January 05, 2014 at 8:28 PM
Maybe there’s no nice way to say this, but I’ll give it a try.
First of all, I’m not trying to put anyone down. Someone wants to tell their story, more power to them. But (you knew there was a but coming, right?) I just wish some of the stories went farther.
A famous person – from sports, politics, pop culture – discloses having been abused. This is good, it models disclosure, puts the shame on the abuser and not the victim. It can help other people to speak, maybe for the first time, about what happened to them.
A survivor of horrible abuse or other life tragedy writes his or her life story, and how he or she struggled for so many years and finally (maybe even with therapy) learned how to cope with the symptoms... Again, it’s great we have stories like this out there, it gives hope to others and maybe inspires them to get there too.
I respect a hero as much as the next person. And given my line of work, I know all too well what they've had to overcome. But when I hear someone’s story, and it ends with “I finally learned how to cope with my symptoms,” I hear a lost opportunity.
There are some really good (proven-effective, well-tolerated, efficient) trauma resolution methods out there by now. These generally give far better results than merely learning good coping skills. For example, Tonya Edmonds and colleagues compared EMDR (one of my favorite trauma resolution methods) to “eclectic” therapy (mainly cognitive-behavioral training [CBT] plus some prolonged exposure, as per personal communication at a conference some years ago) for female adult survivors of childhood sexual abuse. At post-treatment, the treatments seemed to be about equally effective on the outcome measures, and at 3 months follow-up, the eclectic/CBT group had deteriorated a bit while the EMDR group had made further gains (Edmonds, Rubin, & Wambach, 1999). Most striking, though, was what they learned from the exit interviews after that follow-up assessment (Edmonds, Sloan, & McCarty, 2004). The women in the eclectic/CBT group said, in essence, “This treatment was really good – it helped me to cope with my symptoms,” whereas the women in the EMDR group said, in essence, “This treatment was really good – I’m healed, so I don’t have to cope with my symptoms anymore.”
The difference between coping and healing is profound, and healing is available. My mission has been to develop and disseminate effective trauma treatment, so more people can heal from trauma and loss, and have better lives. So here’s my problem.
These role models are often good models, but I wish they were better. I wish they modeled more than telling without shame, more than learning to cope... I wish they also modeled healing. They have so much air time, so much influence to let others know that healing is there to be had, if you do the work, with a properly trained therapist. With role models modeling healing, maybe more people would get their own healing done.
(I do recognize that this is my problem, not theirs. If I do a better job of disseminating effective trauma treatment, then more of the role models will get some. Lots of work to do!)
Edmond, T., Rubin, A., & Wambach, K. (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23, 103-116.
Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors’ perceptions of the effectiveness of EMDR and eclectic therapy: A mixed-methods study. Research on Social Work Practice, 14, 259-272.
Please add a comment
We know that life is not something we want to "heal" from (if you understand my poor joke) and life is certainly something we all need to cope with since it often throws us curve balls when we are least expecting them.
So I guess what you would like some of these well-known people to say is what it specifically was about their healing process that was helpful for them. Yes, that would be good information for other survivors to have.
Yes I agree with you that better able to cope with life is a good thing, and we don't need to "heal" from life. Some people who heal from their trauma still use their trauma experience to guide their life purpose in some way; others go in another direction; and either way is good if it's good for them.
And some people really have not healed as per my definition of healing, and this is what I am posting about. I am specifically referring to memory reconsolidation such as typically happens via EMDR, PC, and other means. This work tends to reduce or eliminate the post-traumatic stress and related symptoms.
A colleague conducted a study of therapists who marketed themselves as specialists in working with women who had been abused as children. Fully 50% of these therapists described "anger" as the appropriate end state of successful therapy!
Healing has to get on the map as a realistic goal not only for the general population, but for therapists.
There's a lot of thought that has to be put into sharing these kinds of stories, to prevent that kind of shame. So I, speaking totally from a personal viewpoint and not trying to undermine the main point, actually prefer the "just" coping stories- I feel like it sends the message that it's okay to not be totally healed, and still want to be strong.
