The Trauma of Rape

One of the main issues I treat in therapy is the trauma of rape.  Since so many women and men face this type of trauma, I feel it is important to talk about how it could impact one’s life. Although each client is unique in how they respond to a trauma, there are certain feelings and reactions that many rape survivors deal with. Here are a few to be aware of:

  • Being on guard/hyper-vigilant: feeling jumpy, anxious, difficulty sleeping, exaggerated emotional and startle responses
  • Physical symptoms: such as sweating, muscle tension, increased heart rate, difficulty breathing, headaches, stomachaches, etc. when triggered by a reminder of the trauma.
  • Mental process: ruminating thoughts, racing mind, etc. Many survivors also try to forget what happened because the memory is so painful. Other may have intrusive imagery or flashbacks of the trauma, making them feel like they are re-experiencing the feelings and sensations associated with the rape.
  • Abrupt mood swings: going from anger, to crying, to temper tantrums. This can lead to withdrawing from people and activities
  • Feelings of helplessness and fears about personal safety
  • Shock and disbelief
  • Dissociated: feeling numb or checked out
  • Shame and lack of self worth, particularly with body image and sexuality
  • Sleep problems: such as insomnia, nightmares, and night terrors

What to do if you are raped or sexually assaulted:

  • Get Medical Care as soon as possible: you may have injuries you are not aware of or that you cannot see. Getting tested for STDs and doing a pregnancy test is also advisable. Having a medical exam will also help you in collecting physical evidence should you make a police report
  • Safety and support: reach out to someone you trust to give you support. Have them join you if you decide to make a police report.
  • Find a therapist that works with rape survivors. Therapy can be a safe place where you can talk about the trauma and learn ways to cope with the aftermath of the rape.
  • A great Resource is RAINN (Rape, Abuse, & Incest National Network). They can connect you to a rape crisis center near you. (800)656-HOPE
  • Another great Resource is “Peace Over Violence:” http://www.peaceoverviolence.org/
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When Anxiety Takes Over

Michelle’s Story

Michelle, now 31 years of age, came into my office to learn how to manage her anxiety more effectively. Michelle grew up with a very anxious mother, who constantly worried about everything. To shed some light on what this anxiety looked like, Michelle informed me of the worries that would take over her mother’s life: overwhelmed about having to go get groceries after work, to wondering if she is going to have time to take a shower quick enough, to not being able to sleep unless her husband feel asleep first, etc. These worries were modeled and then practiced by Michelle on a day to day basis. These worries eventually took over her life, impairing her functioning at work and in her social life. She had a difficult time concentrating at work because she was worried about all the things she had to do before and after work. With friends, she noticed she couldn’t stay present, but instead was in her head, thinking about all the other things she has to do. Panic attacks then began, making Michelle realize that she needed to seek help.

 

Treatment for Michelle
I referred Michelle to get a Medication Evaluation. People with heightened anxiety may sometimes benefit from the use of psychotropic medications.  The main focus of therapy with Michelle was to identify the source of anxiety and improve her coping skills. One technique used frequently with Michelle was identifying the factors contributing to her anxiety. Michelle learned to notice what was triggering her anxiety, brain storm various choices in dealing with the anxiety, make a decision and follow through with it. Michelle was stuck on just worrying about the problem but didn’t think of ways to manage it. Her worrying about the problem constantly lead to her panic attacks.
 
 
 Stress Management Techniques

To cope with her anxiety, Michelle learned the following techniques:

–          Developing flexibility in responding to change

–          communicating more effectively to improve problem-solving

–          building mutually supportive relationships

–          Self Care

–          Deep Breathing

–          Progressive Muscle Relaxation

–          Time Management skills

–          Meditation

–          Utilizing her support system

–          Disputing unrealistic thoughts and worries

 

Feel free to visit my website at http://www.PasadenaTraumaTherapy.com for more info!

