Do I really need therapy?

It’s something I hear a lot – whether being asked about how necessary it really is, or listening to accounts of frustrating experiences – is mistrust, resistance, frustration, and exhaustion in regards to therapy.

And man, do I get it. I had two terrible therapy experiences before I struck gold, and they both left me feeling broken, more fucked up than before, and extremely disgruntled. But this 2-strike history seems to be a ridiculously low number of harmful psychologist interactions compared to what most have gone through.

First, I think my disappointing therapy experiences are relatively mild because I avoided it for so long, compared to many others who have been actively looking for answers for years. So don’t applaud. It just wasn’t a choice. I was too broke and insurance was too ineffective for me to see anyone for the vast majority of my extremely mentally ill days. My first two negatively effective experiences were via free counseling services provided by family poverty and the demands of higher education, respectively. Other than that? I’ve just been out there, flailing around on my own for most of this lifetime.

Secondly, to be honest, I haven’t always been totally alone. I got really fucking lucky by being random Craigslist roommates with a licensed clinical social worker in college and becoming best friends with her. Of course, we could talk about depression and anxiety issues, which helped. When I was finally ready to see a mental health professional and figured out a way to afford it, she told me which type of therapist I should see. “Uhhh… trauma informed.” She picked out three potential matches for me. That was it, I found my trauma angel and I never looked back.

So my path to finding someone I could actually talk to and learn from, without feeling like I was begging to be heard and leaving the office in a triggered fugue every session, was relatively easy. It took 28 years, mind you, but I haven’t endured the decades of torture jumping from one useless therapy appointment to the next like others have.

And for that, I consider myself lucky.

Today, I just wanted to briefly touch on some of the complications that make therapy so baffling, disheartening, and potentially dangerous for us.

Starting with the fact that, you know, therapists largely aren’t educated on trauma. And moving into a laundry list of ALL the forms of therapy I’ve recently found that I think are necessary – or at least highly useful – as you transition through trauma focused recovery and start rebuilding your trauma life long-term.

First – “Do I really need a therapist?”

Fuckers, I’m sorry to say that I think the answer is yes. Maybe not forever – you don’t have to salary this person for the rest of your lives – but you will need to get started with a therapist if you’re just starting to approach your trauma recovery efforts. I wish that wasn’t the answer. I wish we could just save ourselves the mental, scheduling, and financial woes… but no, it’s pretty goddamn important to find someone to work with for a while.

Why? Well, because the proposed phases for recovery really need someone with a psychological understanding to be holding your hand – if not physically – emotionally. Phase-based treatment for CPTSD recommends three stages, and you’re going to need help with them.

First, just getting yourself in a state where you can even accept and integrate information about your mental health is a doozy. If you’re anything like me, you entered therapy because your mental health had reached a breaking point. The daily fear and anxiety levels were so excruciating that I couldn’t handle another moment of it. I was at my wit’s end. I was devolving into a dysfunctional human. Everything was triggering. My body was perpetually on fire. My brain couldn’t handle another single mishap, or I was flinging myself into oncoming traffic.

So, you need to calm down, get your brain-body relay system back under control, and lay your most dangerous “top-level” psychological threats to bed for a while. Shutoff those inflammation responses, if you’re lucky. Maybe learn how to get a few hours of sleep. This is the safety and stabilization stage of therapy. The time when you first have to stop wanting to die before you can start learning to live.

CAN you do this on your own? Uh… maybe… but I’m guessing you would have done it by now, if that was an option. I doubt you’ve been enjoying the anxiety and depression spirals, the complete life degradation, and the sense of becoming a psychopath. You know who can help? Someone with stress disorder, neurofeedback, and grounding technique training. Also, potentially, a psychiatrist to get your endogenous chemicals rebalanced so your head can stop telling you resistance is futile and it’s time to say goodnight.

Again, both of these can be temporary measures. You might not need long-term care to understand your anxiety-depression axis or to take over-the-counter keep-my-head-from-exploding pills. BUT, you will need at least the former in the beginning. Coming to a place where you feel almost like a real human being again is pretty important. Otherwise, your lizard brain is still in control of the whole shitshow.

