Thursday, January 30, 2014

The Good News or the Bad News?

So do you want the good news or bad news?  The sad news?  OK...

I have some sad news Mr. Bilson Blogaholics... Sadly, this will be the last and final post you will see at www.mrbilson.blogspot.com....

However, the good new is that Mr. Bilson has reinvented himself and has started a new blog.  It is called Mr. Bilson 2.0 at www.mrbilson2.blogspot.com.

Oh yes!  It ain't over yet!

The reason you ask?

Well. Mr. Bilson has become a bit old and has entered a new transition in life.  It is very different from what you saw in the past and will have some new twists and bends along the way.  He has discovered some new lands on some distant shores and again extends a hand of invitation. Some come and join the new journey at Mr. Bilson 2.0.

On that note, we hope you all have enjoyed Mr. Bilson and he personally wishes you all the best as he moves into something new.  It ain't over yet!

www.mrbilson2.blogspot.com.

Tuesday, January 21, 2014

Someone's Personal Take on Conflict Resolution in Relation to His/Her Biography, Social Learning and Other Experiences

Recently Mr. Bilson has embarked on a new adventure of counseling.  Here are the results of a client who has consented to allow this to be published here....
The themes of LARB are relevant to counsellor training education and working in the helping profession because conflict situations are faced by all people and is a universal human experience.  It is one of the primary problems that bring many to counseling.   With the existence of conflicts, people realize their mistakes, understand differences in one another, and they strive to become more functional people.  In fact, disagreements and arguments that lead to conflict are essential for individuals to grow and mature in life.  In order to resolve a conflict, it is relevant to invite a third party, such as a counsellor as needed. With this help, the parties of the conflict are able to identify the issue, deal with the conflict in productive ways and reach a sound resolution. Counseling is relevant as a pre-emptive means aimed at correcting an erring behavior and requires the need for corrective action. It can help in guiding, consoling, or advising individuals who need help in problem resolution.  It also helps the disputing parties to understand themselves and reflect on their viewpoints and seeks to let the parties take the situation in a more objective approach and allows them to develop new perspectives.  The realization they get from counseling helps them develop a positive outlook and desirable attitude toward the situation. With a change in perception, the individuals are motivated to find out alternative solutions to the cause of the conflict.  The result can lead to positive growth and productive change

My strengths in LARB are/were influenced by my biography, social learning, and


values. I have done a lot of travelling to many parts of the world that require the use of


bargaining, negotiating and haggling to survive.  These skills are absolutely necessary


in conflict resolution. As covered in the course textbook, “Anytime you want something


from someone who may have conflicting interests, you are potentially in a negotiating


situation.  Negotiating is a skill that helps you get what you want from others without


alienating them.”  This skill became a major strength for me in travelling to different


Asian countries that do not have fixed prices on fundamental products and services like


food, shelter, etc. and require the ability to negotiate in order to survive.  


