Tuesday, August 10, 2010

Emotional Flashback Management in the Treatment of Complex PTSD

This is a fantastic article by Pete Walker from http://www.psychotherapy.net

Early in my career I worked with David,* a handsome, intelligent client who was a professional actor. One day David came to see me after an unsuccessful audition. Beside himself, he burst out: "I never let on to anyone, but I know that I'm really very ugly; it's so stupid that I'm trying to be an actor when I'm so painful to look at."
David's childhood was characterized by emotional abuse, neglect and abandonment. The last and unwanted child of a large family, his alcoholic father repeatedly terrorized him. To make matters worse, his family frequently humiliated him by reacting to him with exaggerated looks of disgust. His older brother's favorite gibe, accompanied by a nauseated grimace, was, "I can't stand looking at you. The sight of you makes me sick!" David was so traumatized by the contempt with which his family had treated him that he was easily triggered by anything but the most benign expression on my face. If he came into session already triggered, he would often project disgust onto me, no matter how much genuine goodwill and regard I felt for him at the time.
I have come to call these reactions, typical of David and of many other clients over the years, emotional flashbacks—sudden and often prolonged regressions ("amygdala hijackings") to the frightening and abandoned feeling-states of childhood. They are accompanied by inappropriate and intense arousal of the fight/flight instinct and the sympathetic nervous system. Typically, they manifest as intense and confusing episodes of fear, toxic shame, and/or despair, which often beget angry reactions against the self or others. When fear is the dominant emotion in an emotional flashback, the individual feels overwhelmed, panicky or even suicidal. When despair predominates, it creates a sense of profound numbness, paralysis and an urgent need to hide. Feeling small, young, fragile, powerless and helpless is also common in emotional flashbacks. Such experiences are typically overlaid with toxic shame, which, as described in John Bradshaw's Healing The Shame That Binds, obliterates an individual's self-esteem with an overpowering sense that she is as worthless, stupid, contemptible or fatally flawed, as she was viewed by her original caregivers. Toxic shame inhibits the individual from seeking comfort and support, and in a reenactment of the childhood abandonment she is flashing back to, isolates her in an overwhelming and humiliating sense of defectiveness. Clients who view themselves as worthless, defective, ugly or despicable are showing signs of being lost in an emotional flashback. When stuck in this state, they often polarize affectively into intense self-hate and self-disgust, and cognitively into extreme and virulent self-criticism.
Numerous clients tell me that the concept of an emotional flashback brings them a great sense of relief. They report that for the first time they are able to make some sense of their extremely troubled lives. Some get that their addictions are misguided attempts to self-medicate. Some understand the inefficacy of the myriad psychological and spiritual answers they pursued, and are in turn feel liberated from a shaming plethora of misdiagnoses. Some can now frame their extreme episodes of risk taking and self-destructiveness as desperate attempts to distract themselves from their pain. Many experience hope that they can rid themselves of the habit of amassing evidence of defectiveness or craziness. Many report a budding recognition that they can challenge the self-hate and self-disgust that typically thwarts their progress in therapy. Read on.

No comments: