What is C-PTSD? How is it Similar and Different from Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) are both neurobiological disorders that occur when someone experiences or witnesses a traumatic event. Examples include, but are not limited to, war or combat, natural disasters, physical or sexual assaults, and life-threatening accidents.

Almost all of us associate PTSD with veterans. We understand combat is gruesome on the body and devastating to the psyche. We realize war is hell, if only we look at the faces of our veterans when they return. We know, even without words, that they went through something far beyond the scope of normal human experience. In fact, generations before the term “post-traumatic stress disorder” became public knowledge, and added by the American Psychiatric Association to the Diagnostic and Statistical Manuel of Mental Disorders in the 1980s, PTSD was known by other names: war neurosis, shell shock, soldier’s heart, or combat fatigue. Furthermore, much of the research, advocacy, awareness, and treatment options for PTSD have been through means such as the U.S. Department of Veterans Affairs. Thus, it makes sense we as a collective society to visualize a soldier in battle when we think of PTSD.

However, across the general population and in terms of numbers, PTSD is most prevalent in people who have experienced dangerous, life-altering events. It seems to be most frequent in survivors of sexual assault or those who went through or witnessed violent car accidents, both which involve powerlessness, danger, and terror. Furthermore, PTSD can occur in populations that often are forgotten to be traumatic, such as ICU stays.

It is believed most people will experience at least one traumatic event in their lives, and a fourth will develop PTSD. It is not known how many people live with C-PTSD.

Symptoms of PTSD

People who suffer from trauma may feel its impact for days; this is called acute trauma. If the symptoms continue for weeks or longer, and if they are disruptive to daily living, that is suggestive of PTSD.

There are three types of PTSD symptoms:
Hyperarousal symptoms. People with PTSD may have sense-of-threat symptoms, as if they are on edge and hypervigilant of their environment. They can have a startled response such as jumpiness.

Re-experiencing symptoms. Nightmares and flashbacks are the hallmark symptoms of PTSD. The individual may “go through” the trauma again via memories, via sensory experiences and emotions. The individual may feel the same smells, sights, sounds of the trauma.

Avoidance symptoms. Those living with PTSD will participate in avoidance symptoms, as in avoiding triggers associated with the trauma. This is broad, and can include places, situations, people, or events (i.e., holidays). They may also attempt to drown the symptoms through self-medicating with alcohol or other substances.

What is Complex Post-Traumatic Stress Disorder?

C-PTSD is a messier, multilayered version of PTSD which involves prolonged or chronic attacks on an individual’s sense of safety, self-worth, and integrity. This is dissimilar to PTSD, which is the result of one traumatic event. The ongoing maltreatment causes a multitude of additional symptoms, which shape neuropsychological development such as personality.

C-PTSD results from situations of chronic powerlessness and a lack of control, such as long-standing domestic violence (whether experienced or witnessed), sex trafficking, or child maltreatment. However, it is most common in those who were subjected to child abuse or neglect beginning in the earliest formative years, especially if the harm is by a caregiver or other significant adult, and there is a lack of hope for escape or that the situation can otherwise improve. Also, multiple traumas increase the risk of developing C-PTSD too.

Symptoms of C-PTSD

People with C-PTSD have compounded symptoms of both PTSD and those from other mental health disorders. These may include the following:

Psychosomatic issues: Psychosomatic issues are physical issues without a medical explanation, caused or worsened by a psychological reason such as stress. It is common for people with C-PTSD to have vague physical symptoms such as dizziness, chest pains, abdominal aches, and headaches.

Emotional flashbacks: A flashback is a vivid, intense experience in which a person will relive some parts of a trauma or feel as if it is happening in the present. Stereotypically, people tend to think of the war veteran who is having a “movie-like” flashback in which the event unfolds again in its entirety. However, a flashback does not need to be so extreme – and usually they are not.

People with C-PTSD are likelier to experience what is called an emotional flashback – that is, the emotions experienced during the trauma, such as shame or fear. Such individuals may react to these events in the present, unaware they are having a flashback.

Difficulty regulating emotions: Those with C-PTSD may experience sharp, vivid emotions which can be inappropriate for the situation. These rapid shifts in mood can be misdiagnosed as bipolar disorder or borderline personality disorder, which can have similar features but are not the same.

Flat affect: People with C-PTSD may also have a flat affect, meaning they appear numb, somber, or emotionless to others. This body language can be misinterpreted by others, making people think the individual is feeling a certain way or is aloof. In truth, the person may have a rich, complex inner world of their emotions and be feeling very differently than how they are expressing themselves.

There are several reasons for a flat affect. One powerful reason is because the individual may not have witnessed emotional expression in their formative years, thus in turn they have been sharpened to be “flat” as an adult. To explain it plainly, imagine a primary caregiver not smiling at their baby. The baby mimics and responds to the caregiver by also not smiling. This is sharpening the baby to respond such a way going forward.

