Hello, friends! In this episode, I answer two interesting questions from listeners of the show. The first talks about living with a traumatic past and what you can do to move forward and grow, especially when dealing with triggers that bring back traumatic memories. The second tackles the issue of being priced out of therapy.
First off let me say thank you for the work that you do. Your podcast has really helped me grow and has given me some enlightenment on many mental health topics. I have always suffered from anxiety and depression. However, I feel that I have done the personal work it requires to live a healthier life with these mental health “issues.” As a child, I grew up witnessing a very abusive relationship amongst my father and mother and in college I was raped. Sorry to state that so matter-of-factly. I feel that I have acknowledged these past truths and have locked the door on them in an effort to move on. However, recently, with everything going on in today’s world AND with the ample alone time I find myself with, I have been experiencing my past traumas creeping into my brain subconsciously and unwantingly (I made that word up but that’s ok)… at all times of the day. The memories of my traumatic past are much more vivid now and I am not sure why they are popping up so frequently. Is there work that people need to do to heal from trauma?
I find that my past memories or shall I say nightmares are not only affecting my mental health, but are also hurting my current relationship with my fiancé as I never feel safe anymore.
What concrete work should someone with a traumatic past do, to heal and grow? Additionally, is this common? Do people who have experienced trauma live with constant; unwanted triggers for the rest of their life?
This is a very good question. Let me start with the final part of your question, “do people who have experienced trauma live with constant unwanted triggers for the rest of their life?” The answer to that is that many people are able to find a way to live without those constant triggers, but it’s not easy.
What is trauma?
I should take a quick moment to discuss what trauma actually is in the first place. Trauma is essentially when you directly experience or witness something disturbing and the memory of what happened gets locked away in a way that is different from your other memories. Rather than being something that is a bad memory and unpleasant to think about, it is stored in a way that makes it feel immediate and threatening. In other words, when you recall the traumatic event, you experience significant psychiatric symptoms and often feel like it is happening to you all over again. Understandably, this often leads to avoidance of what we call triggers.
What are triggers?
The way that memory works is that we store our memories along with cues from our senses. They are essentially like hashtags that helps us store information more efficiently. If you think about the smell of coffee, or the salty ocean, or fresh cut grass, that probably conjures a specific memory for you. Sometimes it’s a physical sensation like sore muscles or the feeling of a certain type of fabric. Well when you are traumatized by something, you will often have cues that very strongly conjure the event. A very minor one for me in the past has been the smell of burning tires because I associated that smell with being hit by a car. For others it might be a certain location, the scent of a certain cologne, a song that was playing, etc. It could really be anything. But those triggers throw you back into the event and your body reacts as if it were happening all over again. It is really really unpleasant and scary.
So for your situation, it is possible that prior to the pandemic and all of this alone time, you were keeping yourself busy enough and working on yourself enough to not really have to actively deal with these triggers so often. I imagine that this was a progressive thing where it became less difficult to cope and life something like a “normal” life as time went on. However, now with the changing circumstances, you might be finding that your normal healthy defenses are not serving you in the same way. Having so much time to yourself to think, having generalized stress and turmoil, and potentially even running into triggers that bring up your traumatic past is making it so that you are having a resurgence of symptoms. I would characterize this less as you failing to address the issues in the first place and more that the circumstances are just pushing the boundary of your willpower and coping skills.
Processing trauma and moving forward
There are things that can be done about this, but I wouldn’t suggest doing any of it without a trained, trauma-informed therapist. Most often you are going to want to find someone who does trauma-focused CBT or EMDR therapy. Since the crux of traumatic reactions relate to avoidance, a portion of the solution is going to have to do with exposure, which I’ve talked about quite a bit on the podcast. You don’t need to expose yourself to the event that traumatized you – definitely not. But the avoidance loop is making you run away from memories, from thoughts, and from cues that remind you of the traumatic events.
So working with a therapist, you can gradually process and work THROUGH the trauma rather than avoiding it and trying to just lock it up in its own little box. Basically you are exploiting the weaknesses in our memory to change the shape of this traumatic memory into something that is less immediately threatening to you. To do this, you will first need to work on your general anxiety coping skills so that you have some tools to rely on when feelings get very intense. From there, your therapist will begin dipping a toe into the memories of the trauma and asking you to recount or connect to certain aspects of this. It’s done in a gentle and gradual way that won’t leave you reeling every time.
