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“Our son…cares about himself and others around him…He has regained hope and faith in life…And as a family, we have a huge increase in the positive interaction and time we share. Thank you for giving us so much.”

- Headway Client

What is trauma, and how can we to treat it?

Posted May 8th, 2014 @ 02:05pm by: Macey Mueller

By Alma Millan, MA

The month of May is trauma awareness month, which gives us a great excuse to learn about and understand psychological trauma and ways to treat it. Trauma occurs when a person has to cope with a sudden, unexpected, stressful event and it becomes apparent that he or she does not have the internal or external resources to deal with that event. For that reason, psychological trauma can profoundly impact or wound as deeply as physical trauma.

When the word "trauma" is used in the medical field, it indicates bodily harm, such as suffering an injury in a car accident. In this case, it would be up to the person and doctor to deal with the wounds the car impact created in or on the body. Sometimes, this type of trauma can leave physical scars for life, depending on the severity of the crash. As for mental trauma, a damaging event occurs, but the difference is that sometimes it is difficult to identify it as easily as trauma in the body. But a therapist trained in trauma can recognize psychological trauma symptoms. Trauma can impact the person on an emotional level -- he or she may have suffered a traumatic experience that causes them to have trust issues, for example, but they may not be aware of it on a conscious level. This person may not want to have a social life because he or she is afraid that everyone would disappoint or hurt them as much as someone from their past might have.

Psychological trauma also affects the person's cognition and the way they see life. Because of the way the trauma changes the way they understand life, their behaviors may also change as a result. For example, if a child or teenager experienced physical aggression from an adult male, they might think that all male figures are aggressors and will hurt them. As a consequence, they might react fearfully to all male figures, generalizing that they will be the same as the particular male who hit them. Or, they might act in a rebellious way toward the male population without being aware they are doing it.

There are many different kinds and degrees of traumas. For example, physical abuse, sexual abuse, and the death of a close relative are considered traumatic experiences. But the internal perception of the person who suffered the traumatic experience plays a very important role in the trauma. This perception can determine if the traumatic wound will become a problem for the person in the future or not.

The mental health diagnosis often associated with trauma is Post Traumatic Stress Disorder (PTSD).

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a book offering common language and standard criteria for the classification of mental disorders, PTSD is associated with some of these symptoms:

The person has been exposed to (witnessed, experienced or confronted with) a traumatic event in which both of the following were present:

1) Actual threatened death or serious injury, or a threat to the physical integrity of self or others.

2) Their response involved intense fear, helplessness, or horror.

There are additional symptoms that the person may experience to meet criteria for a diagnosis of PTSD such as recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; efforts to avoid thoughts, feelings, or conversations associated with the trauma; efforts to avoid activities, places, or people that arouse recollections of the trauma; presents a sense of foreshortened future (does not expect to have a normal life); presents persistent symptoms of increased arousal (not present before the trauma) such as difficulty falling and staying asleep, difficulty concentrating, and hyper vigilance.

What can you do if you are dealing with Posttraumatic Stress Disorder?

When addressing trauma, research has shown that a useful evidenced based therapy is Trauma Focused Cognitive Behavioral Therapy (TFCBT).

TFCBT is a type of exposure therapy that deals with the traumatic experience and helps the person desensitize toward the trauma until they can return to a normal level of functioning. It involves learning different skills and steps to gradually talk about and overcome the traumatic experience. Research has shown it to be very effective when dealing with symptoms of trauma because the therapy is targeted to deal with it.

If you believe you are experiencing symptoms of a traumatic experience, know you are not alone and that you can get help from a therapist trained to understand and heal trauma victims.

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Charlie Greenman's Thoughts on Alcohol Dependence

Posted April 7th, 2014 @ 12:04pm by: Macey Mueller

By: Charlie Greenman, MA, LP

Alcohol Dependence, or alcoholism, is a dangerous, chronic and progressive condition that exists in roughly 10% of our population. Almost every day I hear about someone who has killed, assaulted or injured someone due to alcohol abuse or dependence. About one in four of us are affected by someone with this disease. Children who grow up in homes with active alcoholism run a much higher risk of sexual, physical or emotional abuse. These children may also be at higher risk for becoming alcoholic themselves or having emotional attachments to and/or marrying alcoholics. This disease often skips generations and if untreated, can result in health problems, emotional problems and behavior problems that persist for many years, even resulting in premature death.

Someone who is alcohol dependent does not need to drink every day, have physical damage from drinking, be impoverished, unemployable or in trouble with the law. However, this is an illness that occurs on a continuum and if it is untreated it can lead to these and other, even worse outcomes. What is fundamentally true for an alcoholic is that alcohol functions as a solution to every problem and becomes a primary relationship that eventually excludes all others. The drinker begins to rely more on alcohol for comfort, companionship and, eventually, to avoid serious withdrawal symptoms. Family members and loved ones frequently find themselves caught in a cycle of what is called co-dependence: they become just as preoccupied with the alcoholic as the alcoholic is with alcohol by trying to control, change and otherwise influence the drinker to STOP DRINKING. These efforts usually fail, because they are trying to change something beyond their control, and can also enable the alcoholic to continue his or her destructive behavior. Once family members stop trying to fix the alcoholic themselves, much can be done, including accessing effective treatment for both the alcoholic and family members.