A lack of emotional vocabulary: Finally, individuals with C-PTSD may have difficulty with articulating their emotions or they may not understand what they feel; that is, there is an absence of an emotional vocabulary. They may struggle in therapy when asked “what are you feeling?” and respond with “I don’t know” or they may describe a physiological feeling instead (i.e., tiredness, nausea). This is because in the context of prolonged trauma they had to adapt to shutting down their emotions to survive. For example, they may have been programmed in their earliest years to think “emotions are bad” because they were consistently invalidated or punished for emotional expression by their caregivers.

Dissociation: Dissociation happens to everyone. Dissociation is a sensation of feeling disconnected from oneself and the world through a sensory experience, thought, sense of self, or time. A person who dissociates may feel depersonalization (detached from their body) or derealization (feeling as if their surroundings are unreal). And at one time or another, all of us have dissociated. Getting lost in a daydream, forgetting the details of a car drive, or spacing out during a boring class lecture are all examples of dissociation.

When applied to trauma, dissociation is an innate coping mechanism. It is a protective action taken by the mind to let an individual survive a traumatic experience. At the time of the event, dissociation is beneficial, especially for children as they often lack insight and more sophisticated coping skills. However, the downside of dissociation is that when someone has dissociation and is at risk of developing C-PTSD or another trauma-related disorder, the dissociation does not resolve the trauma. In adulthood, the effects of dissociation can negate the ability to trust, form and maintain healthy relationships, and prioritize self-care. Through the phenomenon of mind-body separation, individuals may develop self-destructive behaviors such as ones that keep them dissociated (“I can’t tell when I’m feeling hungry, so I eat less than I should”) or ones to make them dissociate (“I drink alcohol to numb myself so I don’t have to feel my despair”).

(Dissociation is a complicated phenomenon which cannot be fully explained in a few paragraphs. The article writer will make a detailed blog entry dedicated solely to dissociation in the future.)

Negative core beliefs: Individuals with C-PTSD may have the core belief “I am not safe” or “the world is unsafe.” Alternatively, they may have other core beliefs (“I am unlovable” or “I am not worthy of respect”, for example). These core beliefs are deeply ingrained, at the pool of their identities, which can mean the individual is unaware they even carry such beliefs until they develop more insight.

Relationship difficulties: Individuals with C-PTSD can struggle with developing and maintaining healthy relationships. Such individuals struggle with feeling able to trust others due to their traumatic histories; thus, they may isolate themselves or feel intensely uncomfortable with “opening up” to others. Or they may respond inappropriately in a social situation. Unfortunately, these factors only enhance their risk of disapproval or misunderstanding by others, which makes them more susceptible to social isolation or ridicule.

Additionally, people with C-PTSD are more susceptible to entering and remaining in abusive relationships – especially those who already experienced abuse. 

Treatment for C-PTSD

C-PTSD is a treatable condition. However, clients (patients) should be cautious when selecting their therapist. The treatment of complex trauma is a specialty, and not all therapists have the knowledge, skills, or experience to adequately support those who have C-PTSD. Thus, it is encouraged to “screen” the therapist during the consultation session by asking for their background in treating C-PTSD. Much like we may make thoughtful, careful choices about our medical doctors, the same should be done for therapists too!

Ask the therapist about their intervention styles (treatment approaches) as well.

The following treatments are frequently employed for C-PTSD treatment:

• Eye Movement Desensitization and Reprocessing (EMDR) Therapy. In EMDR, the individual reflects on a trauma while following a bilateral stimulus that results in the eyes moving back-and-forth. EMDR is considered a “hallmark treatment” for PTSD and C-PTSD.
• Trauma processing therapies.
• Exposure therapy, in which individuals re-experience their traumas in a safe, controlled environment.
• Cognitive Behavior Therapy (CBT), which focuses on the relationship between cognitions (thoughts), emotions, physiological sensations, thereby changing the resulting behaviors.
• Dialectical Behavior Therapy (DBT), an off-set from CBT which also includes interpersonal effectiveness (relationship skills), emotional regulation, distress tolerance, and mindfulness.
• Cognitive Processing Therapy (CPT), a behavioral therapy that challenges and changes unhelpful beliefs associated with the traumatic events

There is hope for healing from complex post-traumatic stress disorder!

Looking For a Therapist?

All of our counselors here at Long Island EMDR specialize in trauma work. We have a variety of sub-specialities within that including sexual assault, domestic violence, infertility, childhood abuse/neglect, loss of a loved one and bullying. Contact our office today to schedule with a therapist who meets your needs and start living the in the present.

