How to get unstuck in therapy around trauma?

August 18, 2024 1:44 PM

How do I find more/different treatment for CPTSD, when I don't really know what I need and I'm already doing a whole bunch of stuff that isn't really doing enough? Snowflakes, as always, below.

I've been seeing my current therapist for just under a year, and initially started seeing her to deal with postpartum depression and difficulties with my marriage, after my psychiatrist urged me to get back into therapy. I would like to think I have made some concrete improvements in important areas. I'm still seeing my psychiatrist for my anxiety/depression/ADHD med management, and after a really bad false start with a sex therapist, my husband and I are in couples therapy with someone who seems like a good fit.

But my problems have morphed substantially since I started individual therapy. I knew I had grown up with an abusive dad and had experienced sexual assault, but I thought I'd pretty much gotten a handle on it. But something about the combination of all the medical stuff, the brutal bodily experience of pregnancy and postpartum, the emotional upheaval of actually becoming a mother to a little boy, plus tension in my relationship really stirred the pot. When my son was about 18 months old, I started getting horrible constant intrusive memories of past abuse and assault. I started admitting to myself how remarkably abusive and sexually violent the long-term relationship I'd had with a college boyfriend prior to meeting my husband really was. It was awful and humiliating and soul destroying and I just wanted to be normal and move on, so I put it away. The flashbacks have slowed down over the last six months, but they still happen and I feel on edge and moody and emotionally hungover a lot of the time. I sometimes feel like I'm going crazy. I'm showing up terribly as a spouse, parent, worker, you name it. This isn't sustainable at all.

My therapist, the couples therapist, and my psychiatrist are all aware of the situation. My psychiatrist did some tweaks to help with the panic and my therapist has done some processing with me, although mostly we've been focused on survival self-soothing, self-care, grounding kind of stuff just so I can stay on my feet. But it's still having a big, but unpredictable, impact on my day to day life and it's really hurting my efforts to heal my relationship and it's tanking my work performance. I have days or weeks when I'm fine and then I'll get triggered by something random, or worse yet by my spouse, and disassociate or have a scary flashback and then I'm back in the pit for days after. I want to not be like this. I'm getting better at doing things to ground and soothe myself when it happens but I need to not be this reactive in the first place. I want a normal life, or at least some kind of approximation of one. I want to have sex again without being terrified I'm going to have a flashback or upsetting intrusive memory partway through.

I told my therapist that we needed to change things and she's worked with me on expanding my tools to regulate after an episode, but I feel like I'm reaching the end of her expertise and might need to switch to someone else. I don't know what to try next or even what to look for, and I'm afraid of picking the wrong thing and really upsetting my brain's apple cart and becoming nonfunctional or nuking my relationship. It feels like opening Pandora's box. I have a toddler and a job I need to keep. I know this impacts my relationship, but I don't know what's appropriate to bring into couples therapy. I just don't know what I'm supposed to be doing.

I feel really isolated and paralyzed and ashamed. I wish I could tell another human all of what happened to me so I can quit feeling like I'm holding terrible secrets, and I want to quit feeling so afraid and crazy all the time. I don't have a lot of "real life" support and I don't really feel like I can tell anyone I'm close to any of the details without permanently damaging their view of me and my relationship with them, including my husband. He's also not super supportive about this particular issue because of our ongoing relationship challenges, and so I'd really rather develop a way of coping and getting better that doesn't require his participation. My therapist hasn't been as helpful as I'd hoped. I've been reading about CPTSD on her recommendation but there's so, so much and not a lot of clear consensus and it's overwhelming when I'm already too overwhelmed to think. What should I be googling here? What kind of treatment and supports do I need to set up for myself? How do I find those things? Or is this just a case of suck it up buttercup, and I need to just keep plugging away at what I'm already doing and waiting more patiently for it to work? I've been dealing with one brain problem or another most of my life and this is just One More Goddamn Thing.

