Well that’s the First Session Done!?
Just had my first session of therapy for my Complex-PTSD (C-PTSD) two days ago. Still a bit tired. It is good to have gotten the process going.
But it may take some time. I was hoping the therapist would say we should get this done in 20 sessions but it seems we will be in this process for quite a while.
Possibly most of this year!
My Complex PTSD is very complex and involves repeated traumas inside and outside the home so will take time to process my past.
The good news is that I really like and respect the therapist.
I like her as a person, she is nice and considerate which is important.
I have heard it mentioned that the relationship with the therapist is often key in these therapeutic sessions.
She looks like she knows her stuff and can help me get a bit healthier.
C-PTSD appears to fragment the self and the processing and reprocessing memories from the past also appears to be a process of unifying shattered fragments of the self at the same time. This is my intuition that this will occur anyway.
One of my main issues with C-PTSD is dissociation. I simply had not realised how much I dissociate and have dissociated throughout my life. In fact, I have probably been doing this since very early childhood.
So what is dissociation?
In psychology, the term dissociation describes a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.
Dissociation is commonly displayed on a continuum. In mild cases, dissociation can be regarded as a coping mechanism or defense mechanisms in seeking to master, minimize or tolerate stress – including boredom or conflict.
More pathological dissociation involves dissociative disorders – These alterations can include: a sense that self or the world is unreal (depersonalization and derealization); a loss of memory (amnesia); forgetting identity or assuming a new self (fugue); and fragmentation of identity or self into separate streams of consciousness (dissociative identity disorder, formerly termed multiple personality disorder) and complex post-traumatic stress disorder.
Disassociation is very common to PTSD and C-PTSD.
Obviously it is something that has bothered me. I have thought that maybe I have dissociated a few times in recovery under extreme distress but there appears to be smaller more moderate dissociations going on a lot of the time.
It is essentially a coping mechanism against emotional distress and anxiety but also it seems to have become a coping mechanisms in terms of troubling emotions.
I have learnt to regulate my emotions in maladaptive ways. I dissociate and use other use immature ego defense mechanisms such as denial, rationalising, minimising, justifying, projection etc. I hasten to add that after 10 years in recovery I also have learnt to adaptively regulate emotions so this process has become more automatic as my brain as healed and my emotion regulation improved.
However, this ego defense mechanisms have been rife throughout most of my life.
One of my first reactions to any extreme emotional disturbance is to deny it’s happening or has happened.
This is the main reason I have not entered into treatment for PTSD before. There is a large part of me that denies I was traumatized although the evidence is there in so many ways. Chronic dissociation, regression to traumatized childhood experience, explicit memories of trauma incidents etc etc would suggest not only that I have been traumatized but on multiple occasions over a long period of time.
Regardless, my head tells me “are you sure this happened? But your parents loved you?” It is very similar to when I finally went into recovery after almost dying from alcoholism, my head would say “yeah but you didn’t drink that much?” This isn’t simply denying alcoholism it is also denying the fact I have lost control over me. My denial minimised and rationalised this so that it was not overwhelming. This is why we need to be careful accusing newcomers about being in denial about their alcoholism. We tell them our story and let them identify, this is much better as it does not scare them into even more denial as ego defense.
It was less about denying alcoholism than denying reality and actual lived experience. I will deny anything which I find threatening to my sense of self. Without consciously knowing I am in denial.
Anyway, my dissociation also appears linked to very insecure attachment to primary care giver, e.g. a parent like one’s mother. It is particularly common among those with disorganised attachment styles and very much so with children how have reacted at a young age to their mother’s fear and trauma.
Basically when events are traumatic or overwhelming emotionally it is often common for children to dissociate. Also growing up in a extremely stressful outside environment and society can lead to using this coping mechanism to survive. So in essence a survival mechanism that was crucial to surviving trauma in childhood.
My dissociations over the years has covered so many emotional states. I grew up in a very violent society so dissociated to deal with physical threat. I could and still can dissociate into a “powerful alpha male” state when threatened with violence for example.
I can dissociate to the extent I have no idea who significant people are in my life are, can’t remember names, etc, can dissociate to the extent that I feel my body isn’t mine and so on. I can also dissociate in a way which somehow returns me to feelings of early childhood, almost like I am temporarily a child again which is very traumatic to re-experience. I discussed some of these with my therapist.
She was very enlightened about the subject. She said it was just as it is, for now, it is neither good or bad. It was and is a coping mechanism.
It is not to be feared as it passes but we will become more aware of it’s triggers. It is good to know that it is not “Bad” it just is. It will be dealt with in due time. I liked how she took the “sting” out of my anxieties over it.
I actually dissociated prior to the therapist session, a couple of nights previously as it was obviously distressing me at some unconscious level, the idea of starting treatment, the idea of the emotional pain to come.
The other point that was discussed a lot was the overlap between guilt and shame.
I generally believe shame is a major controlling emotion with me but that I had dealt with my guilt a lot during my 12 steps, steps 4-9 in particular. I have since realised that this guilt over wrongdoings to others primarily as a result of my drinking is very different to post traumatic guilt. All the way through the session I had this knot of guilt in my heart so tightly wound up it felt like a chestnut. I tried to talk about shame but the guilt kept getting in the way.
