Thoughts on closure by Bryan Maier

Is closure after trauma, grief, or some other sort of suffering a realistic goal? If so, how would you know when you arrived?

My colleague, Bryan Maier has a short review post of the book Closure: The Rush to End Grief and What it Costs Us. I think you will find his thoughts compelling to consider.

Sounds like a book we should all read.

Why we react and then think

Human brain parts during a fear amygdala hijack from optical stimulus. (Photo credit: Wikipedia)

Ever wonder why? Check out this quote by Richard McNally¹ about the role of the amygdala,

LeDoux discovered two pathways for activating the amygdala, a subcortical structure integral to the experiences and expression of conditioned fear. One pathway rapidly transmits sensory input about fear stimuli to the amygdala via a subcortical route, whereas the second pathway passes through the cortex, taking twice as long to reach the amygdala. Subcortical activation of the amygdala makes it possible for a fight-or-flight reaction to begin even before information about fear-evoking stimulus has reached conscious awareness via the cortical route.” (p. 178, emphases mine)

If this is true, then in anxiety and intense emotion-producing events our brains begin the reaction phase prior to any thought processes. If true, then we might consider

1. The goal of trauma treatment or anger management is NOT to avoid having reactions but to more quickly reach cognitions and alternative emotions that help moderate a negative reaction
2. the empirical evidence for the clinical process whereby a client adopts a neutral reaction as opposed to a negative reaction is quite lacking. There are a number of models that process to “cool down” the amygdala, but these treatments often lack serious empirical support.

So, the next time you instantly react in a way that bothers you, don’t be so hard on yourself. Instead stop yourself, take a deep breath, work to analyze the situation and to lean into a post hoc truth. We have our hands full enough with what we know we need to do, we don’t need to worry so much about our first reaction.

¹McNally, R.J. (2003). Remembering Trauma. Cambridge, MA: Harvard University Press.

2 reasons why finding the root problem may not be a good goal for counselors

How important is it for a counselor to diagnose the client’s root problem? Consider these analogies:

Imagine being diagnosed with cancer in one part of your body but having your doctor tell you that it isn’t important to discover whether the source of that cancer lies elsewhere. You wouldn’t be happy and you would likely seek another opinion. Or, consider this analogy: you keep cutting off the tops of dandelions only to find that they keep coming back. Not a very wise decision. Instead, you find the tap-root and remove it if you really want to stop the weed from growing.

In the last week I have had three conversations about identifying the source or primary cause of someone’s emotional struggle. In each case I was asked questions about the source of the problem.

Is it a chemical imbalance? Is it the result of childhood trauma? Is the primary problem his sin?

I understand these questions. They are reasonable and important to ask. As a counselor, I am trying to assess how a particular psychological problem develops in an individual. But, maybe these questions aren’t as helpful as they first appear. Here are two reasons why we ought not put too much stock into seeking out the root problem and a suggestion for a different approach than the “why” question.

1. “Why” questions almost always lead to a simplistic/categorical answer. Most psychological (or spiritual) problems have multi-factored roots. There are biological predispositions, experiences, behavioral choices/habits, perceptions, beliefs, etc. all working together to “allow” the problem to develop. Usually, we do not find this kind of complexity very helpful. We like to narrow things down to single or primary problems. Narrowing down to either/or categories helps us ”understand” the problem and exert energy towards a single solution. However, when we demand a primary cause, we will almost always misrepresent the problem and may communicate to others a distorted image of what is taking place. Saying that a psychological problem is the result of sin or neurochemicals or family upbringing ALWAYS flattens the problem and as a result puts too much hope in any intervention.
2. “Why” rarely leads to the most important question, “so, now what?” Let’s say that we can figure out why you struggle with Obsessive-Compulsive Disorder (OCD). Your mother contracted a virus during the 7th month of her pregnancy and that virus altered your prenatal brain and caused your OCD. Okay…so now what? Notice how the why question provides interesting information and possibly helpful in eliminating the problem in future expecting mothers…but as enticing as it is, the diagnosis doesn’t help much with the, “so now what do I do about it.” In fact the desire to figure out the “why” never is as clear and easy as I have just made it in the virus example and so the search for “why” doesn’t lead to the “so now what” question at all. Now, I don’t want you to think that I care little for historical data gathering. The multifactorial etiology of our problems are worth exploring. We ought to take a look at how early childhood experiences shape our current behavior. We ought to explore the possibility of a biological predisposition to our anxiety. We ought to examine how our beliefs about self, other, and God influence our current problems. However, we explore these historical facets not because they answer the “why” question but because they help us understand “how” we function and whether we want to alter some of these shaping influences.