Secondly, it’s recommended that folks move into the second phase of therapy; processing the trauma events. Do you need a professional for this part of the project? Oh, you fucking bet you do. Do not try this at home.

I mean, your brain probably has already been stupidly trying to tackle at least some of the memory processing on its own – through rumination, intrusive thoughts, unwanted memory recollections, and flashbacks – and how has that been going for you? Enjoying the looping thoughts, the emotional upset, and rapid fear responses that you get as a result? Are those a treat when you have no way to re-center yourself and get back to a safe place? No, they fucking aren’t. They are crisis-inducing.

So don’t do your trauma memory processing intentionally unless you have someone on your side, ready to pull you back from the edge of the cliff.

In my therapy sessions, our processing days followed a pattern of grounding, visiting the memory, and grounding again before I walked out the door. You know, so I didn’t drive into a semi-truck on 285 or fling myself into the decorative pond outside the office in a daze after dredging up my more challenging recollections. It worked! It was emotional. It was physically activating. But she always helped me to come back down before releasing me into the wild. I left feeling like I had placed something firmly in my past, recognized how it was still living inside of me, and moved on with relative peace.

At least in the beginning, it’s important to have someone with you, like an acid trip babysitter, when you’re diving deep into the life-upsetting events that got you where you stand now. Someone to give you a reminder that you’re still here, in the present, and you are safe. Someone to pull you out of it if you’re in too deep.

Will memories be coming up for years, possibly? Oh yeah. And you’ll learn how to handle them on your own with increasing stability as you master those grounding and integration techniques yourself. But for those first few months or years of real bangers, get yourself psychological support. DO NOT cause your own personal crisis by thinking you can handle live wires without professional training, or prepare to zap the whole system into oblivion.

Lastly, trauma rehab includes the phase of reintegration. This is when you combine your past memories with your present reality and your future plans.

So, can THIS be done without a therapist? Possibly. But with our pessimistic and limited-scope thinkers, I believe it’s going to be much easier and more absorptive if you have a professional with you for the early pieces of this one, as well.

CAN you theoretically place your past in your history file and see how the document links up with the present folder? Sure. But… with our inner critics and fucked up core beliefs, are we very good at this? Not really. With bleak and dangerous life experiences to reflect back on, do we often find ourselves feeling strong and optimistic about daily details and upcoming events? No way. When you have unhealthy views on life thanks to a family of unhealthy individuals, can you really identify and institute healthy living? Not so much.

This is why it helps to have someone who can see things from an outside, healthy, and less panicky perspective. They can get your mindset set on the right track so positive integration is possible, rather than working hard to convince yourself that your past is your present is your future. They can also help you gain a little positive self-regard so you aren’t trying to forge ahead creating a new life for someone you despise. That is not the desired integration outcome.

So, all three of the phases – stability, processing, and integration – are super important. But the order is, too. And each trauma sufferer might have a different requirement for how these phases are enacted.

As in, you don’t necessarily graduate from one section and move onto the next chapter, never to look back and revisit the old text again. Most likely, you will have to flip back and forth between these phases of recovery… you know… a hundred or a thousand times. Emotions, memories, and self-regard are pretty flippant in our trauma brains – don’t expect that they behave predictably and backslides won’t happen. Restablilization will be necessary at times.

But, overall, the importance of this proposed step-by-step layout is to note that it’s critical not to have actively overwhelming emotions or triggered survival responses. When we’re in full-blown trauma states or our other mental illnesses are dialed up to 11, times are dangerous and unproductive. We can’t accept new information. We can’t even focus our brains on old information. We have negatively intrusive thoughts that are legitimately out of our own control. We’re so distraught that we’re shells of jittery human beings, going through the motions and wishing the ride would end. And we can easily fall into a helpless, defeated, suicidal pattern of thinking where we give up on the whole venture. Not to mention, we easily end up torturing our bodies with stress hormones – and that’s a whole other mental health disaster waiting to happen.

