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Category: Counseling

Multi-cultural Trauma Training in Rwanda!

Join us for a Trauma Training in Rwanda! Following our recent visit to Rwanda, ITTC has established a partnership with the Global Engagement Institute (GEI) and the University of Rwanda to provide a trauma training that is designed for international practitioners who want to build their skills in trauma treatment while learning with and from practitioners who are working to heal a population that has been exposed to significant trauma (this is a notably resilient population!).

The first training will be offered in June; we will select 15 international participants and 15 Rwandan participants; all must have degrees and be practicing mental health professionals.

There will be opportunity for exploring Rwanda, including seeing some animals (my favorite!).

Below is the link to GEI’s newsletter featuring the training and the flyer is also attached. Contact Athena Phillips @ athena@traumacenternw.com.

http://www.global-engagement.org/trauma-treatment-training-in-rwanda01/

Broccoli, Chocolate & Trauma

Many survivors of interpersonal abuse, in its’ various forms find themselves continually adapting to and evaluating their environment; specifically those in proximity who may cause harm. Anticipating the emotional overlay in an unpredictable setting is clearly proactive and protective in that survivors can identify when risk has elevated and thus plan some sort of intervention. Appeasing the abuser, planning to escape, mitigating arguments or planning for complacency to minimize harm are some strategies utilized by those exposed to chronic threat. Having a nuanced and developed defense strategy is advantageous and can help increase the odds of physical or emotional safety. As we travel into adulthood scanning our environment and reading subtleties in other people’s behavior forces us to detach from our own internal barometer that helps us connect to the basics of who we are as individuals.

Working with adult survivors of childhood abuse or those who lived with parents who may not have been abusive but perhaps neglectful or narcissistic turns our attention to the external. A common thread that exists is a lost sense of self, of likes or dislikes and a struggle to rely on authentic internal motivation for guidance. Additionally, because we are social animals, connection to others that includes the capacity of the other to tune into our wants, needs, or emotions help us to be appropriately attuned to ourselves. Those who love us and know us well can often see what we feel before we do; empathy and connectivity help us turn inward to become increasingly familiar with our values and who we are.

In the context of therapy, when I ask adult survivors about what they care about, like or dislike or want to do professionally (for example), the answer is often “I have no idea.” So, we begin the dance of determining what it feels like to want something or to have a distaste for something or to care about something. It can feel like a task that has no beginning, so, I have designed a scientifically sound method (this phrase is used loosely) for starting the conversation; it is a measurement tool intended to discern “wants” from “shoulds.” The measurement is called “The Broccoli-Chocolate Test.” I ask people to imagine broccoli and to describe the color, smell, and texture to me and then to notice what their body or mind communicates to them (most of the time it goes something like this…”I really should eat more leafy greens and vegetables.” And then, I ask them to describe chocolate (or something comparable) alongside the associated smells, textures, and flavors. The response to the chocolate is often something along the lines of “yum.” Again, I ask for the associated physical feeling and we talk about the difference between the broccoli and the chocolate.

The step that follows is of course giving permission to enjoy the things that are wants (which are different from coping mechanisms or escape strategies like alcohol or too much television, for example). Shoulds are easier to identify because unspoken and spoken social rules are fairly overt; we don’t have to turn inward to figure out that we are supposed to live our lives in a certain way or abide by the current social norms. Being guided by our value set is different from being guided by a should; an authentic value is generated internally whereas a should is generated and reinforced externally. Something we want or like reflects the little things about us make us unique; connecting to ourselves is not a frivolous pursuit.

So…if you want some chocolate (or some broccoli)….enjoy.

Rwanda Day 2: Compassionate Curiousity

Our first venture in Rwanda was the iconic safari trek. This allowed us to quietly wander through this new landscape while we appreciated its natural beauty and animal inhabitants.

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We came here to learn from and exchange information with the people in this resilient community…however, watching animals in their natural habitat set the stage for a sense of wonder, admiration and curiosity that we will most certainly take with us in our professional meetings this week.

Even the animal kingdom here is in a revival phase, since many animals were killed in the genocide along with their human neighbors. There are also stories of targeted assaults on specific species, such as the lions, due to the threat they posed to the local livestock. The backlash of farmers poisoning their own cows totally eradicated lions from this area. Just last summer, seven were “re-introduced” to the protected land in the national park we visited, a gift from South Africa, and existing relatively hidden to visitors as they roam the property. Imagine our awe and excitement when we happened to spot one and watch as it sunbathed some 30 yards from our vehicle!

