHealing on the New Book tab, in my Preface: “The Silent Epidemic.”

 What have you done that helped with trauma and what did not work?
I discovered I was maybe 2 weeks old inside. It was so terrifying that this time I did a huge amount of research, found a really good attachment therapist and went back to therapy in 2011. Thus my book title: “Don’t Try This at Home.”  Don’t go it alone. What works is:  1. Do get a qualified attachment therapist but you must do serious research to find a good one.  2. The Grief Recovery Handbook works to get rid of denial,  but with severe infant trauma, don’t do it unsupervised! That was my error.   3. Then what actually healed my trauma was Body Work; Dr. Peter A. Levine’s Somatic Experiencing method helped me enormously. For Body Work, go to AttachmentDisorderHealing; fifth tab from left Featured Topics.  Subtab item #4 is Grief Handbook, then subtab item #5 is Healing: Body Work, with links to videos and books.

What advice would you give to those dealing with their own trauma?
I can only tell you what I learned: Don’t, don’t, don’t try this at home; I’ve put my last nickel into a good attachment therapist. Second, later I discovered the Adult Attachment Interview (AAI) and I wish I’d had that at the outset, to find out scientifically how bad and what type my trauma is.  On AttachmentDisorderHealing see the 4th tab Blogs for my blog on the AAI.   Third, I worked the Grief Recovery Handbook (GRH) with a partner but I wish I’d kept a therapist thoroughly informed, it was dangerous not to. GRH can get rid of denial barriers so we can benefit from the next deeper steps. Fourth and most important is: Body Work.

Not reading books about Body Work – doing body work.  Reading a book about singing is different from physically singing; reading a book about sex is, well, you know…. We need to do Body Work, not hide in books.

But remember: Body Work won’t get through to us unless we do the other  steps first, especially if we have 20 or 40 years of denial to bust through.

Why can’t some Moms help their babies calm down?
Sadly, because Mom’s mom didn’t show her how, and grandma’s mom didn’t show her how; in my family I’ve traced it back to the 1800s and that happens a lot: inter-generational trauma.  That’s why I’m not satisfied with programs for child trauma alone.  We need those but we need more.

Fifty percent of parents out there themselves experienced some degree of childhood trauma, as the ACE Study shows.  So it’s baked into their brain cells to pass it on and traumatize their children, mildly or wildly.  Unless we have mass-based trauma healing programs for at least child-bearing aged adults, we can’t stop the cycle.

You can’t just hand a young couple a book and tell them carry the baby in front.  If they’re deeply wounded, they don’t have the biological capacity to attune to another human being, and they need to learn that, which means serious psychological work.  Otherwise they’re going to hurt babies and others until they get real emotional  healing.

More excerpts next time…

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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How EMDR Helped My Early Trauma

Guest Blog by Amelia
[Amelia is the pen name of an EMDR therapy client of Dr. Sandra Paulsen, pioneer of new EMDR protocols for developmental trauma/early trauma (ET). [FN] Amelia is now with Paulsen colleague D. Michael Coy, MA, LCSW.  She graciously provided this blog to inspire others to seek healing. –kb]

Sandra Paulsen BookIn 2013 I began working with Sandra Paulsen, PhD. I am very grateful for the early childhood trauma (ET) work we did.   It was a stunning process that gave me understanding and resolution of significant traumas.  I learned to understand “ego states” and gained a view of the numerous parts of me that acted as protectors throughout my life.   The use of “the conference room” was difficult and surprising at first, but with Dr. Paulsen’s encouragement and compassion for “the little one” inside me, it quickly became easier for me to imagine a conference room in which I could see “parts of my self” sitting around a table.

We worked intensively in long sessions often using EMDR therapy.   The tappers were scary sometimes, but became easier for me to tolerate; they create a mild, alternating bilateral vibration and can be held.  [EMDR therapy for ET may tap on alternate feet or other areas away from the face, rather than moving a finger before the eyes as in Francine Shapiro’s original EMDR therapy. -kb]

Initially, I learned to ground myself in the present where I felt safe.   Within a short time, I was able recognize parts of self in the conference room, an imaginal place in my mind’s eye where different aspects, or parts, of myself could come to help us understand and access trauma memories.   The process revealed difficult memories that enabled me to understand “the why” of my lifelong struggle with confusing fear, along with the “why” I felt a need to isolate myself from family and friends.

At the end of each session. the content of our work was consciously set aside in an imaginal “vault” in the conference room until next time.  I envisioned my memories and feelings floating down a stream into a large container that held them tightly (the vault).  After most sessions, despite my recall of terrifying memories, anger, and tears, I felt relief.  Thinking of those sessions now, I’m amazed by the sense of safety I felt with Dr. Paulsen.

Developing Confidence, Deep Body Memories

Paulsen Sandra PhotoI developed confidence in the process and believed that one day my “whole self” would be healed.  I realized too that I was becoming valuable to myself for the first time. [Sandra Paulsen, right]

I remembered more than I could have imagined.  Often my body felt memories first.  These somatic memories led me through a long trail of abuse and abandonment by family members.  Remembering specific parts of the abuse was a surprise at times.  I attribute the lack of memory to my amnesia barrier and am grateful that my brain was able to develop the barrier.  I sometimes recall those surprising memories and marvel at the function of our brains.

I’m also grateful that Dr. Paulsen took time to help me build boundaries that I could use then and later to further process my memories.  My new boundaries were a great help in painful relationships, which could have destroyed my fragile but growing sense of self.

When visualizing my childhood “parts of self” with Dr. Paulsen, I began to appreciate each part and welcomed the knowledge we recovered together.  My parts worked together to accept the reality I could not manage to be aware of in childhood.  I love knowing that my unconscious mind protected the conscious me and built a complex support system.  My understanding and knowledge of my parts is pivotal to release, resolution and healing of my fragmented self.

I am learning to accept all of me rather than just “the parts” my family wanted.  The good and bad parts held me together in the midst of chaos.  I’ve decided the difference between some of the “good and bad” parts of self were those behaviors or beliefs that were acceptable or not.

My experience taught me that I was never safe in my family because attitudes could change in a moment.  I lived in fear of the unexpected changes and surprise attacks.  Sometimes it’s difficult to like certain parts because I viewed them as causing the pain of disapproval and abandonment.  In reality, my unacceptable parts were protecting me.

After working with Dr. Paulsen, I understand the functions each had in helping me stay alive.  For instance, I have a split sense of God.  I’ve hated the bad God part (judgment) and love the good God part (compassion).  I understand now that  “bad God” part protected me from my family because “bad God” taught me to act the “right” way.  To understand it now is valuable, but the judgment led to self-loathing.  It’s amazing that hating myself made me safer within my family.  All I could expect was abandonment and a family that used me rather than caring for me.

My feelings about my family are still confusing, but I’m learning to view them from a distance.  My mother and father are not bad.  There were reasons for their behavior.  I am aware that I see them as the bad parts who inflicted pain.  I expect that resolution can be reached in time.

I developed the ability to talk with my parts.  We have safe spaces to talk, reflect and empathize with ourselves.  I’ve found this essential.  The spaces are in nature…a forest, the beach or a quiet space for meditation.   Walking in a peaceful place is important to clearly see our existence together and care about our efforts toward wellness.