I can be a horse with the bit in its teeth when I have a plan but I don't even know how to go about making a plan here. Please help me figure out a few very simple steps I can take to at least get started in a useful direction and feel less like a tangled stuck mess. Thank you for any advice.

posted by bowtiesarecool to Health & Fitness (9 answers total)

Hi
I know exactly how you are feeling because I have felt that way for far too long. Luckily, you have the right diagnosis early on. I've been through a ton of different diagnoses and treatments for the last 20 + years. I think you are going to do far better than me.
It's strange, I was thinking of posting about feeling good on the free thread today, because for the first time in those 20 + years, I've gone for a walk and felt light and energetic, and it made me so happy. Remember, you are in a far better place, it won't take you this long.
Anyway, on the walk, I thought about what has made the change, and I think it is because I found a way to talk with my eldest daughter and aunt about it, without having to go into details, but enough that they understood I am seriously struggling.
Then I thought about the exact things you mention: isolation, paralysis, fear and shame. It's absurd that one feels that way: you and I weren't at fault for what happened, we were violated and abused. But we get to feel the shame and isolation.
Anyway, the way I got to this stage, apart from normal therapy, was that I was in a group therapy thing. Probably your therapist can help you find somewhere you can get that help.
Now it's not like I was in group therapy and then all was fine, but the group helped me feel less alone and less shameful, because I could see how the others felt the same.

Some time ago, I posted here on the green because I thought maybe it wasn't CPTSD after all, maybe I just have Cushing's syndrome. Anyway, exploring that as well as planning for a new round of therapy led me to contact the partner I had when my symptoms first started, where you are now. It was very encouraging and may also have contributed to my tentative recovery. First of all, he took a lot of the blame for our situation then. But second, he said that he wished I could have shared more back then, because he felt it was like I didn't care for him (because of my isolating and shame and even the fearfulness). My daughter said the same. Don't be afraid to share! But have your therapist and an eventual group help you figure out how to share in a way that doesn't create so much noise that the person you are sharing with can't hear you.

I realized I don't have to share the graphic details that appear in my flashbacks and nightmares. There are other ways to describe the seriousness of what happened.
posted by mumimor at 2:12 PM on August 18 [2 favorites]

I’m so sorry you are going through this.

I had some very good success with EMDR for PTSD. It may be worth taking a look at. For me, it took about 10 sessions to clear up some extremely distressing nightmares that caused me days of disregulation afterwards.

Be well. You are doing such a great job of advocating for yourself. I hope you find some relief soon.
posted by hilaryjade at 4:44 PM on August 18 [1 favorite]

As a therapist with zero interest in EMDR I will nonetheless say lots of people find it helpful for otherwise intransigent anxiety and I think one might say it's become the go-to modality for PTSD.
posted by less-of-course at 5:20 PM on August 18

I found EMDR really helpful for CPSTD and it sounds like you’ve learned a lot of really good skills that will help you through it. It’s pretty intense and I’ve needed to do multiple rounds around different dimensions of the bad things i experienced, but it’s been so so freeing.
posted by congen at 8:03 PM on August 18 [1 favorite]

I found EMDR helpful in the short term but can't speak to its long-term power. My therapist was going out on maternity leave so I concluded the EMDR after only ten sessions. It's very possible that I needed more time, but I don't know if I'll try it again. Take it with a grain of salt - I still know plenty of people who have benefited from it, and I do genuinely think it's worth trying.

What has worked for me is microdosing psilocybin (mushrooms). I've done more self-discovery and recovery from trauma in the past three years, after the first of several mushroom experiences, than I have in my entire life. It has made me more accepting of what I cannot change, as well as made me kinder and warmer in my social interactions. It has unstuck some of my most stubborn memories, shown me new ways of processing information, and fed my creativity. I cannot recommend it enough for people who are open to an alternative approach to healing trauma.
posted by nightrecordings at 10:07 PM on August 18 [2 favorites]

Just for the record, due to the nature of my trauma, EMDR absolutely did not work for me. I understand it works for many people and don't want to talk it down. Just don't feel something is wrong with you if it doesn't work.
posted by mumimor at 1:04 AM on August 19 [1 favorite]

One of EMDR's benefits for me is that the very first thing we did in therapy was install coping, calming resources. Right away it gave me more tools.
posted by Jesse the K at 9:02 AM on August 19 [1 favorite]

Look into psychedelics (full dose rather than microdosing). I know a handful of people with similar issues for whom occasional trips in a therapeutic setting have been life-changing.
posted by eggman at 10:46 AM on August 19

I relate to so much of this. I'm sorry it's so hard. I am not a professional, so the following is just my experience after ~10 years mostly trial and error bouncing between different therapies, but I hope it can save you some time.

