Getting to know your different parts

Learning about Tracy

In walks Tracy, a 37 year old female. Tracy had initially come into my office to work on her abuse of marijuana. According to Tracy, she would use marijuana as a means to escape the many troubles of her life, particularly the issues within her relationships. The problem was that her using was getting in the way of her life- in her career, with her family life, as well as with her partner of two years. Tracy was ready to make some changes for herself.

In getting to know her, I learned that Tracy was raised in a single parent household in which her mother was not emotionally available- instead, she took on the role of “caretaker” for her mother, in addition to her two younger siblings. Through this process, she did not know how to be a child- this started at the age of 8, when her mother got diagnosed with cancer, and she took on the role of her mother’s caretaker. Although Tracy went to school, she would come home and immediately start doing all the tasks that her mother needed her to do- especially in feeding her younger siblings and helping them with their homework.

Now as an adult, Tracy has continued this pattern of not taking care of her needs. She has spent all her life taking care of everyone else but herself. According to Tracy, her partner Alex also complains that Tracy neglects herself and goes over & beyond for others. Alex is tried and frustrated in seeing Tracy treat herself so poorly. However, when it comes to her wants and needs, Tracy feels lost and unsure of what to actually do. Instead, she has turned to smoking marijuana as a means to escape. What Tracy didn’t know initially was that that 8 year old little girl who was neglected as a child has followed her into her adulthood.

A big part of Tracy’s therapy was to learn the different feelings that she has, but to also learn about her different parts….

Little Tracy,   age 8                       Addict Tracy, age 24 

Adult Tracy,    age 19                    Artist Tracy, age 37                                              

Lover Tracy, age 21                      Depressed Tracy,  age 12

Sister Tracy- current age 37         Working Tracy, age 37                      

Part of Tracy’s therapy was to learn about all her different parts. The goal here is NOT to eliminate any of her parts, but to start learning about her different parts and to start changing her relationship with them. For instance, the neglected “Little Tracy” who is 8 years old does not need to keep interfering with “Adult Tracy’s” attempts to self care.

“Adult Tracy” can start to learn what she needs and how to get her needs met without the wounds of the past coming in. She can embrace “Artist Tracy” and allow herself the space to be open and creative. One of the most important tasks, however, is to allow “Little Tracy” to grieve-  grieve the childhood she never had and start to nurture that inner child that didn’t get to play.

One of my homework assignments to Tracy was to literally go and play- she told me that she used to like going to be the beach as a little girl, but that she didn’t get to play because she would have to take care of her siblings. Now, “Adult Tracy” took “Little Tracy” to the beach and made sand castles!

By learning about her different parts and how to nurture them, Tracy began to heal the wounds from the past and live a more present oriented life.

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Coping With Flashbacks for trauma

What is PTSD?

  • 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 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.

What are Flashbacks?

Flashbacks are one of several symptoms that accompany PTSD. In a flashback, a person may feel or act as though the traumatic event is occurring all over again, making it very difficult to cope with. A flashback could be brief, with having some awareness to the present moment.

However, a flashback could also make someone lose all connection of what is going on around them, creating a feeling as if they are being taken completely back to their traumatic event. For example, a rape survivor who sees men who look similar to her abuser may begin to feel pain in her body similar to that which was experienced during her assault.

WAYS TO COPE

Self Talk: Tell yourself you are having a flashback and that you are ok

Connected to the present moment:

  • Tell yourself that the worst is over- it happened in the past and you are ok now.
  • Ground yourself to the present by standing up, stomping your feet, etc to remind yourself where you are
  • Use your 5 senses: look around the room and point out objects you see around you—listen to the sounds around you—smell something that soothes you

 Breathe: breathe in threw your nose and out through your mouth. When people get scared, they tend to breathe too quickly and their body can panic. Slow down your breathing to help relax your body.

Connect to your body: rub your legs so remind yourself you are in the present moment and safe.

Self Care: flashbacks are exhausting- make sure you take care of yourself after you’ve had a flashback. For instance, take a relaxing bath, journal, play some soothing music, etc

 

For more information, please visit http://www.cristinamardirossiantherapy.com

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Working with Trauma: Monica’s Story

In walks in Monica, a 33 year old Caucasian woman. Monica has come to see me due to her sexual traumatic experiences she had endured throughout her childhood, particularly by her uncle.

Monica, now a successful broker, has begun to have flashbacks and nightmares come up for her. She came to my office very confused and horrified- confused as to why the flashbacks are coming up for her now, after all these years; but also very horrified at the memories that are presenting.