Anger, Move to Chicago

D. Michael CoyOn the opposite side of the peaceful place is the angry place.  It’s very difficult for me to acknowledge anger at others because it is dangerous to do so.  Working with Dr. Paulsen, I could acknowledge the anger.  My acknowledgment of angry feelings was hard because I was not able to express it in childhood or even in adulthood.  For me anger is the most dangerous feeling.  Others could be angry with me, but I could not express anger toward them.  Our work helped release some of my angry feelings, but it’s still difficult to feel safe enough to express angry feelings appropriately.  I recognize the angry parts of self.  I think we’re still waiting to feel safe and valuable enough to own those feelings.  I continue to work in my messy angry part of self.

In April 2014, I met D. Michael Coy, MA, LCSW [above], to whom I was referred by Dr. Paulsen before I returned to live in the Chicago area.   As it was with Dr. Paulsen, our work together has focused on my dissociated “parts of self,” but now using EMDR and other therapies to focus on the later memories of traumatic experience that I continue to struggle to get past.

Looking back over my time since I began working with Dr. Paulsen, then with Michael Coy, I’ve watched myself grow. I care for the many dissociated “parts of self.”  Visualizing my “parts of self,” I understand how each developed and the job each part did to prevent damage throughout my life.   I love knowing that my unconscious mind always protected me.  My understanding and knowledge of my parts is pivotal to release of trauma on every level.  I expect to function in the months ahead as the “whole person” I am.

In summary… there is so much more to know and say about living with (and healing from) complex trauma.  It’s a relief to know that my symptoms are real and not made up.  I cannot express my relief in light of my work in the therapeutic process called the EMDR early trauma approach, which Dr. Paulsen has so skillfully developed further to work with people like me, who struggle with complex traumatic experience.  I can honestly say that I’ve never been more hopeful in my life.

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Kathy’s blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1, “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315
See also especially Dr. Paulsen’s website: http://www.bainbridgepsychology.com/EarlyTraumaOShea.html

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New EMDR Therapy for Developmental Trauma

Paulsen Sandra PhotoGuest blog by Dr. Sandra Paulsen (left) & D. Michael Coy, MA, LCSW

[First I discovered it deep within myself and called it “trauma since the sperm hit the egg.”  Then I read that Bessel van der Kolk calls it “developmental trauma,” in his drive to have it finally recognized by the psychiatric profession. Dr. Allan Schore calls it “trauma in the first 1000 days, conception to age two.”  Earlier it was “complex PTSD” or C-PTSD.  In EMDR therapy, Dr. Sandra Paulsen, therapist Katie O’Shea, LCPC (who began this work), and D. Michael Coy, MA, LCSW, use “Early Trauma” (ET).  The science is in Chaps. 16 & 20 of Paulsen’s 2014 book. [FN1]
[Well: “ET, phone home!” Dr. Paulsen & friends have good news: they’ve created new EMDR therapy
protocols to heal developmental trauma. -kb ]

Eye Movement Desensitization and Reprocessing (EMDR) therapy “enables people to heal from the symptoms and emotional distress that result from disturbing life experiences,” says Dr. Francine Shapiro’s EMDR Institute website. Standard EMDR therapy has been shown to heal traumatic memories with a conscious, visual component, also called “explicit” memory. As EMDR clinicians, we have seen frankly astounding changes in our clients, both in how they see themselves and in how they experience and take initiative in the world.

But with in utero and infant Early Trauma (ET) occurring from conception to age three, also called developmental trauma, there is no conscious, explicit narrative memory — infants have not developed the parts of the brain which can think.  These traumas precede the existence of consciousness, so they’re called pre-conscious or “implicit” memories. Such memories are “somatic,” that is, held purely in the body — so healing is far more challenging.

How can we listen to the unspoken experience when, so early on, there were no words to tell it? How can we help the body tell its silent—or silenced—story?

Limitations of EMDR Therapy Standard Protocols

OShea Katie PhotoSandra Paulsen and colleague Katie O’Shea  (right) observe the limitations of standard EMDR as applied to early trauma, specifically:

1) There is no explicit memory in the first years of life, only implicit memory, so the standard EMDR procedure of targeting a memory of trauma could not apply;
2) If a client were able to access early experience in EMDR therapy, it could easily be overwhelming, without adequate preparation;
3) Early experience, when accessed, also accesses the client’s “felt sense” from that early time, with all the limits of self and inner structure that went along with pre-natal, infant, and early childhood developmental stages; [FN1]
4) Because of the paramount importance of relationship and caregiver attachment in infancy, the processing of early experience via EMDR therapy required modification to ensure the client had the felt sense of the therapist’s compassionate and attentive presence; and,
5) Because very early experience is ephemeral and does not consciously register as pictures or videos (as later memories may), the new EMDR therapy needed to explicitly accommodate the subtlety of infant early processing.

For these reasons a four step protocol was developed, starting with the work of therapist Katie O’Shea, who later brought it to the attention of Sandra Paulsen. They then worked to make these new ideas coherent with the latest neurobiology research by Jack Panksepp, Allan Schore, Daniel J. Siegel, et. al.

Four Steps of the Early Trauma (ET) Approach to EMDR Therapy

Early Trauma reprocessing includes the following steps to provide remedies to the limitations of standard EMDR therapy approaches above.  NB: There is substantially more to the treatment than described in this brief summary.

1) Cultivating structured containment of all experience yet to be “learned from or sorted through,” to leave a clear “emotional desktop” for work to occur;

2) Developing a felt sense of safety as a starting point for the work, which is achieved by tapping into and strengthening a naturally occurring (but sometimes hidden) “safe state” in the body. Both steps 1 and 2 may require client practice outside of therapy sessions;

3) The most mysterious step—resetting the affective circuits—involves clearing the emotional pathways that develop in each of us early on during our development in the womb, but which may be congested from maladaptive early learning and inhibitions about whether emotions are okay and safe. Once the circuits are clear, they can function as they were intended, to conduct emotional information between the brain and the body. This step may work directly on subcortical affective circuits, according to Jaak Panksepp in his groundbreaking book, Affective Neuroscience. For individuals with complex trauma histories and/or emotional dysregulation and imbalance, there may need to be additional preparation, most commonly ego state work; further education about healthy emotion, brain functioning and/or trauma; sometimes somatic work; and,

4) Clearing the early trauma, which happens by processing small time periods, beginning with a time before conception (owing to what is theorized to be generational, cellular memory), then moving on to conception, gestation in the womb, birth, and on through the first few years of life. These time periods are variable with the client, depending how “gnarled” the roots of the tree have become by growing around early obstacles. The clearing may be of somatic/implicit memory or of explicit memory, or mental constructs related to the time periods. For each time period, if it doesn’t resolve spontaneously, there is an imaginal good outcome of “what you needed, the way you needed it to be.”
As noted, there is much more to it, but for many the careful application of these steps produces a critical emotional shift with subsequent increase in emotional stability, comfort, and peaceful relation to one’s emotions and the self.