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One chord that reverberated from our safari experience was the practice of being with other beings in a way that’s respectful of their unique experience — sensitive that it is VERY different from our own. We found ourselves naturally speaking in soothing, hushed tones to the animals, or simply sitting totally still and silent, in respect for their territory and existence. We asked basic questions of our guides, purposefully leaving behind our presuppositions and entering wholeheartedly into a world that’s very different from our own.

We held our curiosity with a sense of compassion, attempting to understand creatures we easily admitted were foreign, yet important in a way that’s difficult to articulate in words. This ability, this altruism, is something we will intentionally carry over into this coming week … A willingness to enter generously into another’s point of view with humble, compassionate curiosity.

Rwanda Day 1: Listening and Being Listened To; a Western Luxury

On the second leg of my flight to Rwanda, I sat next to a 25 year-old woman who was traveling from Luxembourg to Rwanda for her wedding. I asked what seemed to be a fairly innocuous question; “Why do you live in Luxembourg and why are you getting married in Rwanda versus your home?” She responded that because her parents were murdered in 1995 during the genocide she had been adopted by a family from Luxembourg, however her fiance resided in her home country. Oh. How do you continue a conversation after an acknowledgement of such horror? She talked about the fact that she cannot visit Rwanda during the month of April because 20 years later, she is still terrified (April is the month during which the genocide took place).

I stumbled through the conversation with as much sensitivity as I could; I didn’t want to ask to much or ask too little. I did tell her my intentions in visiting Rwanda, which are essentially to explore the possibility of providing some sort of specialized support to survivors of the genocide and their children. She told me she didn’t know how someone could recover from the kind of atrocity faced by this country, which prompted a brief conversation about parental attunement, listening, and being heard.

She noted the differences between her white adoptive parents and her Rwandan birth parents; one of which was they had luxury to tune into her needs, listen and be able to provide an appropriate response. In countries that struggle economically, the primary concern of the parent is to feed and house their children. Emotional support is last on the list.

Rwandans have recovered from the genocide remarkably and with a great deal of grace. I am not familiar enough with the culture to understand what is happening emotionally beneath the surface or how trauma has manifested here. I also don’t know how many have told their story and how many have had the opportunity to have someone listen or even if that would be useful. Perhaps there is something I can learn from this culture about alternative forms of healing and meanwhile, whenever a local tells me their story, I certainly plan to listen.

Workshop for Trauma Survivors

Coming Soon….Honoring your Internal Warriors: Preparing for Trauma Work from an Internal Family Systems Perspective.”

Athena Phillips, LCSW will be offering a workshop for trauma survivors who are in the early stages of recovery. The decision to engage in therapy is in itself a tough decision and in my opinion, courageous. Revisiting painful memories is counter-intuitive~avoidance is probably more natural. In order to alleviate the influence trauma can have over our lives, we need to go against what our thoughts might be telling us to do (avoid, get away from, never go back). Typically it’s our bodies that won’t allow us to leave trauma behind until we have successfully processed and made some meaning of profound experiences. The conflict between our thoughts that tell us to forget about it or get over it and our body’s unrelenting reminders that we need to tend to our past creates significant internal tension.

The beginning of trauma work should be housed in establishing safety with the therapist as well as trust in ourselves in being able to handle the material we intend to revisit within the therapeutic context. Setting this intention naturally activates our protective mechanisms; the parts of ourselves that understandably have some concern about looking at trauma again. Our internal warriors have likely worked very hard at ensuring safety, at staving off overwhelming emotion, at maintain a safe distance between people, at scanning the environment for potential harm, or at helping keep things stable through numbing and avoidance. Sometimes these efforts can take a more extreme form, like dissociating from trauma, self-harm, excessive use of drugs or alcohol, suicidal fantasy. Many of these coping strategies are cause for concern, naturally, however there is generally some sort of positive intention behind them. Understanding the intention of the parts of self who are often trying to protect (Internal Warriors) and using them to guide safe trauma work is the goal of this workshop.

Participants must be actively engaged in individual therapy and must be able to interact with other group members in an emotionally safe way. Traumatic memories will not be discussed during the workshop, rather we will focus on how to prepare to do so in the context of individual psychotherapy.
Creativity, play and art will be utilized for the workshop and our hope is to have fun.

The workshop will be held July 18th from 1-4 pm. Cost is 125.00 and must be paid in full a week prior to reserve space. Maximum of 8 participants. Location TBA (either our Portland or Vancouver location depending upon number of participants). Call 971.266.6910 ext 301 for inquiries.

