TOO MUCH THERAPY?
Discussing traumas repeatedly with professionals may not be helpful for many survivors
When Prince Harry spoke at a
J.P. Morgan event in Miami about being in therapy to overcome the trauma of losing his mother, it didn’t strike me as particularly newsworthy given the couple’s interest in mental health. What did was the fact Harry said he’d been seeing a therapist for the past seven years.
As a survivor of trauma myself, this set off alarm bells. A lot of questions have recently been raised about the efficacy of talk therapy, particularly the open-ended kind, and particularly for trauma. “Trauma is something you absolutely don’t want to remember,” says Bessel van der Kolk, one of the world’s most respected trauma experts and author of The Body Keeps the Score.
“Neuroscience research shows that very few psychological problems are the result of defects in understanding. Therefore, improving one’s understanding doesn’t help. Most psychological problems originate in deeper regions of the brain that drive our perception and action,” he says.
Hearts went out to the 12-yearold Harry who had to appear in public so soon after Diana’s tragic death. The fact that it was exacerbated by other factors — including being chased by paparazzi in a car driven by someone intoxicated — would make the grief even harder to process.
I was also 12 when Tasha, my 14-year-old sister, was murdered on the grounds of her school in Mclean, Va. I was forced to attend an open casket funeral and to kiss her cold face which was covered in sticky makeup. The fact that my father was then working for Henry Kissinger at the White House and that the murder took place at a wellknown private school made us household names.
Therapy wasn’t a thing then and we got through it the way people have for millenniums; by moving on with our lives, and also moving cities. It wasn’t until I saw a psychotherapist many years later who suggested I talk about what happened that I started to exhibit symptoms of full-blown PTSD.
Like Harry, my story wasn’t simple. It took a series of things to go stratospherically wrong for my sister to be killed. Unpicking each layer in therapy made me angrier and consequently more traumatized. I imagined myself in her shoes. Tasha was sexually attacked by a man who stood sixfoot-seven, tied her to a tree and left her to die in the freezing rain.
My father was the one to find her. Whatever healing had occurred to date was immediately undone by all the horror I envisaged. I now felt terrified from morning until night.
Like Harry, I had also waited many years before seeking help. My issue was a deep sense of foreboding that accompanied any happy moment. On the first day of my honeymoon in Africa, for example, I tried to open the door of the cockpit to jump out. It wasn’t rational to assume the plane would crash because I had found the love of my life but that’s what was happening. Happiness is complicated for trauma victims; strong memories become “fused” together and what should feel good suddenly feels terrifying. I wanted to tackle the symptoms: my therapist wanted the back story. This therapist was like the plumber who tells you what’s wrong with your sink then mentions he doesn’t have any tools (but still bills you). Post-traumatic stress disorder comes with a range of excruciating symptoms from hyper arousal, anger, irrational fears and difficulty concentrating, to numbness, flashbacks, suicidal thoughts and intense physical responses of reminders of the event. For this reason “treatment is meant to be short and sharp,” says trauma specialist Joshua Dickson, clinical director of Resurface UK. “Often going into too much detail will trigger a client out of their window of tolerance and can become overwhelming, with the client often distressed or re-traumatized.”
A college friend who survived a terrible car accident where another friend died, and which left her with hideous injuries, told me that she might have been better off had the hospital not sent in a psychiatrist. Over the years she visited many therapists, but it wasn’t until she started practising meditation and yoga that she began to recover.
“Gratitude really does help,” she says.
We know now that trauma resides in the limbic part of the brain that only has four responses: fight, flight, freeze and dissociation/submission. Modern treatments like EMDR (eye movement desensitization and reprocess), which involves a therapist directing a patient’s eyes as he talks, help to reset the software. It’s in this dual attention state that positive messages (“I am safe, I am loved”) can seep in. EMDR is now the treatment of choice for organizations such as the World Health Organization and the American Psychiatric Association. Many patients report benefits from just one session.
My issue with talking therapy is that it’s a form of storytelling where many conclusions are possible. A good therapist can change someone’s life: a bad one can ruin it. There are no Tripadvisor reviews you can scroll through before committing hundreds if not thousands of dollars to, let’s face it, a business relationship. The more naive the patient, the more extreme the psychological hold can be.
A therapist persuaded a friend to leave her husband after she discovered he was having an affair. Her instinct was to protect the family and heal the wounds; the therapist disagreed. She later discovered her therapist was married to a serial philanderer who seduced his clients. She quit therapy and saved her marriage.
One has to wonder what sort of advice Harry’s long-term therapist is providing. After all, he’s fallen out with his friends, brother, waged war against the media and quit his job and country. He’s lost his title and fallen out with his grandmother. In my mind, a good therapist is one who teaches you to get along with the world, not to blow it up.
The fact he’s still there after seven years also says something. “I see a good therapist as someone who helps a client to become as autonomous as possible,” says Dickson.
Of course, therapy can be an effective treatment, especially when we get stuck in “faulty” thinking about ourselves and others. Many people have difficulty accessing emotions or are afraid to admit them. Therapy can be a safe place to let go, and form a sustaining relationship, which is a large part of healing.
But what has helped me with my own trauma is not revisiting the event, but understanding that my limbic brain is often trying to steer the car. It means well but it doesn’t know how to use the brakes. This kind of faulty thinking responds well to directed therapy such as cognitive behavioural therapy and its offshoots which, unlike a lot of talk therapy, have been scientifically scrutinized and held to account.
I have friends who see a therapist twice a week and have done so for years. What do they discuss? Paint colours? My biggest issue with some talk therapists is that rather than solving their patients’ problem, they end up prolonging their agony.