Complex PTSD

by Pete Walker

  Taking responsibility for your role in a misunderstanding also helps to deconstruct the client’s outer critic belief that relationships have to be perfect. At the same time, it models a constructive approach to resolving conflicts, and over time leads most clients to become interested in exploring their contribution to the conflict. This becomes an invaluable skill which they can then take into their outside relationships.

  As one might expect, fight types are the least likely of the 4F’s to collaborate and own their side of the street in a misattunement. Extreme fight types such as those diagnosed with Narcissistic Personality Disorder have long been considered untreatable in traditional psychoanalysis for this reason.

  With less extreme fight types, I sometimes succeed in psycho-educating them on how they learned their controlling defenses. From there I try to help them see how much they pay for being so controlling. At the top of the list of debits is intimacy-starvation. Consciously or not, they hunger for human warmth and they do not get it from those whom they control. Victims of fight types are too afraid of them to relax enough to generate authentically warm feelings.

  Finally, I believe one of the most common reasons that clients terminate prematurely is the gradual accumulation of dissatisfactions that they do not feel safe enough to bring up or talk about. How sad it is that all kinds of promising relationships wither and die from an individual or couple’s inability to safely work through differences and conflict. Please see Toolbox 4 in chapter 13 for a list of many pragmatic tools to “Lovingly Resolving Conflict.”

  Moving Through Abandonment Into Intimacy: A Case Study

  A sweet, freeze-fawn client of mine suffered severe emotional abandonment in childhood. Both his parents were workaholics. They were, by definition, exceedingly unavailable. As the youngest of five children, Frank always finished last in the sibling competition for the paltry caretaking his parents had to offer. His adulthood was unfortunately a reenactment of the relational impoverishment of his childhood.

  Childhood trauma left Frank hair-triggered to retreat and isolate. He had never experienced an enduring relationship. As a result of our long-term work, however, he became more motivated to seek a relationship. He successfully dated a healthy and available partner. For the first six months of their relationship, my coaching and her kind nature enabled him to show more of himself. He was rewarded by increasing feelings of relaxation and comfort while relating with her.

  When he accepted her request to move in together, however, it became harder to hide his recurring emotional flashbacks. He was more convinced than ever that his feelings of fear, shame and depression were the most despicable of his many fatal flaws.

  As we worked with this belief in therapy, he remembered many times when even the mildest dip in his mood triggered his mother to retreat into her home office. He saw that the only times his mother had a bit of time for him was on those rare occasions when he was buoyant enough to lift her spirits. He had a staunch conviction that social inclusion depended on him generating cheerfulness. Gloomy and abashed, he confessed: “That’s pretty hard for me, Pete. I’m not much fun to be around.”

  A codependent defense of being perpetually pleasant and agreeable had been deeply instilled in him. He could not shake off the fear that if he was not upbeat enough, his new partner would be disgusted and abandon him. He reported that his flashbacks at home had increased. Sometimes he felt a desperate need to isolate and hide. His freeze response was so activated, that he increasingly withdrew from his partner into silence. He knew that he was hiding too much in computer activities, excessive sleeping, and marathon TV sports viewing, but he could not stop.

  During his most intense flashbacks, his fear and self-disgust became so intense that he invented any excuse to get out of the house. He was besieged by thoughts and fantasies of being single again. His critic was winning the battle. He was sure his partner was as disgusted with his affect as his mother had been. He was on the verge of a literal flight response. He was about to leave, as he had before when the brief infatuation stages of his few previous relationships ended.

  We spent many subsequent sessions managing these emotional flashbacks to his original abandonment. He understood more deeply that his silent withdrawals were evidence that he was flashing back. He then committed to rereading and using the 13 steps of flashback management at such times.

  With my encouragement and gentle nudging, he grieved over his original abandonment more deeply than ever before. Over and over, he confronted the critic’s projection of his mother onto his partner.

  At the same time, I encouraged Frank to be more vulnerable with his partner. He practiced doing this in role-plays with me. Encouraged by all this work, he began talking to his girlfriend about his Cptsd. A good-hearted person, she responded with sympathy and support. This eventually helped him to disclose that talking vulnerably made him feel even more afraid and ashamed. To his great relief, she was not only empathic but grateful for his vulnerability. She told him that his vulnerability made her feel safer to share an even deeper level of her own vulnerability. He cried poignant tears of gratitude as he told me this. I commiserated with a welling of sweet tears in my own eyes.

  Frank’s crowning achievement came some months later when he finally felt brave enough to tell her what he was experiencing while he was actually depressed. This breakthrough further enriched their intimacy. Their love expanded into those special depths of intimacy that are only achieved when people feel safe enough to communicate about anything and everything.

  As my client became more skilled at being vulnerable, he was rewarded with the irreplaceable intimacy that comes from mutual commiseration. Over the next year, he and his future wife became such reliable sources of verbal ventilation for each other, that Frank no longer needed my services.