Mindfulness: All it Takes is a Moment

I’ve been running short on time lately, which has threatened one of my most important personal self-care strategies, and one I often recommend to my clients: mindfulness.  When I mention this to folks they usually state: I don’t have time for that! In most cases, what they are in fact thinking they don’t have time for is meditation. Yes, many of us do not have time to sit cross legged on a pillow with our eyes closed, focusing on our breath and nothing else. I agree with that (and suffer from the same challenge!). Fortunately, mindfulness is a little bit different. The technical definition is “paying attention in a particular way: on purpose, in the present moment, and nonjudgementally” according to Jon Kabat-Zinn, founder of the well-established Mindfulness Based Stress Reduction model.

So, if you look at that definition, true mindfulness just takes a moment! Okay, okay, after years of practicing a moment here and there, I now do try to get 10-30 minutes of meditation in my daily schedule (because of the further health benefits which I will detail in another blog post). However, most days, I find myself squeezing small doses of mindfulness into my lifestyle to encourage this beneficial practice and, quite simply, to give myself a shot of pleasantness here and there. This is important because our minds need a break at times, AND, when it comes to pleasant emotions and experiences, our minds are wired like teflon: Nothing sticks. We’ve got to apply mindfulness of pleasant moments here and there like a vitamin so we can counterbalance all the doubt, fear, pain and stress we encounter on a regular basis.

Traumatic experiences and unpleasant emotions like fear and sadness, unfortunately, DO stick. Stress is like velcro in the mind. Why? Because this was important for human survival. Evolution shows us that humans had to face the demands of a threatening environment and HAD to consider safety and react quickly to sustain life. We were lucky to survive until our reproductive years, so pleasant moments might not have been as important as the emotion of fear and the hormones of adrenaline and cortisol we needed for survival.

Now, though, we are living longer and we no longer face the saber tooth tiger or other previous threats. Unfortunately we are hardwired to still have adrenaline and cortisol coursing through our systems, and long term that can be detrimental to our health.

So, start small and counteract this biology by attempting to shift out of auto-pilot and into the present, moment-to-moment experience of your life. Think of a small child who has a sense of wonder about them (maybe start by watching little children and observing how they take in their experience without judging, often noticing the physical sensations rather than jaded thoughts or emotions).

All mindfulness takes is pausing to be more aware of your thoughts, feelings and body sensations. There is no success or failure, it’s simply paying attention (relaxation, having an empty mind or suppressing thoughts or emotions is NOT the goal, that is an incorrect belief many people have about meditation). If a recording would help, take 5-7 minutes to try these online, from the Mindful Awareness Research Center (MARC) in California.

Practicing this behavioral skill can actually help you develop a greater tolerance for the reality of what is occurring within yourself, and often allow the amazing opportunity for choice and strategic change. So just check in, see how you’re doing, and then respond with mindful awareness (this practice also makes those pleasant moments and positive hormones that much easier to access when you are in distress).  Then contact me to join ITTC’s mindfulness groups to cultivate your practice and decrease your stress!

Intuition vs. Vigilance: A Survivor’s Superpower

Survivors often talk about their capacity to assess their environment with greater speed and accuracy than your average Joe (or Jane).  Scanning for emotional and physical safety through a heightened attunement to the behavior of others, their emotional states and placing themselves in a position that ensures the opportunity for immediate exit are sometimes habituated ways of being for survivors.  Safety is dependent upon the capacity to detect threat (even subtle ones) quickly and correctly and often times, scanning for threat is baseline for a trauma survivor; one doesn’t ever come to a place of complete resting; resting equals risk.

Clients talk about their capacity to assess other people and the safety of their environment as something they are both proud of and fairly attached to.  I am often given examples of how vigilance has protected them of injury by providing ample time for fight or flight.  This perspective makes sense to me from the standpoint of someone who has endured; it is reasonable to make every effort to avert further injury.  And, in all honesty, I am often impressed with the capacity and skill survivors have developed in the appraisal of subtle environmental cues that otherwise go unnoticed. People who have witnessed or experienced unbearable things sometimes talk about this capacity as heightened intuition~a sixth sense.

Arguably, vigilance is a departure of intuition; it kicks in when we no longer trust in ourselves to ensure invulnerability and when we no longer trust that the world is safe. Intuition happens without thought or awareness; it is automatic and requires no effort.  I like to think of vigilance as a natural resource; while it is abundant it is not finite.  Habituation of external evaluation and anticipation of response tires the body; we were not designed to be alert consistently.  Additionally, vigilance could be viewed as a departure from ourselves and our sense of agency.  We rely on superheroes and superpowers when we can no longer trust in our own capacity.

I encourage my clients to “save your fear for when you need it” and the rest of the time work towards reconnecting to self, trust in one’s resourcefulness, and to take the risk of resting.  This parallels my admiration for the ways in which the PTSD is adaptive and clearly an attempt at returning to an assumption of safety.  Counseling, massage therapy, reiki and acupuncture are the various attempts we are making at working towards a place of quiet; the juncture of rest and safety are the mini-moments that uncouple rest with risk and begin to teach the body that we can trust our intuition and give our vigilance a vacation.

