PTSD/EMDR questions

June 30, 2009 9:04 AM

I'm a 27 year old female dealing with PTSD from extreme childhood abuse and psychoanalysis is not working. I've read previous AskMe questions, but would like more feedback from people who have had EMDR therapy. I'm also wondering if anyone has any advice on mild dissociation.

A few points:

It would be tough for me to switch therapists now, but is it worth it for me to find someone who practices EMDR? Anyone have advice for or against EMDR? I've heard great things.

I don't take meds and don't tolerate them well due to side-effects.

I'm beginning to realise that I may have "dissociated" from myself, or stepped outside myself when being abused, to avoid the pain. Any thoughts on later repercussions from this? I'm beginning to feel I've left a part of myself behind, and she "comes back" under stress. My psychiatrist doesn't "interact" with me about this, just sits quietly, which is another reason I'm thinking psychoanalysis is not for me.

I'm also having trouble in personal relationships. People I want to trust inevitably sort of "become my parents" in my mind. How does one learn to trust again? Obviously I can't go on like this.

Thanks. I'm not looking for therapy here, just a little direction to get help elsewhere.

posted by anonymous to health & fitness (19 comments total)

I'm beginning to realise that I may have "dissociated" from myself, or stepped outside myself when being abused, to avoid the pain. Any thoughts on later repercussions from this? I'm beginning to feel I've left a part of myself behind, and she "comes back" under stress.

That's a completely normal PTSD thing. It's like you can compartmentalize your life, and you can keep a certain distance from most things, but certain triggers will bring out another side of you. The dissociative tendencies don't help us much in real life, alas. You might try practicing mindfulness. For instance, when you are eating, don't multi-task. Focus on the taste of the food, the texture, your chewing, etc. This sort of practice is very helpful in bringing you back to the present.

My psychiatrist doesn't "interact" with me about this, just sits quietly, which is another reason I'm thinking psychoanalysis is not for me.

Yuck. I'm really sorry to hear that. I had an analytical therapist for awhile, and it just didn't work for those same reasons. I know it's a horse that's been beaten to death, but I really recommend cognitive behavioral therapy with a trauma specialist. If you MeFiMail me, I can try to suggest some therapists, or at least hook you up with someone who knows therapists in your area.

CBT, just to start with, helps you identify your feelings and the thoughts that come with those feelings. Here's an example. Feeling: Despair. Thought: I'm no good. What you do next is challenge those "automatic negative thoughts" by trying to figure out how much you believe them and then restructuring them. The idea is that by challenging your thoughts and behaviors, you can change the way you feel.

I've been doing CBT on and off for about ten years now, and it's really, really helped. The emotional dysregulation that results from childhood abuse is probably the hardest thing to overcome, but the flashbacks, nightmares and dissociation can really be tackled in about a year with a good CBT practitioner.

People I want to trust inevitably sort of "become my parents" in my mind.

Oh, I've been there, too. You're not alone. What you need is a therapist who will talk with you about these things, help you identify exactly what happens in these situations and where you can modify your responses so they are more helpful to you.

I don't know much about EMDR, except that all my doctors, whom I trust on this particular issue, have said it's probably not worth the time/money. Analysis is completely, completely wrong for trauma survivors (personal opinion). You want someone who does a combination of CBT and what's called "dynamic" therapy, meaning your therapist will actually talk with you instead of acting like an inanimate object.

Best of luck, and hugs. You deserve them.
posted by brina at 9:40 AM on June 30 [1 favorite has favorites]

Everything brina said is spot-on, especially about analysis being unhelpful for trauma survivors.

Try to talk with a therapist who is trained in dialectical behavior therapy (DBT). It is designed, in part, to help people who dissociate during stress. It teaches many techniques for dealing with disassociation.

It is also designed for people who have difficulty tolerating and enjoying intimate relationships.

It is focused mainly on your current behaviors and your future.

It is evidence based (of course, CBT is too) meaning there is evidence that it works.

I am confident that you will get better when you find something that works. Keep trying!
posted by kathrineg at 9:59 AM on June 30

I have used EMDR and found it extremely helpful for some similar problems. It is so different from regular therapy that it wouldn't surprise me if you could do it and your regular therapist, though I haven't tried it. Also, you're not usually doing it for years- it does come to an end. Memail me if you want.

Also, it might be worth asking a mod to add a throwaway email, in case people don't feel like publicly discussing their therapy experiences.
posted by small_ruminant at 10:03 AM on June 30

I'm beginning to realise that I may have "dissociated" from myself, or stepped outside myself when being abused, to avoid the pain. Any thoughts on later repercussions from this? I'm beginning to feel I've left a part of myself behind, and she "comes back" under stress. My psychiatrist doesn't "interact" with me about this, just sits quietly, which is another reason I'm thinking psychoanalysis is not for me.

There are repercussions. The problem is that under stress, or even under conditions resembling the previous abuse, or in situations where you may get emotionally hurt and then access the feelings from the past, you will act in ways that are not condusive to you obtaining things you might want, such as intimacy or professional success. And just rereading the question, I see it is doing exactly that.

