Frozen Personalities: Why Talk Therapy Needs More Than Talk

Talk

The time-honored treatment for psychological trauma is to uncover the wound, then gently expose it to the light. The “infection” must be drained, ever so slowly. Healing should follow.

Perhaps. Yet this method is rather like digging a hole, uncovering a buried skeleton, and raising it to earth. No revival is guaranteed. The bones still need to be fleshed out. The heart must beat. The creature needs to walk — away. Otherwise, the perimeter of the territory around the hole circumscribes the rest of his life. As the blunt, sometimes too impatient saying goes, you must “move on” — away from the place you’ve been stuck.

Movement is the key.

The patient will survive, but must live for the first time. Psychiatrist Bessel van der Kolk describes the brain dysfunction produced by trauma: the victim is both more prone to agitation and less able to distinguish what is happening in the moment. Despite the chronological distance from injury, one’s life remains organized as if the danger were still present. Imagine an army after the war is over, forever in “stress mobilization” mode, ready for the next onslaught. The brain and body sense the world through the old, cracked lens of an ancient injury. Thus, rewiring the brain is now thought to be an essential treatment element for Post Traumatic Stress Disorder (PTSD).

The patient must become alive to the present. A number of methods might accomplish this, though research on how best to produce brain changes is in its infancy. Among the approaches suggested are neurofeedback, mindfulness meditation, yoga, and group theatrical or musical performance. These techniques engage the body, where so much of the damage is “felt,” almost as if it were written on the skin. Little is proven, but the field of recovery from trauma is buzzing with discussion.

In my own practice I treated those who took flight once the hurt wing was mended — and those for whom there was no bottom to the hole they had fallen into — pushed by an unkind hand.

For the latter group, the therapist’s office sometimes serves as both a refuge and a prison. One sees the dual function of the doctor’s consulting room for patients still afraid, wary, and worried. They continue to scan the environment for signs of the next disaster. Their lives are fraught with endless repetitions and imaginings of future grotesque events. The counselor can be like a magnet for them, offering a sometimes too tight embrace. The therapist becomes a metaphorical talisman in such cases, a rabbit’s foot one cannot do without. In effect, the therapy appointment itself is the only safe time in the only safe place; the shrink, the only safe person.

This is not enough. Both the doctor and the patient must recognize the goal is not only to grieve the trauma, but to reclaim a life; or to learn how to live for the first time. The participants in the therapy hour should leave rabbits’ feet to rabbits. They must recognize that, however lifelike, the client has not been living. He has been trapped in self-defeating routines. His life consists of traveling at considerable speed in a circle, always returning to the same place. Adventure, imagination, and joyful relationships are absent. The patient lives in his traumatized past or a fearful future, but not in the moment. Lacking the resilience to take on an imperfect world, he ventures nowhere.

Yes, you must talk about what happened. Yes, you must understand what happened. Yes, you must grieve what happened. But life, not an imitation, requires movement, change, and repeated abandonment of old ways for new ones. The therapist and her office, taken together, are like a stepping stone on your trip into the rough stream of remembrance: a place to land, but not a stopping place.

Nor is the shore the goal. The truth is, one never lands in a completely safe spot. Good therapy simply helps one become a better navigator in today’s waters, not yesterday’s or tomorrow’s.

You are safer not because of the place or the doctor, but because of yourself: newly designed, rewired, and outfitted, ready for the wind to catch your sails — ready for adventure even without the wind.

Cisne-2g

The top image is called, Mr. Seafall’s Talk Button, by Mr. Seafall. The second photo is a Naval Ship of Brazil by the Brazilian Navy. Both are sourced from Wikimedia Commons.

14 thoughts on “Frozen Personalities: Why Talk Therapy Needs More Than Talk

  1. Very good article. I agree with your point of view.

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  2. Rich with insight, Dr. Stein. Thank you.

    “Adventure, imagination, and joyful relationships are absent. The patient lives in his traumatized past or a fearful future, but not in the moment. Lacking the resilience to take on an imperfect world, he ventures nowhere.”
    ~ I find the American way of life very alienating. At least, in my little piece of space in Los Angeles. It has taken years to succeed in engaging a limited few of my neighbors in conversation. I do believe that when we realize that we are not alone in this imperfect world, it becomes easier to confront our fears and to heal.

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    • Living in cities is interesting. I don’t have intimate knowledge of LA, though I’ve visited a couple of times. I do think in some places one needs to make considerable effort to find compatible communities where a person will “fit.” Taking classes, joining library reading groups, and the like are what I’m thinking of. Indeed, as you say, we are hardly alone in looking for companionship despite the obstacles of urban living. Thanks for commenting, Rosaliene.

