TOO MUCH THER­APY?

Dis­cussing trau­mas re­peat­edly with pro­fes­sion­als may not be help­ful for many sur­vivors

Calgary Herald - - YOU - HE­LEN KIR­WAN-TAY­LOR

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.

CHRIS JACK­SON/GETTY IM­AGES

Prince Harry, sec­ond from left, seen with his wife Meghan, sec­ond from right, at a Waves for Change event to raise aware­ness for the chil­dren’s men­tal health or­ga­ni­za­tion, has re­cently said that he has been in ther­apy for seven years.

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