Another strength in LARB are/were influenced by my biography, social learning,


and values are my use of self disclosure.  In my biography, you’d find I did a lot of youth work (10 years) where I would spend time expressing my values and social lessons to those under my care.  They have given me feedback that this has helped us develop closer intimate relationships and improved communication.  The more I shared, the more the youth would share and a greater level of self knowledge was accomplished by the both of us.  This helped define and expand details of inconsistencies and possible areas of conflicts in both of our lives that needed to be solved.  One example of a conflict area that I had in common with many youth involved the family.  I would share how I felt very misunderstood by my parents and the conflicts that would result.  I also expressed how I overcame some of these conflicts when I realized that I sometimes put unreasonable demands and expectations on my parents.  I also wasn’t clear about how I communicated these expectations to them.  The combination of these problems was the source of a lot of fighting.  I learned to change my expectations and accepting that my parents can only do so much with me.  I also learned how to be more concrete in my communication that led to a huge shift and positive relations with my parents.  They have found that I was too vague about what I expected and needed from them.  Some youth have found that this is what was the cause and solution in their conflicts with their parents and have had better relations as a result of this disclosure.
There are many areas to develop in LARB that are influenced by my biography, social learning and other experiences. In the past I have been known to start yelling when I am being yelled at in a conflict situation.  This is a result of a learned pattern of behavior I had while I was in highschool and often got bullied into physical fights.  I used to use anger, threats, yelling and intimidation as a way of getting out of conflicts.  These areas can be a hindrance in any setting at my current age.  Under certain circumstances, a person with this type of behavior may get into major legal complications if threats, intimidation and anger are used to deal with conflict.  I have also learned that under certain circumstances, this kind of behavior can escalate a situation and not diffuse it making a conflict more complicated.  I have learned this was the case in smaller percentage of conflicts I had in the past when I feel like I am being bullied by someone.  Sometimes they didn’t feel threatened or back off but continued to antagonize me.  I recognized my need to use more constructive and civil ways of addressing conflict in a manner that doesn’t provoke intimidation.  
Another area to develop in LARB are blocks to listening  This would make certain people feel like I didn’t appreciate them and lacked a commitment to know and understand and value what they say and who they are.  I have had to find ways of dealing with this glaring weakness.   
I intend to strengthen my areas of development both emotionally and in  concrete ways by making an ongoing commitment to training and education.  I believe that through training and education I can learn new skills and sharpen old ones to be more effective as a counsellor. So far, I have found the following concrete ways in dealing with my aggressive emotions, from the course concepts, effective :
  • Remain calm. Try not to overreact to difficult situations. By remaining calm it is more likely that others will consider your viewpoint.
  • Express feelings in words, not actions. If you start to feel so angry or upset that you feel you may lose control, take a "time out" and do something to help yourself feel calm: take a walk, do some deep breathing, play with the dog, write in your journal- whatever works for you.
  • Be specific about what is bothering you. Vague complaints are hard to work on.
  • Deal with only one issue at a time. Don't introduce other topics until each is fully discussed. This avoids the "kitchen sink" effect where people throw in all their complaints while not allowing anything to be resolved.
  • No hitting below the belt. Attacking areas of personal sensitivity creates an atmosphere of distrust, anger, and vulnerability.
  • Avoid accusations. Accusations will lead others to focus on defending themselves rather than on understanding you. Instead, talk about how someone's actions made you feel.
  • Try not to generalize. Avoid words like "never" or "always." Such generalizations are usually inaccurate and will heighten tensions.
  • Avoid make believe. Exaggerating or inventing a complaint - or your feelings about it - will prevent the real issues from surfacing. Stick with the facts and your honest feelings.
  • Don't stockpile. Storing up lots of grievances and hurt feelings over time is counterproductive. It's almost impossible to deal with numerous old problems for which recollections may differ. Try to deal with problems as they arise.
  • Avoid clamming up. Positive results can only be attained with two-way communication. When one person becomes silent and stops responding to the other, frustration and anger can result. However, if you feel yourself getting overwhelmed or shutting down, you may need to take a break from the discussion. Just let your partner know you will return to the conversation as soon as you are able and then don't forget to follow-up.
  • Establish common ground rules. You may even want to ask your partner-in-conflict to read and discuss this information with you. When both people accept positive common ground rules for managing a conflict, resolution becomes much more likely.
    In dealing with daydreaming, I used many of the following course concepts in the past to develop and strengthen this area by paraphrasing, clarifying and giving feedback.  Stating, in my own words, what I think some just said with lead ins like, “What I hear you saying is…” “In other words…” “So basically how you felt was….” “Let me understand, what was going on was…” “What happened was…” “Do you mean…?”    
This alone has resulted in people feeling deeply appreciated and heard and has stopped escalating anger and cools down a crisis. It also has helped me remember what was said and stopped a lot of miscommunication.   
Clarifying by using questions to get a better picture was also effective.  I like to ask questions about the circumstances, the person's thoughts, feelings, and history or cultural context of the conversation at hand and it has led people to feel how interested I am in them.
           Giving feedback has also been helpful.  This is where I talk about my reactions and 

perception of what I thought, felt and sensed in a non judgemental way.  I also check my 

perception and transform what I said and heard into a tentative description using: “I want to 

understand your feelings - is that (giving a description) the way you feel?” “Listening to what 

you said, I wonder if (my description) is what’s really happening in the situation.  This is all 

done to see if I was accurate. It invited a chance to correct errors or misconceptions.  

Tuesday, December 31, 2013

2013 A Great Year!


I can imagine what a lot of you are thinking... 2013... A Great Year?  What was so great about it?  Did you read the headlines this year?  Remember some keywords like Charm Offensive, Philippines Relief and Miley Cyrus, and Boots on ground, and Economic downturn, and Rob Ford and Nelson Mandela on and on and on... It is true.  It was a startling year in the world.  But in the smaller world of Mr. Bilson... it was a Great Year.  Now don't get him wrong, there were many challenges, however, there were also a lot of answers to prayer.  Let's take a look at some of them...

What is one of the biggest answers this year? 

"They devoted themselves to the apostles’ teaching and to fellowship, to the breaking of bread and to prayer."  (Acts 2:42)

COMMUNITY and Fellowship.  For nearly 5.5 years, Mr. Bilson was attending a wonderful church who have amazing leaders.  The leaders are so kind hearted and ministered to Mr. Bilson at many crisis and at great length.  However, for some reason, he couldn't seem to connect to members of the congregation.  And anytime he did, they would end up moving out of the province.  Nonetheless, he used to attend the men's group which is one of the hardest ministries in any church... but than that later shut down.  From there, nothing seemed to fill the gap..  Even a Pastor at the Church prayed Mr. Bilson would find a loving community. It is and odd feeling trying to throw himself in the company of people and not clicking...  I guess Mr. Bilson was starting to become a KLING ON!  Sorry friends but he meant well and didn't mean to hurt anyone.  Luckily that didn't happen... Any frustration expressed here is not towards a person or church or leader but is directed at the situation...

"In my distress I called to the LORD; I cried to my God for help. From his temple he heard my voice; my cry came before him, into his ears." (Psalm 186)


So he cried out to God and God answered.  He put him into a beautiful community of Vietnamese people.  They were so humble, sincere and inclusive. They hosted him for many dinners, home groups, opportunities to grow in preaching, teaching and a little bit of playing guitar.  Thank the Lord for answering another prayer... 

T was also in town a number of times and didn't seem to forget Mr. Bilson.  He remembered some of the marvelous ministry done in the past and always made time to spend with him.  It was such a releif to not be forgotten.  He was the one who helped open the door in gaining community and a chance to move into a calling to be active in a local church.  Amen.