We discussed this. Essentially PTSD and C-PTDSD are linked, one affects the other. Essentially we have PTSD with complex other issues added on.
I had trauma incidents which would constitute PTSD diagnosis alone plus other things too.
When a person has experienced trauma, one has an overriding feeling of terror and helplessness and a very strong feeling of guilt.
This guilt tells one that they are somehow to blame for everything happening as it did – it whispers that one could have somehow prevented it happening. The self balks against helplessness.
We may feel that it was our fault that it happened. For me this is one of the roots of my troubles.
I once dissociated back to childhood (regressed perhaps) and I suddenly said “when I make mistakes people die!” which is a very extreme thing to say and a statement obviously steeped in trauma.
This memory related response and associated networks of memory still lives in me and it is this and other traumatic memory associations which need to be reprocessed.
It may even be that there are memories preceding this that I cannot access in my memory at present but which will crop up in my mind as all memories are linked in memory networks to other memories. It is in reprocessing certain memories that other memories appear in one’s mind too.
It may even be a “memory” of something that did not happen in the sense that I interpreted something as happening in a way it didn’t. For example, two parents having a violent argument in front of a child may lead to the child blaming himself instead of the parents as it would be too emotionally overwhelming to blame the idealised “perfect” parents. This is more interpretation of events rather than the actual events themselves.
This is called the encoding of a memory. Memories are often encoded emotionally especially if the memory was encoded during a moment of emotional distress. Mood congruent memories, for example, happen when we remember something from the past because we are in similar mood to when other memories were encoded, hence the emotion helps us retrieve this and similar memories.
The same happens with trauma memories. They are often retrieved during similar heightened distress or states of hyperarousal as when first encoded.
A problem with C-PTSD memories is that we cannot always consciously access them at times or sometimes we have little memory at all of traumatic events.
This does not mean they are not in our memory banks are that they do not have influence on our behaviours, they simply do so implicitly without much explicit and conscious representation in our minds.
They do still influence our reactions and behaviours regardless of being really recalled. I used to say they lived in our bones but they more accurately they live in our nervous systems.
The guilt and helplessness is linked to shame in me. The situations of my trauma were exposed to the community I lived in – people in the surrounding area had to intervene in certain traumatic episodes to help us and so knew about our crazy family.
My guilt has thus been compound by shame, by not only being guilt but my self-perceived “guilt” and it’s repercussions had been exposed to wider society. Everyone knew what I did and that I was to blame for everything that happened. They knew it was all my fault and what I was really like. A secret I have kept hidden since then, decades later. So toxic shame is linked to traumatic guilt.
This fear that people die when I make mistakes has led to a chronic perfectionism for myself and those around me. If I am perfect then all will be well. All will be controlled and bad things will not happen and everyone will be not fighting.
I set the bar high for many other people too as well as myself. It is like I can’t afford to make mistakes and either can others, particularly men as I have obviously blamed my father for our shared traumas and assigned my mother as the victim of the trauma. Hence I am wary often of men and protective of woman.
In fact, I grew up too quickly because of this, to protect my mother and guard against my father.
Although I consciously love both and have forgiven both and myself for what happened in our shared traumatic past, the memories of the events live on and colour my responses to and views of the world, men and women, even today. My memories of decades ago are like a computer virus corrupting my data files.
I write all this to process my therapy but hopefully to connect with others who are experiencing this stuff too.
I need to write to understand exactly how I am feeling and also to make connections in my brain/mind.
Whatever happened prior to my trauma episodes from childhood which led I believed to a life and death situation in more than one occasion was not the fault of a child who was say 6-7 years old. A child does not affect the behaviour of adults in such a profound way.
What happened, as is common in PTSD, is a mis-appraisal of what happened, a levying of unfair guilt on the person who witnessed the event. This guilt, that it was their fault or they could have done something, keeps the trauma going – it becomes post trauma but still lives on in one’s mind and body and behaviours.
It is the misinterpretation of events that is internalised and processed as memory. It is this mis-appraisal that gets embedded in memory as if it was the truth, as a true reflection and recollection of what actually occurred when it was not what actually occurred.
Sometimes the trauma is so profound that the child does not want to think his parents did not love him or would hurt him (why would the be acting the way they do if they did?) and takes the blame rather than face this overwhelming emotion.
It being his or her fault is more tolerable at the moment. This too lies on in inaccurately embedded memory. It is a memory that perpetuates a traumatic lie throughout our lives. It is this lie which lives on in our negative self concepts. Telling us untruths about ourselves, that we are defective, not good enough, that if people really knew US?
It is a poisonous, malevolent neural and mnemonic ghost which haunts us decades later.
It needs to be re-addressed and the memories need to re- encoded accurately instead, that way we allow them to rest, embedded in our long term memory.
Via this process memories are reconsolidated, all the fragmented parts of self, stored away from each other in faulty interpretations and falsehoods about ourselves, that we keep alive in our memory networks and listen to as if they were the truth.
This is how I think EMDR helps exorcise the past leaving a past reality closer to the truth.
More will be revealed…