I had to explain to Monica that this is a very common experience- that most survivors of abuse need many years, and sometimes many therapists, before they can face the truth of their abuse. I explained to Monica that many survivors of abuse may be dealing with addictions, anxiety, depression, eating disorders, etc, before facing their abuse. Like many trauma survivors, Monica was going through the following:

1-   Repeated/reliving of the event: Can be seen via flashbacks, repeated dreams/nightmares, or physical reactions to certain stimuli

2-   Avoidance: Can be seen as feelings of detachment, inability to remember aspects of the trauma, withdrawing from people, places, or things that remind you of the event

3-   Arousal: Hyper-arousal (i.e. tension, anxiety) or hypo-arousal (numbness, withdrawal)

Long after a trauma has occurred, many individuals find themselves anticipating and reacting to stimuli that directly or indirectly resemble the original trauma. They unconsciously narrow their field of consciousness to reminders of the trauma and neglect to see cues of safety.

Monica was experiencing this hyper-vigilance and needed to be grounded to the present moment. One way of getting Monica to focus on the present moment was to direct her to physically adjust her body towards new stimuli. This was done by asking her questions that helped focus attention when she got triggered (such as having her name all the objects in the room, naming the colors in the room, etc). Another way of helping Monica get grounded was to help her get connected to her sensory experiences (here-and-now experience of what she smells, sees, hears, and feels with her sense of touch).

Some other Grounding Techniques:

  • Keep your eyes open and your feet on the ground
  • Hold a stuffed animal or other comforting object
  • Listen to calming music
  • Breathe, focusing on each inhalation and each exhalation
  • Do something that involves each of your senses, such as reading, watching TV, touching a stone, smelling a flower, or eating your favorite candy.
  • Choose a grounding phrase that you can say to yourself such as “I’m an adult now and I’m safe.”
  • Journal to help yourself understand what triggered you and how you might be able to handle it differently in the future
  • Doing movements that feel soothing, such as wrapping arms around the body

 

 

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Emotion Regulation Skills

Having the tools to help regulate your emotions is crucial in maintaining a good quality of life. These tools help you stay grounded in your day to day functioning, even if things aren’t looking like they are going to improve. Emotion regulation skills are also helpful in that they help you respond to life events rather than react to them.

Here are some effective ways to start practicing some of these skills to assist you in regulating emotions:

-Build an awareness of the parts that you like about yourself and about the parts you don’t like about yourself. Acknowledge that there are certain things that you will not be able to change about yourself, but by being aware of these parts you can lessen the distress on yourself.

-Practice Acceptance: realize that you cannot change/control people or things around you- you can only control how you react.

-Make changes in your life so that positive events will occur more often (i.e. going for a walk, going to the movies, calling a friend, etc).

Distract yourself from unnecessary worries such as:

– thinking about when the positive/good experience will end

-thinking about whether you really deserve this positive experience

-thinking about if the experience will occur again

Get to know your feelings

 -Learn to identify and label your emotions

 

-Learn about the accompanying body sensations that come with these feelings

 

 -Describe the thoughts that come along with these feelings

 

By being simply noticing and acknowledging these feelings (rather than pushing them away), the intensity tends to dissipate on its own.

Know that Feelings are just feelings- you don’t need to act upon them. You can choose to engage in them or tolerate them while doing nothing.

 

 

 

 

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Managing Panic Attacks

What is a Panic Attack?

A panic attack is a fear response that is out of proportion for the given situation. It involves an intense anxiety that causes much discomfort. A panic disorder comes into play with the person is constantly living in fear of having another panic attack.  This could really affect a person’s daily functioning. Therefore, it is important to shed light on how to manage these panic attacks, so that they do not take over.

Christian had his first panic attach when he visited his father in the hospital, after a car accident. Christian saw his father asleep in the hospital bed, looking pale, with a cast on his leg. Christian felt himself trembling. He also had difficulty breathing and felt faint. He began to perspire and felt like he was going to die. His mother, who had experiences with panic attacks, helped Christian take long, deep breathes, until his panicky feelings subsided. After a couple of minutes, Christian felt better, but was confused as to what just happened with his body.

Symptoms of A Panic Attack

Difficulty breathing             Trembling or shaking           Pounding/racing heart

Feeling of terror                     Numbness                                Feeling Choked

Sweating/chills                       Feeling Dizzy                          Nausea/ stomachache

Tingling                                  Chest Pain                             Feeling like you’re dying

  Managing Panic Attacks

Using Your Mind:

  • Remind yourself that you are not in actual danger. You are having an exaggerated response to a reaction to stress.
  • Tell yourself that you can help yourself manage these feelings.
  • If you are worried that you can’t breathe, remember that if you are able to talk, you are able to breathe.
  • Seek help to get an understanding of what is causing your panic attacks.