By standing up to the memories and the triggers in this way, you lessen their impact on you. The goal is not to forget about the trauma or make you feel positively about it. It’s still supposed to be a bad memory. But the idea is that with effort, you can turn it into something more similar to all of your other bad memories. It’s an unpleasant thought, but it doesn’t hijack your body and make you feel like it’s an immediate threat.
In addition to finding a therapist, there are tons of great books on trauma out there. I’d suggest having a look at The Body Keeps the Score as a starting place. Whatever you do – actively approaching the issue and doing something about it will serve you better than continuing the avoidance process or numbing out the strong feelings with things like drugs, excess medication use, or impulsive activities.
What should you do when you get priced out of your therapist’s services?
When mine switched from BetterHelp to her own private practice, I basically had to stop seeing her. I’ve made appointments maybe once a month, or in difficult circumstances if really necessary.
I’m super sorry to hear that you essentially lost your therapist. That can be really hard when you’ve bonded with someone. I hope that you aren’t taking it too personally. It’s a tough situation. If you listen to episode 219, I talk a bit about how it is actually harder than you think to make a living as a therapist. While I am a supporter of BetterHelp, there are definitely challenges on both sides, especially if you are trying to use that as your primary source of income.
As a good therapist, your job is to develop a strong rapport and working relationship with each client. At a certain level, that means that if you suddenly had to drop clients due to moving or other issues, it is naturally going to be disappointing and somewhat hurtful for the client. That’s just how it is.
I like that you’ve kept the line of communication open with your therapist so that you can reach out if needed, but it seems like you need more frequent help than you can afford at full fee. It might be time to start looking for other options.
Do you have insurance? If so, there are likely going to be plenty of people that take your insurance. There are different ways to go about this. If your insurance company has a good online portal, they might have a provider search that you can use on the website. In other cases, you can call and ask them for a list of providers that are covered under your plan. You can also use the find a therapist tool at psychology today. I have a video showing you how to use it at duffthepsych.com/findatherapist.
We’ve been navigating this with my wife. Our insurance, which is a Blue Shield HMO has a shitty provider search, but we found an organization called Foresight mental health, which is a cool company that I actually interviewed for. All of their providers are covered under our insurance, so we were able to narrow our focus and look at people within that organization. These days, it’s a bit easier to put inquiries out there with therapists since you can often email instead of calling. For many of my clients, I did not speak with them directly until our first session. It’s more efficient and sometimes more comfortable.
If you don’t have insurance, your next option would be to find someone with a more reasonable rate for you, although most full-fee therapists are going to charge a fairly similar rate. This just has to do with making ends meet, as I mentioned. There are some therapists who work on what’s called a “sliding scale”. This is where the fee for sessions varies depending on your income. Beyond that, there are often training clinics attached to universities where you can get low-cost or free services. One good thing about therapy at the moment is that most therapists are now doing telehealth. This is something that I’ve been doing for a while, but it’s one of the main options now due to COVID. Regulations vary depending on your country, but in the US, you can see any therapist in the same state as you, so that opens up your search quite a bit. For my wife, we were trying to find someone who is skilled at working with LGBTQ people, who is aware of poly relationships etc. So rather than searching in our direct local area, we broadened the search out to larger places like San Francisco. You have more access now – it just takes a bit of leg work.
The last idea that I’d give would be to continue with your therapist but do so less often. Like once a month maybe. Whatever you can afford. And then to supplement that lost time with other things. Could be group therapy, yoga class, personal training, music lessons, an Audible subscription… anything really. Whatever will fill you up and help your mental health in another way.
I wish that I could say there is some special loophole to get your therapist to charge exactly what you can afford, but there isn’t. Hopefully these ideas give you some food for thought and help to illuminate your other options though.
This episode of Hardcore Self Help is sponsored by BetterHelp.
BetterHelp is an online therapy platform that provides affordable and convenient access to professional counseling with a licensed psychologist. Right now you can get 10% off your first month of secure online counseling for being a listener of the HCSH Podcast!
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