  Earned Secure Attachment

  In therapy, clients get the most out of their session by learning to stay in interpersonal contact while they communicate from their emotional pain. This gradually shows them that they are acceptable and worthwhile no matter what they are feeling and experiencing.

  As survivors realize more deeply that their flashbacks are normal responses to abnormal childhood conditions, their shame begins to melt. This then eases their fear of being seen as defective. In turn, their habits of isolating or pushing others away during flashbacks diminish.

  Earned secure attachment is a newly recognized category of healthy attachment. Many attachment therapists believe that effective treatment can help a survivor “earn” at least one truly intimate relationship. Earned secure attachment is the good enough and intimacy-rich attachment discussed throughout this book.

  I believe the principles outlined in this chapter are keys to achieving an earned secure attachment. In this vein, good therapy can be an intimacy-modeling relationship. It fosters our leaning and practicing of intimacy-making behavior. Your connection with your therapist can become a transitional earned secure attachment. This in turn can lead to the attainment of an earned secure attachment outside of therapy. I have repeatedly seen this result with my most successful clients, and I am grateful to report that my last experience with my own therapy lead me to this reward.

  Rescuing The Survivor From The Critic

  I will conclude this section with a final note to therapists. The term rescuing and what it represents has become taboo in many psychotherapy circles and in the 12-Step Movement (e.g. AA, CODA and ACA). The word “rescuing” is often used in such an all-or-none way that any type of active helping is pathologized. However, I believe that helping survivors out of the abyss of emotional flashbacks is a necessary form of rescuing.

  A key place to practice healthy rescuing is in the realm of the critic. I believe there is an unmet childhood need for rescue that I help meet when I “save” my client from the critic, the proxy of her parents. This is the need no one met. The child was not rescued from her traumatizing parent. This was terrible neglect on the part of the other parent, the relatives, the neighb
ors or teachers who ignored the signs that she was withering from being abused.

  Decades of trauma work have taken me to a place where my heart no longer allows me to be silent when someone’s inner critic is on the attack. Silence, in my mind, is equivalent to tacit approval. I can no longer sit quietly and not intervene when survivors abuse themselves with their parents’ internalized voice.

  I am additionally motivated to challenge the client’s toxic critic because of the failure of my first long-term experience of psychoanalytic therapy. My “blank screen” therapist let me flounder endlessly in attacking myself with self-hate and self-disgust. Never once did she point out that I could and should challenge this anti-self behavior. UCSF trauma expert Harvey Peskin would call this a failure to bear witness to the traumatization of the child.

  I now vocally challenge the critic’s lies and slanders, and I try to give the survivor a hand to climb out of the abyss of fear and shame into which the critic has pushed him.

  It took me some time to break through the dysfunctional guilt that my early training instilled in me about rescuing. Now, ironically, when I feel guilty, it is sometimes because I have regressed and let the inner critic get away with abusing my friend or my client. This guilt is actually healthy emotional intelligence. It comes from my empathy as a right action-call to challenge the critic. At such times, I feel derelict in my human and professional duty if I do not bring attention to how he is hoisting himself on his parents’ petard.

  Gratefully, I can no longer passively collude with the internalized critical parent by failing to actively notice it like all those other adults did while he was growing up. If an adult does not protest when a child is being attacked with destructive criticism, she is in an unspoken alliance with the critic. The child is forced to assume contempt is normal and acceptable. The witnessing adult has forsaken her/his tribal responsibility to protect the child from parents who perpetrate child abuse.

  When I label the traumatizing behavior of the client’s parents as contemptible, I begin the awakening of his developmentally arrested need for self-protection. I model to him that he should have been protected, and that he can now resist mimicking their abuse in his own psyche. With most of my clients, this eventually encourages disidentification from the aggressor and weakens the internalization of the attacking parent as the locus of the critic.

  In my own case, I felt loved by my grandmother who lived with my family, but she failed to help me see that my parents’ vitriolic rages were wrong and not my fault. In retrospect, I believe that her neglect crystallized my belief that I deserved their abuse. The stage was then set for me to morph their contempt into self-loathing. I did this chapter and verse for nearly two decades.

  I have also noticed a significant difference in survivors who were helped in childhood to see that it was not their fault that they were being traumatized. When there was one witnessing adult who sufficiently decried what was being done to them, most did not develop such a ferocious, self-annihilating critic. Typically this was the other parent, an enlightened older sibling, a relative, a teacher or a kindly neighbor.

  FINDING A THERAPIST

  I have as yet to do any therapist trainings in my approach outside of the San Francisco Bay Area, so I cannot make any recommendations for therapists outside this area. However, because my approach is compatible with that of John Bradshaw’s, I refer people to a website that lists therapists around the U. S. and the World who report that they embrace his approach. The link to this is www.creativegrowth.com/referral.htm.

