Forgiveness

Je suis desolee.

Maaf kijiye.

Mottasefam.

Aasefa.

I’m sorry.

I can apologize in five languages. I know how to say I forgive you in only one. Maybe that’s an accident or maybe that has something to do with me. I can recognize when I have wronged someone, but I don’t know how to forgive.

Most people working at healing some kind of emotional wound–any kind of wound–will tell you that you need to forgive those who have wronged you in order to heal. Others will tell you the whole idea of forgiveness is offensive. What was done to them cannot be forgiven.

Forgiveness is an essentially contested notion: we cannot agree on what forgiveness means or whether forgiveness is required. But we do agree on its importance.

In my experience, whatever it is we are angry or hurt about, the person we most urgently need to forgive is ourselves. We need forgiveness for the ways the damage to our souls has been allowed to continue to harm us long after the perpetrator stopped. We need forgiveness for the poor choices we’ve made as a result of the past that allowed the past to go on hurting us. We need forgiveness for the ways we went on harming ourselves for reasons that were never our fault.

Reverend Desmond Tutu says that forgiveness is always available to us. All that is required is an earnest confession of our wrongs.

So here goes:

I’m sorry.

Je suis desolee.

Maaf karen.

Mottasefam.

Aasefa.

I’m sorry for expecting the impossible from myself for far too long. I’m sorry for not eating right most of the time. I’m sorry for attempting suicide at 2 years old. I’m sorry for considering it again all through 9th grade. I’m sorry for cutting myself in high school and again in college. I’m sorry for every one of my destructive relationships. I’m sorry for being so slow to understand I deserved better.

I am.

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Treating Complex Trauma: Trauma-Focused Cognitive Behavior Therapy

In an earlier post, War and Torture: Treating Survivors of Ongoing and Repeated Traumas, I mentioned rather briefly that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has shown good results in treating survivors of repeated and complex traumas such as war, torture, and childhood sexual abuse. As survivor of complex trauma myself (torture and childhood sexual abuse, as well as ritual and severe physical abuse), I can attest to the veracity of those findings.

Psychodynamic therapies encompass a wide range of theories and practices derived from Freud, his followers, and those who broke away from him. It is focused on expanding the range of the ego. An entity I continue to fail to understand.
Psychodynamic therapies encompass a wide range of theories and practices derived from Freud, his followers, and those who broke away from him. It is focused on expanding the range of the ego. An entity I continue to fail to understand.

For more than 20 years, I have been a psychotherapy services–on and off, but mostly on. Most of it has been unhelpful. I kept going back because I needed help and, darn it, something had to work. But it really didn’t help. Not very much.

And then about 8 years ago, I quit therapy, focused on my job and friendships, found myself an appropriate and supportive intimate partner, began to research some of the mental illness I grew up with, joined online support groups, and started up some do-it-yourself dialectical behavior therapy.

For the first time, I began to get noticeably better in terms of my overall mental health and general sense of well-being. It wasn’t roses by any means, but it wasn’t just running on a hamster wheel anymore. When I did return to therapy two years ago, I used it in a particular, self-directed way. I didn’t just go and see where the conversation took me. And I stopped looking to therapy to provide me some kind of magical insight into myself and focused on telling the story I needed to tell. And I kept getting better.

I’ve been wondering recently why this was. I think I have an answer.

We need a network of people who care about us, even if it's just a little. (Children 6 months after the Haitian earthquake.) Photo credit: IFRCT
We need a network of people who care about us, even if it’s just a little. (Children 6 months after the Haitian earthquake.) Photo credit: IFRCT

Most of the psychotherapy I’ve been engaged in has been psychodynamic in nature. And it is not especially effective with complex trauma. I’m not sure it’s especially effective at all–not more than having a good friend who cares about you and listens to you talk once a week. Or getting a dog. But I can’t really say one way or the other. I haven’t researched it, and I do think different problems have different solutions. So maybe psychodynamic therapy works with some problems. But it doesn’t help you deal with repeatedly being raped, for example, or having lived in a war zone. Not much anyway. And it might take 30 years to notice substantial improvement. And frankly most of us just don’t have that kind of time. Or money.

What works is relatively new on the scene, and that’s why it took so long for me to get help. The science wasn’t there, and I was so conditioned by psychotherapy to believe I needed to confront my difficult feelings that I couldn’t believe there was any other way of working.

I’ll tell you what I did in the end and why it worked. First, I provided myself with psychosocial support. I did not make friends, but I made better acquaintances. I gave myself meaningful work to do that gave my life a sense of meaning. Both the World Health Organization and The International Red Cross and Red Crescent Societies  say that psychosocial support helps communities marshall existing resources to manage difficult situations.

