Avoidance and Trauma Therapy

What does avoidance have to do with trauma therapy? Avoidance is a common coping strategy. In psychotherapy, when we talk about avoidance we mean strategies for avoiding unwanted or uncomfortable feelings. Avoidance is a natural and understandable response to a traumatic event. Who wouldn’t want to avoid reminders of a painful and overwhelming experience? Or attempt to avoid situations because you fear something similar could occur again?

The problem is, avoidance doesn’t really work. In fact, avoidance strengthens the fear and anxiety response! The more we avoid a place, person, or even feeling, the more likely we will continue to feel anxious about it and continue avoiding it. A vicious cycle!

Ongoing avoidance is one criteria required for a diagnosis of PTSD in the DSM V:

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event:(one required)

  1. Trauma-related thoughts or feelings.
  2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

The presence of avoidance is diagnostic of PTSD and research has found that an avoidant coping style is related to increased PTSD symptom severity for sexual assault survivors.

Avoidance can happen within therapy too. Sometimes therapists collude in avoidance, for perhaps in an unconscious effort to prevent the client from feeling more pain. In trauma therapy avoidance can look like:

  • talking about any and everything but your trauma
  • minimizing the severity of your experience “other people have it worse than me”
  • forgetting to do homework in between sessions
  • forgetting or missing appointments

Trauma therapy is all about facing, being present with, and moving through your traumatic experiences instead of avoiding them. It involves processing your traumatic experiences by staying present with the associated feelings and beliefs. No small task! The payoff for this hard work  is decreasing the high intensity emotional charge while creating meaning.  A trauma-informed therapist of course understands to need to approach this work gently and with compassion. Avoidance exists for self-protective reasons. With help and support you can learn more effective ways to overcome trauma.

avoidance and trauma therapy



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Blazing a Path

Mass murder. Misogyny. Maya Angelou. Jane Doe. The Transgender Tipping Point.

These are the things on my mind and heart.

I’m reading, thinking, talking about the recent spree shooting murders in Isla Vista, California and the connections to our cultural devaluation and hatred of women. The violence that occurs in the context of misogyny, racism, transphobia. Our rush to explain away such atrocities as the work of someone “crazy” contributes to the stigmatization of mental health issues. It furthers the myth that mental illness equals and explains violence in our efforts to make sense of the senseless, to try to regain our illusion of control.

It also helps us ignore the larger, systemic, institutionalized issues involved, such as misogyny. As feminist blogger Melissa McEwan tweeted “dismissing violent misogynists as ‘crazy’ is a neat way of saying that violent misogyny is an individual problem, not a cultural one”. When Do We Talk About “Unpleasant” Truths In the Wake of Elliot Rodger’s Destruction? Soraya Chemaly asked, and tweeted:


Breathe and see if you can really take that in, if just for a moment. ALL women live with the threat of male violence. #yesallwomen is happening on Twitter. Have you seen it? Can you look away? A powerful, profound, painful shout back to all the deniers, apologists, and trolls of rape culture and sexism. It is real and raw, the voice of girls and women speaking truth to power: gendered oppression, discrimination, and violence happen. We are all impacted. It is empowering and of course incredibly painful to witness, so be mindful and take good care.

And Dr. Maya Angelou died. Her words and being have impacted me, changed the way I saw the world, since I first read I Know Why the Caged Bird Signs. A survivor of sexual abuse, artist, activist, inspiration. Once silenced by trauma, her voice touched so many.

maI reveled in Laverne Cox on the cover of Time magazine, wondered if this truly is the “tipping point”.  Simultaneously, Jane Doe, a 16-year-old trans girl sits in adult prison with no criminal charges for over 50 days. In An Open Letter to Jane Doe, the 16-year-old Girl Who Smiles & Dreams From Behind Bars, Janet Mock wrote:

Today, I read that you look up to me, and it caught me in an emotional moment, pushing me to think of someone I look up to. Her name was Maya Angelou, and she passed away this week. And the connectivity of your existence, of mine, of hers was not lost on me. Like you, Maya Angelou lived a life full of highs and lows, of struggle and triumph, of abuse and of self-revelation. It was a life of her own creation, a path she blazed for herself in a world not built for her. When there was no blueprint, Maya Angelou created one — a blueprint which became mine.