Citations/further information:

Websites:
American Psychological Association (APA) – PTSD Treatments
https://www.apa.org/ptsd-guideline/treatments

CPTSD Foundation: https://cptsdfoundation.org

Healing From Complex Trauma & PTSD/CPTSD

(Complex) Post Traumatic Stress Disorder

https://www.healingfromcomplextraumaandptsd.com

Mind – Complex post-traumatic stress disorder (complex PTSD)
https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/complex-ptsd

U.S. Department of Veterans Affairs – National Center for PTSDhttps://www.ptsd.va.gov/index.asp

WebMD – What to Know About Complex PTSD and Its Symptoms
https://www.webmd.com/mental-health/what-to-know-complex-ptsd-symptoms


Books:
Pete Walker – Complex PTSD: From Surviving to Thriving

Arielle Schwartz – The Complex PTSD Workbook

Bessel van der Kolk – The Body Keeps the Score

-Valerie Smith, LMSW

How Does Trauma to One Family Member Affect the Entire Family Unit?

What Does This Look Like When a Child is the Victim of Trauma?

Children are incredibly resilient beings and can overcome trauma or have the effects significantly minimized by having supportive, empowering and understanding parents. When the parents' response to the traumatic situation is negative it can be more traumatized to the child then the direct trauma exposure.

For example, if a teenage girl is raped by a stranger and the parents belittel and blame the teenager for “being stupid”, not “knowing better”, dressing a certain way or being in a certain place- this inevitably leaves that child feeling like they are to blame for what happened to them and something is inherently wrong with them to have caused such a thing to occur. This can leave that teenage girl feeling hopeless, lost, unsupported and very alone. If she then begins to act out and becomes promiscuous, or her grades drop because she has PTSD and cannot focus as well, or become irritable and has more outbursts towards the parents, the child again will likely be blamed for their behavior. All of her cries for support, her showing she is struggling will only continue to serve the narrative that that child is inherently bad, defective, and unlovable. The parents' reaction to her only continues to show her the world is unsafe, unsupportive, and people in general are not to be counted on or trusted. 

Consequences of When it is Not Discussed

In both cases, parents' own trauma may account for their responses. A parent may be too triggered by that child’s sexual abuse to listen to them discuss it causing scenario 2. Alternatively, the parent could have their own history of sexual assault and blame themselves so they project their anger and blame on the child as they never fully coped with what happened to them. Furthermore, a parent’s lack of experience dealing with trauma themselves can cause them to feel inadequate in supporting their child in coping with trauma.

What Effect Can a Traumatized Parent Have on Their Children?

There are two main ways that children are affected when a parent is traumatized:

1. Witnessing a parent’s trauma.
2. Experiencing posttraumatic symptoms of the parent.

1. Witnessing a Parents Trauma

Witnessing could be through a child witnessing domestic violence or sexual assault of their parent. Children who witness a parent’s trauma may feel fearful and anxious. They may always be on guard, wondering when the next violent event will happen, waiting for the next shoe to drop. This can be seen in different behaviors depending on the child’s age.

Family Trauma Signs in Children under 5:

• Regressive behaviors such as bed wetting, thumb sucking and increased need for attention (whining/crying). 
• Difficulty falling and/or staying asleep
• Development stutters
• Development of fear-based behaviors such as hiding
• Severe symptoms of separation anxiety

Signs in Elementary School Children:

• Feelings of guilt and self-blame for the abuse
• Low self esteem
• Decrease in academic performance
• Increased behavioral issues at school
• Difficult making and keeping friends
• Somatic complaints such as stomach aches or headaches with no known medical cause

Signs in Teens:

• Acting out or oppositional behaviors
• High-Risk Behaviors such as unprotected sex, drug/aclohcol use, stealing, crimal behaviors
• Low self-esteem
• Low threshold for stress

It is important to note that there is a distinction between common behaviors for girls and boys- though this does not mean it cannot present in the opposite way. Boys are more likely to engage in oppositional, aggressive, and what we would generally call “acting-out” activities. Girls are more likely to “act-inward” and thus struggle with low-self esteem, depression, self-harming, and socially isolative behaviors.

2. Experiencing posttraumatic symptoms of the parent

When individuals struggle with PTSD they can have a range of symptoms that have an effect on their children and spouse. The 2 most common that affect the family unit are: re-experiencing symptoms and avoidance and numbing symptoms. 

Re-Experiencing Symptoms:

PTSD can cause flashbacks and/or nightmares which are what we call re-experiencing symptoms. These symptoms can occur quickly and seemingly to bystanders as “out of nowhere”. They usually bring with them strong feelings and emotions of guilt, shame, anger, grief or fear. For some individuals the flashbacks can be so severe they feel as if the memory is occurring in real time. To children and partners this can be quite scary. The parent’s behavior is unpredictable. They may not understand why the family member is acting this way or what caused it. It can cause children to worry about that parent or feel that their parent is too fragile or unstable to take care of them. For a partner it can put them in a caregiver role and make them feel hopeless about how to get their partner back to who they were before the trauma. 

