Reader Question: Treating Emotional Numbness

Reader questionSometimes readers ask questions in response to one of my posts that  become fodder for a future post. This is one such time. A reader asked

 How do you help clients come back from emotional numbness?

as part of a response to my post on Complex PTSD. I want to provide a bit of background before I move on to addressing this question in more depth. PTSD can be diagnosed following a single traumatic event that occurs at any age. Complex PTSD (also referred to as complex trauma or developmental trauma) is characterized as a response to prolonged abuse and/or neglect in the context of important relationships, with onset in childhood. The following diagnostic criteria has been proposed:

History of prolonged subjugation resulting in alterations in

  • Affect Regulation (impulsive acting out)
  • Consciousness (dissociation)
  • Self-perception (shame, helplessness)
  • Perceptions of Perpetrator (preoccupation which may take the form of fear/sadness or identifying with and defending)
  • Relations with others (isolation, search for rescuer, revictimization)
  • Systems of Meaning (hopelessness)

What do we mean when we talk about emotional numbness? It may mean different things to different people. Emotional numbness can be a symptom of either type of PTSD.   Some in the trauma field think it is worth specifying that there may be a subtype of PTSD which involves numbing more than or instead of hyperarousal. Numbness can also be how clients describe their experience of dissociation. Overall, I see emotional numbness as a coping and survival strategy.

Emotional numbness can be an immediate reaction to a traumatic event such as sexual assault or relationship violence. With time and a supportive environment, such as trauma-informed therapy, this type of numbness is often self-limiting. The therapeutic relationship, coupled with prior strength and coping skills, may enable to trauma survivor to access and express feelings about the event.

When emotional numbness is a symptom of complex trauma or dissociative disorders such as depersonalization disorder or dissociative identity disorder, the focus in therapy may be different. In these situations numbness has often been of longer duration, has been used to cope with such intense experiences, and may have prevented the development of other coping skills. Decreasing emotional numbness then also involves building skills that allow for the capacity to feel and cope with intense emotions.

Skills building may involve things like:

  • learning to identify and express emotions: those who have been numb since childhood may not even know how to tell what they feel.
  • mindfulness to increase what Dan Siegel, MD calls the “window of tolerance”,  the capacity to look at traumatic experiences without becoming overwhelmed by the associated emotion.
  • grounding techniques like deep breathing, focusing on your senses.
  • learning to self-soothe, engage in self-care.
  • relationship skills: how to connect, who to connect with.

Think of your emotional numbness as having served a purpose. Perhaps this was the best way you had to cope for a time. However, the price of this form of coping is high. Being able to experience the whole range of our emotions is part of what makes life rich and meaningful. The good news is that you can build new skills now. You can lay the foundation that will make it possible, and safe, for you to be in touch with your authentic, emotional self.

Posted in Dissociation, Dissociative Identity Disorder, Mindfulness, Psychologist, PTSD, Relationships, Self-care, Trauma | Tagged , , , , , , , , , , , , , , | 10 Comments

It Was Rape

Coming soon!

The Oasis Program at the University of Arizona is proud to partner with campus and community groups to present this film It Was Rape by Jennifer Baumgardner.

It Was Rape

I will be updating with more information about local events as we head into Sexual Assault Awareness Month.

Posted in Activism, Psychologist, Rape, Trauma, Tucson | Tagged , , , , , , , , , , , , | Leave a comment

To This Day Project

Many people still grapple with the concept of emotional abuse. Words do hurt. Bullying in the form of name calling has a tremendous impact on children and needs to be addressed in the schools.

This video gets to the heart of the matter:

What do you think?

Where you called names in school? How did it impact you? Does it impact you still?

Posted in Psychologist | Tagged , , , , , , , , | 1 Comment

Appearing Elsewhere: Resistance and Trauma Therapy

What a lovely surprise! A guest blog post I wrote some time ago is live today on my favorite therapy cartoon site, Therapy Tales. Please go read all about the “R” word and trauma therapy over there, and while you are at marvel at WG’s ability to capture all that is the therapeutic relationship in cartoon form.

Resistance and Trauma Therapy

You may also be interested in our prior collaboration: Talking vs. Processing in Trauma Therapy.

Posted in Psychologist | Tagged , , , , , | 2 Comments

What Comes After Connection?

I really value those of you who take the time to comment. You often help me refine my thinking and inspire topics for future posts. A commenter to my article Overcoming Shame through Connection did just that by saying the following:

The observation that connection disarms shame is astute and very useful. The dark irony that people suffering from depression are least well able to pursue the “connection cure” on their own might suggest that the therapeutic relationship is a critical foundation to build on for these patients? The counselor can perhaps offer sufficient re-assurance to give the patient enough strength to seek out other support, breaking down the vicious cycle of depression -> isolation -> shame -> depression.

One pitfall I have experienced that arises from relying solely on interconnections to mitigate shame is that it leaves my happiness dependent on the vicissitudes of other people’s moods. Relying on the ability to connect with others to produce the feeling of belonging is not always a reliable antidote to the experience of shame, since other people have their own problems and even close friends won’t always be available to interact.

I have stressed the importance of connection and written about the challenges to connecting created by trauma. I want to go deeper here and say more about why I see connection as so important and how exactly I see it as helping. I also agree that if one’s sense of well-being stems only from the status of relationships with others it is vulnerable to constant fluctuation. This is one reason therapy can serve a purpose different from other important relationships. I see the therapy relationship as transformative.

For many who have experienced early abuse and/or neglect, the therapy relationship may be the first place that feels safe enough to explore connection. The goal however is not to just stop there. The hope is that clients can take what they learn in therapy and apply this to other situations and relationships. The how of this depends on many things, including the therapist’s theoretical orientation.

I believe that we develop many things in the context of a “good enough” attachment to a consistent and caring other: frustration tolerance, the ability to self-soothe, trust in the world, and love of ourselves. I believe that this positive, mutual connection (for we need to value and feel valued by another) is what predates our ability to love ourselves.

Ideally this process happens in early childhood. When it does not, or these capacities get disrupted by later events, problems in adulthood abound. This then becomes the work of therapy: connecting in the service of developing and internalizing these capacities.

At first a client may only be able to experience things like self-soothing while in the therapist’s presence or shortly after a session. Over time this can become something you feel like you own and carry with you. You take what you learn and experience in therapy and use it to create a new self or to reconnect to a self that was lost. This is how the therapy relationship transforms.

We do not believe in ourselves until someone reveals that deep inside us something is valuable, worth listening to, worthy of our trust, sacred to our touch. Once we believe in ourselves we can risk curiosity, wonder, spontaneous delight or any experience that reveals the human spirit.  -e. e. cummings

Posted in Abuse, Complex Trauma, Psychologist, Relationships, Therapy, Trauma | Tagged , , , , , , , , | 9 Comments