Friday, April 10, 2009

PTSD Healing: Let's Talk - About the Couch

For the next couple of weeks I want to really take this idea of education and drill down into the most popular available treatments so that we learn, hear and see just what, exactly, they have to offer. During my healing I tried all of the most popular techniques, so I can tell you my experience mixed with the theory and facts of each approach. Since it’s the place where most of us begin, I’ll start with psychotherapy.

I went into traditional talk therapy kicking and (not talking but) screaming. I was not a talker. I was a hold-everything-inside-and-to-myselfer. I never spoke about my trauma or divulged the pain in which I lived. I raged and that was all you’d get if you asked me what was wrong. Off with your head! And then I disappeared down my own rabbit hole. I was 30 when I began therapy, which means 17 years had passed since my trauma.

I wound up in therapy before my PTSD diagnosis. As my PTSD experience progressed and became wildly out of control my coping mechanisms and strategies began to fail. The more emotionally unstable I became the more my body began to manifest physical illnesses that mirrored the deterioration of my mental state, plus aspects of my original trauma. Finally, I was one very sick woman in both body and soul. So sick, in fact, that I required constant medical care and lost my job because I was too ill to work.

After about a year of this total disintegration it was my mother who – despite my screaming to leave me alone – found a therapist for me to speak with. The original intent was that I find someone to help me learn to cope with chronic illness. The focus was on helping me find a way to hold myself together while everything around and about me fell apart. I finally agreed to therapy one dark December day 1998 as I stood on the corner of Park Avenue and 52nd street in Manhattan, having a meltdown, sobbing hysterically, frightened by my physical and mental ill health and unable to get a grip.

OK, so not everyone has to be hit over the head to realize they need help. I am that kind of person; you don’t have to be. The benefit of therapy before you have a meltdown is that you can… well… perhaps avert the meltdown and so your healing doesn’t have to begin on the level of micro-organisms. You can begin your ascension to health a little higher up on the food chain than I did.

Later today I’ll post about my first meeting with my therapist. It’s a chapter from my forthcoming memoir about living and coping with – and healing – PTSD. For those of you who haven’t yet gotten yourself into the chair, you’ll see it’s not so bad, and that many good things can come out of it.

For now, let’s get a little clinical in our understanding of psychotherapy and its place in the healing mix. A definition of psychotherapy provided by MSN Encarta is as follows:

“…treatment of individuals with emotional problems, behavioral problems, or mental illness primarily through verbal communication. In most types of psychotherapy, a person discusses his or her problems one-on-one with a therapist. The therapist tries to understand the person’s problems and to help the individual change distressing thoughts, feelings, or behaviors.”

A few stats about psychotherapy:

--According to one study summarized by the APA online, 77% of people who entered therapy were better off than those who didn’t.

--91% of Americans are likely to consult or suggest that a family member consult with a mental health professional

--50% of Americans believe the stigma surrounding mental health services has decreased

--Long-term psychotherapy accounts for only 15.7% of psychotherapy

Talk therapy, as the most ubiquitous and familiar type of therapy, is a good place for PTSD sufferers to begin. In order to successfully heal, we need to find the words to describe what’s wrong, what we’re thinking, how we’re feeling and why we’re feeling it. For me this was the hardest part of healing and the thing that most impeded my progress. I could not find the words. And if I could, I could not speak them. I had a terrific fear that saying anything aloud would completely decimate me. I could barely hold myself together when I wasn't speaking; I utterly believed I’d lose my fragile grip on sanity if I had to put it all in language and share it with someone else. Plus, I didn't want to be pitied and I didn't want to appear weak. I was a survivor, after all. I had an image to uphold!

But these are ridiculous thoughts when PTSD is strangling our lives. When we find the right person to talk to in the right environment where we feel safe, secure, unjudged and supported the words can be coaxed and the mind can find the strength to face what needs to be faced and this is a strong act. It ain’t easy, but it's necessary. There were many days that were worse in the short-term because I was putting all this awful stuff on the table. But the long-term benefits included a clarity that was unexpected. The amorphous stuff in my head finally began to take shape: I finally regained an iota of control over what I was thinking and that is powerful stuff.

I don’t believe traditional talk therapy can heal PTSD. Talking exists too much and too completely in the conscious realm and I believe the crux of healing PTSD lies in a major perceptual shift in the deeper subconscious realm. But it’s a vital place to begin. In the way that psychotherapy helps us give language to our experience, I believe it is the perfect place to commence recovering our own personal power, and paving the way to reach that part of the mind that lies below the 12% of our conscious experience the world.

Trauma takes away the words. A survivor wrote me recently that trauma and PTSD are a ‘silent scream’ – and I thought, Yes!.

In order to heal we have to break the silence. With the right therapist, psychotherapy gives us tools for learning to how do that.

For further reading:

1 – An overview of psychotherapy on Encarta

2 – ‘The Risks and Benefits of Psychotherapy’ – a great (and short) summary by Joyce Nash, PhD.

3 - ‘To Reap Psychotherapy’s Benefits, Get a Good Fit’ – A terrific article by Howard Friedman in the New York Times about the importance of finding the right therapist.

4 - American Therapy: The Rise of Psychotherapy in America – This new book by Jonathan Engle traces the evolution of American mental healthcare covering contributions of personalities, theories and techniques in psychiatry, psychology and social work.

What’ s been your experience with psychotherapy? Has it helped? What’s been the biggest benefit for you? Leave a comment or shoot me an email.

(Photo: maryanna)


Anonymous said...

" Talking exists too much and too completely in the conscious realm and I believe the crux of healing PTSD lies in a major perceptual shift in the deeper subconscious realm"

I think there is a lot of truth in that. PTSD is much more a function of our 'older' emotional or primitve brain and this is largely unconscious.

The two treatments that seem to work well - CBT and EMDR seem to be working more directly with the unconscious mind.

Talking about it may help a little but there are limits because it's not our conscious thinking that is so faulty. Instead it's the swamp out of which conscious thinking grows that needs to be cleaned up.

I'd be surprised if even 10% of the work I've done is involved with what we normally call thinking.

Anonymous said...

what a wonderful blog. thank you! i have never been diagnosed with ptsd but i can relate to many of the symptoms. i have found therapy very helpful, but only to a certain extent. as you mentioned, talking only gets so much done. and therapists are human too and not miracle workers! but definitely the talking was so important. finding my voice. feeling like i had the right to speak and take up any space. writing and finding friends with whom i could relate and share our stories has also been very healing. i look forward to reading more of your blog. thanks!

Michele Rosenthal said...

@mountainmama - Hey, great to hear from you! So true to remind us that therapists are only human. I'm sure I deified mine when I needed something BIG to believe in. :)

I wish there was a definitive path for all of us to follow that would make us feel we have 'the right' -- in so many ways that's important to healing.

Looking forward to hearing more from you in the future!