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  3. O my goodness Gerald, how true this is. It seems to me though that the psychological ressurection you are talking about requires as much of a miracle as the literal ones Jesus performed. my bottomless pit isn’t so much from fear or desire to heal but the sheer magnitude of the trauma that I lived through. It seems that as I work through one issue the next is there waiting in line. it has also been hard to find a good therapist who can work with the extreme trauma and damage. Here in Australia there is no clinics or specialists that deal specifically with developmental trauma not just PTSD. Even some very experienced psychiatrists have struggled and not always been effective. I have got an excellent psychologist now who uses ISTDP treatment which is very emotion focused and has very specific techniques that the therapist uses to handle anxiety and defenses. It seems to be working. I often worry about my therapist having to listen to some of my horrible memories and what it took for me to survive. Sometimes he cant hide how upsetting it is for him to hear these things although he does manage most times to keep a poker face. I often wonder what it is like from the therapist point of view to hear trauma stories and how they deal with hearing the unspeakable truths of human depravity. Im always a bit scared that I’m traumatising him from hearing my story. I just trust that he has supports in place. Is it possible that you could write about your experience of this please? I often want to ask my therapist if he is alright but I dont think he would tell me or that my knowing would get in the way of working through it all. Anyway you describe the process very well in this post

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    • Thank you, Claire. I’m glad you and your therapist have found a productive track for your treatment. Yes, I think your suggestion of a blog topic is a good one. I already have some thoughts about it related to the notion of “second generation effects” of traumatic events. You might want to read “Children of the Holocaust” by Helen Epstein, which opened the discussion of impact from hearing the stories of parents who were Holocaust survivors or, even more common, NOT hearing them and still being impacted. All the best.

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  4. Another amazing post, Dr.G, which fits perfectly with my own therapy process. I know that treadmill too well and have always had a problem understanding what “moving on” actually entails. Your take on this process, “moving on – away from the place you’ve been stuck” has clicked something inside my head today.

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  5. Thank you for this post. As a survivor of childhood trauma who is in the process of unraveling and relearning to live in the present, I have lived this quote….”The therapist becomes a metaphorical talisman in such cases, a rabbit’s foot one cannot do without. In effect, the therapy appointment itself is the only safe time in the only safe place; the shrink, the only safe person.” And what that therapy did NOT prepare me for was my first therapist leaving due to an unexpected job change, or my second therapist closing her practice due to sudden illness. What happens when your “rabbit’s foot” is suddenly taken away?

    I’ve learned now – the hard way – that my safety can’t come in the therapist’s office. I can find help there, yes, but I can’t rely on my therapist or that space for my safety. And yes, you said it best. “…one never lands in a completely safe spot.” I will rethink the purpose of my therapy a bit after reading this post. Perhaps my goal isn’t to arrive at a destination of healing, but rather to live each day as a bit more healed – a bit better equipped to take on the present moments of my life in a healthy way.

    I’ll be sharing your post with my therapist for discussion tomorrow. Please keep writing – your perspectives are valuable.

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    • Your thanks, and those of others, is more than enough to keep me writing. I loved this: “Perhaps my goal isn’t to arrive at a destination of healing, but rather to live each day as a bit more healed – a bit better equipped to take on the present moments of my life in a healthy way.” It takes most therapists and patients a long time, if ever, to figure this out. You’ve said it beautifully. Thank you for sharing your hard won wisdom.

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  6. How do you define an excellent blog post? It was the subject of the meatiest segment of my therapy session yesterday! Thank you, Dr. S, for your post. As you may remember, I’m disabled with PTSD and I’ve been struggling in this area for the past few months. With my therapist yesterday, we discussed key aspects of your essay, easily bringing them out in the open. Big smiley emoji here! Hope you have a great day.

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  7. This is an excellent blogging article and very true! As somebody who survived unspeakable childhood trauma and who escaped luckily age 16 I can attest that all that is written is true. In my opinion, though a therapist can be on the side of a person and help in some way – the healing needs to happen in real life, in the present. There need to be connections and opportunities that enable somebody with trauma to have a “somewhat” normal life, the 50 minutes in a therapist’s office are not sufficient to move to s fulfilled life. And in my opinion it is the traumatized person who has to do much of the work, the therapist can cheer on. My own persistence got me where I am at today 30 years after running away from home. My life is not perfect (nobody’s life is perfect …), but I have my own family, very good profession, went back to school for more education, just got another job I really want to try. I have friends, I am out in the community and I experience nature, life events and other joyful occasions. It does not mean that I never get PTSD symptoms or never have to struggle with the past, at times I do, but I do not get stuck in it because I have a life in the present I can live.

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