But God continued to add to this blessing and gave even more community.  Out of the blue, a buddy named Al rang up Mr. Bilson and when Mr. Bilson shared his need for community, He to came through.  He surrounded him with another community of Saints and you wouldn't believe it but they were a community Mr. Bilson was loosely associated with in his early days in Christ.  He had the chance to meet and old friend he hadn't seen in over 10 years.  Boy, God is good.  And you wouldn't believe where they met!  It was on a Volleyball Court of all places.  This God fearing group started a Volley Ball ministry, outreach almost identical to the one A-Bomb did in the past.  But wait, it gets better.  It is run by a Mr. Singh.  He is a convert to the kingdom who shares the Word at the meetings and also goes to a church Mr. Bilson went to over 13 years ago.  WOW!  And he wasn't the only Mr. Singh he'd meet.

God would introduce another Mr. Sing.  This Mr. Singh gave timely advice and a testimony that would help Mr. Bilson and his bro A-Bomb.  He told of how he waited on the Lord and waited and waited and the Lord came through and united him to a beautiful woman of God. He to was in his late 30's but held out for God's best and it all came through.  She even visited India and learned the beauty of submission from Indian culture.  This testimony gave Mr. B and A-Bomb a much need faith boast as they enter into the 3rd decade of life.  They also treated the brothers at Camp 10 where new friendships were formed and lots of V-ball was played!  God is never to late and never will be.   

Yurk's was the other blessing of community.  He approached us at the Mega Church and put aside all other ministry opportunities to specifically minister and pray and have fellowship with us especially to a major need of the brothers.  They were deeply touched by his kindness, hospitality, prophetic words and testimony.  Yurk's just entered a new phase of God's blessing that was unlike any other season in his life.  He was also on the other side of many of the goals the brothers wanted to accomplish.  God can exceed all our expectations!

2013 was also the release of and album by one of Mr. Bilson's favorite Christian Bands, Skillet.  Occasionally, Mr. Bilson will pray for some good music that gets him closer to God.  Skillet came through.  Their album Rise has two phat tracks that absolutely rock but there are other tracks that have great riffs but not so rich lyrics and a little too much kiddie vocals.  But it is great to see that their previous album was one of three to sell over 1,000,000 copies which is a huge feet in this day an age and for a Christian band.  Way to go!   It also a band Mr. Bilson wished he could've have played on... He loves the crunch guitar and cello, violin combination.  Not to mention the lead singer has most of the same influences as Mr. Bilson. 
 
Sure, Mr Bilson would get his prayers answered for community, ministry opportunities, listening to nice music and he would also start on a path to fulfill another dream.  He enrolled in a school the specializes in his other love outside of studying the Bible which would be in counseling Psychology.  He has always been fascinated by human behavior and was surrounded by people who would be a great counselor for him.  Now he would learn to step into this area of service and it has been an exhilarating journey so far.


2013 was also the year that Mr. Bilson would also see the a long awaited answer to prayer of a close friend.  Cy would not only move into his career but also excel to a position coveted by people in his career who have been at it decades ahead of him, but he would also meet his better half.  Mr. B would have the esteemed chance to spend time with the both of them in beautiful Mtn. R!  They truly have a relationship blessed and ordained by God.  Not to mention Mt. R is absolutely gorgeous!  


But 2013 was not over yet... Mr. Bilson would get some phone calls and messages from some unlikely people.  He would start to hear from the old youth group from many eons ago.  Some came back to thank him.  Almost all of them have left high school to get into post secondary schools pursuing great careers and callings.  Some have even gone to very prestigious schools.  They called Mr. Bilson to thank him!  What?  Thank?  Are you serious? Is it possible?  Yes!  Mr. Bilson was reminded of an old prayer project he did with them.  There was a list of many requests like growing deeper in God, live a holier life, reach the community etc.  But the one that was highlighted was to do good in school and careers. You can never beat the spiritual value of prayer!  Nothing beats it!  Some youth testified that they got into schools that they didn't have the GPA for!  HA!  One even said that those who were under the ministry of Mr. Bilson are doing way better that the ones who are not.  Sure all are facing challenges but the ones who were close to Mr. Bilson are doing far better.  This is not ego greasing by the way..., it is encouragement for God's glory.  Actually it is God that is to be thanked!  Let's pray that ministry will remain Christ Centered and reach more young people.

Until then!  Happy New Year and Mr. Bilson would like to send his best regards to all of you!  Take care and see you next year!

Thursday, December 12, 2013

Christmas Gifts and Giving

Christmas Time is coming soon. It is the time of year where families come together. Decorate houses. Eat nice Meals and celebrate the birth of Jesus.  We celebrate by giving and receiving gifts.  

Do you like to give gifts or receive Gifts? I like to receive gift myself.  There is nothing like getting some new toys to play with.  Toys for all people.  It could be a computer, video games, movies, gadgets like a tablet.  There is something about getting something you really long for.  But the Bible says that:

‘It is more blessed to give than to receive.’ " (Acts 20:35)  

Who gives you the best gifts?  Is it from your parents?  Wife? husband? Best Friend?  Have you gotten gifts that you don’t like? Like an ugly sweater? Exercise bike? Board games?  

The Bible says the best gifts are from God:  

"Every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows."  (James 1:17) 


Good gifts and perfect gifts are from God and only God gives them away.  Do you have a favorite gift?  Is it phone?  Computer?  Tool?  Toy?  Food?  


Why is it your favorite? 

Did it help make you life easier?  Have a nice computer with more memory can make life easier.  You can store more things....  A faster computer can help you do you work faster?