This is why early trauma recovery is so dangerous. One condition links up to the next, and pretty soon your head and body are effectively tangled up in a net of mental illnesses and ailments that you lose track of yourself. This is why you need a professional who actually knows how to de-escalate a PTSD patient. This is why you shouldn’t start trying to do inner work when there is no safety net in place.

Start learning the basics, get to a safe place, and then practice standing on your own, under the care of a licensed therapist. Once you’re walking steadily without outside support, you can consider weaning yourself off of counseling.

But yes, you need it to get started. Sorry. I know we all wish this wasn’t the case.

Next, let’s talk about this quick blurb as an introduction to the next section: “guidelines note that a lack of improvement during treatment does not label the individual as a poor responder or resistant to treatment; rather, it may be that they have been offered the wrong treatment or combination of treatments. The wrong therapist, using the wrong therapy at the wrong time may in fact be psychonoxious.”

The problem with trauma therapy – the therapist’s understanding

Psychonoxious. My new favorite word. It means “Having an unfavorable effect on the emotional life and reactions mediated by higher levels of the central nervous system; may be endogenous or exogenous. And, denoting people who or situations that elicit fear, pain, anxiety, or anger.”

Ah, yes, sounds like my life on trauma. And, hey, mental health professionals, themselves, can be sources of psychonoxia. I’ve lived that before, too. How about you?

What am I trying to say here?

Just relaying a simple message; your therapist and their training matters. One mental health professional is not like another. Everyone has unique understandings of various mental illnesses, treatment options, and lifestyles. Signing up with any old counselor and calling it a day isn’t going to be helpful. Getting in bed with the wrong person is actually a potentially dangerous option. You need someone trauma informed and well-versed in a variety of therapy techniques. But, specifically, they have to be trauma-trained with a wide array of experience to be effective. And that’s a whole challenge, in and of itself.

Here’s a short set of recommendations that I found for therapists in their treatment programs with complex trauma sufferers from a really useful paper that I’ll be coming back to in another episode. For today, hear this opinion from a trauma-informed therapist about the counselor’s requirements for effective trauma therapy:

When providing psychotherapy to clients who have experienced any type of complex trauma, the following basic considerations must guide the work. The safety of both the client and practitioner must stand as a primary concern. The practitioner must acquire clinical competence in this area and remain up-to-date with the current research. Clients who present with CTSD and DID pose many clinical challenges and often require follow-up with the client between sessions.

One should expect that intense transference, and countertransference issues will crop up and demand attention treatment. Consultation (for licensed practitioners) or supervision (for those in training) will often prove critically important. Having such expert resources available and knowing when to make use of them will prove an essential skill. Because the antecedents of CTSD may occur during critical periods of brain development, practitioners can benefit by considering the neurobiology that some authors have posited as contributing to the disorder.

(Hey, what do you know! That’s what we often talk about here!)

Many victims of complex trauma seem to rely on their more primitive survival mechanisms to maintain a sense of safety. For such clients, emotions and bodily changes may be experienced as signals of danger or actual threats. Some authors have posited that such clients lack the ability to integrate these traumatic experiences as individuals with more mature brain development do. As a result, the individual may be left with persistent affective states of anxiety, anger, sadness and depression, increased sensitivity to pain, and even hysterical states as well as behavioral disinhibition.

Correlational neuroimaging studies suggest that in such clients the visual feeling parts of the brain around the amygdala become activated. The left anterior prefrontal cortex shuts down, and the client essentially becomes speechless.

(And, clearly, a tongue-tied patient in talk therapy is also a challenge. Hey, those sound like freeze states! We’ve also talked about that!)

This is just to say, here are just a few of the considerations and training suggestions, from one expert in the trauma field to all the rest. It clearly states the need for practitioners to be specially instructed and educated on the ways that trauma therapy is going to be challenging and potentially harmful if conducted without a specific plan and expert-level understanding of the disorder.

The author of this paper, Elaine L. Ducharme has a lot to say about the most effective ways to work with PTSD and dissociative disorders – which we will be talking about again.

