Give me some advice and hope about a particular stage of CPTSD treatment
March 21, 2024 6:08 AM Subscribe
Help me not give up just as things are getting better.
I've been in some flavour of therapy for >10 years after leaving an emotionally abusive household. This has gotten much more effective in the last couple of years after discovering therapies that explicitly target trauma, and slowly being able to accept that I have CPTSD. For the first time I'm noticing that I'm actually responding in a significant way to therapeutic exercises, which is such a relief. That said, it's been so. much. work. It just feels like I've been working on this forever at this point, and as usual it's easy to have doubts about the whole process.
I feel like I keep experiencing 'it gets worse before it gets better' over and over but the current flavour of that is that I'm doing less minimising and disassociating and distracting myself from my feelings, but hurting a lot more. And I've dismantled a bunch of coping mechanisms but don't really have new ones to replace them with. I feel like every day I'm functioning less and less which for a person who previously coped by overfunctioning is pretty vulnerable.
I'm fairly sure now that I'm getting support from therapy that works for me and practicing the right things, so intellectually I know to keep on with what I'm doing. I guess I'm just looking for strength to keep doing that -- hope that I'm moving towards some good outcome, rather than just towards things being bad in new different ways over and over. Any stories of things getting significantly better for people or reassurance that I'm on the right track or any other advice for this stage would be really helpful. And thanks, MeFi, your advice already has helped me with making it this far.
I've been in some flavour of therapy for >10 years after leaving an emotionally abusive household. This has gotten much more effective in the last couple of years after discovering therapies that explicitly target trauma, and slowly being able to accept that I have CPTSD. For the first time I'm noticing that I'm actually responding in a significant way to therapeutic exercises, which is such a relief. That said, it's been so. much. work. It just feels like I've been working on this forever at this point, and as usual it's easy to have doubts about the whole process.
I feel like I keep experiencing 'it gets worse before it gets better' over and over but the current flavour of that is that I'm doing less minimising and disassociating and distracting myself from my feelings, but hurting a lot more. And I've dismantled a bunch of coping mechanisms but don't really have new ones to replace them with. I feel like every day I'm functioning less and less which for a person who previously coped by overfunctioning is pretty vulnerable.
I'm fairly sure now that I'm getting support from therapy that works for me and practicing the right things, so intellectually I know to keep on with what I'm doing. I guess I'm just looking for strength to keep doing that -- hope that I'm moving towards some good outcome, rather than just towards things being bad in new different ways over and over. Any stories of things getting significantly better for people or reassurance that I'm on the right track or any other advice for this stage would be really helpful. And thanks, MeFi, your advice already has helped me with making it this far.
Best answer: Your question resonates deeply, pandabanter. I'm currently on a pause from therapy, as I landed in a similar place a few months ago (feeling overwhelmed by more emotions and sensations but without replacement coping/stabilization techniques).
I've since learned a little more about the triphasic trauma treatment model conceptualized by Judith Herman in Trauma and Recovery. (It's worth a Google to read up on the triphasic model to see if it resonates for you.)
The first phase is safety/stabilization, which focuses on building safety in the body and in your present-day environment. For many trauma survivors, it's vital to attend to this phase before or along with phase two, which focuses on trauma processing. My own therapy was focused on trauma processing, and I realized I was missing some safety/stabilization/grounding skills when my feelings started to break through and overwhelm me. (Phase 3 is about integration, connection, and moving forward).
Seconding Lyn Never's recommendation of somatic experiencing. Peter Levine's book, Healing Trauma, has some concrete and simple exercises. I have been checking out the work of Luis Mojica, a trained somatic experiencing practitioner, whose approach resonates for me. He puts out a podcast and some courses and resources through Holistic Life Navigation.
I'm new to learning about somatic experiencing, and I've been surprised by how much it involves gentle, short doses of observing our bodies and feelings. Titration/pacing is a huge part of SE. Everyone says slow is fast - I'm finally starting to understand that means I can't goal-set and overachieve my way to feeling better on an arbitrary timeline. It is so much less effortful/striving than a lot of the cognitive and behavioral work also involved in healing from trauma. I have been stunned to catch how the little doses of SE already grant me moments of felt safety (something I don't know I've ever really felt before). And that is helping me feel less overwhelmed and more capable of taking on my present day life, without sliding back into overfunctioning.
Wishing you compassion and encouragement on your own journey.
posted by Jade Horning at 9:27 AM on March 21, 2024 [8 favorites]
I've since learned a little more about the triphasic trauma treatment model conceptualized by Judith Herman in Trauma and Recovery. (It's worth a Google to read up on the triphasic model to see if it resonates for you.)
The first phase is safety/stabilization, which focuses on building safety in the body and in your present-day environment. For many trauma survivors, it's vital to attend to this phase before or along with phase two, which focuses on trauma processing. My own therapy was focused on trauma processing, and I realized I was missing some safety/stabilization/grounding skills when my feelings started to break through and overwhelm me. (Phase 3 is about integration, connection, and moving forward).
Seconding Lyn Never's recommendation of somatic experiencing. Peter Levine's book, Healing Trauma, has some concrete and simple exercises. I have been checking out the work of Luis Mojica, a trained somatic experiencing practitioner, whose approach resonates for me. He puts out a podcast and some courses and resources through Holistic Life Navigation.