These gifts are great to help ourselves but some of God's gifts are for the good of others:

"Each of you should use whatever gift you have received to serve others...."  (1 Peter 4:10)  

God gives us spiritual gifts as well, for    
God has given us spiritual gifts
         
"Now about the gifts of the Spirit, brothers and sisters...," (1 Cor 14:1)    

They can be used to strengthen the church:   "...try to excel in gifts that build up the church" (1Corinthians 14:12) 

But God also gives gifts for our own good as well.  One of those gifts is hope: 

"In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead... (1 Peter 1:3)
We live in a world where hope seems to be dyeing... Countries in debt, Wars, Fierce storms, etc. But we Christians have a living hope in all this

Not only does God give us perfect gifts for ourselves and the good of others but God gives Gifts for next life  

"In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead, 4 and into an inheritance that can never perish, spoil or fade. This inheritance is kept in heaven for you," (1 Peter 3:3-4)

This is better than any inheritance we will ever get from our parents. God's inheritance never spoils, fades or perishes.   There are so many families who get ripped apart sueing each other over and inheritance.  Some get ripped off while others get what wasn't there's.  But God's inheritance is far better.  It is for you and in a safe place which is heaven where it can never be stolen. Most inheritances can come in the form of material goods but all that can spoil, fade and perish but not an inheritance from God.  In can never perish, spoil or fade.         

                                                                                                   
Do you ever ask for certain gifts? Are you embarrassed or ashamed to ask? Have you had someone give you the wrong thing you asked for? 
 

You never have to worry about that with God because he invites and he gives the right things when you obey him...:  
 
 “Which of you, if your son asks for bread, will give him a stone? 10 Or if he asks for a fish, will give him a snake? 11 If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him! "  (Matthew 7)  

Again, good gifts are from God.  He invites us to ask him.  We don't need to be embarrassed to ask.
 

Are your favorite gifts expensive? 

Did it have a high price?  God gave his most expensive gift, his son:  

"16 For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life."  (John 3:16)  
 

Very few people would give there son away.  God did.  He did it show how much he loved us.    



God gave his son Jesus and Jesus to gives gifts. 

"8 This is why it says: "When he ascended on high,  he took many captives and gave gifts to his people.” Eph 4:7-8  

Jesus was given to us and He himself gives...

Do you ever brag about the gifts you give? Or do you ever meet people who brag about gifts they give? 


Sometimes people will say, "I got my wife an awesome new ring?" or "I got my kids new video games!"  etc.  Some do it to impress you or to make themselves seem so generous.

But the Bible tells us to be different:

4 Love is patient, love is kind. It does not envy, it does not boast, it is not proud. (1 Cor 13)

Especially when giving to the needy.  

3 But when you give to the needy, do not let your left hand know what your right hand is doing, 4 so that your giving may be in secret. Then your Father, who sees what is done in secret, will reward you. (Matthew 6)  

Christmas is a time of giving but let us not forget the one who give the perfect gifts.  
Let us not forget Jesus who gave the most precious gift of himself and much more....

 

Tuesday, November 19, 2013

Sexual Misconduct and Therapeutic Relationships

Possible Warning Signs

* Inappropriate sexual jokes or references made by the practitioner.
* Having concern that a treatment relationship is moving from the professional to the inappropriately personal.
* When the practitioner tells you his or her intimate personal problems.
* When the practitioner asks you to go outside the bounds of a professional relationship (e.g. – going on a dinner date, or social meeting outside the office).
* When the practitioner tells you that having a sexual relationship with him or her is good treatment/the only way you can get well.
* When the practitioner offers recreational drugs or alcohol.
* When the practitioner asks you to keep your relationship with him or her a secret.
* When the practitioner suggests to you that intimate forms of touching have been proven to be therapeutic for your condition.
* Extension of office hours to see a particular patient.
* Discussion of meeting outside the professional setting.
* Telephone calls or other communications to or from patients about issues unrelated to medical care.
* Inordinate preoccupation with thoughts of the patients

Preventative Self Care:

* Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically.
* Seek professional support during times of personal loss or crisis
* Make it a practice to examine and monitor feelings and behaviors toward clients
* Know the difference between having sexual attraction towards a client and acting on this attraction
* Learn about he possible adverse consequences for clients and therapist who engage in sexual activity
* Establish and maintain clear boundaries when a client makes sexual advances toward you
* Terminate the therapeutic relationship when sexual feelings obscure objectivity.
* Counselors should enroll in training programs on ethics, boundaries, and the management of erotic transference and counter transference.
* This educational background at least provides a conceptual framework so they can think about the risk of boundary transgressions and carefully monitor counter-transference as they notice deviations occurring from their standard way of practicing.
* Documentation of what one does and why is essential.
* Regular consultation cannot be overemphasized as a preventive measure.
* Colleagues should take responsibility for their profession by monitoring the behavior of one another.

Friday, November 15, 2013

Notes on Trauma and Recovery by Judith Lewis Herman, M.D. Basic Books, 1992

Trauma and Recovery

Judith Lewis Herman, M.D.

Basic Books, 1992

To return to Psych 270's home page, click here.

The conflict between the will to deny horrible events and the will to proclaim them aloud

is the central dialectic of psychological trauma

When the truth is fully recognized, survivors can begin their recovery. But far too often,

secrecy prevails and the story of the traumatic event surfaces not as a verbal narrative but

Denial exists on a social as well as an individual level... We need to understand the past

in order to reclaim the present and the future. An understanding of psychological trauma

begins with rediscovery the past.