But, for now, let me also regurgitate a statement she makes that kind of gives me the trauma warm-and-fuzzies. And by that I mean, it’s obvious that she really cares, which is nice to hear when I think some of us have been left doubtful in the past:

Treatment of clients coping with trauma is challenging but extremely rewarding. The fact that men and women, for whom trust has become incredibly difficult, can let a practitioner assist with their most sensitive thoughts and feelings is, in many ways, remarkable. These individuals arrive seeking care with a wide array of symptoms. They may not neatly fit into the DSM–5 diagnosis of posttraumatic stress disorder (PTSD) or any other single category. It therefore becomes critical that all practitioners know how to assess for complex types of trauma and determine their own competence to work in this area. Practitioners must recognize when and how to treat any need for consultation or supervision, and when to refer to another therapist more experienced in this type of work.

Cool. Thanks, Dr. Ducharme for the reminder that even mental health professionals need to recognize when they are in over their heads with traumatized patients. They might be acting unethically by continuing to see someone who they are not uniquely skilled to help. And, gotdamn, I don’t think a lot of our past therapists felt comfortable with admitting their lack of expertise, based on the stories I hear.

It’s also a quick reminder for all of us: if you’ve had an unsuccessful bout in therapy, the problem likely isn’t you. It’s lack of training in the specific area that’s required for the task.

And piggybacking on that sentiment… Can we all acknowledge that we face a massive uphill battle just getting the Complex Trauma diagnosis to be recognized. Let’s get that out of our systems next.

Have you even heard of Complex PTSD?

Does the DSM recognize Complex PTSD yet? Nope! The International Classification of Diseases does, but the good ole DSM-5 still hasn’t caught up with the times. Gotta love being at the forefront of a controversial disease, so medical professionals can point to their heavy book and relay that you’re full of shit more than they’re already inclined to. Love that.

I think most of us recognize at this point that our symptoms of CPTSD are easily noted by professionals – the depression, anxiety, obsession, attention deficit, insomnia, life disturbances, impulsiveness, relationship degradation – all that fun stuff is easy to spot, report, and – hopefully – respect. But how many practitioners actually roll it all up into one issue and see the C-PTSD for the trees? Not so many.

This is why you’ve probably heard that you’re bipolar, generally anxious, manic-depressive, ADD, OCD, autistic, borderline, schizophrenic, and beyond! It’s wonderful to receive every disorder in the book, while ignoring the one issue that explains them all and actually gives you a place to start processing from, huh? Fill up that bingo card – your prize is feeling like an even toastier nutjob than before. Fantastic.

I’m not a psychology education or training expert. I don’t know anything about public health. So I’m going to hand this back to someone who is. Let’s read an excellent excerpt from an article that I stumbled upon, called The Need for Trauma Training: Clinicians’ Reactions to Training on Complex Trauma. It’s regarding a myriad of the challenges faced in receiving trauma-informed care – specifically related to Complex PTSD.

There’s a lot of information in the selection I’m about to share. First, just some background CPTSD information that I’m including because I think we all enjoy hearing that we aren’t ridiculous. Secondly, a ton of small pieces about the gaps in trauma-informed care and the reasons why targeted therapy is critical that made me say, “oh.” It’ll make you feel better about your therapy efforts, too, I promise.

Rates of trauma exposure in the general population are alarmingly high. Over 70% of individuals worldwide will experience a traumatic event at some point in their lives, and exposure to multiple traumatic event types is most common. Those exposed to multiple and repetitive episodes of victimization or other traumatic events— defined as “complex trauma”— often display a wider range of difficulties as compared to those who have only experienced a one-time or short-term traumatic event. For example, individuals with complex trauma histories often display greater complications involving cognitive (including dissociative), affective, somatic, behavioral, relational, and self-attributional problems beyond symptoms of the “classic” form of posttraumatic stress disorder (PTSD), which need to be specifically addressed to render treatment both comprehensive and effective.