Connectivity. What threads weave themselves through all these events and issues? Misogyny. Racism. Transphobia. Violence and oppression. Struggle and triumph. Tipping points and simultaneously so much more work to do.  Human rights work. Social justice work. Anti-violence work. We are doing that work. We speak our truths and take up space. We claim our right to this world not made for us. We blaze a path, making it just that bit easier for those who come after us.  And we rise.

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Private Practice Update

ImageI am excited to announce an expansion of my private practice in a new Tucson location! I can’t believe I am nearing the three-year anniversary of my relocation to Tucson from Chicago. In addition to my private practice, I will be continuing to coordinate a program for survivors of sexual assault, relationship violence and stalking at the University of Arizona.

I am accepting new clients, especially those seeking a LGBTQ culturally competent therapist, or someone with expertise in treating trauma, complex PTSD, and/or dissociation.

Here are the details:

Services offered

Time: Thursday evenings and Saturday hours by appointment. Contact me for details.

Location: 430 N. Tucson Blvd.

I will also continue to offer some online/distance therapy options.

Please feel free to contact me with any questions.

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University of Arizona – Take Back the Night 2014

Every year, students and community members come together to protest sexual violence at Take Back the Night. Take Back the Night originated in the 1970s and continues to take place in communities across the country and the world.

Take Back the Night will include music, speakers, and an open-mic speak out, during which survivors of sexual violence can share their stories. There will also be a resource fair featuring campus and community organizations.

Join us on April 22 to take a stand against sexual violence!

Take Back the Night is free and open to all ages.
UA Women’s Plaza of Honor
West of UA Centennial Hall

Schedule of Events:
Resource Fair from 4:30 pm to 5:30 pm
March begins at 5:30 pm
Rally begins at 6:00 pm
Survivor Speak Out begins at 7:00 pm

Dolce Voces
Gwendolyn Valentine
Desiree Feria
Esperanza Dance Project

Keynote Speaker: Lelani Clark
A special thanks goes out to the following people. This event wouldn’t be possible without you!

UA Students
Oasis Program Against Sexual Assault & Relationship Violence
Campus Health Service
Women’s Resource Center
Pride Alliance
LGBTQ Affairs
UA Panhellenic Council
Alpha Kappa Alpha Sorority, Inc.

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2013 in review

I can’t believe I am starting my 5th year writing Treating Trauma! I surely have not been blogging as frequently this past year and I continue to miss that, and my interactions with all of you!

I must admit, I do enjoy all the year in review and best of 2013 lists this time of year. WordPress provides bloggers with their own version. I thought I’d share some of it with my readers.

Attractions in 2013

Wow! This blog was viewed about 130,000 times in 2013. I am so glad to be part of this important conversation about trauma and healing. As you can see, some of my most popular posts were written well before 2013. This highlights how much we need access to information about complex trauma, dissociation, and that healing is possible! I feel inspired to contribute more, new content for 2014.

These are the posts that got the most views in 2013.

One of my most popular recent posts was How to Avoid an Abuser: Understanding Grooming. I was honored that one of my favorite bloggers, Captain Awkward, helped folks find this post.

How did they find you?

I find it fascinating that such varied sites refer to my blog. I also learn a lot from the search terms that lead you here. For 2013, the most common search terms leading to Treating Trauma were complex ptsd, questions, ptsd, complex ptsd treatment, and emdr. This helps me know what you want to know!

As do your comments. The most commented on post in 2013 was Reader Question: Treating Emotional Numbness. What could be better than a reader-inspired blog post? It seems you all agree! For 2014, I welcome more questions and suggested topics. What do you want to know about trauma and healing?

Who knows what 2014 will bring? May we meet it with acceptance and make of it what we need! I feel great appreciation for all of you who have connected with me here and look forward to what the new year will bring.

Posted in Complex Trauma, Dissociation, Health, Holidays, Psychologist, Therapy | Tagged , , , , , , , | 6 Comments