Avoidance and Numbing Symptoms:

It is common for anyone experiencing PTSD to try to avoid trauma reminders and/or triggers. This may cause them to avoid people, places and things that remind them of their trauma. It can also cause them difficulty in experiencing joy and pleasure in things they used to love. Leaving that family member to feel detached or cut-off from their partner and children. Avoidance and Numbing can leave partners and children feeling unloved, unsupported and unimportant. As the trauma survivor may be hesitant to go to family events, holidays, kids games and struggle to connect with and engage with their loved ones like they used to. 

Because the re-experiencing symptoms are so upsetting, people with PTSD try not to think about the event. If you have PTSD, you may also try to avoid places and things that remind you of the trauma. Or you may not feel like doing things that used to be fun, like going to the movies or your child's event. It can also be hard for people with PTSD to have good feelings. You may feel "cut off" from family and children. As a result, children may feel that the parent with PTSD does not care about them.

How Does Trauma of One Sibling Effects the Other Siblings?

In my work, I have seen children whose siblings have experienced trauma struggle with many of the same trauma reactions and negative core beliefs. This is often due to parents focusing on trying to help the traumatized child and thus the sibling feeling neglected or pushed aside and unsupported. These children then tend to have a lot of the same acting-out or acting-in behaviors we described above. Many of them struggle with core beliefs of “I am responsible” “I have to be in control”; “I am unimportant/unlovable/defective”. This also occurs in children who are just so terrified of what happened to their sibling happening to them or anyone else they love that they are chronically anxious and fearful of the world.

Where to Start if You're Struggling With Family Trauma

What Therapy Will Look Like for Family Trauma:

Our assessments will focus on both individual and interpersonal consequences of the trauma, including parent-child interactions, discipline, communication and other areas of family functioning. Depending on your family situation, we may recommend individual sessions for multiple family members who are being affected by the aftermath of the trauma, in conjunction with family sessions to work on the interpersonal relationships when everyone is ready. As always our approach will be tailored to each unique family and individual. We have a range of therapists and modalities, including: EMDR, TF-CBT, art therapy, bereavement counseling and couples counseling, to ensure that each family and family member has an approach that works for them.

California was the first state to legalize marijuana for medical purposes in 1996, having come a long way since marijuana was placed as a Schedule 1 drug in the Controlled Substances Act of 1970. Since then, there have been many debates surrounding the medical benefits of marijuana.

While many states have legalized marijuana for medical purposes, the FDA has only approved the use of medical marijuana for two rare forms of epilepsy, Dravet syndrome and Lennox Gastaut syndrome. With regards to mental health, some states have approved medical marijuana in the treatment of PTSD. While research into medical marijuana and its effect on PTSD is underdeveloped, clinical trials and anecdotal evidence from PTSD sufferers demonstrate the positive impact of the drug on their symptoms. This may be due to the fact that cannabis can reduce activity in the amygdala, the brains “fight or flight” center. There is also some evidence that demonstrates the plant’s cannabinoids could play a role in extinguishing traumatic memories.

Advocates for the drug claim it has therapeutic benefits for a variety of mental health conditions, including insomnia, depression, anxiety, stress, and schizophrenia. An internet search on the topic will lead you to believe that medical marijuana is a “cure all”; a natural remedy that has endless benefits. However, when you take a closer look at the information available, one thing becomes clear: there is just not enough research to draw any substantial conclusions regarding the benefit of medical marijuana for mental health. 

Research on medical marijuana extremely limited in the United States. This is due to the fact that it is still not legal on a federal level. From 1968 until now, researchers have only been allowed to use cannabis from one source for research, a facility at the University of Mississippi. However, as of May of 2021, the DEA stated its plan approve more growers, which will allow for more widespread research to be conducted.

Until then, here’s what we know when it comes to marijuana as it pertains to mental health. The main psychoactive ingredient in marijuana, THC, stimulates the part of your brain that responds to pleasure. This results in production of the dopamine, a neurotransmitter that results in relaxation and euphoria. Subjective experiences and limited research indicate marijuana may have a positive effect on anxiety and insomnia. However, not everyone’s experience with marijuana is the same. Some users experience increased anxiety, fear, panic, or paranoia. Using marijuana also has the potential to increase the likelihood of clinical depression, or worsen the symptoms of any mental health challenges you already have.

Due to the above risks and lack of evidence of the benefits, self-medicating with marijuana to manage your mental health symptoms is not advisible. However, whatever you chose to do, the most important thing is to talk openly with your doctor, psychiatrist, and/or therapist about your usage and how it impacts your mental health. If you believe medical marijuana to be of benefit for your mental health, ideally it would be prescribed and regulated by a doctor. Due to current laws in the state in which you reside, this may not be an option. In the meantime in addition to being honest with your providers, be sure to explore alternative techniques to manage your symptoms, including mindfulness, psychiatric medications, meditation, herbs/supplements, and exercise.