Alcohol Dependence is one of the most treatable conditions I deal with as a psychotherapist at Headway. It is very rewarding to see individuals and their families recover and heal from the impact of this devastating condition. To begin the healing process, someone -- the alcoholic or a loved one - needs to honestly admit what is going on and that drinking is the problem. Due to denial, stereotypes, shame and embarrassment this is often a difficult step to take. Without it, conditions will likely deteriorate and nothing will change. Acceptance of the problem is the first step in 12 step groups such AA, Alanon and Alateen that provide support and information about the disease and more importantly, the recovery process. This first step is the admission that the alcoholic and family are all "powerless over alcohol and that their lives have become unmanageable." These groups can be powerful allies in combating the problem once the first step is taken. Because alcoholism is so isolating for everyone I favor these kinds of groups as they help the alcoholic and family members to realize that they are not alone and that others have struggled in much the same way with the disease.

Many people find that formal treatment is an effective way to address the dysfunction due to alcohol dependence. This treatment can take place in a residential or outpatient setting and can last for weeks or months. The most effective treatments of this kind include an intensive inpatient or outpatient component and longer, less intensive aftercare. It is quite common for an alcoholic to have another mental health disorder and this should be addressed during and after any primary phase of treatment. Traumatic experiences including childhood and adult abuse, combat, or severe injury must also be addressed to prevent relapse. In my work I particularly value being able to help people who are in the recovery phase of their treatment. They have started to build a support network, have remained sober and are beginning to see themselves as valuable and worthy individuals. This is also a time when couples and family therapy can be beneficial. Families in recovery have a lot of change to navigate and are usually developing new roles and ways of communicating with each other. While these are positive changes they can feel overwhelming and frightening, especially for children. Providing a safe place in family therapy to build trust and enable honest conversation relieves children from feeling responsible for their parents' well-being.

For additional helpful resources, please visit:

The National Institute on Alcohol Abuse and Alcoholism




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Dr. Hal's Thoughts on Talking to Kids About Self-Harm

Posted March 3rd, 2014 @ 02:03pm by: Macey Mueller

Self-Injury is a complex and often misunderstood issue. Many people think that self-injury is an indicator of suicidal tendencies or will result in an attempted suicide. But the best evidence we have from research and from reports by those who have participated or participate in self-injury is that self-harm is mostly unrelated to suicidal behaviors. In fact, for some self-injury may be a protective mechanism against suicide.

There is no single reason that people self-injure. When interviewed, people provide a variety of reasons. Some youth who self-injure report it as a release, allowing bad and perhaps self-destructive feelings out. Some youth report that they feel disconnected or depersonalized and cutting helps them reconnect to their feelings when they see the blood. Occasionally, youth say cutting is a way of punishing themselves; others report it being a "high." One youth indicated that cutting is the only way they know they are alive, because they feel "dead" already. And more rare are those youth who cut for attention or because it is "cool."

The majority of those who hurt themselves for emotional reasons typically try to hide it. But if someone is blatantly self-injurious and showing it off, it is likely that person is using it as a scream for help. Youth who want to be noticed are not doing it because they are obnoxious; they want to be noticed because they feel invisible, which is never a good feeling.

So what do we do? The first thing is what NOT to do: overreact. The best place to start is to calmly initiate a listening session. Read that again. Start a listening session, not a talking session. That means the youth talks and you listen, listen some more, and then listen some more. The youth may not have facts, times and concrete evidence about why they cut. Their experience may be very somatic - or related to their physical selves--and thus not easy to describe in words. If you cannot listen anymore, or the conversation stalls, ask questions like, "Do you know what you would like for me to do?" or, "Do you know what you need from me or others?" Note that those who cut and use drugs or alcohol tend to self-harm more when under the influence. Not every youth who self-harms has a substance abuse problem but together the two issues can exacerbate each other.

The treatment for self-harm is also complicated. Simply engaging the youth in behavioral and cognitive behavioral treatments to get them to stop cutting does not always fix the reason they started. They may simply find another self-destructive behavior to use to stop the emotional pain. Many youth also need to heal the emotional wounds, traumas and uneasy "emptiness" in their lives. I recommend seeing a therapist skilled in self-harm behaviors who can help with both decreasing the behaviors and initiating the healing process simultaneously. Throughout the process of healing, parents need to continue to keep the communication channels open and be patient. Self-harm behaviors will not typically disappear overnight.

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