 

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Learning to be Assertive

STEVEN’S STORY

Steven has been with his girlfriend for almost two years and is tired of not getting his needs met. According to Steven, he has a difficult time in asking for what he wants and needs. A simple decision, for example, about where to eat dinner is challenging for him. Instead, he allows his girlfriend to pick the restaurants, while he gets frustrated with himself for not speaking up. Steven acknowledges that he is passive in many of his relationships. Non-assertive people such as Steven are often unable to express emotions of any kind, negative OR positive.

It’s very harmful for a relationship when the person can’t be open about their thoughts/feelings. Assertiveness is a learned behavior and thinking style. The messages that we receive growing up have a lot to do with the way people act and think. In Steven’s case, his family taught him that you should always please others before yourself- in other words, he learned to put his needs on the backburner. Now, in his relationships, he has a tough time voicing his needs. 

What is Assertiveness?

Assertiveness is the ability to express your thoughts, feelings, opinions, attitudes, and rights, without unwarranted anxiety, in a way that doesn’t invade or disregard the rights of others.

Assertiveness differs from aggressiveness- It is true that both assertive and aggressive communication consist of have your needs stated; however it is different to state your needs assertively and state them aggressively. There are variances in the words and tone used, as well at the body language used.

Some questions that I explored with Steven when thinking about how he may have learned to become unassertive are: 

 How did your family handle conflict?

  • What did they do when they disagreed with somebody or were upset with people? 
  • What were their messages given to you about dealing with conflict? 
  • In what ways did you learn to get what you wanted without asking for it directly?
  • (e.g., crying, yelling, making threats etc.) 
  • How do you still use these in your present life? Are they working for you?

Types of Behaviors:

Above I described what Assertive behavior looks like. In addition to Assertiveness, there are also other ways of behaving:

Passive / Non-assertive Behavior is when someone gives up their right to express thoughts, feelings or desires (directly or indirectly) i.e. “We can go whatever you want. You know of better places to go.”

Aggressive Behavior is when someone stands up for themselves without regard for others; typically demands, attacks or humiliates other people i.e. “I want this done right now.”

Passive-Aggressive Behavior is when someone tries to get what they need or want indirectly or manipulatively. i.e. “I’m sorry I’m so late. I didn’t realize this was such a big deal.”

Here are some helpful Assertiveness Skills:

  • Use assertive body language: such as maintaining eye contact, stand/sit straight, keep your voice calm, etc.
  • Use “I” statements. Keep the focus on the problem you’re having, not on the other person. i.e. “I would like 5 more minutes to get ready” instead of “You always rush me.”
  • Make clear, direct, requests, instead of “will you please…” or “do you mind…”
  • Don’t apologize when it isn’t necessary. Avoid lines such as “I’m sorry but I really can’t…”
  • Avoid making excuses or trying to defend yourself when it’s unnecessary. “Oh you don’t want to hang out today, how about tomorrow?” Trying to find excuses is typically dishonest. It’s not that you can’t do it, but you choose not to.
  • Asking for a time out: Letting someone cool down before discussing an issue.

For any questions, feel free to email me at cnm.therapy@gmail.com

http://www.PasadenaTraumaTherapy.com

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Tamara’s Story

Tamara is a 23 year old female who came to see me after a robbery at her home. She remembers lying down in bed reading her book, when all of a sudden, she started to hear noises in her home. In particular, she recalls hearing footsteps in her hallway. Immediately, Tamara knew that this was a different noise from the typical noises she would hear from being in an old home. She knew she wasn’t alone. She felt her heart racing faster than ever and her breathing became more rapid. She got up quickly to try and escape her bedroom. She was fortunate to have ran outside, called the cops, and have the robber arrested. However, ever since this incident, Tamara has been having panic attacks at night, disturbing nightmares, and difficulty falling asleep.

There are three types of defense mechanisms used during trauma. The first one is flight, in which the person attempts to escape the situation at hand. Fight is when the person tries to defend themselves and fight. Lastly, freeze is when flight or fight responses are not possible and the body freezes. These responses are instinctive responses to a perceived threat. Tamara’s brain at the time of this incident perceived that she had enough time and space for flight– hence why she was able to ran outside of her house and call for help.

