Trauma Overreach
Bob Lynn Ed.D
National and International Professional Clinical Advisor, Professor, Trainer and Researcher
Trauma Overreach
Having worked with the symptoms of?traumatic experiences around the globe for several years including being a 9/11 first responder, I am intrigued by the recent wave of articles suggesting that?a single focus on trauma should inform institutions, therapeutic protocols, and research.
In an effort to sort out what has popularly become ?a major cause for ?emotional challenges, I write this with the intention of creating ?discussion.
Let’s begin with some definitions.
Traumatic event: An event may?be?traumatic if it is experienced as seriously disturbing. Such events may cause a wide range of reactions based on many predisposing factors. ?Some of these after-effects are challenging, but transient.?In other words, a traumatic event whether current, historical, or multi-generational is?something?experienced which may cause individual trauma either transient or long lasting, Bonanno (2004). ?Experts do not know why some people experience PTSD after a traumatic event while others do not. A history of trauma, along with other physical, genetic, psychological, and social factors may play a role in developing PTSD.
Trauma?is an emotional response to an?event or experience ?like an accident, assault, or natural disaster. ?According to the American Psychological Association, Trauma may or may not create a predisposition to emotional challenges which may or may not be realized in the future. It is unlikely that someone will go through life without experiencing some degree of trauma. Often intensity of the experience is related to severity and duration. As Dr. Daniel Sumrok MD reports: Trauma is not a diagnosis. It is adrenergic with more or less stress,?the individual effects dependent upon many interacting factors of severity and innate resilience of the organism.
It may also be helpful to look at what trauma is not. Trauma is not a diagnosis or a cause of ?a particular ?predisposition or emotional challenge resulting from an event.?Most lives are filled with regrets, disappointments, losses, and varying degrees of stressful and disturbing experiences. That is to say, trauma is part of the human experience. Intensity and duration are always a major concern in understanding the impact of trauma on one’s life. It is?interesting that some people report that they “treat trauma.” A therapist does not treat trauma, what they may treat is?the many challenges one may have resulting from a traumatic experience. ?Also, one should consider that neuroplasticity plays a role following traumatic events.?As reported in Psychology Today:?The ability of the brain to change and grow in response to experience enables people to bounce back from setbacks and adversity—to be resilient. They can bend without breaking.
A question that I would like to put forward is how did some ?arrive ?at ??a place?of ?seeing all emotional challenges through a single lens? Of course, we know, based on ACEs studies and many more that traumatic events can disrupt lives and create serious predispositions to physical, neurological, and psychological challenges. There are decades of research linking ACEs to an increased risk of developing chronic diseases and behavioral challenges ?including obesity, autoimmune disease, diabetes, heart disease, poor mental health, alcoholism, and even reduced life expectancy . ?The ?quantum leap ?to such concepts as??“trauma informed therapy”, ?“trauma informed workplaces” and schools etc. has created an?industry based on popular belief that ?trauma is responsible for all challenges in life.
Trauma is not a diagnosis or a state of being. Trauma informed implies that you are informed as to the possible emotional challenges one may experience as a result of exposure to a ?traumatic event. I would suggest that a ?therapist should?treat what is presented by their patient regardless of cause. Causality can inform therapy but not always as one cannot treat a cause, which is in many cases is a best guess. Further mining for pathology not available as the patient presents, may be ?a mistake as sometimes it hurts more coming up than it did going down. It is interesting?to note that Besse A. Vander Kolk MD and Robert S . Pyknons, MD have made a compelling argument for the diagnosis of Developmental Trauma Disorder to be included in the DSMV.
What makes this most problematic in real time is that people experience multiple reactions to trauma and cause and effect is difficult. Further, the contemporary context often determines how ?predispositions will be actualized. ??Epigenetics should be considered?i.e. ?your behaviors and environment can cause changes that affect the way your genes are expressed.
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I have seen many patients who were the victim of overzealous therapists mining for pathology while ignoring the contemporary context.?
Brief Case Studies
One example is a 23-year-old woman who called my practice to make an appointment to focus on the sexual abuse she experienced as ?a child by ?her father. When I asked her about past treatment, she informed me that she had seen several therapists, some known as trauma experts and after revisiting her traumatic experiences several times her symptoms worsened. She also went on to explain that she lives with her husband although they had not been intimate for a long time and slept?in separate parts of their home. I asked her to bring her husband to the first session which she cautiously agreed to do. During our first session she arrived with the expectation that once again she would be asked ??to discuss her past in detail. When I asked her to relate her greatest??concern ?to her husband, she stated ?“I ?fear that if you know my story you won’t love me.” He turned to her and said “ I will always love you unconditionally and your past story is not a concern to me”.?Shortly after, ?they embraced and after a one year follow up,?I was informed that her problems had resolved after that first session.