What I've found helpful is going over the abuse. Write letters to the abusers or confront them verbally. If you can't do either of these, just write the letter but don't send it. Do imagery, but imagine yourself standing up or advising the young you to stand up or get away.

The real problem is that the abuse you suffered as a kid was the result of being trapped in relationships with the abuser. Kids have zero options in terms of controlling where they live and most of the relationships they have with adults.

What has really worked the best though is realizing that my fears that I will again be trapped are not realistic, because I can get away. Now when they come up I say "It is never going to be like that again."

The other issue is that much of your trust issues stem from a fear of facing the emotions from the past. Indeed, this is the biggest problem you may have. Being hurt would mean accessing those feelings and your disassociation is designed to avoid that. Indeed, when you are trapped, disassociation is an excellent strategy. But when you are in the big world, away from your abuser, it isn't very helpful.

Finally, I'd be realistic about the time frame for getting stuff out of psychoanalysis. It is generally a long-term therapy. In situations like yours, it could take several years. Those several years are worth it, in my personal experience. It may seem like the payoff is far off. But I do think it is the best way of getting through this stuff, long as it takes. You do need to process that stuff because, as you've indicated, your coping mechanism from the past is getting in the way of a lot of the things you want. You're torn in two--general desires for intimacy, workplace success and general risk-dependent goal-seeking behavior are stalled by the fear. The therapy is designed to work slowly but get through exactly that. I'd advise talking with your therapist and reevaluating how long this is going to take.

All of this is of course dependent on having the right therapist. There's nothing wrong with seeking a change.

Please, feel free to contact me at any time for anything I can do to help--I have been through this and there is a light at the end of the tunnel, I can promise. Use my email address or mefi mail me at any time. I have been there and I have done that in ways that are quite similar to yours.
posted by Ironmouth at 10:03 AM on June 30

Also, EMDR (as practised by my therapist anyway) doesn't involve a lot of analysis, for the reasons mentioned above.
posted by small_ruminant at 10:05 AM on June 30

I am dealing with PTSD which came about through similar circumstances. A few years ago, I found myself fascinated with EMDR. After some research (and, though I am in no way a member of any sort of profession related to psychology, I wrote a little paper on EMDR for my own purposes, so, if I can find it, I'll be more than happy to share the bibliography) I noticed that the studies I had looked at had shown that when dealing with PTSD caused by a single traumatic event, EMDR seemed to aid recovery significantly, whereas if the cause is a long-term traumatic situation, EMDR did not fare much better than CBT. However, I have not tried EMDR, so I cannot say much from personal experience on that end.

As far as the disassociation goes, from what I understand that is a pretty normal aspect of PTSD. My own personal repercussions from this include a limited range of emotions (well, emotions that I actually feel), and, when I get stressed or overcome by some negative emotion, I start operating on some kind of autopilot and people tell me that "it's like there's no 'you' there." This is something that has been improving over the past three years of therapy, but I expect to deal with it to some degree for the rest of my life. One thing that has helped me is, when I'm feeling disassociated from myself, I try to stop and imagine what emotion makes sense for the situation, then I try to at least pretend to feel that emotion. This doesn't always work, but sometimes I can use that to push myself into releasing the stress/anger/sadness that I know that I must be experiencing on some level.
posted by The Great Big Mulp at 10:06 AM on June 30

kathrineg's recommendation of DBT is also a good one. DBT is a branch of CBT that was specifically designed for borderline personality disorder sufferers, but there are a lot of ways in which PTSD in trauma survivors is similar to BPD. Our fight/flight instincts are constantly triggered, we may feel things with a great intensity, and we often have problems with dissociation.

The mindfulness technique I recommended was a DBT exercise. The only reason I don't recommend DBT more highly is that I personally don't find it as helpful. It sort of depends on the kind of person you are. If you don't like acronyms, don't do DBT -- it's all about acronyms. But if you don't mind them, and you're looking for something that will allow you to talk a lot more about your feelings and not just your actions, it may be a good fit.

Another option: If changing therapists is too difficult for you right now, you might consider joining a CBT or DBT group, which you could add on to your existing therapy.
posted by brina at 10:11 AM on June 30

Brutal honesty: As a client, I tried EMDR, and it did not do anything for me. As a student training to become a therapist, I studied EMDR for a special project and found an amazing lack of sound clinical research to support its efficacy. As a therapist, I would not practice it, because I do not personally believe it to be good practice.

Your symptoms do sound pretty textbook for PTSD and trauma. A psychiatrist is one thing, but a finding a psychologist (Ph.D. or Psy.D.) or a marriage and family therapist could be a great step, as they are trained to do talk therapy and help you with tools to improve your current state. In addition, a good therapist tailors treatment to you--whether it's CBT, psychodynamic, narrative, whatever theoretical orientation. Not every treatment modality is a fit for everyone, so I would encourage you to seek therapists with experience in trauma and PTSD, rather than experience in EMDR, CBT, DBT, etc.
posted by so_gracefully at 10:36 AM on June 30

I'm sorry you're going through this. You need to change therapists. Unfortuantely it can be an in and out game for you until you find the right person. I agree, cognative therapy is better then analytical. Good luck.
posted by dasheekeejones at 10:47 AM on June 30

You need a different kind of therapist.