The Mechanics of the Early Trauma Approach

Sandra Paulsen BookThe experience of the infant is almost entirely a “felt sense,” as there is not much cognition at the beginning. So when therapy taps into those early felt senses, it often occurs without as the access to the more conscious and cognitively informed resources usually available to adults. Because of its central role in early life, this felt sense is an ideal entry point for attending to early, emotionally overwhelming experience so that it can be reprocessed and cleared.

As we are relying upon the most primitive information available to reprocess early experience, the standard EMDR therapy modality of eye movements or taps conducted with equipment may be too scary, too technical, and too alienating for some. Therefore, the reprocessing is facilitated by tapping on the client’s ankles, while the client is sitting back in a comfortable, reclining chair.

Because processing may occur over a period of hours, people often want to take off their shoes. This certainly makes it easier to tap on the ankles, and is mentioned here because people sometimes wish they’d worn different socks!
Early trauma reprocessing is designed to come in from the beginning, ‘under the floor-boards’, so to speak, so it is typically quite gentle and tolerable in comparison to consciously-focused EMDR therapy. Grounding is needed much less than in standard EMDR therapy procedures. People learn a lot about their own story in this lovely and very powerful procedure.

Highly-dissociative people are only appropriate for this method if they have already established considerable groundwork in therapy and there is a self-system to allow the work. The early trauma therapist ideally is experienced in working with dissociative clients and addressing concerns protective parts may have, as this piece is critical to ensuring positive outcomes in early trauma resolution work. If a potential client is dissociative and, after the initial evaluation, the early trauma therapist agrees to work with the client using the EMDR early trauma approach, it is necessary that the client have an ongoing therapeutic relationship to receive them after leaving the intensive work, assuming that the client is not working with the early trauma therapist in an ongoing treatment relationship. When the client has a primary therapist, it is typically necessary for the client to grant written permission for the early trauma therapist to collaborate with the primary therapist before and/or after the early trauma work takes place.

Intensive or Week by Week Treatments?

D. Michael CoyAlthough early trauma reprocessing can occur piecemeal, from week to week, hour by hour, this can be both terribly inefficient and not particularly cost-effective. The ideal way to experience this type of reprocessing is in extended, face-to-face sessions. Because the work is subtle, deep, and more felt than thought about in a conscious way, extended sessions allow the work to unfold viscerally and deeply. It’s akin to being on a commercial flight from Chicago to Minneapolis versus a flight from Chicago to Tokyo: yes, you get somewhere in both cases, but if you’re on the long-haul flight, you’re up in the air longer, you move more quickly, and your fuel efficiency is significantly better.

Notably, the Dr. Paulsen uses the intensive approach exclusively. In some instances where there is an ongoing therapy relationship, and insurance coverage is involved, the early trauma therapist and client may resolve that week-by-week treatment is the only way to go. This is the only option for a number of the clients who see Michael (above left), either because the client is not able to do the intensive work immediately (owing to extended preparation being needed), wishes to use their insurance in order to afford it, or they’d like to do the work in the context of longer-term therapy work.

However, the client should expect that it will take a number of months to complete the process of clearing early trauma. Michael does both intensive and week-to-week early trauma resolution work, as appropriate and necessary. Other therapists experienced in the EMDR early trauma approach likely structure the work in a way that fits the needs of their own practice and clients.

It is not easy to predict whether a client will need one, two, or more days of intensive work to clear the entirety of early disturbances and replace it with a felt sense of well-being. This goal is typically possible, but not necessarily easy to schedule or predict. Most people who have participated in intensives require two to three days, or more, to clear the first few years. The time required is variable, based upon how many traumatic experiences there were, how much neglect there was, and how maladaptive the learning outcomes were from those experiences. (Note that it’s not you as an adult who consciously assesses all of what was traumatic in those early times. Your brain did that for you before you were even consciously aware that any kind of wounding was taking place.)

Is This Treatment Right for You?

As different EMDR early trauma therapists may handle assessment, differently, we will speak here to how we approach it. Diagnostic assessment involves looking with the client at the following factors: 1) the client’s present safety and stability; 2) the client’s capacity for experiencing emotion and body sensation; 3) any internal conflicts that may complicate or block trauma resolution; 3) medical concerns; 4) substance use; 5) any evidence of structural dissociation, which would require additional assessment and preparation prior to embarking on trauma resolution work of any kind.

Biographical assessment is also an important piece of assessment. The biographical assessment covers areas of the client’s history such as work, education, military service, nutrition and self-care, basic family history, spiritual and cultural experience, and so on. Biographical assessment can provide both a helpful ‘fly over’ of the client’s experience, as well as point out the ‘smoke trails’ emanating from the client’s early, unresolved experience.

During and After Early Trauma Intensive/Reprocessing

On the first day of the intensive, the therapist and client ensure that all the necessary preparatory steps have either already been undertaken, or they will begin there in the work together.

It is not unusual for a client to feel ‘drained’ after early trauma reprocessing has taken place. Most people don’t want to do much in the evenings after an intensive session. The work is profound and will take some time set aside for introspection just plain rest.

Self-care is key in this work, so plan on drinking plenty of water, getting plenty of sleep, inviting oneself to dream, eat good food, maybe take some anti-oxidants because the client will be releasing energetic holdings. Fruits and vegetables will be put to good work in reconfiguring a ‘new you’. If the client is traveling from a different time zone, it is recommended that they are taking Melatonin or some other supplement (as approved by their primary care physician, as appropriate) to manage the effects of jet lag.

After the work, the nervous system will be “knitting and purling” for a time, and this is usually gentle and comfortable. Occasionally, if the work was paused in a gnarly hurtful baby spot, the client may feel stuck there. In those instances, the client may need help in person or by phone to move through such a spot.

It is also really important to keep in mind that any unusual experiences during the work or in the time right after the work may be related to the work. One can think of these as ‘vapors leaking up from King Tut’s tomb’. So, for example, if the client’s spouse, partner, or a good friend seems, for whatever reason, suddenly to resemble demon spawn, they are encouraged to consider the possibility that something about the early work has a theme of demon spawn in it somewhere.

Similarly, if it seems to the client that the early trauma therapist is suddenly just like the meanest parent ever, they are encouraged to mention this, because, although it may have a basis in present time (and, for Michael, his dogs might agree, depending on which chew-thing he’s rescued from them that day), we’ll consider that, often those kinds of feelings and perceptions are part of the client’s story, telling itself without words. The therapist and client use
information in the room and about what is happening between them, moment to moment, as clues to that story. Client and therapist become detectives together, hearing the client’s story together, however it seems to want to be heard. The most common unsettling experience after early trauma work is to feel oddly inert or flaccid. This seems to be part of a baby state, as if baby is just sitting, waiting, not mobilized for much action.

Closing Thoughts

We feel honored to do this important early trauma work with their clients. Michael was fortunate to have been trained in the EMDR early trauma approach both by its originator Katie O’Shea and by Sandra Paulsen, PhD, with whom Katie has collaborated to bring it to public consciousness and develop it into a replicable, systematic process for healing early wounding that can be used safely and effectively even in the most complex situations. (Notably, a cartoon book for therapists and clients on the EMDR early trauma is currently in press.)