The best available data regarding undergraduate and graduate training in the area of trauma psychology (indicates that)… only 21% of postdoctoral or graduate internships across the United States offered specialized training in trauma, PTSD, or sexual abuse and their treatment. A relatively smaller number of degree programs and internship sites routinely offered topics related to trauma as a part of the training curriculum. Most students independently seek education in trauma and its treatment by gathering professional literature and attending conferences, workshops, and seminars. Consequently, there is a deficit of professionals who have been systematically trained to provide specialized trauma services including assessment and treatment of complex trauma.

This deficit creates a public health issue, given that individuals who have experienced trauma are more likely to utilize mental health and medical services than those who have not experienced trauma. It is imperative for clinicians to understand trauma-exposed individuals’ preferences and needs and how to work with them… However, a lack of trauma training among mental health professionals—including not learning how to assess for a history of trauma using clinical interviews or psychological tests— has been documented. This lack of trauma training is problematic, as there is a possibility that failing to recognize trauma-related symptoms or failing to adequately focus on the impact of trauma in session could result in misdirected or harmful treatment.

Clinicians’ lack of awareness and training with regard to trauma-exposed populations can have deleterious consequences, such that victims may not receive treatment that addresses trauma as a primary contributor to their difficulties. A clinician who practices trauma-informed care may be better able to understand patients’ trauma-related symptoms and offer strategies for management and resolution, whereas an unknowledgeable clinician may inadvertently exacerbate patients’ distress. Patients may reexperience traumatization during treatment by well-meaning but unprepared clinicians, and clinicians themselves may experience vicarious traumatization and secondary traumatic stress without proper training that includes attention to these issues and their management.

Clinicians unfamiliar with trauma may also misdiagnose trauma-related difficulties, such as misattributing the high level of reported symptoms as indicating malingering rather than being common among individuals who have experienced trauma, or misinterpreting dissociative symptoms as indicative of schizophrenia, bipolar disorder, or borderline personality disorder. In forensic cases, misdiagnosis may have serious ramifications.

Because many health care professionals lack knowledge about trauma, they may feel unprepared to provide appropriate treatment. In a survey approximately 66% reported that they received some sort of trauma training during their career, yet only 30% felt sufficiently trained to assess or treat trauma and its aftereffects. Another study found that 81% of mental health professionals surveyed believed that more trauma training would be beneficial to their practice.

Clearly, issues of trauma need to be broadly incorporated into the foundational training curriculum of mental health professionals, and programs that teach about trauma and its treatment are needed as supplements to this training.

It is likely that many individuals who have experienced trauma and seek treatment will have complex traumatic stress disorders. Survivors of complex trauma have difficulty with regulating emotions and trauma-related symptoms, as well as managing self-destructive behaviors including nonsuicidal selfinjury, suicide attempts, substance abuse, and other dangerous behaviors.

Therefore, the treatment of complex trauma usually requires stabilizing safety and improving the ability to regulate emotions as primary tasks early in treatment before any past focused explorations of trauma. By teaching mental health professionals about complex trauma and the therapeutic interventions that can help patients establish safety, as well as how to manage trauma-related emotions and symptoms, professionals may become more competent in empowering survivor clients and providing suitable treatment.

Boom. These folks, Kumar, Brand, and Courtois, said it all. There is a lack of trauma recognition and training in psychology education and intervention programs. Even among those folks who do seek their own trauma-specialized training, a majority feel unequipped with the experience necessary to competently handle a post-traumatic patient. And, lastly, here are a million reasons why this shit is so hard and people regularly get fucked up by their therapy efforts with unqualified professionals.

I hope this was a nice reminder that you aren’t the only one struggling to find that glass slipper of a mental health practitioner. Based on the peer-reviewed perspective of these researchers, the psychology field doesn’t seem to be doing us any favors in bolstering education efforts in an area that they’re desperately needed. And, uh, looks like everyone under the PTSD sun is in for a rough time in this therapy venture.

Got it, therapists need to be trauma-trained, few of them are, and we get tossed around a lot in the interim… and we never really wanted to get on this ride, in the first place, so we’re likely to jump off at the first rumble. Now let me move on to one more thing that I’ve been personally pondering in Jess’s “make things up” corner.