Cognitive Behavioral Therapy assumes that our thoughts, behaviors, and emotions all interact. If we can create change in one, we can often create change in another.
Cognitive Behavioral Therapy assumes that our thoughts, behaviors, and emotions all interact. If we can create change in one, we can often create change in another.

Victoria Follette in her book Cognitive Behavioral Therapies for Trauma mentions that beginning with an initial course of Dialectical Behavior Therapy prior to starting TF-CBT is helpful for some patients with especially intense or complex traumas. It was helpful for me, as I lacked the skills necessary for managing the extremely intense feelings involved in working with my memories of trauma.

This isn’t to say I lacked emotional skills in general. The extremely intense emotions of trauma requires specialized skills. And we don’t learn these just anywhere. They are learned through deliberate effort and practice.

In particular, I incorporated mindfulness and distress tolerance into my emotional management toolbox. Mindfulness helps works against dissociation, and it is the habit of dissociation that makes resolving trauma so difficult. Distress tolerance reduces impulsivity, and it allowed me to dredge up memories strongly associated with suicidal thoughts and urges without endangering my own safety. Those skills gave me a foundation for further work.

Only after that did I start working with memories. I used two strategies from TF-CBT, although there are other strategies with a track-record of effectiveness, and one other variety of CBT that is not specifically designed for treating trauma but was important for helping me address my faulty beliefs from having been raised in a religious cult.

The TF-CBT strategies I used are prolonged exposure therapy (PE) and Cognitive Processing Therapy (CPT). I repeatedly exposed myself to memories of trauma while making a conscious effort to manage the emotions effectively without dissociating (dissociation shuts down the ability to engage in a conscious or deliberate way with the world or with our minds) and I looked at what thoughts and beliefs I had formed during trauma in order to challenge them with more complete information.

The third form of CBT I used was schema therapy, which looks at important beliefs that interfere with functioning. Because I was raised in a cult, and because I was raised by parents who thought in deeply faulty ways, I have inherited a number of faulty beliefs about the world and what it means to be a good person. I don’t believe in these whole-heartedly–I did after all leave the cult world when I was 15–but they linger at the margins of my mind and are also closely tied with trauma memories so that the intensity of the trauma experiences sustains them.

When I returned to work with a therapist, I used my therapist to help me with the PE by telling her about specific, difficult memories. Her role as a sympathetic witness to my experiences has been invaluable, and helps me to re-interpret the world as a place in which I can be cared about and supported. It provides me with direct evidence that my sense of being utterly alone with the trauma is no longer true.

I don’t really recommend a do-it-yourself approach to trauma. It’s much easier and more likely to get you good results if you can undertake it with a trained therapist. But I do recommend that you look for a therapist who can provide you with the appropriate form of therapy.

Just as you would see an oncologist to treat your cancer, you probably want to see a therapist competent in providing effective, trauma-focused therapy to treat your complex trauma. You would not see a family doctor to treat your cancer, or a witch doctor, or a priest, and it won’t help very much to see a psychoanalyst, a generalist, or your local religious leader for your complex trauma. Difficult problems require highly expert solutions.

Further Reading:

Follette, V. and J. Ruzek. (2006). Cognitive Behavioral Therapies for Trauma. New York: Guilford Press. (Available from Google books.)

Resick, P., P. Nishith, P. and M. Griffin. (2003, May). How Well Does Cognitive-Behavioral Therapy Treat Symptoms of  Complex PTSD? An Examination of Child Sexual Abuse Survivors Within A Clinical Trial. CNS Spectrums. Retrieved from: http://www.nctsnet.org/nctsn_assets/Articles/40.pdf

Growing up with a Narcissist: Five Myths You Might Believe

Myth #1 Everyone wants admiration.

Reality: Most of us want connection and appreciation. A little admiration is fine, but what’s really important is mutual positive regard with the people most important to us.

Myth #2 We are important to the extent that we can be of use to others or to the extent that we can persuade others to allow us to make use of them.

Reality: We are important to others to the extent that they are attached to us, meaning they feel safe and at ease in our presence. Being of use places us in the role of objects–not people.

Myth #3 Everyone is just looking out for themselves.

Reality: We need to be able to look out both for ourselves and each other. None of us can do life on our own.

Myth #4 There is an objective standard for being an acceptable person. Usually, the narcissist defines this, while simultaneously claiming it is the standard that everyone holds.

Reality: While people generally seem to prefer others who have symmetrical features, lighter skin, thinner bodies, confident personalities, a moderately warm manner, and a sense of humor, we are all unique in our tastes. Other qualities often win out in importance over generally preferred traits. None of us are anyone’s ideal, and yet there are always plenty of people out there who can find us good enough to care about.

Myth #5 God agrees with the narcissist.