I'm new to learning about somatic experiencing, and I've been surprised by how much it involves gentle, short doses of observing our bodies and feelings. Titration/pacing is a huge part of SE. Everyone says slow is fast - I'm finally starting to understand that means I can't goal-set and overachieve my way to feeling better on an arbitrary timeline. It is so much less effortful/striving than a lot of the cognitive and behavioral work also involved in healing from trauma. I have been stunned to catch how the little doses of SE already grant me moments of felt safety (something I don't know I've ever really felt before). And that is helping me feel less overwhelmed and more capable of taking on my present day life, without sliding back into overfunctioning.
Wishing you compassion and encouragement on your own journey.
posted by Jade Horning at 9:27 AM on March 21, 2024 [8 favorites]
Best answer: I'm doing less minimising and disassociating and distracting myself from my feelings, but hurting a lot more. And I've dismantled a bunch of coping mechanisms but don't really have new ones to replace them with.
Looking back I remember this as a seminal moment in therapy, where I stopped tearing down and started building up. I spent so much time not wanting to be who I was, and that was when I decided I was finally healthy enough to envision who I wanted to be and start working towards it.
I still dragged the old mechanisms along for a while and occasionally I find myself falling back into those habits, but my life now is much more about being the person I want to be as opposed to being constrained by the battering I took previously.
posted by Tell Me No Lies at 10:52 AM on March 21, 2024 [4 favorites]
Looking back I remember this as a seminal moment in therapy, where I stopped tearing down and started building up. I spent so much time not wanting to be who I was, and that was when I decided I was finally healthy enough to envision who I wanted to be and start working towards it.
I still dragged the old mechanisms along for a while and occasionally I find myself falling back into those habits, but my life now is much more about being the person I want to be as opposed to being constrained by the battering I took previously.
posted by Tell Me No Lies at 10:52 AM on March 21, 2024 [4 favorites]
Best answer: As far as the stages of trauma, it's not unusual to have to go back and forth between stage 1 and stage 2. (Not sure about stage 3, haven't gotten there yet.) But I have been through that "less dissociationg/less negative coping strategies" but now I've dug up all this horrific shit and it HURTS.
And when it gets to be too much, my therapist and I have temporarily transitioned back to more of a "stage 1: stabilization" approach, to focus on better coping skills, to give me a break before forging ahead more.
So I would try discussing something like that with your therapist.
posted by litera scripta manet at 2:09 PM on March 21, 2024 [1 favorite]
And when it gets to be too much, my therapist and I have temporarily transitioned back to more of a "stage 1: stabilization" approach, to focus on better coping skills, to give me a break before forging ahead more.
So I would try discussing something like that with your therapist.
posted by litera scripta manet at 2:09 PM on March 21, 2024 [1 favorite]
Anecdotally, i've been doing Internal Family Systems therapy for trauma and it's been life changingly helpful. Within that context, the maladaptive habits that you picked up in order to survive trauma manifest as independent 'parts', doing their best to keep you safe against dangers that may not be present in your current life. You can learn to have an internal dialogue with those parts around this and collaboratively make adjustments (this is a really really broad strokes summary).
What I have been trying to do while in a similar situation as yours is to think about, in whatever situation, "if not this, then what". I just kind of pose it to myself and see what comes up in my mind. I don't try to implement it or argue for or against the answer. Just kind of let it be there. Write it down, if it helps.
The frustrating answer to this is that you likely already have the knowledge and information about what choices you'd like to make and how you'd like to show up differently for yourself and for those around you, and there are strong protective forces within you that may be distracting or creating a strong emotional narrative around implementing them.
The first step is to approach yourself with neutral curiosity. "If I wasn't going to freak out/lash out/self-flagellate in this situation, what would I want to be doing" and then whatever answer comes up be like "ok that's interesting, thank you for sharing that".
posted by softlord at 11:39 AM on March 28, 2024
What I have been trying to do while in a similar situation as yours is to think about, in whatever situation, "if not this, then what". I just kind of pose it to myself and see what comes up in my mind. I don't try to implement it or argue for or against the answer. Just kind of let it be there. Write it down, if it helps.
The frustrating answer to this is that you likely already have the knowledge and information about what choices you'd like to make and how you'd like to show up differently for yourself and for those around you, and there are strong protective forces within you that may be distracting or creating a strong emotional narrative around implementing them.
The first step is to approach yourself with neutral curiosity. "If I wasn't going to freak out/lash out/self-flagellate in this situation, what would I want to be doing" and then whatever answer comes up be like "ok that's interesting, thank you for sharing that".
posted by softlord at 11:39 AM on March 28, 2024
I'm here to recommend a recent first person account of the recovery process for CPTSD. It might help to see that you are not alone in some of the stuff you are experiencing?
What My Bones Know: A Memoir of Recoving from Complex Trauma
posted by gigimakka at 8:35 AM on April 17, 2024
What My Bones Know: A Memoir of Recoving from Complex Trauma
posted by gigimakka at 8:35 AM on April 17, 2024
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Have you flagged this to your therapist? It's totally legit to choose to soft-pause some of the progressive dismantling work to spend some time...mantling? new healthy coping strategies to replace maladaptive ones.
And especially, in CPTSD treatment, you want to be incorporating more than just CBT-type narrative reframing, you want to be doing body/nervous system/vagus nerve techniques to literally cool your jets when you're dysregulated. Is your therapist incorporating anything like somatic experiencing or similar?
As a jumping off point, I recommend Burnout to everyone, but that's not super specific to trauma so I would encourage you to talk to your therapist about trauma-informed somatic/bodywork/movement/nerve-type work to help you re-regulate on demand.
You're doing good work, but you are right that it is very hard work and you deserve ways to induce a calm and present state as needed.
posted by Lyn Never at 8:55 AM on March 21, 2024 [13 favorites]