Tamara’s mind knew that she was safe, but her body was still in trauma mode. Since this incident, Tamara moved into a new apartment and installed an alarm system. Safety is a very important element of trauma work. It is not possible to resolve trauma when someone lives in a traumatizing environment. For Tamara, it was important for her to find herself a safer place to rest her head at night. This didn’t eliminate her nightmares, but decreased them dramatically.

A big portion of Tamara’s trauma therapy was to help her understand her body reactions and sensations. She couldn’t understand why she was still having nightmares and feeling on edge. The sensations she was having in her body were so intense that Tamara was unable to differentiate between the present moment and the past- she kept feeling like she was re-experiencing the same sensations over and over again. Whenever she heard footsteps at night, she would go into a panic.

As she described her trauma incident, my job was to observe her present-moment experiences (including: body languages, emotions, sensations, thoughts, movements- for indicators of trauma related tendencies). It was important for me to help Tamara shift her concentration from talking about the trauma to observing what is occurring in her internal experience. I would ask about emerging thoughts, emotions, body sensations, movements, five senses, etc. This would help remind her that this is a here-and-now experience of the traumatic past, “old-stuff” coming back up.

I also helped Tamara get into her body by building muscle tone- the idea here was to help build a positive experience of being in her body. Tamara began to build tone in her arms and chest by light weight lifting. She did not respond well to aerobic exercise (note: aerobic exercise can actually be re-triggering for some clients. The accelerated heart rate and respiration could have been part of their trauma experience). The muscle tone was very helpful to Tamara and made her feel more confident in her body. Her panic attacks started to decrease as she became aware of what was going on in her body.

Tamara’s healing is a work in progress. She has acquired coping skills that allow her to stay in the present moment, but also grounding techniques to help her stay connect when trauma triggers come up for her. Connecting to her body and body sensations has been key.

 

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What To Know About Bullying

Bullying is a type of abuse that attempts to create power over another person. Here are some of the common types of bullying:

  • Emotional/Verbal bullying includes things like name-calling, social alienation, intimidation, sexual comments, joking about someone’s race, gender, etc. It also includes threats to a person’s safety.
  • Physical bullying involves a violation of someone’s boundaries. This can include behaviors such as pushing, kicking, and punching another person.
  • Indirect bullying includes spreading rumors about a person or constantly talking behind their back. The purpose of this type of bullying involves someone being emotionally hurt or in pain.
  • Social Bullying is hurting someone’s reputation or their relationships, such as leaving them out on purpose, telling others not to be friends with them, and spreading rumors.
  • Something that is becoming more common now is cyber-bullying, which includes sending hurtful or threatening information using electronics, emails, text messages, voicemails, etc.

Why Do Kids Bully?  There isn’t one specific cause to bullying. Many things could contribute to a person bullying, including individual, peer, school, family, and community factors. Here are, however, some risks to consider.

Family risk factors for bullying:

  •  Harsh, physical discipline (i.e. verbal threats, physical abuse, etc).
  • A lack of warm, nurturing involvement from the parents.
  • A lack of supervision by parents/overly-permissive parenting
  • Bullying behavior role modeled by parents

Peer risk factors for bullying:

  • Bullying behavior role modeled by peers
  • Seeing other children use bullying as a means to gain power or attention
  • Bullying used if you want to hang out with the “right crowd”
  • Bullying others so that you don’t get bullied

Some Effects of Bullying

  • It can affect a child’s school performance. Those who get bullied might be afraid to go to school and start to skip school or drop out.
  • Some turn to drugs and alcohol in order to cope with being bullied.
  • If the child is scared to tell an adult that they are getting bullied, other symptoms might start to arise, such as difficulty concentrating, low self esteem, feelings of fear, trouble sleeping and/or eating, depression and anxiety. In some cases, children could also start to have suicidal thoughts.
  • The children who bully are more likely to get into fights, drop out of school, vandalize property, steal, and use alcohol and drugs.