An Alternative Approach?

I’ve just tipped my hand in the last point. How is a better question. Finding out how a particular feature (belief, habit, experience, perception, biological process, etc.) influences current life and how a person might respond to or engage differently over a problematic emotional expression is more likely to bear good fruit. Consider these examples:

1. How does your history with pornography and secret shame influence your seeking accountability from your other men in the church?
2. How do you react to trauma triggers and what different responses to triggers might you want to practice?
3. How do you want to think about or assess your unwanted sexual desires and feelings?

So, asking why we do what we do or why we are the way we are is interesting but not always the most helpful question from a counselor. Instead, explore your perceptions, reactions, thoughts about what is happening and explore how you might come to feel, think, or engage the problem from a different perspective or with a different goal in mind.

Do your labels help or hurt?

I have a post over at the Seminary’s faculty blog today. You can find it here.

Counselors label all the time. Even when we don’t offer official DSM diagnoses, we label things as good, bad, healthy, unhealthy, dysfunctional, sinful, etc. The key question counselors face is WHEN and HOW to share their views on a subject. Just because we can see something is wrong doesn’t mean we ought to share it yet. While you may wish your family doctor to share suspicions of Lyme’s disease with you on the first visit, your counselor may need to earn the right to say, “I think you have become embittered over your husband’s insensitivity.”

If you are in a position of authority (parent, teacher, boss, counselor, leader, etc.) consider how quickly you use labels and whether or not they invite dialogue and action. If the result of our labeling is increased passivity in the one being labeled, then maybe we need to consider that our labeling is part of the problem.

Validating your client’s distrust of you

Ever had a person tell you they can’t trust you when you know they can? What was your response? if you are like most people, you notice the tendency to want to defend yourself. No, really, you can trust me. Why don’t you give me a chance? Or maybe your response isn’t one to beg but to back away and treat the person with a cool demeanor.

What should counselors do when a client doesn’t or won’t trust their intentions or motivations?Janina Fisher (see previous post) reminds us that the right responses is…acceptance validation. Especially with clients who experienced invalidation in violence and abuse. Notice that the effort to press a client to trust you or distancing from them sends the exact same message: your feelings and experiences are wrong and something to be rejected. Not surprisingly, clients feel invalidated once again.

What does validation look like?

You are right. You don’t know if you can trust me. Trusting important people meant that you got hurt in the past. So, not trusting me is understandable. So…what should we do? Validation doesn’t mean that we agree with whatever our clients say but that we find the truth and we underline it. Further, it means that we give the power back to our clients since many of them experienced being controlled.

Too often we think we know what is best for our clients and we try to indoctrinate them to our wisdom. Even when we are right, our efforts may unwittingly re-enact the stealing of power to set proper boundaries. Even when our clients want us to convince them that we are okay and worthy of trust, we ought to be careful. In everyday life we have to trust others, live with the possibility that our trust may be violated…and that we will need to respond to such violations with grace and truth. Promises to always be trustworthy perpetuate the myth that protection from all pain is possible in this life.

eye contact and amygdala stimulation?

I’m in the midst of a CE training by Janina Fisher–Traumatic Attachment & Affect Dysregulation–and here is something she just said (not quote…my recollection),

When you make eye contact with another, you stimulate the amgydala. The arousal of this part of the brain arouses emotions, especially those connected with desire for or fear of intimacy. The point is that eye contact stimulates the attachment system which in turn plays on our feelings about being in relationship with others.