Using Your Body:

  • Find a place you could sit and feel safe (for instance, if you are driving, pull over to the side of the road to let your body relax).
  • Begin to do some deep breathing exercises: breathe in through your nose, take a long deep breathe in, and then exhale slowly through your mouth. The oxygen will help calm your body, stop your heart from racing, etc.
  • Do other things that feel comforting to you (such as listening to soothing music, sipping cool water, calling a friend, yoga, going for a walk, etc).

Cristina Mardirossian, LMFT
Licensed Marriage and Family Therapist
(818)434-6051

Website: www.cristinamardirossiantherapy.com

Follow me on Facebook: http://www.facebook.com/TraumaTherapy

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Connecting to Emotions

In walks Mark, a 37 year old man who looks tougher than nails. Mark sits down and tells me that he doesn’t think he needs to be in therapy. He is strictly coming to therapy at his partner’s request. In slowly building rapport with him, I realized that he has difficulty in connecting to his feelings. Instead, he would put on this mask that made him appear like a “macho man,” as he would call himself. Many people who have suffered with pain have either never learned how to recognize and connect to their feelings or experience their feelings in a disconnected way. This typically begins as a defense mechanism. However, this disconnection eventually can decrease one’s ability to regulate stressful feelings, increase arousal in the body, and impairs decision making. Mark’s task in the beginning stages of therapy was to just learn how to recognize and understand his feelings along with the accompanying sensations he has in his body.

 In this process, Mark began to slowly trust me and eventually shared with me that he was severely emotionally abused and neglected in his childhood. According to Mark, his parents were always working and when they were actually home, they would degrade him consistently. He frequently was called an idiot, a failure, and a piece of shit. What Mark also remembers being very traumatic for him was never being touched.  Mark stated that he never received hugs or any form of intimacy with his parents.  When he attempted to sit close to one of his parents, he would be told to move away or go to his room. Now, as an adult, Mark has moments in which he is intimate, but then quickly withdraws (hence why his partner sent him to therapy). The “macho man” was just a cover up for Mark’s fear to connect.

Treatment

I helped Mark begin to learn how to listen to his body. For instance, he learned how to feel the “no” in his gut when he didn’t want to do something or when he felt uncomfortable. He also learned to notice what his body feels like when he is tired. As a result of Mark being more able to read his own body and express his needs, he became more able to increase his emotional connectedness. Mindfulness is the ability to be aware of what is happening in the present moment without judging yourself. It also includes noticing what is going on in your body, including physical sensations and emotions. As Mark learned to incorporate these mindfulness skills in his everyday life, he was able to tolerate slowly removing the “macho” facade without getting too overwhelmed.

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Sally’s Childhood Abuse

Sally, age 32, initially came to therapy to deal with her anxieties and fears. She talked about her phobia of being in the dark, being in environments that were unfamiliar to her (especially in the evening/night time), and avoidance of certain men. Sally described how her anxiety had been getting in the way of her relationships. One concern in particular that she shared was her fear of being in the dark with her boyfriend. She also stated that she’s had nightmares since she was 7 years old, but that they intensified when her boyfriend would sleep over. Sally also stated that she has a lot of anxiety around sex- She reports that her body shuts down and freezes when she attempts to have sex. Sally eventually revealed to me that she was sexually abused by a family relative at the age of 7.

In therapy, I initially spent the first part of treatment building trust and rapport with Sally. Although I had known about her childhood sexual abuse early in treatment, Sally first needed coping skills and grounding techniques prior to dealing with her trauma memories. She learned skills in how to deal with her anxieties, such as learning to relax her body when in fearful situations. Part of this first phase of therapy involved assisting Sally in identifying and verbalizing body sensations- helping her find the words to describe sensations i.e. tingling, twitching, burning, tight, numb, etc. and helping her get connected to them. She also learned to connect with sensory experienceshere-and-now experiences of what she smells, sees, tastes, hears, and feels in the present moment. I also helped Sally in developing a list of coping skills. One of the skills she favored most was keeping her eyes open and feet planted to the floor as a means to keep herself grounded when anxious. She also started to play calming music at night when her boyfriend would sleep over, which helped her sleep more peacefully.

Once Sally had the tools to deal with her anxieties trauma triggers, she was able to use the therapeutic space to talk about her sexual abuse. While Sally described her sexual abuse, I would ask her about emerging thoughts, emotions, body sensations, movements, five senses, etc. Through mindfulness of her present-moment experiences, she was able to shift from being caught up in the trauma to becoming curious about her sensations. This was very beneficial for Sally- she began to differentiate between traumatic memories/sensations from her abuse to her present reality of feeling safe.

Cristina Mardirossian, MA., LMFT

Licensed Marriage and Family Therapist

Lic. # MFC 49234

  (818)434-6051

Cnm.therapy@gmail.com

http://www.PasadenaTraumaTherapy.com

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