What to do when you are being bullied

  • Always tell an adult: Keeping the bullying to yourself will not make it go away. Try to talk to an adult who you can trust. If you have tried to tell an adult and they haven’t done anything about it, don’t give up. Try to tell someone else until you find someone who is willing to help you. Make sure you tell the adult what the bullying you experience looks like – who is bullying you, where is the bullying taking place, when does the bullying happen, how long the bullying has been happening, and how does the bullying making you feel. If you talk with an adult at your school, it is their job to help keep you safe. Some people to also consider talking to include: your parents, a teacher, principal, school counselor, or someone at your church or synagogue.
    • Note to parents: Do not encourage your child to physically retaliate – this will likely result in your child being disciplined at school. Instead, work with your child’s school. It is their responsibility to respond to bullying in school. You must also work with the school to make sure that your child will not have repercussions for telling on the bully.
  • Groups: children who bully tend to pick on those who are alone. Try to have others around you when you can. For example, if you are at school, hang out with other children or make sure there is an adult who can see you. You can also use the “buddy system.” This means that you could buddy up with a friend in places that you think you might get bullied, such as on the bus or in the hallways.
  • Don’t reply to online bullying: Try to block communications from the person who is bullying you. (For example, you can send their emails to go into Spam). Keep evidence of the bullying to show an adult.
  • Don’t react: The bully wants a reaction out of you, either to make you cry or get you angry. Try to not react and practice relaxation skills (such as taking deep breaths or walking away). You can also practice ways to ignore hurtful statements, such as pretending you don’t care about their words. By ignoring the bully, you are showing them that they can’t get to you. If you continuously act like the bully isn’t getting to you, the bully will get bored with trying to bully you.
  • Remove the value. If the bully is coming after your lunch money, start bringing your lunch instead. If the bully is trying to get your I-pod, leave it at home.
  • Ignore the Bully. Take a different route to class if you can in efforts to avoid the bully.
  • Stand up for yourself. Sometimes acting like you feel brave will make you feel brave. When you stand tall and keep eye contact, you will show the bully that you aren’t scared. You can also say “Don’t mess with me” or “No, stop” in a loud voice and then walk away.

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Veronica’s journey of sexual abuse recovery

In walks in Veronica, a 24 year old sexual abuse survivor. Veronica had a long history of sexual abuse growing up by various family members, including her uncle and an older male cousin. Veronica had avoided sex as an adult but has recently engaged in sex and sexual activity with her boyfriend of 8 months. This is what brought Veronica into my office. Many survivors may react strangely to the possibility of sex. They might feel like they are being pulled in two different directions- wanting and not wanting sex. This ambivalence is what Veronica was also experiencing. She realized that she had a problem when she started to give her boyfriend mixed messages about intimacy and sex. She would describe situations in which she would put on lingerie, but as soon as her boyfriend came too close, she would pull away. Her reactions were confusing for the both of them. Veronica’s automatic reactions after these situations were to bury her anxiety, fear, and shame. This reaction to hide from her feelings had protected her in the past from dealing with the emotional pain of the abuse- but it was no longer working for her in her current life; in fact, it was perpetuating her pain from the past.

A big part of Veronica’s healing process was helping her identify what triggers her automatic reactions. I let Veronica know that it is possible for her to learn about her automatic reactions and to start gaining control of how they impact her.

When a survivor starts to identify what their triggers are, the triggers start to lose their secrecy and their power. For Veronica, practicing being aware and in the present moment was a very big step towards her healing process. She learned to connect to her body and become aware of body sensations. She learned to acknowledge her reactions even when she was unsure of what triggered them. This was a huge adjustment for Veronica because in the past she would run away from them.

Acknowledging what’s happening is the first step. Veronica then had to learn to calm herself down. Instead of running away or shutting down with her boyfriend, she started to bring herself to the present moment. For Veronica, the grounding phrase of “I am an adult now and can take care of myself” was utilized over and over in these triggers moments. She would also take deep breathes to calm her body down. Sometimes she would walk around the room, in efforts to get her body to connect to the floor, as a way to remind herself that she is safe and is capable of getting away (versus when she was a child and felt stuck in the abuse).