Later, she quoted someone (named Benjamin), “To be known or recognized is immediately to experience the other’s power. The other becomes the one who can give or withhold recognition: who can see what is hidden; who can reach, conceivably even violate, the core self.”

Thus, some clients (those who are ambivalent) find our “seeing them” (via empathy) as anxiety provoking. Counselors do well to help the client notice these reactions without over-stimulating reactions (which likely would trigger fight/flight reaction).

How you feel about making eye-contact with another depends largely on (a) how you feel about that person, or (b) how you feel about yourself. Both feelings depend on prior experiences and perceptions of self and other.

Try out a few moments of eye contact, either with someone you have authority over (supervisee, child, student) or someone who has power in your life (spouse, boss, teacher). What reactions did you have? Reactions in your body, thoughts, feelings? What impulses did you have? What does this tell you about how your brain works in regard to knowing and being known?

Disagreeing in public? Are there some best practices?

I’ve written a post over at our Biblical Seminary faculty blog about the art of disagreeing with others in public. By public I mean the kinds of conversations that take place in face-to-face with an opponent, discussions of a thinker’s position in a classroom, or the kind that take place on Internet sites (e.g., blogs like this, news sites, etc.).

Check out  my 5 tips to more loving disagreements.  Try it out with your next conflict with a friend or family member.

Learning to get good grades or just learning? Or both?

I’m a professor and I know it is all about learning. Who cares about the grades? Right? What matters is whether or not students comprehend the material and can use it in real life. In my world, I want counseling students to understand the nature of trauma, how to recognize it and respond well to it when evident in their clients. I don’t care if they get an A or a C as long as they are competent. And, I know that some students test poorly and yet are exceptional counselors.

Yeah right, grades DO matter

But ask students and parents of school-age children, and guess what–grades do matter. Good grades get better scholarships; get parents off your back. Good grades get better internships. Good grades make teachers think you are smarter. Good grades help you feel better about yourself. Wait…those last two…are they true? Yes, even if it shouldn’t be that way and probably worth another post at some other time.

Is there a relationship between good grades and learning?

But how close are getting good grades and learning? Can you get good grades and not really learn? How many readers aced a history or statistics test years ago but now couldn’t tell you the first thing about the subject? You can memorize, recite, and forget…and get good grades. So, we know that you can teach and study to the test (notice I didn’t say learn) without learning.

And yet, let me suggest one positive relationship between getting good grades and learning. The student who learns to get good grades (but hopefully isn’t obsessed or controlled by them) has learned to

• Decipher what the teacher is looking for and to complete assignments as required
  • Learning: decoding, organization, self-assessment, predicting time/effort needed to complete tasks
• Get the information needed to complete an assignment
  • Learning: speed reading, efficient categorization of material
• Deliver the information needed in an appropriate format
  • Learning: concise communication, learning to differentiate between essential and non-essential material

The real reason I’m writing this post

Okay, the real reason I am writing this post is that I just helped my teenage son take a difficult, on-line quiz that covered an inordinate amount of material. He was allowed to complete the quiz while having the material still open. However, the amount of material he had to read and understand comprised overwhelmed his ability to remember what he learned and where he learned it. So, I taught him how to read the quiz question and then go back to the multiple e-documents and use the “find” button on his web browser to find the pertinent information he needed to answer the question.

Did I help my son learn or just to get a better grade on his assignment? If he chooses to not read the material in the future but just use the search functions, is that a failure to learn well or did he learn to become efficient in work?

Why is some trauma complex? A helpful distinction from Judith Herman

Counselors talk about trauma as if all traumas lead to traumatic reactions. They do not. Some people have significant distress from what might be considered slight traumatic experiences (surely an oxymoron!) while others appear not have any negative or ongoing reactions to very large distressing events.

There’s another problem. We sometimes talk as if all traumatic reactions are the same. This is also not the case. While the symptoms of posttraumatic stress disorder (PTSD) are well-known to many (i.e., intrusive re-experiencing of trauma experiences, emotional numbing and other attempts of avoiding memories or triggers, and hypervigilance), you can find counseling students and practitioners who are less aware of a cousin of PTSD: Complex Trauma.