We consider this work a sacred trust. It is such a privilege to hear the story of the baby within that may never have been told or heard before, except in symptoms or reenactments. The EMDR early trauma therapist’s intention is to help the client review, release and repair very early experience in a way that provides a felt sense of well-being. We encourage our clients to spend a little time before we meet identifying, if they don’t already know, what their highest resource is, and what their relationship is to the spiritual realm. Then we are more able to support the client’s process in a way that makes sense to them, on their own terms. This is the most helpful way we know to repair very early injuries, hurts, betrayals and disappointment.

See also the EMDR therapist finder directory of the EMDR International Association: http://www.emdria.org/search/custom.asp?id=2337

Sandra Paulsen, PhD, is the founder of the Bainbridge Institute for Integrative Psychology and a leading edge practitioner who has integrated her knowledge of Ego State Therapy, somatic therapies, and EMDR therapy to effectively treat clients struggling with complex trauma and dissociation safely and effectively. Dr. Paulsen accept clients for early trauma treatment in the intensive format but only via therapist referrals at this time. See: http://www.bainbridgepsychology.com/ET-Referring-Clinicians.html

D. Michael Coy, LCSW, LICSW, is a Master’s level therapist in independent practice in Chicago, IL, certified in EMDR therapy and also trained in clinical hypnosis, Ego State Therapy, and essential somatic methods for enhancing trauma resolution work. Michael’s primary focus is with clients who struggle with complex PTSD and/or dissociative disorders. Michael is also a clinical associate of the Bainbridge Institute for Integrative Psychology. For more information about Michael, see https://www.dmcoy.com.

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Kathy’s blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1, “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315
See also especially Dr. Paulsen’s website: http://www.bainbridgepsychology.com/EarlyTraumaOShea.html.

FN2  For Eugene Gendlin’s foundational work on the “felt sense,” a term he developed, see Gendlin, Eugene T (1978), Befindlichkeit: Heidegger and the philosophy of psychology. Review of Existential Psychology and Psychiatry 16 (1–3): 43–71. 
Dr. Peter A. Levine uses Gendlin’s “felt sense” work strongly in his “somatic experiencing” trauma healing:  Levine, Peter A., PhD, “Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” ‘Sounds True, Inc.,’ Boulder CO, 2005; ISBN 1-159179-247-9

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What is EMDR – and Why is it So Effective?

Francine ShapiroDuring REM sleep, the brain is attempting to process survival information until it’s resolved.

Eye Motion Desensitization and Reprocessing (EMDR) is a potent trauma treatment developed by Dr. Francine Shapiro (left), a literature professor who was diagnosed with cancer.  The shock of suddenly finding her survival was under threat, affected her so strongly that Dr. Shapiro mindfully paid attention to how her body was reacting.

She discovered by accident that when the survival fear got intense, her eyes would sometimes move back and forth diagonally or from side to side, as if in dreaming – following which she felt less upset, much to her surprise.

So Dr. Shapiro began to study mind-body programs for trauma and PTSD – and went back to school for a PhD in trauma psychology.  EMDR, the treatment she developed,  is now used by the Departments of Defense and Veteran’s Affairs, the World Health Organization, and many others.  Dr. Vincent Felitti, co-director of the Adverse Childhood Experiences (ACE) Study, recommends EMDR as “highly effective” for the healing of trauma.

In EMDR a therapist moves a finger or two from side to side (or diagonally) before the patient’s eyes.  This guides the eyes to move as they do during the Rapid Eye Movement (REM) phase of sleep in which we do most active dreaming. Dreaming can “process” a lot of trauma, move it from short-term memory banks where it feels like a terrifying flash happening “right now,” to long-term memory banks where we feel it’s past and we’re “over it.”

I use EMDR to calm myself at home, sitting with eyes closed and moving my eyes back and forth while focusing on the upsetting thought until it dissipates.  This works with upsetting incidents in the present, such as arguments.  I also use EMDR to heal grief over specific past incidents such as hurtful acts by others. But long-term healing needs a therapist.

It had been thought that EMDR is best for “incident trauma” due to one or any finite number of incidents, such as battlefield traumas, car accidents, rape, threats such as Dr. Shapiro’s cancer, or incidents like mine above.

EMDR  had been considered iffy for developmental trauma which starts with fetal stress and continues while the infant brain is developing. As Dr. Bessel van der Kolk notes, it’s a continuum of panic until we become a “frightened organism.” Drs. Shapiro and van der Kolk have said that in developmental trauma, EMDR may bring up infant feelings so overwhelming as to be re-traumatizing. [FN1]

More recently, however, Dr. Sandra Paulsen and colleague Katie O’Shea  have had success using new EMDR methods they’ve created specifically to address developmental trauma, documented in  “Neurobiology and Treatment of Traumatic Dissociation.” [FN2] Here’s a summary: http://attachmentdisorderhealing.com/emdr-sandra-paulsen-developmental-trauma/

“EMDR is effective and well-supported by research evidence for treating children with symptoms accompanying post-traumatic stress (PTSD), attachment issues, dissociation, and self-regulation,” GoodTherapy.org also recently reported: http://www.goodtherapy.org/blog/emdr-for-children-how-safe-and-effective-is-it-0430155

Dr. Paulsen’s collaborator Dr. D. Michael Coy details how he keeps patients safe while going deep into infancy with EMDR on his website:  https://www.dmcoy.com/main/my_practice/emdr-therapy/emdr-pre-verbal-trauma/.  See also Dr. Coy’s comments below, including a link to the EMDR International Association’s EMDR therapist finder directory: http://www.emdria.org/search/custom.asp?id=2337

I still say, as in my book title, “Don’t Try This at Home.”  Please do not “do it yourself.”  Get a highly-trained attachment therapist and/or EMDR specialist with a lot of specific training in your type of trauma.

When Nightmares are Real

Until you’ve been beside a man/ You don’t know what he wants
You don’t know if he cries at night/ You don’t know if he don’t
When nothin’ comes easy/ Old nightmares are real
Until you’ve been beside a man/ You don’t know how he feels
Bob Seeger

Francine Shapiro Getting_Past_Your_Past_smallDr. Shapiro gave a terrific webinar on EMDR which even explained what nightmares are, how they work in trauma, and how we can leverage this to heal traumatic feelings.  It was Dr. Ruth Buczynski’s April 17, 2013 interview for the National Institute for the Clinical Application of Behavioral Medicine (NICABM) “Trauma 2013” series.  [FN3]  Her book is seen above (please click on the graphic to see it best; my software’s not behaving well…)

“Disrupted REM (Rapid Eye Movement ) sleep is often a marker of PTSD,” Shapiro said. “The earlier memory in PTSD, the trauma, is being held unprocessed with the emotions as physical sensations.  The brain continues to try to process it; sleep researchers say that during REM sleep, the brain is attempting to process survival information until it’s resolved.  That’s why we’ve all had the experience of being disturbed at something, going to sleep, and feeling better about it, with a better understanding of what to do next.