The fundamental stages of recovery are:

2. Reconstructing the traumatic story

3. Restoring the connection between the survivor and his/her community.

It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the

bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil.

The victim ask the bystander to share the burden of the pain. The victim demands action,

engagement, and remembering. (A tendency to render the victim invisible; to look the

Freud's investigations led the furthest of all into the unrecognized reality of women's

lives. His discovery of childhood sexual exploitation at the roots of hysteria crossed the

outer limits of social credibility and brought him to a position of total ostracism within

his profession. (He eventfully repudiated his own findings.)

Traumatic Neurosis of War

The soldier who developed a traumatic neurosis was at best a constitutionally inferior

human being, at worst, a malingerer and a coward. They were described as moral

invalids. Hysterical symptoms such as mutism, sensory loss, or motor paralysis were

treated with electric shock; threatened with court martial. The goal of treatment was to

return the soldier to combat.

In WWII, it was recognized that any man could break down under fire and that

psychiatric casualties could be predicted in direct proportion to the severity of combat

There is no such thing as "getting used to combat." Each moment of combat imposes a

strain so great that men will break down in direct relation to the intensity and duration

of their exposure. Thus, psychiatric casualties are be inevitable as gunshot and shrapnel

In their quest for a quick and effective method of treatment, military psychiatrists once

again found the mediating role of altered states of consciousness in psychological trauma.

They found that artificially induced altered states could be used to access traumatic

As in earlier work on hysteria, the focus of the "talking cure" for combat neuroses was

on the recovery and cathartic reliving of the traumatic memories with all their attendant

emotions of terror, rage, and grief.

Combat leaves a lasting impression on men's minds, changing them as radically as any

crucial experience through which they live. It points to the need for integration.

After Vietnam, the diagnosis "post traumatic stress disorder" included in the APA's DSM,

Not until the women's liberation movement of the 1970s was it recognized that the

most common PTSDs are those not of men in war, but of women in civilian life. The

cherished value of privacy created a barrier to consciousness and rendered women's

reality practically invisible.

Research of the '70s confirmed the reality of women's experience that Freud had

dismissed as fantasies a century before. Sexual assaults against women and children were

shown to be endemic and pervasive in our culture. The results: On women in four had

been raped. One women in 3 had been sexually abused as a child.

Rape was the feminist movements's initial paradigm for violence against women in the

Women experienced rape as a life threatening event having feared mutilation and death

during the assault. Rape victims complained of insomnia, nausea, startle responses, and

nightmares as well as dissociative or numbing symptoms. The symptoms resemble that of

Necessity for a political movement to support the continued exploration of trauma or its

survival as a legitimate are of study is in jeopardy.

Psychological trauma is an affliction of the powerless. At the moment of trauma, the

victim is rendered helpless by overwhelming force. Traumatic events overwhelm the

ordinary symptoms of care that give people a sense of control, connection, and meaning.

Certain experiences increase the likelihood of harm.

3. Being at the point of exhaustion

4. Being physically violated or injured

5. Being exposed to physical violence

6. Witnessing grotesque deaths

Trauma occurs when action is of no avail--when neither resistance nor escape is possible.

The traumatized individual may experience intense emotion but without clear memory

of the event--or may remember everything in detail but without emotion. Traumatic

symptoms have a tendency to become disconnected from their source and to take on a life

of their own. (Dissociation)

The Main Categories of Post Traumatic Stress Disorder

1. Hyperarousal: Persistent expectation of danger

2. Intrusion: The indelible imprint of the traumatic even returning unbidden.

3. Constriction: The numbing response of surrender

The system of self preservation goes into permanent alert as if the danger could return

at any moment. (Symptoms: Startle easily, reacts irritably to small provocations, sleeps

poorly). It is the constant arousal of the autonomic nervous system.

Long after the danger is past, traumatized people relive the event as though it were

continually recurring in the present. The trauma interrupts daily life. (Symptoms:

Flashbacks during waking; nightmares during sleeping)

Traumatic memories lack verbal narrative and context; rather they are encoded in the

form of vivid sensations and images. They resemble the memories of young children.

Traumatized people find themselves reenacting some aspect of the trauma scene

in disguised form without realizing what they're doing (e.g., putting themselves in

dangerous situations this time to make the end come out differently (a version of the

Seen as a possible attempt at integration--to relive and master the overwhelming feelings

of the traumatic moment(s).

Attempts to avoid reliving the trauma too often result in a narrowing of consciousness or

withdrawal from engagement with others and an impoverished life.

In Constriction (numbing)

The system of self esteem shuts down completely (a state of surrender). The helpless

person escapes not by action, but by altering her/his state of consciousness.

Events continue to register in awareness but its as though these events have been

disconnected from their ordinary meaning (similar to trance states).

Those who cannot dissociate may turn to drugs or alcohol for their numbing effects.

Adaptive during the trauma, numbing becomes maladaptive once the danger is past.

In an attempt to crease some sense of safety, traumatized people restrict their lives.

In avoiding any situation reminiscent of the past trauma or any initiative that might

involve future planning and risk, traumatized people deprive themselves of those new

opportunities for successful coping that might mitigate the effect of the traumatic

Because post traumatic symptoms are so persistent and widespread, they may be

mistaken for enduring characteristics of the victim's personality.

Traumatic events breach the attachments of family, friendship, love, and community.