- Alexandria Baxter, LMSW

There are many differences between experiencing trauma as an adult and experiencing trauma as a child. One difference is that experiencing a stressful event as a child can cause an everlasting impact throughout adulthood. This everlasting impact is what affects the ‘inner child’ when those children become adults. The inner child is something that exists within everyone. It is the playful, fun, cheerful, hurt, as well as saddened child we once were. Any traumatic or stressful event that was experienced as a child is remembered by the body, and that is how it continues to affect us into adulthood.

"A child who does not play is not a child, but the man who does not play has lost forever the child who lived in him." - Pablo Neruda

The obstacle to overcome when attempting to heal the inner child is being able to understand, connect with, and accept the child within. Inner child wounds can be because of abuse that was experienced as a child, neglect, distressful events, loss of a loved one at an early age, as well as many more. Tending to the inner child can allow for growth and prosperity for later life.

Some Signs That Your Inner Child May Be Impacting You:

• Having feelings of shame, guilt, inner restlessness
• Having feelings of worthlessness, never feeling satisfied with self
• Negative self-talk
• Having the need to be a perfectionist with responsibilities or tasks
• Self-sabotage, self-destructive behaviors
• Excessive work ethic
• A pattern of unhealthy/unstable relationships
• Chronic overworking and overachievement (to knowingly or unknowingly gain approval, praise or belonging)
• Not being able to be in the here and now (present moment)

Taking steps towards healing the inner child can be done with seeking therapy, practicing mindfulness skills, as well as increasing one’s own level of self-awareness. Navigating inner child work with a therapist can allow you to work through that trauma, distressing memories and emotions. Working through these events can be distressing in and of itself, though having someone who is trained to support people with these types of issues can allow for many doors to open. The goal of inner child work within therapy is to explore these past events, with an emphasis on early memories to learn skills on how to regulate the self. 

Some Inner Child Mindfulness Practice:

Heal Your Inner Child Meditation

-Conor Ohland, MHC-LP

Many of my clients have difficulty living the life they want and need to feel truly happy. They struggle with expectations placed on them by others, feelings of guilt if they put themselves first and most days feel like they cannot catch their breathe. Trauma therapy can help you to end old patterns and put yourself first. Self-care isn't selfish- I know it's a clique but it is true. You need to take care of you to be your best self for your family, friends and career. If this is speaking to you, strap in- I have some Pro-tips for you.

1. Evaluate Your Values

What is most important to you? List 3 things. Could be family, honesty, integrity, compassion, trust etc. Then you need to start seeing if your actions actually align with your values. Those that do keep at them- those that don't make an effort to change them. For example, if you choose "family, compassion and health" and you are offered an additional work shift. Is taking this shift detracting from your family time? Do you need a mental health break or day off to take care of you? If so say no. If it's to help a colleague who is going through a rough time and you feel you have enough time on another day to take care of you and spend time with family and you want to honor that "compassion" value you can also say yes. Seeing how our actions are in align with our values helps us to begin living a life that makes us happy- not a life that is spent trying to appease or please others.

2. Set Some Boundaries

In set with setting those values is setting up some boundaries with those around us. When we have no boundaries- meaning we having difficulty saying no or often do things out of pleasing others even if it's not what we want- we continue to feel exhausted, unhappy and overwhelmed. Boundaries despite what childhood may have taught you are actually healthy. Saying "No I'm sorry I can't go out tonight", "No I won't be able to take on that extra project with my current workload as it stands",or "I would appreciate if you refrained from "xyz" in front of my children" is the first step to reducing our triggers, reducing your stress load and giving yourself the time to focus on you and do what makes YOU happy.

3. Let Go of the Guilt

Often times my clients struggle with boundaries because of the guilt they feel in saying no to others. They feel responsible to take on the problems of those around them. They are accustom to the role of "fixer". Those around them, often family members but sometimes even colleagues or bosses sometimes push back on boundaries set and plead or ridicule them if they don't get what they want. I'm not going to say setting boundaries is an easy task when you are accustom to saying "yes" to everything because your role has always been to put others before you. But I will say the more you stick to your boundaries, the less others push back over time. It helps to see if keeping those boundaries is in alignment with your values or the type of person you are aspiring to be. Simple answer my look like "yes, I value helping others". With a closer look though it's easy to see it is hard to be our best self for others when you are running on empty. As I often tell my trauma therapy clients, and as they say on the air plane "put your mask on first" before you help those around you. It also helps to make a list of the short term positive gain of letting others violate your boundary and the long term consequences. For example, lets say you have difficulty saying no at work and are constantly taking on additional tasks asked of you.

After making this list you may decide to have a conversation with your boss and say "I would love to be able to help with that project but I already have 3 other projects I am currently working on. I will need to finish those first before I can take on any more. It's important to me that the quality of my work meets the standard and I am afraid I won't be able to complete all projects to our client's expectations." Starting an honest dialogue can help you feel more in control and will likely make you a better employee. Same with friends and family, when you are happier and more relaxed you can be your best self for your spouse, children, parents and friends. If this seems daunting, trauma therapy can surely help you work through your fears and doubts.