“The brain has done what it’s supposed to do: it’s processed the information, and now it’s guiding us appropriately into the future.  But if a trauma has disrupted that process, although the brain may be again trying to process this (survival information) in dreams, the person continues to wake up in the middle of a nightmare (ie., stop the processing prematurely), because it’s too disturbing.”

“When people are jarred from sleep because of a nightmare, the disturbing images can be difficult to shake,” Dr. Buczynski said on her blog April 12, 2013.  “Even though they’re ‘just dreams,’ nightmares can be very upsetting and can sometimes haunt us long after we’ve awoken. But believe it or not, there may be a good reason for them. Nightmares are part of the brain’s attempt to help us resolve traumatic experiences. But when they wake us up too soon, a key process for healing gets interrupted. So how can we finish what the brain is trying to start?”

“In EMDR,” Dr. Shapiro then explained, “we look for what are the nightmare images that a person can recall. One person would continually wake up from a nightmare of being chased by a monster through a cave.  So (in the EMDR session) we target that dream image, so she’s holding in mind being chased through a cave by the monster.  Then we start the EMDR processing – and it’s like a veil gets peeled back, and the individual sees what the actual experience was, and she reports, ‘OMG, that’s the person who molested me, chasing me through my childhood home!’

“The EMDR processing moves the past memory to resolution, and now the person no longer has that dream, because once it’s processed, it’s integrated with larger memory networks and arrives at adaptive resolution, so that dream image does not come back. So with EMDR you don’t have to try to change their mind about it or talk about it. It’s simply identifying the image and their thoughts that go with it, and then processing it (by EMDR) to complete resolution.”  Check out her video: http://www.nicabm.com/nicabmblog/the-brains-attempt-to-help-us-heal-from-trauma/

Dr. Shapiro reports fantastic results especially with rape victims and war veterans.  “These past traumatic experiences get locked into the brain until they can get processed… We try to process how the earlier traumatic memories created the problem, then we process their current situations that are disturbing, and then what might disturb them in time in future.  If they can’t identify the past memories, we talk about what is currently disturbing them.  That often automatically takes them back to the past experience — and in those instances where it (the past traumatic experience) hasn’t fully be stored (in  long-term memory,) we can see that it shifts (from short-term to long-term memory) and ultimately they’re no longer disturbed…

“My PhD dissertation on rape victims was published in the Journal of Traumatic Stress back when PTSD was viewed as intractable, but I was getting results in a single session,” Shapiro said. “So the controversy was: ‘how could anything be that rapid, and how could eye movements have any effect?’  There were 20 randomized controlled trials introducing EMDR. One done with rape victims was by a very experienced cognitive behavioral researcher viewed as extremely credible; she reported that 90% of the rape victims no longer had PTSD after three EMDR sessions.

“That corresponded to another study at the time published in the Journal of Clinical Psychology which showed the same with a mixed trauma group, that after three EMDR sessions, 84% no longer had PTSD.  We’ve continued to see that… a rule of thumb is, a single trauma can be processed by three 90-minute EMDR sessions.  A study by Kaiser Permanente that used 50-minute sessions found… that an average of 6 EMDR sessions, found 100% of single-trauma victims no longer had PTSD and 76% of multiple trauma victims no longer had PTSD.”

Here’s an ABC News clip by the CalSouthern School of Behavioral Sciences featuring Dr. Shapiro. Again it notes that EMDR is best done with a therapist, which is why they don’t post “How To” on the internet.  It also notes that in Shapiro’s original discovery, her eyes “flickered,” and therapists continue to have patients move eyes fast, “like watching tennis,” as one rape victim (who got huge relief) reports: https://www.youtube.com/watch?v=GTLLfdcJE0Q

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Kathy’s blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Francine Shapiro, PhD, “The Power of EMDR to Treat Trauma,” April 17, 2013 and Bessel van der Kolk, MD, “Expanding the Perspective on Trauma,” April 24, 2013, webinars by the National Institute for Clinical Application of Behavioral Medicine (NICABM): http://www.nicabm.com/trauma2013/trauma2013-post/

FN2  “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315

FN3  Transcripts and recordings of this and five related webinars again at  http://www.nicabm.com/trauma2013/trauma2013-post/

More reading:

Shapiro, Francine, PhD, “Getting Past Your Past: Take Control of Your Life with EMDR Therapy.”

Shapiro, Francine, PhD, “The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences,” Permanente Journal, Perm J. 2014 Winter; 18(1): 71–77   A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications. Methods: All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment.  Results:  Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/

van der Kolk, Bessel A, MD, “Restoring the Body: Yoga, EMDR, and Treating Trauma , July 11, 2013 interview by  Krista Tippett of OnBeing.Org.  Human memory is a sensory experience says psychiatrist Bessel van der Kolk. Through long research and innovation in trauma treatment, he’s learning how bodywork like yoga or eye movement therapy can restore a sense of goodness and safety: http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801

van der Kolk Bessel A, MD, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB,  “A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance, J Clin Psychiatry. 2007 Jan; 68(1):37-46. Abstract: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reup-take inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. METHOD: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.RESULTS: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. CONCLUSIONS: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma: http://www.ncbi.nlm.nih.gov/pubmed/17284128

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Comments are encouraged with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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The Body Keeps the Score – Bessel van der Kolk

Bessel Book bodykeepsscore “The Body Keeps the Score” by Bessel van der Kolk, MD, will “permanently change how psychologists and psychiatrists think about trauma and recovery,” as trauma scholar Dr. Ruth Lanius writes.  She was the first to call developmental trauma a “hidden epidemic,” source of my book’s subtitle “Silent Epidemic.” Dr. van der Kolk repeats this in his new book.  [FN1]

And it is about the body. “Infants are psycho-biological beings, as much of the body as of the brain,” writes Prof. Ed Tronick, author of the Still Face Experiment. “Without language or symbols, infants use every one of their biological systems to make meaning of their self in relation to the world.  Van der Kolk shows that those same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation.”

I reported van der Kolk’s work on developmental trauma and on getting the military to recognize PTSD in March 2014.  When the New York Times damned van der Kolk’s insistence on body work in June 2014, I roasted them.  In this book, van der Kolk makes his case much better than anyone else could.

I’m having trouble reading the book; I keep starting to sob. That started on page 3 where Dr. van der Kolk describes his heart-breaking childhood experience in bombed-out post-war Holland, with his father prone to violent rages, and his mother acting out her childhood trauma on him. I could feel that little boy, what he’s been going through all these years, and see the depths of what he has accomplished by giving his life so passionately to heal himself and all the rest of us.

These are “good sobs;” they feel good, because once again van der Kolk has told the truth about reality where few dare. Half the human race has had significant childhood trauma, and most of them are in complete denial and live in a state of dissociation, aka freeze or numbness. People in trauma, he writes, feel “numb” to most of life. One patient felt “emotionally distant from everybody, as though his heart were frozen and he was living behind a glass wall. He could not feel anything except his momentary rages, and his shame.”

Dr. Stephen Porges calls van der Kolk’s book a “courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines.” As van der Kolk and Porges have said before, medical and psychological experts have been just as much in denial and dissociated regarding the serious nature of trauma as are the traumatees.  “As our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings,” Porges says. “Van der Kolk offers hope by describing treatments and strategies that have.. helped his patients reconnect their thoughts with their bodies.”