Can ONE therapist do it all?

So, it has dawned on me that part of the reason why therapy is so hit or miss for folks is that – not only do we need trauma-trained practitioners and not only do we need a lot more than just a basic vent sesh each week… but for long-term trauma management and life-reordering, we need a wide array of therapy models.

When we’re talking about a pervasive mental disorder that affects so many areas of our lives, it makes sense that we need many approaches to effectively tackle ALL of the issues with our thought patterns, physiological responses, and unique array of mental illnesses. There’s a lot of maladaptive ground to cover, generalized beliefs to be erased, and life skills to be learned, on top of the memory processing and emotional regulation.

The truth is, processing every trauma with a professional probably isn’t necessary. Talking through all the stresses of all your normal days is a bit codependency enabling. Chatting about the same old issues on a loop can only help so much before it’s just grounding your head in a shitty history. We need a lot more mental dexterity and belief-challenging experience to successfully rewire our brains in so many areas.

In what ways? Who knows, but here’s what I can relay in my not-a-trauma-specialized…. Anything… experience.

So, this isn’t a list made by a professional. It probably isn’t comprehensive. And it’s very unique to the things I’ve tried and observed myself. Who knows if there are diff’rent strokes for diff’rent folks that would work better – probably, yes! But these are the therapies and psychology specialties that I now recognize have been critical for me in getting my head on track for the first enduring time. i.e. Feeling stable, hopeful, and somewhat balanced for more than a few weeks or months.

Basically… it’s always been clear that my trauma-informed therapy helped me enormously… but then I helped myself a whole fucking lot with my own learning efforts, too.

My trauma reckoning took place in a forest and a minivan as much as it took place in an office. For years, I knew that certain overarching concepts helped me… but I just found that there are legitimate titles for a lot of these the other day. Color me thrilled as I repeatedly realized, “Oh, there’s a name for that shit?!” Other people find value in what I also find useful? Hell yeah. Research is so goddamn validating. Connections between your experience and others is powerful. And our trauma brains are often so goddamn similar.

Here’s what I’m seeing, listed in order by function, and also generally progressing from the most initially important and well-known in-office therapies to the more abstract and high-level brain maintenance models that you can probably get elsewhere. Yes, it’s a very basic rundown. Yes, I’m just throwing out general descriptions to get you acquainted. You know, if you ask nicely I can dig in deeper some other day.

If any of these strike your fancy, I recommend you research them further to see how they can be of use. Today, I’m just letting you know they exist and they can be transformative.

Traditional therapy

Traditional Talk Therapy – also known as psychotherapy, is what mental health professionals use to communicate with their patients. The purpose of talk therapy is to help people identify issues that cause emotional distress. May result in a diagnosis such as depression or anxiety. A safe place to discuss feelings and emotions triggered by daily stressors, a medical illness, relationship issues, grief and loss, or the impact of a specific trauma. Understand how these stressors are affecting your life and work to develop strategies and solutions.

Trauma Therapy – is a specific approach to therapy that recognizes and emphasizes understanding how the traumatic experience impacts a child’s mental, behavioral, emotional, physical, and spiritual well-being. This type of therapy is rooted in understanding the connection between the trauma experience and the child’s emotional and behavioral responses.

Cognitive Behavioral Therapy – is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.

Psychodynamic Psychology – involves the interpretation of mental and emotional processes rather than focusing on behavior. Psychodynamic therapists attempt to help clients find patterns in their emotions, thoughts, and beliefs in order to gain insight into their current self.

Right. So, learn how to feel, identify, and deal with emotions. Start practicing grounding techniques and perspective reframings. Begin understanding where maladaptive thoughts, behaviors, and beliefs were originally born, and better ways to cope. Bring those disruptive emotions from an 11 down to a 5, so any quality of life is possible. Got it. Moving on.

Education

Developmental Psychology – looks at how thinking, feeling, and behavior change throughout a person’s life. A significant proportion of theories within this discipline focus upon development during childhood, as this is the period during an individual’s lifespan when the most change occurs.