They shatter the construction of the self that is formed and sustained in relation to others.

They undermine the belief system that gives meaning to human experience. They violate

the victim's faith in a natural or divine order and cast the victim into a state of existential

crisis. It is a shattering of "basic trust." A sense of alienation, disconnection pervades

Trauma forces the survivor to relive all earlier struggles over autonomy, initiative,

competence, identity, and intimacy.

The developing child's positive sense of self depends upon a caretaker's benign use of

Traumatic events violate the autonomy of the person at the level of basic bodily integrity

(Body ego -> first sense of "I")

The belief in a meaningful world is formed in relation to others and begins earliest life.

Basic trust, acquired in the primary intimate relationship is the foundation of faith.

Trauma creates a crisis of faith.

Damage to the survivor's faith and sense of community is particularly severe when the

event themselves involve the betrayal of important relationships.

Survivors oscillate between:

Uncontrollable outbursts of anger and intolerance of rage in any form.

Seeking intimacy desperately and totally withdrawing from it.

Self esteem is assaulted by experiences of humiliation, guilt, and helplessness.

Vulnerability and Resilience

Individual personality characteristics count for little in the face of overwhelming events.

With severe enough experience, no person is immune.

Individual differences play a part in determining the form PTSD will take. It is related to

individual history, emotional conflicts, and adaptive style.

Highly resilient people are able to make use of any opportunity for purposeful action in

concert with others, while ordinary people are more easily paralyzed or isolated by them.

Some features of highly resilient people:

1. Alert, active temperament

3. Good communicating skills

4. Strong internal locus of control

Increased vulnerability is enhanced by:

1. Disempowerment (children, adolescents)

2. Disconnection from others

4. Poor or absent communication avenues

The Effect of Social Support

The survivor's social world can influence the eventual outcome of trauma.

The emotional support that is sought takes many forms and changes during the course of

In the immediate aftermath, rebuilding of some minimal form of trust is the primary task.

Assurances of safety and protection are of the greatest importance.

Then, the survivor needs assistance of others in rebuilding a positive sense of self.

Others must show tolerance for the oscillating behaviors of the survivor. It is not blanket

acceptance but the kind of respect for autonomy that fostered the original development of

self esteem in the first year of life. (Movement toward self-regulation).

The survivor needs the assistance of others in her/his struggle to arrive at a fair

assessment of her/his conduct. Harsh criticism or ignorance or blind acceptance greatly

compounds the survivor's self blame and isolation. Realistic judgments include a

recognition of the dire circumstances of the traumatic event and the normal range of the

victim's reactions. They include the recognition of moral dilemmas in the face of severely

limited choices. This, hopefully, leads to a fair attribution of responsibility.

Finally, the survivor needs help from others to mourn her/his losses. Failure to complete

the normal process of grieving perpetuates the traumatic reaction.

Sharing the traumatic experience with others is a precondition for the restitution of a

Once it is publicly recognized that person has been harmed, the community must take

action to assign responsibility for the harm and to repair the injury. Recognition and

restitution are necessary to rebuild the survivor's sense of order and justice.

Repeated trauma in adult erodes the structure of personality already formed, but repeated

trauma in childhood forms and deforms the personality.

Under conditions of chronic childhood abuse, fragmentation becomes the central

principle of personality organization. Fragmentation in consciousness prevents the

ordinary integration of knowledge, memory, emotional states, and bodily experiences.

Fragmentation in the inner representations of the self prevent the integration of identity.

Fragmentation of the inner representation of others prevents the development of a reliable

sense of independence within connection.

By idealizing the person to whom she becomes attached, she attempts to keep at bay

the constant fear of being either dominated or betrayed. Inevitably, however, the

chosen person fails to live up to her fantastic expectations. When disappointed, she

may ferociously denigrate the same person whom she so recently adored. Ordinary

interpersonal conflicts may provoke intense anxiety, depression, or rage. In the mind

of the survivor, even minor slights evoke past experiences of deliberate cruelty. These

distortions are not easily corrected by experience since the survivor tends to lack the

verbal and social skills for resolving conflict. Thus, the survivor develops a pattern of

intense, unstable relationships repeatedly enacting the drama of rescue, injustice, and

1. Desperate longing for nurturance make it difficult to establish safe and appropriate

2. Denigration of self and idealization of others.

3. Empathic attunement to the wishes of others and unconscious habits of obedience

make her vulnerable to people in positions of authority.

4. Dissociative tendencies make it difficult to form conscious, accurate assessments of

5. The wish to relive dangerous situations to make them come out differently leads to

A New Diagnosis -- Complex Post Traumatic Stress Disorder

A history of subjection to totalitarian control over a prolonged period (months or

years). Examples include hostages, prisoners of war, concentration camp survivors, and

survivors of some religious cults. Examples also include those subjected to totalitarian

systems in sexual and domestic life, including survivors of domestic battering, childhood

physical or sexual abuse, and organized sexual exploitation.

Alterations in affect regulation, including

Chronic suicidal preoccupation

Explosive or extremely inhibited anger (may alternate)

Compulsive or extremely inhibited sexuality (may alternate)

Alterations in consciousness, including

Amnesia or hypermnesia for traumatic events

Transient dissociative states

Depersonalization/derealization

Reliving experiences either in the form of intrusive post traumatic stress disorder

symptoms or in the form of ruminative preoccupations.