Defining Complex Trauma

I’m reading Treating complex Traumatic Stress Disorders: An Evidence-Based Guide, edited by Christine Courtois and Julian Ford (Guilford Press, 2009). This is an excellent text if you are interested in exploring the symptoms, neurobiology, and treatment protocols for complex trauma. In the foreword, Judith Herman helps the reader clarify the main difference between regular and complex trauma

These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator. (xiv, emphases mine).

For trauma to become complex one needs to experience the trauma at the hands of those who are most perceived to control a social unit (family, community, etc.). It needs to be repeated and woven into the fabric of distorted relationships. You can see that prolonged abuses experienced as a child prior to development of an understanding of the world and of the self would have more devastating impact than an unfortunate and distressing event that happens as an adult. If I experience a horrific accident and an unexpected attack by a stranger, I would not, usually, begin to feel unsafe amongst friends and family. I would likely continue to trust them even as I might not trust the larger community. However, if I experience repeated abuse by a teacher, a parent, a relative, a church leader as a young child, I do not have the prior experiences of safety to rely on and thus, I am likely to experience all of the symptoms of PTSD and then some more.

What More Symptoms?

Courtois and Ford give a cursory description of complex trauma on the first page of the book,

…involving traumatic stressors that (1) are repetitive or prolonged; (2) involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults; (3) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and (4) have great potential to compromise severely a child’s development.

Adding to the typical symptoms of PTSD, complex trauma victims also struggle to regulate emotions, impulses, somatic experiences, consciousness, and evidence significant distortions in views of the self and others leading to difficulty forming trust relationships and finding meaning in life and faith.

Those interested in learning more about the current thinking on complex trauma conceptualization and treatment may find this book useful. Others may wish to check out the latest articles at www.traumacenter.org, one of the leading centers in the country focused on the problem of trauma.

3 important goals for trauma recovery

In the last week we have been discussing the best words used to describe the process of trauma recovery (see related post below). While words are important and carry much meaning, it may be more helpful to consider what recovery goals are in order for trauma victims. While we know recovery road can be long and arduous, it helps to know when we make progress and a general sense of the direction we are headed. In the days before GPS, if you went on a long car trip you probably consulted a map on several occasions in order to make sure you were headed in the right direction. So also, when you are working to get better after a traumatic experience, you want some sense you are still working on good goals. This need is especially great if the traumatic symptoms are complex and the treatment not brief (think war, genocide, child sexual abuse, etc.)

What three goals?

Esad Boskailo, as noted on p. 94 in his memoir (written and reported by Julie Lieblich) works toward these three goals that in turn support the ultimate goal: thriving (notice that the goal is not being free of symptoms, free of triggers, or back to life as if the trauma did not happen).

• Acknowledge losses
• Foster resiliency (i.e., build the capacity to use current coping resources)
• Find meaning in life again

I think these do function well as helpful signposts or intermediate goals in the process of recovery from traumatic experiences. Now, I don’t believe these goals are necessarily in sequence. For some clients, they stumble on something that gives new meaning to life and thus are better able to acknowledge losses. Others get to work on building better coping mechanisms (e.g., a vet puts away items that cause him or her to dissociate, an adult victim of CSA stops cutting and develops acceptance strategies, etc.) and then can acknowledge losses.

So, in the murky water of therapy (and it surely is murky!), the trauma victim can find some comfort in activities pointing to these intermediate goals. Each day they reject self-condemnation for not being who they used to be before the trauma, they are moving toward thriving. Each day they embrace available coping resources (e.g., a friend who will call or pray), they are moving toward thriving. Each day they find one meaningful experience, they are moving toward thriving.

the how we meet these goals is, of course, the 64,000 dollar question…and not something we can set in stone. I will write on some general activities that are common in most treatment modalities in the coming days.

Related articles

• Trauma recovery? Healing? Integration? Which words communicate a good outcome to you? (wisecounsel.wordpress.com)