Is this just a case of suck it up buttercup, and I need to just keep plugging away at what I'm already doing and waiting more patiently for it to work?
In my experience, no -- I experienced a vast improvement after switching from CBT/ more generic talk therapy to therapy specifically focused on healing trauma.

Therapies I know of focussing on trauma:
- EMDR. I haven't worked with this myself yet. When it works it seems to work really well, however it's more likely to work for once-off traumas (PTSD) than recurring traumas (CPTSD)

- Internal family systems. I've had good experiences doing this self-guided or with my non-trauma specialised therapist after explaining exercises I wanted to go through. I found the parts model incredibly resonant with my experience. It eased a lot of frustrations at feeling that different parts of my brain were at war with each other and that I couldn't help but act against my own interest sometimes. This was also the first therapy model that successfully allowed me to feel compassion for myself. Downsides: in my experience there is not enough in the IFS framework itself about keeping the body safe and preventing retraumatising when processing of trauma memories. I assume a good trauma informed therapist would be monitoring for this, but on my own I found IFS more useful for calming down my defense mechanisms (protective parts) than working with deep trauma memories (exiles by the IFS framework)

- Somatic experiencing. I have had really good experiences working with a professional on this, and I think like with EMDR you would need a professional to do this safely. In my understanding this is about working with the body to feel physically safe and comfortable again after a traumatic experience -- allowing the body to move out of being in survival mode. This does involve processing traumatic memories/feelings but the idea is to do it very very slowly, so you're just feeling the start of the physical response without getting overwhelmed by it, then allowing some of that stress cycle to complete. My therapist is hugely focussed on moving slowly and not retraumatising, to the point where they're usually slowing me down more than I'd like in my impatience. I totally get your fear of upsetting the apple cart and not being able to function and that is a real danger with CPTSD. If you go this route look to see that your therapist is erring on the side of moving slowly.

These have been some key concepts in healing trauma for me:
- Parts: the idea that the brain experiences some fragmentation/disassociation/repressing parts of the self after trauma
- Attachment theory: how healthy attachment develops in early childhood and how trauma disrupts this, and the effect of this on later relationships
- Reparenting: developing the feeling of having a healthy and loving adult living in your head who can give your inner child new and healthy attachment experiences.
- The triphasic trauma treatment model: the idea that trauma treatment should have three stages: 1) safety/stabilisation 2) trauma processing 3) integration and moving forward. Importantly, you might need to return to 1) safety/stabilisation multiple times. Researching more on this might be a good place to start for resources on how to stabilize/monitor for when you're getting overwhelmed and need to slow down.
- Toxic shame: this is a huge part of the experience of CPTSD. For me understanding that my anxiety attacks had shame and abandonment underlying them and treating the shame directly was a big part in getting unstuck in therapy.

Books/resources:
- 'Healing the fragmented selves of trauma survivors' -- Janina Fisher: for an introduction to trauma therapy that includes a discussion of both parts and attachment theory.
- 'Coping with trauma-related dissociation: Skills training for patients and therapists' -- Suzette Boon: I found this to be a very gentle and practical set of exercises for stabilisation and integrating parts of the self after trauma. It's focussed on not triggering further overwhelm/disassociation so may be another good place if you're wanting somewhere safe to start from. I just sort of jumped around chapters depending on what topic seemed relevant at any given time.
- 'Good Inside' -- Becky Kennedy. Aimed at parents with CPTSD and includes help with triggers that come up during parenting. I personally found this helpful for reparenting work for myself as it talks a lot about healthy experiences that kids that came from abusive situations miss out on getting from their parents.
- CPTSD, from surviving to thriving, Pete Walker — best description of what an emotional flashback feels like that I’ve read, helped me feel less alone. Note it is a bit old and the stuff about getting angry at parts of yourself is out of date, generally believed not to work very well with the IFS approach being better.
- Heidi Priebe youtube channel videos -- I found the resources about treating toxic shame particularly useful, eg https://www.youtube.com/watch?v=Y47iJrbO2ug

I really hope this helps at least a bit. And just re-iterating that these are just based on my experiences. If any of these don't feel right with you please go with what feels safe for you.

TLDR: If I had to choose one place to start I would learn about Internal Family Systems and read 'Healing the fragmented selves of trauma survivors' by Janina Fisher.
posted by pandabanter at 12:03 PM on August 19 [4 favorites]