Reality: No one really knows what God thinks. We are all just doing the best we can to sort it out for ourselves–the narcissist included.

Reconstructing the World: The Push towards Evil

Traumatic experiences interrupt our understanding of the world in important ways. They violate the rules we have in our heads about how the world is supposed to function. There is something about these events that makes us think, “These things don’t happen. Not in real life. Not in my life. Because if they do, I will never be safe.”

After trauma, a part of recovery involves reconstructing our world views and resolving the cognitive dissonance of thinking something that can’t and shouldn’t have happened really and truly did.

Like Piaget’s children repeatedly dunking soap bars in the water, we sometimes keep putting ourselves in similar types of danger until we understand that big things don’t always sink and that terrible things sometimes do happen.

But how we reconstruct the world after trauma depends on what else we know and think about the world and also upon who we are. Everyone comes to their own understanding.

I’ll tell you mine. I believe I live in a world where most people are good, or at least try to be. There are some are genuinely callous, amoral, selfish, or even sadistic. But it isn’t most of us. It’s just a few of us. But those of us who are good, or at least basically good, are capable of carrying out tremendously evil acts. It isn’t just the psychopathic killer or the mentally unhinged time-bomb of a person we need to worry about. It is everyone. Because we all live a step or two away from committing atrocity.

I think this because I grew up with it. I grew up with ordinary people who allowed evil to flourish within their midst, failed to notice or prevent it, and provided protection to perpetrators rather than to victims. I saw that when confronted with evil, not everyone stands up to. In fact, a lot of people do nothing at all–they deny it outright, or claim they are helpless against it, or find ways to justify it. Their desire not to know is stronger than their desire to do right.

And I think that also because of history. Something it seems to me we should all know something about by now and not need to be told. Eleven million people couldn’t have been killed in Europe during the Holocaust without the support and complicity of the vast majority of ordinary citizens. The men and women who tortured detainees at Abu Ghraib and Guantanamo (and are perhaps continuing to do so at Guantanamo) can’t all be hopeless ideologues or sadists. They are fathers, mothers, daughters, sons, brothers, and sisters. They are good providers and caring family members. They are people just like us.

Some people possess extraordinary moral courage and will resist evil despite tremendous risks to themselves and their families, but I suspect that not all of us are that brave. Most of us are decent because we are lucky. Whatever push it would take for us to stand aside and watch evil acts or even join in–even lead–has simply not happened to us.

As a species, we are a bit cobbled together. Some of us with stronger baling wire and better chewing gum than others, but baling wire and chewing gum nonetheless. We’re frail. And it doesn’t always take much to push us over the edge into violence, into cruelty, and to atrocity.

It isn’t the prettiest world to imagine living in, but I can live with it. I can live with seeing myself that way: someone a step or two away from evil, who is mostly just lucky not to need to know how much of push it would take to get me there. I have been there once, but I was a little girl then. The push it would take for me to do similar things now is not the same, but I assume there is one. I know that. I know I’m not immune.

In light of that view, though, I believe we all need to work to prevent those “pushes” from occurring and of innoculating ourselves from the power of that push. Whatever it is that makes people the most desperate and prone to violence needs to be interrupted and prevented. And factors that add to our resilience and wholeness–that make us strong enough to resist evil–need to be nurtured.

Do It Yourself Resilience

Some people manage adversity better than others. Children who are resilient survive trauma and other setbacks with fewer signs of trouble. If their parents divorce, their grades may drop, but not as much or as long. They don’t get into fights after police activity in the neighborhood and they go onto college even after the death of a parent.

archspider2There’s been a lot of research on what it is that helps some people cope better than others and about 100 different markers for resilience have been found. (I may be exaggerating there, but it is a lot.)

I’m not going to list them all—there are too many, and some factors that lead to resilience are largely outside our control. But what I am wondering is if there are things we can do for ourselves that can help us cope better with our ordinary struggles and difficulties—if there’s a way to make do-it-yourself resilience.

Specifically, I was wondering if resilience is partly about meeting our basic human needs well enough that, despite difficulties in one area in our lives, we can still function well in other areas.

Everyone knows that we don’t perform as well if we are hungry, tired, or feverish. My students don’t even seem to do as well if they are too hot or cold. But what about other needs?

hierarchyMaslow set out a hierarchy of them. Most teachers are familiar with his theories, because the assumption is that kids aren’t going to learn how to solve quadratics that well if they feel unsafe or insecure or aren’t loved. Staub built on this in his writings about genocide, claiming that rather than a hierarchy, basic human needs exist simultaneously. They all need to be filled to at least some degree or we suffer psychologically. We don’t perform as well. And sometimes we act in destructive ways.