Now that she was able to reorient herself to the present reality, Veronica was able to make healthier, present oriented decisions instead of shutting down. These really came in handy for her when she was sexually active with her boyfriend. Here were some of the techniques Veronica used:

1.)    Stop the activity, pause, re-engage: this entails Veronica and her boyfriend to stop, have Veronica acknowledge her trigger and bring herself back to the present moment. Then, when ready/calm, allowing herself to re-engage the sexual activity

2.)    Altering the triggers: rather than avoiding the trigger, Veronica learned that she could take a break and continue the same activity in a different way. For instance, if being kissed on her neck is too overwhelming, she learned to ask her boyfriend to start kissing her stomach instead. This gives her power over her triggers.

3.)    Stop the activity and continue the intimacy in another way: so instead of stopping all activity, Veronica would continue to be intimate with her boyfriend in different ways- such as holding each other, taking a shower together, dancing, etc.

By learning to take control of her automatic triggers, Veronica was able to get unstuck from her old, trauma based reactions. Instead, she learned tools that gave her the opportunity to have a more positive and healthy sexual experience.

 

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Addiction and Trauma

Jaime, age 48, came into therapy to work on issues from her childhood. Jaime is a single mother who had a history of alcohol abuse, starting from the ages of 15 up to 43. She stated that she had been clean for the past five years, but is now dealing with all of the memories from childhood that she was hiding with her addiction. Memories of her mother hitting her with a belt, threatening her with a knife, and locking her in the bathroom when she was “bad” were returning to her, something that she thought she had left behind her. Jaime began to have flashbacks, feeling as though she was reliving the traumas she endured as a little girl in the present moment. Jaime at first tried to tell herself that she is fine and acted as if nothing had ever happened. However, her anxiety had taken over, as evidenced by her flashbacks, her nightmares, and racing thoughts about the past. Jaime started to think about drinking again, remembering how alcohol helped her numb these painful experiences. That is when Jaime decided that she needs to do something about these symptoms, especially since she did not want to pick up her old habits of using alcohol again.

Post-traumatic stress disorder (PTSD) is an anxiety disorder. PTSD can occur after someone has witnessed or experienced a traumatic event that involved their belief of being threatened of injury or death. Traumatic events could include sexual abuse, physical abuse, neglect, emotional abuse, car accidents, rape, assault, war, natural disaster, etc. The stress caused by trauma can affect all aspects of a person’s life, including mental, emotional and physical well-being. Jaime’s trauma of being emotionally and physically abused by her mother throughout her childhood has lead to her using coping skills that have been unhealthy for her. Jaime is now learning to use new coping mechanism that are healthy and could lead to managing symptoms more effectively.

Treatment:

I initially provided Jaime with psycho-education about PTSD and what it could look like in the body. The PTSD treatment did not take away Jaime’s painful memories; what it did was allow her to start living her life again. Jaime was able to live with her trauma memories and when the triggers came about, she was able to deal with them. She learned how to keep herself safe without the help of alcohol. I assisted Jaime in creating coping skills that were comfortable for her. Jaime began to write in a journal every day, allowing herself to give her thoughts and feelings some space on paper. Jaime also began a Trauma Group, something that she enjoyed very much. The group showed Jaime that she is not alone and that there are others like her who have gone through painful experiences growing up. Jaime also went back to her Alcoholics Anonymous meetings, in efforts to maintain her sobriety. Due to the positive therapeutic relationship built with Jaime, she began to draw her trauma memories during individual therapy sessions, using crayons and pastels to process her experiences. Drawing was something new for Jaime. As a child, she was not allowed to draw, due to her mother thinking it was “too childish” and “a waste of time.”  Drawing became a tool for Jaime to process her shame, guilt, and being “bad” as well. Therapy gave Jaime a safe space to explore different avenues of expression and to integrate her memories from childhood.

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