Dissociative Identity Disorder & Authenticity

Dissociative Identity Disorder (DID)

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The Question of Authenticity

Many of us find ourselves contemplating the question of “who am I” at some point or another; perhaps we are pursuant of a spiritual connection to our place in the universe or may be hoping to connect with ourselves veritably. Evaluating the supposition of authenticity highlights the fact that fidelity to self is layered and complex.  The foundation is characterized by a knowing; awareness of internal strata and facets of one’s constitution.  Secondary to knowing is acceptance of one’s characteristics; only with knowledge and acceptance of who we are can we begin to navigate our relationship to the world around us. Presenting ourselves genuinely without fear or regret is risky and requires significant ego strength; the venture of rejection of true self is more painful than that of a disingenuous self.  Relating to others in a real way while being accepted simultaneously is a challenge for all of us; individuals with Dissociative Identity Disorder (DID) are faced with a normal question that is complicated by multiplicity (and it’s functions).

The basal layer of authenticity poses a problem to dissociative individuals; the function of fragmenting can be to hide selves from the self.  Presupposing this is a protective process, how does one connect to who they are if overwhelming information is held in the answer to the question? Parts or “alters” are often hidden from view or are “behind the curtain” of consciousness in order to protect the rest of the system.  Self-awareness can seem commensurate to emotional gambling.

The second layer of authenticity requires acceptance. Assuming trauma is the etiological base behind DID, acknowledgement of some alters can feel parallel to an acceptance of unacceptable events.  Protective alters who hold anger, self-injure, engage in addictive, or violent behavior are often completely rejected by the rest of the internal system.  Child alters (who often hold the traumatic memories) are sometimes viewed by the rest of the system as pathetic, shameful and weak.  Managerial alters do find external belonging, but become fatigued from their overwhelming task of hiding and pushing for success. Recognition of a fragmented identity may equate to acceptance of the past, acceptance of a controversial diagnosis, and acceptance of an experience that many people will find challenging to connect to.

A common theme that arises in working with DID reflects this quandary; how can I be myself if my self changes?. Essentially this is a logistical question; how does one establish an authentic connection to the outside world when it feels like one’s demographics are in flux? Age, gender, and race are significant determinants of who we relate with and how relationships develop.  Small children like to play in very different ways than teens or adults do; men develop different relationships with women than they do with men and adolescents think adults are ridiculous. What if you are male sometimes, a five year-old at other times, or an adolescent girl at others?  This is an experiential truth for those with DID and it is very unclear as to how to be real and accepted under the umbrella of fragmentation.

When asked the question of how to relate to others in a way that feels real, my response is likely fairly inadequate.  I can only acknowledge the reality that DID is difficult even for some mental health professionals to accept (although research is making this more and more challenging); friends, family members, co-workers, and strangers are even less prepared to navigate such relationships.  There is truth in this experience and I have not discovered the right answer to living authentically in a world that is accustomed to and expects continuity.   It could be argued that we all are multi-faceted and are accustomed to disguising our vulnerability or less acceptable components of personality. Authenticity is a collective challenge, although it is a far more complex aspiration for those whose experience of who they are is relatively fluid.  Someone who lives with alters may say that in order to be genuine, they may require acknowledgement of all parts of self, to accept them, and to interact with the world from varying perspectives.

Massage, Acupuncture, Reiki & Mental Health

After watching the relationship between the mental health and the body be conceived as somehow distinctive from each other and thus the assumption is to treat them as separate entities, I thought it might be interesting to offer adjunctive treatments to folks. When I opened Integrative Trauma Treatment Center, that was a large factor in what drove the design of our model. We have massage therapy, acupuncture, medication management and psychotherapy available in one location. These services can be utilized together or a la carte. The goal is to provide a safe place for folks to get body work done, where they know their practitioners will tune in to them and have a nurturing but empowering presence. I also wanted to acknowledge the despair, suffering, and isolation that can go with trauma, depression, anxiety, or other mental heath concerns and to create a community that was open, welcoming, playful, and safe. A place for people to spoil themselves. I suspected that clients would appreciate it. I knew I liked the concept. What I didn’t expect is how I feel comforted by the fact that there is a team working with me and my clients in their process. I am not only surrounded by other like-minded therapists, but other practitioners who can approach the same challenges from different angles. This provides me with a safety net that I appreciate so much and did not expect that I would feel comforted by them. I feel less isolated as well. Hopefully, the gift to me as equally meaningful to those who visit ITTC.