Evolutionary Psychology – is a theoretical biological approach to psychology that attempts to explain useful mental and psychological traits—such as memory, perception, or language—as adaptations, i.e., as the functional products of natural selection.

Cognitive Science – the study of internal mental processes—all of the things that go on inside your brain, including perception, thinking, memory, attention, language, problem-solving, and learning. Often uses comparison between human and computer processing of information.

Okay, so start trying to understand the equipment you’re operating on. How has your brain been impacted by millennia of evolution and decades of personal adaptation? What is happening when you’re feeling X and responding with Y? What areas of your brain are particularly strong and what processes are lagging? How do you work with all of your biological constraints? We do a lot of this work here.

Self-practice (eventually)

Exposure Therapy – is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress.

Behavioral Science – is a systematic approach to understanding the behavior of humans and other animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual’s history, including especially reinforcement and punishment contingencies, together with the individual’s current motivational state and controlling stimuli.

Dialectical behavior therapy (DBT) – provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on mindfulness, distress intolerance, emotion regulation, interpersonal effectiveness.

Neuro-linguistic programming (NLP) – is a pseudoscientific approach to communication, personal development, and psychotherapy. NLP’s creators claim there is a connection between neurological processes (neuro-), language (linguistic) and behavioral patterns learned through experience (programming), and that these can be changed to achieve specific goals in life.

Applied Behavioral Analysis – is a natural science that seeks to understand the behavior of individuals. It is an extension of psychology, as it uses the principles of behavioral psychology to understand the relationship between behavior and the environment.

Alright. So, these are skills to be practiced with help in the beginning, and then throughout your entire lifetime on your own. Understand what’s actually not going to kill you and convince your brain of the same thing. Start to learn how your behaviors are impacting your inner world and vice versa. Begin experimenting with regulating your own emotions in the context of relationships through slowing your reactivity. Try talking to yourself with different approaches than before – imparting confidence and peace through changing your inner and outer language. And… you know my favorite. Start functionally changing your life by tracking your experiences and outcomes to create an existence that supports your mental health.

Relationship rehab

Relational Psychoanalysis – is a school of psychoanalysis that emphasizes the role of real and imagined relationships with others in mental disorder and psychotherapy.

Interpersonal psychotherapy – is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery.

Relational therapy – sometimes referred to as relational-cultural therapy, is a therapeutic approach based on the idea that mutually satisfying relationships with others are necessary for one’s emotional well-being.

So, start to see how you’re a necessarily social animal. Begin examining the ways early relationships are still affecting your social dynamics today. Recognize where your emotional and physical self starts and stops in relation to others. Re-examine the social roles you traditionally play, and therefore, your expectations for yourself and others. Practice setting boundaries, identifying unhealthy patterns, and creating safe, balanced, long-lasting relationships.

Continued motivation

Narrative therapy – is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to live these values so they can effectively confront current and future problems.

Humanistic Therapy – is a mental health approach that emphasizes the importance of being your true self in order to lead the most fulfilling life. It’s based on the principle that everyone has their own unique way of looking at the world.

Existential Therapy – is a unique form of psychotherapy that looks to explore difficulties from a philosophical perspective. Focusing on the human condition as a whole, existential therapy highlights our capacities and encourages us to take responsibility for our successes.

You know, mental health management only lasts as long as you’re motivated to do it. So convince your brain to put your past into a logical, cohesive story that brings you meaning and hope in the present. Start identifying who you really are, removing the negative judgments about your mental health and history, and celebrating the things that are actually you. Identify and learn to leverage your strengths in the real world. Recognize what your purpose is on this planet. Give yourself credit for the positive change you’re enacting.

Overall, take a birds eye view of this ridiculous thing we call consciousness and stand firmly in your meat husk as you work each day to fulfill whatever the point of your individual existence may be. You get to decide. Isn’t that empowering and terrifying?

Alright, did I just throw a bunch of head-spinning brain reprogramming options at you with descriptions that I pulled of the internet? Yep.

Sorry – as you know, this trauma recovery thing is best characterized as overwhelming. Why wouldn’t we need a different psychology specialist every day of the week and about a thousand new workbooks?