Why all the denial?  “We don’t really want to know what soldiers go through in combat,” writes van der Kolk. “We do not really want to know howe many children are being molested and abused in our own society and how many couples – almost a third –engage in violence at some point…. We want to think… of our own country as enlightened civilized people. We prefer to believe that cruelty occurs only in faraway places like Dafur…”

Solutions for Recovery

Bessel van der KolkLet’s get right to what everyone wants to know.  Here are Dr. van der Kolk’s “Paths to Recovery,” which I think of as  “body solutions” :

— Healing starts with owning our “self,” 100% total acceptance of our self, exactly as we are today, no guilt, no self condemnation. It means developing pride in who we are; only by accepting ourselves as we are now, do we become free to change. We must respect our body for putting us into trauma freeze; it was the only way to defend us, as Stephen Porges says at the end of my blog last week.

– Recognize that language is a “miracle and tyranny,” van der Kolk says. “Telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted, or violated at any time. For real change, the body needs to learn that the danger has passed.” At some point we must let go of all the verbiage as yackety-yack largely in the conscious frontal cortex and logical left brain.

Instead, we must grasp that there is something more fundamental underneath all that, lead by our body sensations, non-verbal subconscious, and non-logical right brain. The body literally needs to have many, often thousands, of new, good physical experiences, such as being taught to physically move or defend itself, just where it could not during the original trauma. Only these can create a “visceral” certainty of safety, to race the old experiences of danger.

EMDR (Eye Movement Desensitization and Reprocessing) is van der Kolk’s next step, to integrate the right and left sides of the brain. In trauma often neural pathways between them have been frozen; in developmental trauma from infancy, these pathways may not have developed well and must be developed now.  By moving the eyes back and forth, we simulate Rapid Eye Motion (REM) sleep, which the brain uses to take events of “now” (today) out of short-term memory, where feelings like fight-flight and trauma reside, and put them into long-term memory.  Instead of feeling as if our trauma is happening again now, it begins to feel like an old story that loses its sting.

Yoga then teaches us how to inhabit our bodies right here, right now; that’s why it’s been used as a path to enlightenment for thousands of years.  Easy to say, but the challenge is to actually practice it rigorously and regularly; only then comes the benefit.

Neurofeedback programs done by trained neurofeedback specialists really help.  Dr. van der Kolk also recommends the computer (and smart phone) -based electronic feedback system EmWave by HeartMath, which trains users to synchronize breathing and heart rates, known as heart rate variability (HRV). In good HRV, heartrate speeds up when we breathe in and slows when we breathe out.  But in trauma we lose HRV coherence; breathing is very rapid and shallow, and heart rate de-synchronizes from the breath, also hazardous to physical health.

Finding Your Voice:  As Bruce Perry says, “Patterned, repeated rhythmic activity”  can re-tune a traumatized brain stem.   Dr. van der Kolk likes  “communal rhythms” such as drum circles and dance.  He particularly likes theater work because it gives the players a substantial voice and a character they can use to express all their feelings in a way everyone can accept.

Trauma Experts Praise “Body Keeps the Score”

“This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, ‘The Body Keeps the Score’  helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.
– Vincent J. Felitti, MD
Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego;  Co-Principal Investigator, ACE study

“Breathtaking in its scope and breadth, ‘The Body Keeps the Score’ is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse.
– Peter A. Levine, PhD, Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.

“This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.”
– Jon Kabat-Zinn, Professor of Medicine emeritus, UMass Medical School, Author of “Full Catastrophe Living.”

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN  Van der Kolk, Bessel, MD., “The Body keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” Peguin Press Viking, New York, 2014  http://www.amazon.com/The-Body-Keeps-Score-Healing/dp/0670785938#reader_0670785938

Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also Professor of Psychiatry at Boston University School of Medicine and Director of the National Complex Trauma Treatment Network. When he is not teaching around the world, Dr. van der Kolk works and lives Boston, Massachusetts.

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Readers Defend Van der Kolk

Bessel van der Kolk pic Trauma CenterI had the most comments ever last week, as readers spoke up to defend Dr. Bessel van der Kolk (left) and his ideas about somatic (body) healing for trauma, after the sideswipes against science by the New York Times May 22.  But the comments section got buried under all the footnotes I had to put in my letter to the Times to document their ignorance, so I’m posting the comments here where they’re easy to find.

 

Barbara Findeisen | June 7, 2014
Thank you, Kathy, you speak for many of us.  Did you see the “60 Minutes” show that Sunday? Most of my friends in the field do not think cognitive (therapy) is the way to go.

Some do. I have a hunch it is because they are afraid of their own trauma and need to be in control. As I am sure you know it an be messy when you are back in that pain and terror.

Kathy | June 8, 2014
Dear Barbara,
I’m grateful for your work on somatic healing and attachment trauma at Star Foundation (www.starfound.org).  A transcript of the May 25 “60 Minutes” show on PTSD is here.  Personally I was horrified by the VA forcing vets to do cognitive talk therapy, retelling their trauma over and over.
Not only Dr. van der Kolk but also somatic therapy experts Dr. Peter A. Levine, Dr. Pat Ogden, Belleruth Naparstek, Janina Fisher, and others with extensive vet experience warn that “just talk” about trauma only makes victims relive the trauma.  So it gets worse.
That’s why I took Dr. Levine’s somatic book “Healing Trauma to my therapist; he’s an attachment expert, but into cognitive talk therapy.  I said: “Sorry you’re not familiar with somatic work, but I got traumatized before I was 3 and had a thinking brain, so the trauma’s baked down into my body parts, where talk and cognition can’t get at it. This book is what we’re going to do.”  Our results were spectacular.  Levine’s results with vets are also spectacular.

Cheryl Sharp | June 9, 2014
While the coverage of van der Kolk’s work looked good on the surface, the innuendos throughout left me feeling that it was more of an attack.

It would have made much more sense for the article to go further and talk about why the way he works with people actually works, such as follow up with Bruce Perry’s work.

Only when people understand how the brain gets stuck and that the only way to that part of the brain is through the body, will they understand that healing and recovery is a real possibility.

Kathy | June 9, 2014
Amen when it comes to healing!  Dr. Bruce Perry, MD, Dr. Dan Siegel, MD, Stephen Porges and show that trauma shuts down higher brain functions like cognition. Instead, body parts and the primitive brain stem get “stuck” repeating bodily feelings from the past trauma events. Without higher brain functions, we can’t put the past trauma events into long-term memory. Instead, our body is reliving the past, now.
Siegel also says trauma memories can get so fragmented that we can’t gather them into a working picture at all; they sit scattered around the nervous system and body.
Perry says  “rhythmic regulation” by body movement can get the brain stem to calm long enough to let the higher brain functions come on line.
The Times ignores all this and repeats Richard McNally’s 2005 insistence that all trauma is remembered — though many said at the time that his work lacked proof. Lisa Najavits called McNally “disappointing… landing too forcefully on one side…by no means an end to the debate.”