Alterations in self-perceptions, including

Sense of helplessness or paralysis of initiative

Shame, guilt, and self blame

Sense of defilement or stigma

Sense of complete difference from others (may include sense of specialness, utter

aloneness, belief no other person can understand, or nonhuman identity)

Alterations in perception of perpetrator, including

Preoccupation with relationship with perpetrator (includes preoccupation with revenge)

Unrealistic attribution of total power to perpetrator (caution: victim's assessment of

power realities may be more realistic than clinician's)

Idealization or paradoxical gratitude

Sense of special or supernatural relationship

Acceptance of belief system or rationalizations of perpetrator

Alteration in relations to others, including

Disruption of intimate relationships

Repeated search for rescuer (may alternate with isolation and withdrawal)

Repeated failures of self protection

Alterations in systems of meaning

Sense of hopelessness and despair

They present a bewildering array of symptoms. They come for help because of their

many symptoms or because of difficulty with relationships, ,problems in intimacy,

excessive responsiveness to the needs of others, and repeated victimizations.

Often receive the diagnosis of (1) Somatization Disorder; (2) Borderline Personality

Disorder; or (3) Multiple Personality

Communalities in the above three diagnoses

1. High levels of dissociation

2. Unstable relationships (oscillating between clinging and withdrawal; submissiveness

3. Disturbances in identity formation (fragmentation leading to good self/bad self

Recovery is based upon the empowerment of the survivor and the creation of new

connections. It can take place only in the context of a relationship.

The survivor must be the author and arbiter of her own recovery.

The therapist abstains from using her/his power over the patient to gratify his/her needs

and does not take sides in the patient's inner conflict or try to direct the patient's life

decisions. The therapist is called upon to bear witness to a crime.

"It is as if the patient's life depends on keeping the therapist under control." -- Kernberg

Because the patient feels as though her life depends on the therapist, she cannot afford to

be tolerant; there is no room for human error. There is likely to be a displacement of the

rage from perpetrator to caregiver.

The patient feels a desperate need to rely on the integrity and competence of the therapist

but cannot because her capacity to trust has been damaged by the traumatic experience.

The survivor also mistrusts the therapist who does not move away. She attributes the

same motives as those of the perpetrator. The dynamics of dominance are reenacted in

The patient scrutinizes the therapist's every word and gesture in an attempt to protect

herself rom the hostile reactions she expects. Because she has no confidence in the

therapist's benign intentions, she persistently misinterprets the therapist's motives and

Traumatic Countertransference

No therapist can work with trauma alone.

As a defense against the unbearable feelings of helplessness, the therapist may try to

There is also the danger of identifying with the perpetrator.

Witness guilt is also a danger. Guilt over having been spared the same plight.

The two most important guarantees of safety are the goals, rules, and boundaries of the

therapy contract and the support system of the therapist.

A relationship of existential engagement in which both parties commit themselves to the

• Emphasis on truth telling and full disclosure

• Cooperative nature of the work

• Preparation for repeated testing, disruption, and the rebuilding of trust

• Careful attention to the boundaries

• Decision on limits based on whether they empower the patient and foster a good

working relationship--not whether they patient should be frustrated or indulged.

Because of the conflicting requirements for flexibility and boundaries, the therapist can

expect repeatedly to feel put on the spot.

Recovery unfolds in three stages: (1) The establishment of safety; (2) Remembrance and

mourning; and (3) Reconnection with ordinary life.

Therapist who believes that the patient is suffering from a traumatic syndrome should

share the information fully. There is a name for what is going on.

Patients with Complex PTSD feel as if they have lost themselves. Patients with PTSD

feel as if they have lost their minds.

A guiding principle of recovery is to restore power and control to the survivor. The first

task is to establish the survivor's safety. Nothing can happen until this is accomplished.

Establishing safety begins by focusing on control of the body and gradually moves

outward toward control of the environment.

With the survivor of chronic abuse, establishing safety can be an extremely complex

and time consuming task. Self care is disrupted and self harm may take various forms

(symbolic reenactments of the initial abuse) serving the function of regulating intolerable

feeling states. Self soothing must be painstakingly constructed in later life. As she begins

to exercise these capacities (e.g., initiating action, using her best judgment) she enhances

her sense of competence, self esteem, and freedom.

To counter the compelling fantasy of a fast cathartic cure, the therapist may compare the

recovery process to running a marathon. Recovery is a test of endurance, requiring long

preparation and repetitive practice.

Completing the First Stage

• The survivor no longer feels completely vulnerable although still less trusting

• Development of some confidence in the ability to protect her/himself

• Patient know how to control her most disturbing symptoms

• Patient knows t who to rely on for support

Remembrance and Mourning

Reconstruction: (Telling the story in depth.) Transforms the traumatic memory so that

it can be integrated into the survivor's life story. The choice to confront the horrors of the

past rests with the survivor. The therapist is witness and ally.

As the survivor summons her memories, the need to preserve safety must be balanced

against the need to face pain. (Negotiating a safe passage)

The patient's intrusive symptoms should be monitored carefully so that the recovering

work remains within the realm of what is bearable.

A narrative that does not include the traumatic imagery and bodily sensations is barren

and incomplete. The ultimate goal, however, is to put the story, including the imagery,

into words. The patient must construct not only what happened but also what she/he felt.

The therapist must help the patient move back and forth in time, from the protected

anchorage in the present to immersion in the past, so that she can simultaneously

reexperience the feelings in all their intensity while holding on to the sense of safe

connection that was destroyed in the traumatic moment.