Right. Well, the great news is, a good therapist can cover several of these therapy options in your weekly sessions. By “good,” I mean someone with a lot of training and experience in the trauma field. Not a counseling newbie who read about wartime PTSD and decided they were ready to rectify your childhood. Find someone who has experience in psychotherapy, CBT, dissociative disorders, and possibly even EMDR, and you can get a lot of work done in one office.

But, the even better news is, after getting a few steps down the road with a mental health professional, you can learn to therapize yourself through a lot of the latter suggestions without the help of a paid support system. Get into podcasts and audiobooks, start diving into materials about routine formation, healthy mindsets, relationship rehab, and life philosophy, and try applying the ideas to your thought patterns. That’s how I absorbed and achieved most of my mindset shifts after my therapist gave me a few running steps.

Do your own research outside of the counseling office. Experiment with your own life-skill behaviors. Be open to new ideas about the universe and the meaning of life. You know, that sort of shit that our trauma brains 500% do not want to entertain.

The resistance you feel? It’s your stubborn narrative built on your shitty life history trying to protect that trauma identity you’ve been living with. Your therapist can help you start to identify and overcome those challenges, too.

First, find one you trust.

Wrap it.

What else is there to say? Therapy is hard, painful, and necessary. It can take a long time to find your ideal therapist match, and it’s only more challenging when unqualified professionals don’t recognize their lack of expertise in a particularly baffling specialty.

Getting the wrong type of therapy can actually be deleterious to your mental health. Perpetually receiving the wrong diagnoses definitely isn’t helping you to feel like a hopeful or sane person. And yes, there will be many varieties of mental health intervention that might be necessary to get your head fully removed from the traumatizing circumstances you were born into.

I think you can get a lot of work accomplished on your own, but you do at least need a therapist to help you with the foundational building blocks of stabilizing your brain and body, establishing a sense of safety, learning how to handle emotional and survival responses, seeing unhealthy patterns, and getting your particular diagnoses so you can better help yourself.

You might need meds, you might not. You might want to stay in therapy forever, or you might find that you can wean yourself off as you develop new skills and coping behaviors. You might need more than therapy – like outside support and your own educational efforts. And fuck, I guess that’s why you might be here in the first place. Hope it helps.

If you want to know an uncomfortable truth, now that I’ve just pinpointed all the ways mental health treatment can be deeply uncomfortable and often triggering… Here’s a personal anecdote. You know who definitely didn’t want to go to therapy? This guy.

I refused after my first two failed attempts, which were absolutely not with the right variety of therapist. I only started my trauma recovery in a clinical setting because I convinced my ex to go to therapy, himself. When it was recommended that I needed to seek outside help, too? I boldly stated, “no one can help me. I already know about depression and anxiety. There’s nothing they can tell me that I haven’t figured out already myself – it just doesn’t help. This is just how I am.”

Bahaha, seriously, fuck me. I was WRONG. If you have this mindset right now, you aren’t alone… but also, you need to tell yourself to fuck off, too. I think every person on this planet probably needs therapy, and when it comes to trauma sufferers, that requirement is a billion-fold.

Sorry if you’ve had a disappointing experience or five. Sorry if a past mental health professional has made everything worse somehow. Sorry if the process of looking for a counselor, shelling out loads of cash, and being personally stressed by the getting-to-know-you experience has left you scarred.

I get all of that. It’s a bleak landscape looking backwards. But the perfect therapist for you does exist. Unfortunately, just like everything in this trauma life, you’re probably going to have to work harder than the rest to get it done.

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Ducharme, E.L., (2017) Best Practices in Working With Complex Trauma and Dissociative Identity Disorder. American Psychological Association. https://psycnet.apa.org/doi/10.1037/pri0000050

Kumar, S. A., Brand, B. L., & Courtois, C. A. (2019, October 3). The Need for Trauma Training: Clinicians’ Reactions to Training on Complex Trauma. Psychological Trauma: Theory, Research, Practice, and Policy. 10.1037/tra0000515