Need Help?

If this sounds daunting, you may need some extra support in navigating beginning to set boundaries and taking back control of your life. This is really common with clients who have trauma, are children of alcoholics, were parentified children (children that functioned more as parents), and those with low self-esteem and attachment difficulties (as they often fear boundaries will push others away). Trauma therapy can help! Just like my clients you can take back your life, begin to feel in control, less overwhelmed, more peaceful and joyful. You deserve happiness too. If you need the extra support in getting there give our office a call. We would love to help you on that journey.

Sending love & light,

Jamie Vollmoeller, LCSW

LGBT+ affirming therapy/counseling in Smithtown, NY and Bohemia, NY

LGBT+ affirming therapy/counseling online across New York State

Long Island EMDR offers counseling/therapy to the LGBT+ population.

A counselor or therapist that treats LGBT+ people needs to be more than just “gay friendly”.  

Being “LGBT+ informed” is ever changing! Our therapists engage in continuing training/education to best meet your needs. LGBT+ affirming therapy is based on the idea that being a part of the LGBT+ community is not in itself pathological or wrong. What is wrong, is the discrimination that LGBT+ people face, just by choosing to be who they are. This discrimination can happen in very bold or very subtle ways and it can happen in many different aspects of society. The impact that this discrimination has on LGBT+ people can lead to the development of symptomatic conditions.

Trauma-Informed LGBT+ Therapy

LGBT+ individuals experience abuse and neglect as children and adolescents at higher rates than the general public. As a result, the prevalence of sexual assault is higher among the LGBT+ population. Growing up LGBT+ many of our clients experience trauma in: coming out, deciding not to come out and just being your true and authentic self. Therefore, our practice is proud to be a trauma-informed practice with multiple EMDR and TF-CBT trained clinicians.

Long Island EMDR is proud to offer a safe space and open environment to talk about who you are and who you may want to be. SFT is also proud to offer affirming therapy/counseling to individuals, couples, families and groups in the LGBT+ community. Contact us today!

TF-CBT may sound like an intense acronym and a bit overwhelming. We therapists love our acronyms! It stands for Trauma-Focused Cognitive Behavioral Therapy. In everyday terms, it is a trauma-focused intervention that is specifically for people from ages 3 to 18 that are diagnosed with PTSD due to experiencing a traumatic event. The key components of TF-CBT that make it a unique intervention is it utilizes measures to track symptoms, it emphasizes gradual exposure, it includes the caregiver throughout the entire treatment, and it provides the client and caregiver with multiple skills to utilize at home to combat symptoms. Also, to become fully certified and recognized on the roster, a clinician must complete a year-long intensive training that includes multiple two-day in-person seminars, biweekly supervision with a consultant, monthly group consultation calls, and an exam at the end if the clinician chooses to become nationally certified. Throughout the training, the clinician is working with at least two cases and receiving constant supervision to ensure fidelity to this model.

The Measures

Within the first couple of sessions, the clinician will ask the client and caregiver to complete some pre-treatment measures. These measures will be completed before treatment and then after treatment to show exactly how and where the client and caregiver have improved. Trauma and PTSD symptoms in a child have a significant effect on caregivers as well, so some of the measures will be specific to the caregiver. TF-CBT has a significant amount of research to back up why and how it works. Measuring symptoms before and after treatment continues to add to that research as clinicians can track symptoms with clients and provide clients and caregivers with straight numbers to show improvements. Often it can be difficult for the client to feel the changes at first, so tracking symptoms is helpful to instill hope as well.

Gradual Exposure

This is another one of those therapy words that we all love. Gradual exposure means that the clinician will not dive into the dark depths of the trauma right off the bat. Flooding is a term that is used often in therapy and it means overwhelming the client by moving too deeply too quickly during trauma treatment. TF-CBT emphasizes gradual exposure every single step of the way to avoid flooding and an increase in symptoms. We want to dip our toe in the water and SLOWLY move into the shallow end and eventually into the deep end of the pool. We never want to jump into the deep end when it comes to trauma. One of the first steps of TF-CBT is teaching the client and caregiver coping skills. Coping skills are used for two main reasons: to begin decreasing symptoms and to provide client and caregiver with tools to use to calm themselves as the trauma is being processed throughout treatment.