Another woman who was 70 ??came to my practice ?presenting as depressed and informed me that her past husband humiliated her sexually and she has never recovered from the resulting shame. ??She had been to several therapists and was hospitalized once where she ?was asked to relive these events through telling her story several times.?I began by asking her what she wanted, and she informed that she was lonely and although her daughter who had two small children lived close by, she rarely saw them. I asked her to bring her daughter to the next session which she did. When they arrived, I asked my patient to speak to her daughter about her feelings of isolation and despair. Her daughter became tearful and told her mother that she never realized that she was feeling this way and, in her zeal to take care of 2 children and hold down a job just did not make time for her mother. Following the session, they began to schedule regular visits and my patient became much more involved with her family. Her symptoms abated and at the 6 month follow up she reported that her quality of life had signicantly improved and she was no longer depressed.
I do not relate these sessions to in any way negate the value of providing a safe place to heal for patients who are experiencing challenges related to traumatic events. ?What I am suggesting is that therapy needs to be patient focused and not ?defined by popular beliefs of ?how trauma affects a patient.
Finally, I would suggest that what is now being labeled “trauma informed” workplaces, schools, therapy ?etc. is tangentially related to trauma as self-care, safe places to heal, and compassion and have always been a good idea far beyond a focus on trauma.
?Rather than only focusing on?the impact of trauma, which is typically best guess, perhaps a focus on building resiliency makes more sense. Being trauma informed as a therapist, school, workplace etc. is basically being life informed, and ?most important is ?kindness and compassion for all challenges irrespective of cause. ?Standard protocols for working with the challenges presented by symptoms that may be related to trauma are popular while what is required is ?informed and well-trained therapists that view their clients through a broad lens and meet them at the intersection of science and compassion.
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Bob Lynn Ed.D 2023
Vice President of Accounts and Organizational Strategy at HealthLinx?
1 年Personally, my goal of TIC is related to creating an environment that causes no further harm and promotes our team remembering that the individual is impacted by experiences that have happened often “to” then that they are responding or reacting against. In this crisis state and the chaos of every emergency department across the country/world, and the horrific failure of healthcare that sends our most vulnerable mental health patients into the daily grind of an ED we fail patients. For every inpatient psychiatric facility or outpatient group home or assisted living, skilled nursing facility who sends their patients in crisis to the ED, and does not accept them in return once the crisis is stabilized, the situation worsens. For every inpatient psychiatric unit or behavioral health unit or jail who cannot manage the violent or potentially violent patient, because it is a risk to the milleau, I beg- please go spend an evening in the ED. The ED is like a “land of misfit toys” aka patients that no one feels capable of keeping safe, and no one feels safe to keep. Our society fails these people. This is why TIC is important… and remembering the gift and grace of resiliency, especially with the unrelenting patterns we see daily.
PRESIDENT/CEO/PSYCHOLOGIST at LEWIS SMITH PHD PC
1 年I have captioned your picture— Trauma On The Rocks WOLPE’S SUDS SCALE or subjective units of disturbance along with the Intensity Frequency and Duration of negative cognitions and emotional states of mind are helpful in quantifying a person’s perceived subjective experience of Trauma or Pain.
Polyvagal Informed Therapist, Addictions Specialist, Cognitive Analytic Therapist, Dialectical Behavioural Therapist, Traumatologist
1 年Not sure whether these are beliefs about trauma Bob? Or whether you're creating controversy for the sake of controversy. It's as if you are ignoring the major developments in the field. I understood that PTSD describes the reaction to an event and complex trauma describes developmental and a history of trauma also it is not an emotional reaction. In most of the literature how they cope, if person freezes or becomes mobalised is on of the main indicators how they will react to trauma. which you also find to mention Bob putting this together with you getting the meaning of PTSD and development trauma mixed up is is ironic since you go on to criticis the therapists and how it was you that done it right. You also use one doctor again to prove your hypothesis and a relatively unknown one no offence to the doctor ) who actually did research in the Vietnam War and works in rural distr look at working with opiate addictions. Considering the Dr actually contradicts you by mentioning the importance of Tx trauma and of SUDs. Also Bob trauma is not viewed as just an emotional reaction, I don't think y look u can or anyone else about the advances in me loop neurobiology and the affects on ANS
Thoroughly enjoyed reading this article, some really salient points.
BSc Psychology, MSc Social Policy & Planning. Mum of amazing teen. ACTIVIST
1 年Great stuff Bob Lynn Ed.D . I'd been having lots of similar thoughts myself, especially regardin the way so many, both docs and 'patients' speak of Trauma, as if it is new or different from what PWUDs use to seek help for And I definitely agree that we keep therapy, peer support etc Client centred, as opposed to centred around this or that latest theory of human pathology. It's so friggin' obvious when we actually Think about it ..