Jane | June 9, 2014
Kathy, thanks for this informative post.  Several parents in my online support group have been discussing this very issue – body work to heal trauma – this past week.

Kathy | June 9, 2014
Thank you Jane!  Bruce Perry, Dan Siegel and others show even a normal child’s brain has no capability to remember much from conception to 36 months of age. Memories come in as discrete packets of sensory data from the eyes, ears, nose, etc., and sit in the body and primitive brain stem.
Only when the higher cognitive  functions like the hippocampus kick in around age 3, can we create real long term memory.
But if developmental trauma occurs from conception to 36 months, the primitive brain stem gets so traumatized that it harms the development of the higher brain lobes — which are outgrowths of the brain stem. The hippocampus, our ability to create long term memory, and many other higher brain functions can be badly damaged.
So we physically can not “think our way out” as van der Kolk says.

Rebecca | June 7, 2014
Excellent. Glad you wrote a defense. Have you heard back from them??

Kathy | June 8, 2014
No, nothing yet; frankly I didn’t expect anything.
They’re like King George or Marie Antoinette… They think they are Royalty at The Most Important Newspaper In The World – so they can just print anything they like, and the rest of us peons must cower.
Like I said, I grew up in New York and I’m not impressed.
When Thomas Edison invented the light bulb, they literally wrote an editorial denouncing him as a charlatan. I don’t have a copy of it anymore but maybe you can find it on the internet?

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Kathy’s news blogs expand on her book  “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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In Defense of Van der Kolk

Bessel van der Kolk portrait by Matthew WoodsonThe New York Times May 22 spotlighted Dr. Bessel van der Kolk MD’s idea that to change the way we heal a traumatized mind, start with the body (as noted last week). (Van der Kolk portrait by Matthew Woodson for the Times, left.)  But the Times had its own slant, some of it not cricket.

So here’s the letter I wrote to the Times about the gnarly
innuendos they also threw in — against Dr. van der Kolk.
These are innuendo against the science of how the human
organism deals with trauma and how widespread trauma

Some 50% of Americans have insecure attachment trauma
and roughly 50% of us suffer one or more types of Adverse Childhood Experience (ACE) trauma.  But the Times isn’t sounding the alarm about that.  Instead they’re damning the scientists trying to sound the alarm, with faint praise and innuendo.

I grew up in New York; I’m not impressed by Their Majesties.  I don’t care to let the Times’ arrogance stand.

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Subject: J. Interlandi 5-22 Van der Kolk feature
From: Kathy Brous   Date: Thursday, May 29, 2014
To: Letters@nytimes.com, “Sheila Glaser” <sfglaser@nytimes.com>
Cc: “Jeneen Interlandi” <jeneeni@yahoo.com>

Re:  “A Revolutionary Approach to Treating PTSD” by Jeneen Interlandi, May 22 New York Times Magazine

Dear Editors,

I appreciate Ms. Interlandi’s  allowing Dr. Bessel van der Kolk the space to explain that “to change the way we heal a traumatized mind, start with the body.” It’s especially true that standard “cognitive” treatments often don’t work, “patients are still suffering, and so are their families. We need to do better,” as van der Kolk says.

Of 208 reader comments, I only found two that didn’t hail his work; the two attacked van der Kolk for stating that “repressed memories” are possible.

But so, in effect, does the Times – and more. Which I found alarming.

“In the 1990s, van der Kolk served as an expert witness in a string of high-profile sexual-abuse cases that centered on the recovery of repressed memories, testifying that it was possible… for victims of extreme or repeated sexual trauma to suppress all memory of that trauma and then recall it years later in therapy,” Ms. Interlandi wrote.

Then, as if seamlessly, she segued into this next sentence: “In the 1980s and ‘90s, people all over the country filed scores of legal cases accusing parents, priests and day care workers of horrific sex crimes, which they claimed to have only just remembered with the help of a therapist… But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned… Harvard psychologist Richard McNally called the idea of repressed memories ‘the worst catastrophe to befall the mental health field since the lobotomy ‘.”

Bessel website pix vanderKolkportrait1I loathe witch trials; I was alarmed.  Is van der Kolk a butcher?  So I did an extensive internet search, and found zero evidence that van der Kolk personally had anything to do with the fraudulent cases.  Let alone aliens or cults.

Then I realized that the Times doesn’t have a single footnote to show it either. Is it all innuendo?

In my search, the worst van der Kolk’s worst critics could do, was to condemn him for repeating his clinical findings that repressed memories are possible. Period. [1]  Yes it’s horrible that there was a witch hunt in the 1980s-90s. It’s horrible that others distorted van der Kolk’s findings and as a result, innocent people were jailed.

But it’s just as much of a distortion to accuse him of doing the witch hunting. Is Edison responsible for everything ever done under electric lights?

The Times doesn’t report any of that.

The Times also doesn’t report this: since Richard McNally, Elizabeth Loftus and others flatly declared repressed memory to be impossible in 2002-2005, several peer reviewers have concluded that they were (flatly) wrong. The American Psychological Association website now states that while most traumas are remembered, “repressed memories” are also often reported and quite possible — and far more research is needed before anything can be dismissed. [2]

I appreciate Ms. Interlandi for covering trauma and van der Kolk, and at such length. I appreciate she seeks balance. But was that balance?

She also describes a follow-up visit she made to the Iraq vet with PTSD, whom van der Kolk treated using group therapy in the article’s opening passages. She concludes the article by reporting that the vet has no idea whether it worked or not. This leaves readers thinking: “Hmm. Van der Kolk?  His stuff doesn’t work.”

Without any review of what van der Kolk’s actual recovery rate might be?  Why the innuendo?  Where are the facts?

The Times also doesn’t report another key fact: according to Veterans Administration chief PTSD authority Dr. Matthew Friedman and several other studies, only 10-15% of veterans who experience war trauma incidents, come down with enduring full-blown PTSD. The rest heal within a relatively finite period. [3]

Traumatized little boyThe problem is the “invisible elephant” on the national mental health lawn: child trauma.

Child trauma is a topic Dr. van der Kolk discusses constantly, but which the article only mentions in passing, by way of asking whether it can be remembered or not. Yet the ACE Study has already shown that roughly 50% of us suffer one or more types of childhood trauma.

Those 10-15% who get PTSD? They are almost always survivors of some unrelated childhood trauma, which damages memory during brain development, such that yesterday’s events continue to be experienced as today’s events. That means the Iraq vet in the article, who has enduring PTSD, very likely had childhood trauma, a huge topic in itself.  [4]

To address child trauma — and what it would really take to fully heal this vet — would require giving Dr. van der Kolk the space for a whole other article. Which more than 200 of your readers would welcome.

Unless there’s a reason why not?

Unless we instead might have an article by those who allege that van der Kolk promoted the fraudulent cases — if, that is, they can show proof? And please: proof means footnotes and documentation.

Kathy Brous, Dana Point, CA
http://attachmentdisorderhealing.com/blogs/

Footnotes (provided in letter to the Times)

FN1  The False Memory Syndrome Foundation (FMSF) (www.fmsfonline.org), the premier site exposing fraudulent accusations based upon false trauma memory, has dozens of references to Bessel van der Kolk testifying on the science. Yet it never mentions that he supported any particular therapy, therapists, false memories or particular cases at all.  It certainly never connects him to anything to do with aliens or satanic cults.