Also, you suggested that meds were not helpful-if you haven't tried Keppra, it might be worth a shot. It's helpful for PTSD and at least when I took it, no side effects I could notice. But of course I understand ymmv.
posted by St. Alia of the Bunnies at 10:49 AM on June 30

Also, therapists who refuse to interact drive me up the wall.

Although I obviously disagree with so_gracefully about EMDR, I agree that finding someone comfortable for you and who has more than one tool in her toolbox is important.
posted by small_ruminant at 10:54 AM on June 30

My mom is a therapist trained in EMDR and when she discovered it and started using it in therapy sessions she was thrilled at how much it improved her ability to help her clients. However, I know she doesn't use it with every client or even every client who is dealing with trauma/PTSD. I just wanted post this to agree with so_gracefully and small_ruminant--you can and should find a therapist who specializes in trauma and also happens to be certified in EMDR.
posted by horses, of courses at 12:06 PM on June 30

One thing I love about both CBT and DBT is how practical and present-focused they are. While there may be some value in therapy that lets you free-associate and probe your past for the sources of your current troubles, eventually it's like, "OK, that's interesting. But now what?" It seems psychoanalysis just leads you back down the rabbit hole of your memories without giving you the tools to address them, much less the tools to address life as you're now living it.

CBT and DBT move the focus from your past to your present, which is not to say they don't address your past at all - they just use it to formulate the particulars of how to address the present. They're both very structured and accessible, which keeps you from flailing when you're used to dealing with the stresses of life by falling back into old destructive thought patterns and habits. I don't know about EMDR but I highly recommend both or either DBT and CBT.
posted by granted at 12:58 PM on June 30

I work in the mental health field and a significant number of my clients have reported a decrease in problems related to the trauma after participating in EMDR. I also participated in EMDR and was amazed at how quickly it helped me/ I resolved a complicated, traumatic event. Metamail me for more details. I am pursuing EMDR certification. I don't believe it always works but I do believe it can work very well for some people. I am beyond thrilled that I tried it and with the results. All therapies, including EMDR, talk therapy, and CBT have advantages and disadvantages and every person and therapist and situation will have different responses.
posted by aliksd at 3:26 PM on June 30

EMDR appears to work-- like posters say above, primarily for people who experience a single traumatic event, rather than prolonged child abuse. According to a meta-analysis of the data, it is equivalent in effectiveness to exposure therapy (a form of CBT in which you recount the experience in a safe environment and essentially help move the traumatic flashbacks from being perceived as "repeating" and "happening now" to being ordinary memories).

That same analysis found that what works about EMDR is nothing to do with the eye stuff but actually the same stuff that helps in exposure. So, while it does work, it doesn't work for the reasons its propopents say it does. Some have argued that means it doesn't work-- but that isn't what matters to the patient.

Nthing recommendations to find a therapist who uses some form of evidence-based treatment-- whether it be EMDR or exposure CBT.

it's very hard to find people who actually practice these things as intended-- and it's also important to find someone with whom you feel safe and comfortable. The overwhelming finding in the research on psychotherapy in general is that therapist empathy matters most of all-- so if someone is "not connecting," don't waste your money even if they are perfect on the technique.
posted by Maias at 4:46 PM on June 30

I think non-interactive types of therapy are typically not well suited for trauma. Some colleagues of mine even think that the therapist silence in some way re-enacts the traumatic environment.

Be that as it may, the bottom line is that if a therapist isn't helping you, you should bring it up, and if that doesn't help, you should find another therapist.

Not sure what so_gracefully is referring to, but there seem to be a lot of research backing the efficacy of EMDR for trauma. It may not be demonstrated to be *more* effective than other trauma-focused therapies, but it certainly has evidence backing it up.

You don't say where you are, but there's a SF Bay Area therapist who works a lot with EMDR and trauma and has written about it, including a new self-help book. If you like her approach, you could certainly email or call her to discuss your situation and see if she can recommend someone in your area.
posted by jasper411 at 4:52 PM on June 30

EMDR worked very well for me as I've stated before here on AskMe. I think you should give it a try.
posted by IndigoRain at 7:52 PM on June 30

EMDR also worked extremely well for me. I wasn't dealing with a one-time traumatic episode. I sought treatment due to on-going family issues that started in early childhood. I was not dealing with extreme childhood abuse, however.
EMDR worked for me where years of talk therapy and meds failed. I know no one else who has tried EMDR, so I only have my own experience to go by. Feel free to memail me if you have specific questions I might be able to answer.
posted by Brody's chum at 12:37 AM on July 1

EMDR has worked amazingly well for several friends who have had childhood issues and abuse. PLEASE do try it.
posted by metametababe at 1:35 PM on September 30