I just don't want that to be the only visible end point. I would like some light at the end of the tunnel, as well as lights along the way :^)
I've been singing this song for so long that I can't recall when I started. I make a strong distinction between "treatment" and "symptom management". This is a distinction too seldom held to, with the result that we keep getting mass media articles with titles like "New treatment approach for vets with PTSD: trained therapy dogs". (Note that for the cost of training such a dog - $15-2000, I can, and have, successfully treated approximately 10-12 people with PTSD. This is not odd; it's just how real treatment works.)
Treatment means "elimination of diagnosis", or at least "permanent reduction of symptoms". If we don't make this distinction, we continue to throw up dust clouds in which all sorts of non-treatments can reside, while mis-representing themselves. To be blunt: this hurts people.
I have never yet met someone who's "learned to cope" with their trauma events who's actually had real treatment. Not once. I invariably end up being the last therapist they see, because they leave without the diagnosis they had when they first walked in. (And no pricey dogs were needed!)
But if it's not getting the memory reconsolidation done, then it's not getting the memory reconsolidation done. EMDR and PC (and some other treatments) can get this job done so well that it's hard to justify not doing it.
I haven't even had the nerve to share my story yet. Despite the fact that I've seen so many therapists I still haven't learned to cope or been healed, I have never even imagined in my wildest fantasies that there was a remote possibility of being healed.
It seems to me that as soon as I have any time together were I'm feeling some relief from the trauma of my past something triggers and I'm right back to square one.
There are many therapists who do helpful things but who do not offer healing via memory reconsolidation work. Once someone has gone through something like EMDR or PC, usually the "triggers" don't get the same strong reaction anymore.
Thanks so much for this excellent piece that was just forwarded to me.
I think one of the biggest problems here is that there is no standard for what "healthy" or "healed" is. The DSM pathologizes practically every way in which we can be dys-functional, yet we have almost no standard for measuring and identifying emotional health. I think there are two reasons for this.
First - functionality itself is not well defined, and would likely be a relative measure given the differences between individuals (e.g. can we say that the standard for "functionality" would be the same for people with significantly different IQ's?). Second - since every individual has a unique set of characteristics (trauma history, resilience, physical health) it's very difficult to say that the methodology that works for one person will work equally well for the next. It's far too easy for professionals to label someone who does not respond well to a course of treatment as being intransigent or hostile.
We have 4 "key" or "seed" messages that we share with male survivors, their loved ones, and the professionals who work with them.
1. You are not alone
2. It was not your fault
3. It is possible to heal
4. It is never too late
As a survivor and peer advocate myself (I'm ED of an org called MaleSurvivor), I've always felt that it's not my place to tell anyone else what the right thing for them to do is. Rather, I think the only thing I can truly offer someone else is my compassion and the message that they can absolutely do the work of healing, and that it's actually up to them to take on that responsibility. I'm more than happy to share my story with other survivors, as I know that it's in sharing our stories that we can break down shame and isolation. But I also make sure that it's the healing that takes center stage, as opposed to the abuse.
I also believe that we need to encourage the MH profession to ask what the goal of treatment should be. In cases where a survivor won't engage in a healing journey, perhaps stabilization is the best we can hope for. But I think holding out the paradigm that thriving is always a possibility is an incredible powerful motivator for survivors and professionals both.
I think your approach represents a nice stance for advocates, therapists, and friends. Respectful, balanced, supportive, and encouraging.
And as Louise mentioned above, when it comes to role models, it's important to have some models at various steps along the way.
Like Christopher above, I find that there are many ways to heal and know that EMDR is one tool that is effective with many survivors.
However, Ricky, what resonated for me most in your post above is your reference to lost opportunities. All too often I meet clients who had assumed that "everything" had been tried and that they must resign themselves to continuing to struggle.
I suppose in each life there are periods of struggling. However, there should never be a place where any of us is resigned to suffering needlessly.
When hope is lacking . . . it's time to go shopping for a new therapist.
But that doesn't mean that they're all equivalent, because they're not. If the memory reconsolidation doesn't get done, then the memory is still a wound. This might be done with EMDR, PC, or some other method, whether with a therapist or otherwise.
What so many of the posters seem to agree on is that it's important for people to have hope, to have healing to at least be a possibility, something worth going for when the time is right.
Seriously, though, it's a great time in history to be a therapist, (other than that pesky little problem of the health insurance system that so often prevents us from providing service). Presumably therapists have always aspired to be healers, and now we have reliable procedures to get that done.