FN2  The American Psychological Association’s 2007 “Working Group on Investigation of Memories of Child Abuse” presented findings mirroring those of the other professional organizations. The Working Group made five key conclusions:
“1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged;
“2. Most people sexually abused as children remember all or part of what happened to them;
“3. It is possible for memories of abuse that have been forgotten for a long time to be remembered;
“4. It is also possible to construct convincing pseudo-memories for events that never occurred;
“5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.”
– Source: Colangelo JJ, “Recovered memory debate revisited: practice implications for mental health counselors,  PRACTICE, Journal of Mental Health Counseling, 2007

The American Psychological Association’s website www.apa.org/topics/trauma/memories.aspx?item=1 currently adds:
“Q: Can a memory be forgotten and then remembered? Can a ‘memory’ be suggested and then remembered as true?
“A: Experts in the field of memory and trauma can provide some answers, but clearly more study and research are needed. What we do know is that both memory researchers and clinicians who work with trauma victims agree that both phenomena occur.
“However, experienced clinical psychologists state that the phenomenon of a recovered memory is rare (e.g., one experienced practitioner reported having a recovered memory arise only once in 20 years of practice). Also, although laboratory studies have shown that memory is often inaccurate and can be influenced by outside factors, memory research usually takes place either in a laboratory or everyday setting. For ethical reasons, researchers do not subject people to a traumatic event to test their memory. Because it has not been directly studied, we can not know whether a memory of a traumatic event is encoded and stored differently from a nontraumatic event.
“Some clinicians theorize that children understand and respond to trauma differently from adults. Some furthermore believe that childhood trauma may lead to problems in memory storage and retrieval. These clinicians believe that dissociation is a likely explanation for a memory that was forgotten and later recalled. Dissociation means that a memory is not actually lost, but is for some time unavailable for retrieval. That is, it’s in memory storage, but cannot for some period of time actually be recalled. Some clinicians believe that severe forms of child sexual abuse are especially conducive to negative disturbances of memory such as dissociation or delayed memory. Many clinicians who work with trauma victims believe that this dissociation is a person’s way of sheltering him/herself from the pain of the memory.
“Many researchers argue, however, that there is little or no empirical support for such a theory.”

FN3  “We know that if a hundred people are exposed to a traumatic episode…that most of them will not develop PTSD… The pre-traumatic risk factors are things you really can’t do anything about: whether your parents were well adjusted or had a mental health history, whether you were previously exposed to a disruptive household – your father was an alcoholic or that you were very poor and there was a lot of deprivation, or there was physical or sexual abuse during your childhood.”
– Source: Dr. Matthew Friedman, “Psychological First Aid: Diagnosis and Prevention of PTSD,” June 8, 2011 webcast, National Institute for the Clinical Application of Behavioral Medicine, www.nicabm.com
Dr. Matthew Friedman recently retired from the position of Executive Director and now serves as Senior Advisor at the U. S. Dept. of Veterans Affairs National Center for PTSD. Source: www.ptsd.va.gov/professional/continuing_ed/presenters/matthew-j-fri… [Dated March, 2014]

FN4  “The purpose of this study was to compare rates of childhood abuse in Vietnam veterans with and without combat-related posttraumatic stress disorder (PTSD).
“Results: Vietnam veterans with PTSD had higher rates of childhood physical abuse than Vietnam veterans without PTSD (26% versus 7%). The association between childhood abuse and PTSD persisted after controlling for the difference in level of combat exposure between the two groups.
“Conclusions:These findings suggest that patients seeking treatment for combat-related PTSD have higher rates of childhood physical abuse than combat veterans without PTSD. Childhood physical abuse may be an antecedent to the development of combat-related PTSD in Vietnam combat veterans.”
– Source: Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS, “Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans,”.Am J Psychiatry. 1993 Feb; 150(2):235-9.  http://www.ncbi.nlm.nih.gov/pubmed/8422073

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Kathy’s news blogs expand on her book  “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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“Heal trauma? Start with the body”

Bessel van der Kolk by Matthew Woodson, NYT 5-22-14“Bessel van der Kolk wants to change the way we heal a traumatized mind — by starting with the body,” reports Jeneen Interlandi in the New York Times Magazine May 22. (Dr. van der Kolk in session drawn by Matthew Woodson for the Times.)

It features Dr. van der Kolk’s new approaches to healing trauma by group therapy, yoga, meditation, EMDR, and “rhythmic regulation.”  I’ve reported on this in these recent posts: http://attachmentdisorderhealing.com/developmental-trauma/  and http://attachmentdisorderhealing.com/developmental-trauma-3/

“Trauma has nothing whatsoever to do with cognition,” van der Kolk says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures (brain stem), regions that, he says, no cognitive therapy (frontal cortex) can access.

“It’s not something you can talk yourself out of.”

It’s a great Friday read: “A Revolutionary Approach to Treating PTSD” by Jeneen Interlandi, New York Times Magazine, May 22, 2014 at: http://www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?smid=tw-share&_r=2#permid=11865712

OK, it’s a bit off my topic. The Times doesn’t mention attachment trauma, although van der Kolk talks about that constantly. As to healing, it focuses on adult war PTSD. It only speaks to child trauma by debating what a child abuse victim can and can’t remember (not much of a call to heal child trauma).

But Ms. Interlandi does let van der Kolk speak to his charge that there is a lot more trauma than we think, and that standard “cognitive” treatments are not working. “Patients are still suffering, and so are their families. We need to do better,” van der Kolk says.

“Van der Kolk says he would love to do large-scale studies comparing some of his preferred methods of treatment with some of the more commonly accepted approaches,” she points out. “But funding is nearly impossible to come by for anything outside the mainstream. In the wake of the Sept. 11 terrorist attacks, he says, he was invited to sit on a handful of expert panels. Money had been designated for therapeutic interventions, and the people in charge of parceling it out wanted to know which treatments to back.

To van der Kolk, it was a golden opportunity. We really don’t know what would help people most, he told the panel members. Why not open it up and fund everything, and not be prejudiced about it? Then we could study the results and really learn something. Instead, the panels recommended two forms of treatment: psychoanalysis and cognitive behavioral therapy.

“So then we sat back and waited for all the patients to show up for analysis and C.B.T. And almost nobody did.” Spencer Eth, then medical director of behavioral health services at St. Vincent’s Hospital in Manhattan, (later) gathered data on the mental-health care provided to more than 10,000 Sept. 11 survivors.

The most popular service by far was acupuncture. Yoga and massage were also in high demand. “Nobody looks at acupuncture academically,” van der Kolk says. “But here are all these people saying that it’s helped them.”

Out of 208 reader comments to the Times, I only found two that weren’t deeply grateful for his approach, as I am.  These two didn’t mention healing either.

Enjoy reading about Dr. van der Kolk today, but read carefully – the Times, ever a bit arrogant, puts in some gnarly innuendos I didn’t like, which the two comments made worse. So I had to do further research on this one.  My results to come next week…

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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