The Caregiver

The caregiver is an integral part of treatment for many reasons. The caregiver provides support for the client and is with the client day in and day out. The trauma the client experienced also significantly affects the caregiver. It is difficult to care for a child that has experienced a trauma. It can trigger the caregiver if he/she has his/her own past trauma, it can be traumatizing and cause the caregiver to experience symptoms of anxiety or vicarious trauma, and it is difficult to fully understand the client’s symptoms and behaviors related to the trauma. Education is an important part of TF-CBT, as well. Psycho-education is provided throughout treatment to the client and the caregiver. It is important that both parties understand the ins and outs of trauma to better equip themselves to heal from it. A caregiver can be a parent, another family member, a foster parent, a social worker, or whoever is the primary caretaker of the child at that time. It is ideal to have someone that will be able to commit to the full process of treatment to provide the greatest benefits to the child. TF-CBT treatment works to heal the child and the family because trauma often ripples farther than we realize.

TF-CBT The Skills

As I mentioned earlier, the clinician will provide the client and caregiver with coping skills from the beginning of treatment. These skills will include calming skills, grounding skills, communication skills, and mindfulness skills. The skills will be tailored to the client’s and caregiver’s symptoms. One of the goals of providing these skills is to allow the client and caregiver to see that they can begin to combat the symptoms in a healthy way. It is ideal that the client and caregiver work on these skills together outside of sessions to increase efficiency. These skills are also important as the client continues in treatment and begins to get to the deep side of the pool that involves the details of the traumatic experience. These skills will allow the client and caregiver to be able to walk into those deep dark places knowing they can come out of them and ground themselves and calm themselves. Coping skills can provide a sense of empowerment to the client and caregiver during treatment and throughout life.

Valerie Smith is our lead clinician doing TF-CBT. For more information on TF-CBT please contact us.

 Much to the relief of mental health workers the stigma attached to depression is lessening as awareness increases. Times are changing and so are your options when it comes to seeking treatment for depression. EMDR can be an effective means to treat your depression when traditional options have not helped.

Most people are familiar with depression, or at least familiar with the fact that it exists and anyone can struggle with it. However, many people may not know where to start when it comes to how to treat it effectively. Traditional therapy and medication do help, without a doubt. But what happens when it’s just not enough or you aren’t feeling relief? If that question rings true for you, please know that you do have options for EMDR therapy for depression in Suffolk County, NY.

What is EMDR?

 I’d like to bring to your attention a treatment option, which you may or may not have heard of, known as EMDR (Eye Movement Desensitization and Reprocessing). Are you familiar with this treatment? During EMDR treatment, bilateral stimulation activates the opposite sides of the brain allowing the brain to release and redefine emotional experiences that are “trapped” within the brain. This type of stimulation actually resembles REM sleep as our eyes move from one side to the other. It is during sleep that the brain naturally sorts out our experiences from the day, discarding useless information and transferring memories appropriately.

Sometimes when we experience a traumatic events, big or small (i.e. getting in trouble at school, bullying, or the emotional trauma experienced when dealing with infidelity), these negative experiences can get “trapped” or “frozen” in the brain and they are unable to resolve naturally which may result in nightmares, depression, anger, anxiety, or emotional disturbance.

Along with the “trapped” negative experience is the negative emotional and sensory information, and childlike or initial interpretation of the experience.

Even locked away these negative emotions can still affect us greatly. We can be triggered by any number of things; a scent, a visual object, even being spoken to a certain way can trigger a memory or negative feeling, often without any understanding why. When a negative memory is triggered, the neurological response is protection and the result is a state of hyper-arousal commonly referred to as fight or flight. Stress hormones are released into the body and we find ourselves saying things without thinking or doing things that seem out of character. Unfortunately, the initial and untrue negative beliefs about oneself are reinforced.

What’s an EMDR session like? 

During a typical EMDR session you would be asked to identify a disturbing target memory. That memory is then processed using bilateral stimulation, the negative feelings, beliefs, or experience become desensitized, meaning they simply become less bothersome. The feelings, beliefs, and/or experience is then reprocessed and a new meaning is attached to the experience or triggers. As your brain arrives at a new conclusion, the original trauma no longer contains the negative emotional charge originally associated with it. The triggers are now neutral, the interpretation of the experience is now intentional and the beliefs about oneself are more positive and present hope instead of powerlessness.

Should I do it? So you may be wondering, “Is EMDR right for me?” Well, if you feel like your traumas, or inner demons, have too much power over you; and if you have a strong desire to be liberated from the traumas of your past, then, yes, EMDR may be a good fit for you.

Please keep in mind, EMDR is not only for those who have suffered significant trauma.

Reasons for choosing EMDR include a desire to let go of the rational, logical self and to be able to engage at a deeper level. If focusing solely on symptom management is not getting you the results you desire then you may benefit from EMDR, leading you to a deeper understanding of the root cause of the problem and allowing you to deal with it and find resolution.

If you have any thoughts or questions related to EMDR therapy for depression in Suffolk County, NY., or other mental health issues, please feel free to contact us. We would love to help you.

Let’s face it-the COVID 19 pandemic was something that most could have not imagined, let alone prepared for. Life as we knew it was immediately turned upside down. While there were many losses incurred, none seemed to compare to the families who lost loved ones to COVID-19. As a society, we were called on to do everything we could to prevent this from happening. This resulted in losing our way of life as we knew it and disenfranchised grief.