He lays out the following needs as being of primary psychological importance: the need for safety and security, a positive identity, connection, a comprehensible reality, and autonomy. I would add that all of us strive for equilibrium related to emotions and arousal: we want a certain amount of stimulation, but not too much, and a certain amount of feeling, but not too much, and only so much frustration or other negative emotions.

What I wonder is if making a concerted effort to have our own basic needs met can add to our resilience—making us more effective in dealing with life’s ongoing adversity as well as unusual and unexpected stresses. Just as I do best when I have slept well and had a good breakfast, maybe we do best if our psychological needs are met.

Most of the factors that create resilience in children seem to be related to meeting a basic human need. I have also noticed that when my students aren’t getting their needs fulfilled in one area, they often compensate by filling a different need—if they feel lonely or disconnected from others, they will settle for power, for example.  So, I’m also wondering if making sure we fill as many of our “need cups” as possible can off-set a cup that is empty.

Safety and Security

This one seems easy, but also less within our control. Do we live in a safe neighborhood? A house we find comfortable? Are we worried about bills? Do people in our lives frighten us? Some of these things we can work on. Some of these things are more difficult. But this is the magic of the hot bath for some people. The calm and quiet and physical comfort meet our need for a sense of safety and security.

Positive identity

We all need to believe we have worth and value and we need to like who we are as people. We can gain a sense of having a positive identity in many different ways: by doing work and having hobbies where we excel, by surrounding ourselves with people who appreciate us, by being members of groups we see in a positive light or by developing positive ideas about group identities we already hold (like ethnicity or race), and by doing things we believe make us “good” people. (So, going to church or volunteering for a worthy cause counts).

Connection

We need friends and people who love us. We need people in our lives who listen to us. But other warm interactions can give us a sense of connection as well: having pets, for example, or being a member of a club. It also makes a difference how well we connect with strangers and acquaintances–if you have a pleasant chat with the woman ahead of you in the check-out line, that’s connection, even if you never see her again.

Comprehensible Reality

Having a comprehensible reality means we understand what happens around us and what has happened to us in the past. We aren’t shocked or confused on a regular basis by what occurs around us. Information can help with this. When people read up on a frightening disease affecting their families, they are meeting their need for a comprehensible reality. Someone who talks endlessly about an abusive relationship is looking for understanding (and possibly connection). Gathering information about some of the things that don’t make sense to us can help fill this “cup.”

Autonomy

We feel autonomous when we have an acceptable amount of control over important decisions in our lives: where to work, who to marry, when to have children. We can work at having more autonomy in big ways, such as by furthering our education so that we can enter a career where we will have more responsibility and independence in doing our jobs, or in small ways like scheduling visits to our parents at times that are convenient for us.

None of these measures is a cure-all. I’m not suggesting we can achieve great happiness by simply working at these five areas. But building resilience by making sure we’ve met as many as our important needs as possible can take the edge off and help us perform better during stressful times.

Further Reading:

Staub, E and J. Volhardt. Altruism Born of Suffering.

Being There

In One Minute Therapy, I suggest trying to tell a few people in our lives what is real for us at that moment for one minute. The thinking behind it–which isn’t my invention, although I’m not sure whose it is–is just that sometimes our most powerful gift to one another is simply being there

Often, when someone confides their struggles to us or their pain, we want to suggest solutions, we want to make things better, we want to say we understand. But we aren’t that person, and much of the time we really don’t understand exactly what it is like to be her. We don’t have any great insight into the problem. We don’t know what the best direction is for anyone other than ourselves–and we aren’t always clear on that.

But we can be there.

When we tell ourselves our own troubles, sometimes we also want to suggest solutions. We want to tell ourselves the precise origin of our problems and how we should go about solving them. But we often don’t know. We have no great insight, only pain.

We can still be there with ourselves, accepting the state in which we find ourselves. We can know that it is not a nice place to be, we don’t like it, and we wish things were different. We can still be there with ourselves, bearing witness.

One-Minute Therapy

A year ago and a half ago, I sat with a group of four of my 7th grade students with a box of tissues in the center of us telling each other what was real for us at that point in our lives. We all had one minute to speak, and we could say what we wanted or nothing, but there was an expectation of honesty. We all spoke, and I think we all cried.

It’s hard to get up the courage to speak about what we are going through in our lives, what’s bothering us, and what we wish we could get past and can’t. Some of us–me–have spent a long time hemming and hawing over things or never speaking at all.

But when we had only one minute to speak, it turned out to be long enough to get the point across, to connect with each other over our pain and our tough times, and when we had finished speaking there was time to offer support to one another. There was time enough to cry.

I wonder what would happen if we did that more often in our lives–if we chose particular people to be real with for one minute from time to time. I wonder if we would find we could speak about our most difficult experience, that we could get across what we needed to, we could be heard, and we could be supported.

One minute isn’t so long.