  I and the Creative Growth Center are however unable to personally endorse these therapists as we are not personally familiar with their work. Nonetheless, I think this is a good place to start. Please begin by first reading the following recommendations for interviewing a therapist.

  The purpose of the interview is to ascertain whether your potential therapist is able and willing to work at the levels I describe above. I recommend interviewing and having a trial appointment with at least three therapists, if possible, to determine if their approach is compatible enough with the one I describe above.

  A suitable therapist will be happy to answer your question about their approach and generally talk with you on the phone for at least five minutes before scheduling a meeting. Should the therapist respond to you in an aloof, critical or shaming way, I would immediately cross them off your list and keep looking.

  Finally, it is important to note that there are many untherapized therapists who are licensed to practice psychotherapy, and my experience is that these types are rarely able to work at the depth required for guiding Cptsd recovery.

  I believe it’s appropriate to ask a prospective therapist if they have done their own therapy. I would then at least expect from him/her a response that they have and have found it helpful. Ideally, the therapist would also be willing to disclose that they have done their own family of origin work.

  Further guidance on how to find a therapist can be found at www.alice-miller.com. Click on “articles” at the top, and then on the next page in the left column, click on “FAQ How to find the right therapist.” This is a very helpful website – the website of “The” Alice Miller, who wrote the great book: The Drama of The Gifted Child.

  Good luck in your search. If you live in a reasonable sized city and persevere, I think your chances of finding a “good enough” therapist are good.

  Finding An Online Or Live Support Group

  If you cannot afford or find helpful enough therapy, there are many types of self-help groups that are free and powerfully therapeutic. Moreover, if you are in therapy, your recovery process may be enhanced by using any of the resources that follows. Here are some websites that have been repeatedly recommended to me:

  www.outofthefog.org

  www.ptsdforum.org

  www.coda.org is the URL for Codependents Anonymous, one of my favorites, which can be especially helpful for anyone who is a fawn type or subtype.

  www.ascasupport.org for survivors of childhood abuse in general.

  www.adultchildren.org provides support for ACA’s – Adult Children of Alcoholics.

  www.siawso.org is a helpful site for survivors of incest.

  www.standagainstdv.org is a site for those survivors whose childhood abuse has lead them to become victims of domestic violence.

  www.nobully.com is a very helpful website for survivors who, because of bad luck or repetition compulsion, are stuck in a job or relationship where they are being bullied.

  www.daughtersofnarcissisticmothers.com

  www.narcissisticmother.org these last two are for recovering from being raised by a narcissistic mother

  Several of these sites also have listings of live meetings that can be attended in person. The Creative Growth Center mentioned at the beginning of the last section also offers groups for recovering from shame and grieving the losses of childhood. They are located in Berkeley CA.

  Finally, if none of these recommendations seem suitable, Googling “online support groups for recovering from childhood trauma” brings up a plethora of results.

  An important guideline for finding a safe enough online or in-person group: If you find that a leader or member is over-dominating a group through narcissistic behaviors such as monologing, monopolizing the time, pressuring anyone with unwanted advice or shaming anyone in anyway, please allow yourself to leave and try another group.

  CO-COUNSELING

  If you are not able to find or afford a “good enough” therapist, and/or if you want to supplement your current therapy as my wife and I do regularly with each other, you can look for a safe partner who is willing to work with you to mutually evolve a co-counseling relationship.

  There are many forms of co-counseling. {Google “co-counseling” to learn more.}

  My wife and I have a simple structure for establishing a safe and healing co-counseling relationship. We have been using this model for many years and derive great benefit from it. I have similarly benefitted from co
-counseling with two wonderful friends in the past. Please feel free, of course to adapt the model to fit your own mutual needs and agreements.

  Meet weekly and exchange 30 or 60 minute sessions.

  Begin with the counselee talking about all and any of his/her concerns and with the counselor refraining from intervening other than to practice, Active Listening.

  Active listening is based on an attitude of “unconditional positive regard”. It enhances the counselee’s process of full verbal ventilation, and it uses non-directive, non-intrusive verbal feedback to let the counselee know that you are attuned and paying attention to him/her.

  Active listening includes responses like “un hunh” and “mmm-hmmm” as well as a technique known as mirroring. Mirroring occurs when we repeat key words or phrases that the other person says to let them know that we are paying attention to them.

  Advanced mirroring occurs when we paraphrase in our own words what we hear. This is only helpful however if we make an accurate translation of what’s been said.

  Finally, the use of open-ended questions is perhaps the penultimate active listening techniques. Questions such as “Can you tell me more about that?”, “What else happened?”, and “Do you have other thoughts and feelings about that?” can be very helpful.

  Opened ended questions stand in contrast to pointed questions which tend to limit or shape the way the counselee responds. “What do you think or feel about that?” allows the other person greater internal exploration than “Did you feel upset about that?” which may be perceived as a statement rather than a question. It can sound like you are telling them what they should be feeling.