Disenfranchised grief is defined as experiencing grief and loss that is not readily recognized by a person, group of people, or society as a whole. The symptoms of grief are the same-experiencing shock, sadness, guilt, regret, anger, fear-however disenfranchised grief makes the process of grieving more challenging due to the lack of validation, social support, and rituals that are often associated with grief. This can induce feelings of isolation and powerlessness, leaving one to feel helpless to reducing their own pain and struggle. 

“But we were all going through the COVID-19 pandemic together,” you think. “Doesn’t this count for something?” While we can cite many examples of people making the best of a difficult situation during the pandemic, the undertone has always remained the same-our loss pales in comparison to the loss of human life. The time we lost with loved ones, the loss of our routines, missing graduations, homecoming, sports, weddings, travel plans, holiday traditions, and in general life as we knew it-these losses were expected of us to protect the greater good of human life. We told ourselves, “Those who lost loved one’s to COVID-19; THOSE are the people who are struggling.”

I am here to remind you that everyone’s grief matters. Loss in any form deserves to be validated, acknowledged, and processed. Symptoms of grief are not to be taken lightly, as left unattended can lead to depression, anxiety, and other mental health challenges. It does not serve us to minimize, separate, or compare our losses. 

So, what can we do to cope with our disenfranchised grief?

1. Acknowledge and validate your loss. Hopefully this article started you on your journey of awareness in understanding that your loss MATTERS, regardless of the messages you have gotten from others, society, and yourself. Remind yourself that you are worthy of the time and space to grieve your loss.
2. Begin to get to the root of your grief. When dealing with grief, what you don’t address will ultimately address you. Avoid the urge to suppress your grief and hope it goes away; unresolved feelings have a tendency to resurface later on.
3. Write! Writing can be a therapeutic tool to uncover suppressed emotions. There are many writing prompts available online for coping with grief and loss. Do so slowly and with self-compassion, going at a pace that feels right to you.
4. Make your own grieving ritual. Part of the challenge of coping with disenfranchised grief is that there are no clear rituals to honor and provide closure for the grief experienced. Rituals will vary from person to person; however, it may help to pick a place that has emotional significance where you can spend time to honor what was lost.  
5. Find support. If there is a name for it, someone has experienced it. Seek out friends and family members that have experienced similar losses, or that you feel are supportive. Consider what you need from others and ask for it. As always, seeking professional help is recommended, as this individual is trained to guide you through this challenging process.

-Alexandria Baxter, LMSW

A traumatic event is an occurrence that overwhelms our stress response system. When we endure trauma from someone close to us we can develop a trauma bond, especially when we experience trauma repeatedly by an attachment figure. A trauma bond occurs when the abused develops sympathy or affection towards their abuser. This can happen over any time period and rarely, if ever, develops into a healthy relationship. A trauma bond can cause the abused to experience guilt, confusion and self-judgment when analyzing their feelings towards their abuser, however this type of bond, while unhealthy, can originate from a protective place in the abused person.

How Trauma Bonding Occurs from Our Fight, Flight Or Freeze Response

Our brains have a survival response system, often referred to as the “Fight, Flight or Freeze” response. The body can activate this response system if our brains detect danger and turn on different pathways to get us out of the dangerous situation safely. This is the same response system that is responsible for the increase in adrenaline we experience after we hear an unexpected loud noise or are startled. It is our “Fight, Flight or Freeze” response system has allowed our species to survive for as long as we have and it is this system that becomes activated when we experience trauma. 

Survivors who endure abuse from their loved ones, especially their parents as children or their partners as adults, go through an extremely complicated process to try to make sense of their relationship with the abuser. In an effort to allow the survivor to be able to function with their abuser the brain may turn on protective defense mechanisms in the form of dissociation, forgetting or minimizing abuse or even to take responsibility if the abuse with an attachment figure. For example, it would be extremely difficult for a child to function with the knowledge that they have to rely on the same person who is mistreating them so the brain may “try to make sense” of the abuse by using one of the above tactics to allow the child to still function with their abuser day to day. This is not the say that abuse is therefore alright. It is not and no one deserves to be mistreated or abused. 

What This Does Not Say About The Survivor

1. That the abuse did not happen.
2. That they want the abuse to happen.
3. That they deserve abuse.
4. That there is something “wrong” with them.

What This Means

Forming a trauma bond with an abuser does not mean there is something wrong with the survivor but rather speaks to the survivor’s ability to survive in a dangerous, unpredictable environment. No one deserves to be in a dangerous, unstable relationship or environment. If you feel you may have this type of attachment to a person who has made you feel unsafe, please call our office to work through your emotions related to trauma bonding to enhance self-compassion and secure safety for current and future relationships. 

By Marissa Ahern, LMSW