Why me? The arbitrary random quality of her fate defies the basic human faith in a just

or even predictable world order. She is faced with the double task of rebuilding her

own "shattered assumptions" about meaning, order, and justice in the world and also find

a way to resolve her differences with those who beliefs she can no longer share.

The therapist's role is to affirm a position of moral solidarity with the survivor.

As the therapist listens, she/he must constantly remind him/herself to make no

assumptions about either the facts or the meaning of the trauma to the patient.

The goal of recounting the trauma story is integration, not exorcism.

Transforming Traumatic Memory

Flooding: A controlled reliving experience in which the patient learns how to manage

anxiety. A script is prepared including (1) context; (2) fact; (3) emotion; (40 meaning.

The patient chooses the sequence for presentation from easiest to most difficult memories

Testimony: Similar to Flooding, it is used with survivors of political torture. The central

point is to create a detailed, extensive record of the traumatic experience.

It appears that the action of telling the story in the safety of a protected relationship can

actually produce a change in the abnormal processing of the traumatic memory.

The patient may be reluctant to give up symptoms such as nightmares and flashback

because they have acquired important meanings. The symptom may be symbolic means

for keeping faith with the lost person, a substitute for mourning, or an expression of

Mourning Traumatic Loss

Trauma inevitably brings loss. The descent into mourning is at once the most necessary

and the most dreaded task of this stage of recovery. It is an act of courage not

The Revenge Fantasy: where victim and perpetrator roles are reversed. Based on the

fantasy of getting even which is not possible. A goal is to transform anger into righteous

The Forgiveness Fantasy: transcending the rage through a willful, defiant act of love.

Healing depends on the discovery of restorative love in her own life--not on the contrition

The Compensation Fantasy: is a formidable impediment to mourning. Prolonged, fruitless

struggle to wrest compensation from the perpetrator or from others, may represent a

defense against facing the full reality of what was lost. Mourning is the only way to give

due honor to loss; there is no fair compensation. The wish for compensation ties the

survivor's fate to the perpetrator's and she is then held hostage.

In the course of therapy, the patient may focus her demands for compensation on

the therapist. She may resent the limits; insist on some form of special dispensation.

Underlying these demands is the fantasy that only the boundless love of the therapist can

undo the damage of the trauma. Unfortunately, therapists sometimes collude with their

patients fantasy of restitution. Boundary violations ultimately lead to exploitation of the

patient even when they are initially undertaken in good faith.

The only way the survivor can take full control of her recovery is to take responsibility

for it. The only way she can discover her undestroyed strengths is to use them to their

Survivors of chronic childhood abuse face the task of grieving not only what they lost

but also for what was never theirs to lose. The childhood that was stolen from them is

The reward of mourning is realized as the survivor sheds her evil, stigmatized identity

and dares to hope for new relationships in which she no longer has anything to hide.

The second stage of recovery has a timeless quality that is frightening.

The survivor may wonder how she can possible give her due respect to the horror she has

endured if she no longer devotes her life to remembrance and mourning. She will never

forget. But the time comes when the trauma no longer commands the central place in her

The reconstruction of the trauma is never completed; new events at each stage of the life

cycle will inevitably reawaken the trauma and bring some new aspects of the experience

to light. The second stage is completed when the patient reclaims her own history and

feels renewed hope and energy for engagement with life.

The survivor faces the task of creating a future:

Developing new relationships

Developing a sustaining faith

Empowerment and reconnection are the core experiences of recovery.

Taking power in life involves the conscious choice to face danger. Survivors have come

to understand their symptoms are a pathological response to danger. It is not the same

as reenactment because the task (facing danger) is taken consciously, in a planned,

As survivors recognize their own socialized assumptions that rendered them vulnerable

of exploitation in the past, they may also identify sources of continued, social pressure

that kept them confined in a victim role in the present

"I know I have myself." Her task is to become the person she wants to be. She draws

upon the aspects of herself she most values from the time before the trauma, from the

experience of the trauma itself, and from the period of recovery. Integrating all these

aspects, she creates a new self both ideally and in actuality.

Here, the work of therapy focuses on the development of desire and initiative.

As the survivor recognizes and "lets go" of those aspects of her/himself that were formed

by the traumatic experiences, she/he also becomes more forgiving of him/herself.

The survivor has regained some capacity for appropriate trust. The therapeutic alliance

feels less intense but more relaxed and secure.

As trauma receded, it no longer represents a barrier to intimacy.

Finding a Survivor Mission

This may take the form of social action and a willingness to speak the unspeakable. It is

also a form of pursuing justice.

The survivor who elects to engage in public battle cannot afford to delude herself about

The resolution is never complete, it is often sufficient for the survivor to turn her

attention from the task of recovery to the tasks of ordinary life.

Dr. Mary Harvey's (colleague of Judith Herman) criteria for the resolution of trauma:

1. Symptoms are brought within manageable limits.

2. Survivor is able to bear the feelings associated with traumatic memories.

3. Survivor has authority over the memories.

4. Memory is a coherent narrative.

5. Self esteem has been restored.

6. Important relationships have been reestablished.

7. There has been a reconstruction of a coherent system of meaning and belief that

encompasses the story of the trauma.

The restoration of social bonds begins with the discovery that one is not alone and that

others have experienced similar events and can understand them. Participation in a group

may provide a sense of "universality."