Trauma-PTSD & Dissociation Psychotherapy in Edinburgh and Online
What is psychological trauma-PTSD and dissociation?
Psychological trauma can be understood as the distressing direct experience (either short or long lasting) of an event that is experienced as being exceptionally threatening to our physical and/or psychological survival and that can shatter our sense of security and safety. To put it simply, it is a threatening experience that is either too much, too fast, too soon, or for too long so that it overwhelms our body’s ability to recover and reach stability. Psychological trauma can cause severe emotional and bodily distress in the totality of our central and peripheral nervous system (our brain, spinal cord and all major organs) that can create a sense of helplessness, often accompanied by feelings of intense fear, pain, confusion and insecurity.
Psychological trauma can be caused by a wide variety of often sudden or unexpected events such as: traffic accidents, serious injuries, sexual abuse and rape, terrorist attacks, war, violence and torture, the unexpected or violent death of a loved one, serious harm or threat of death, suffering or witnessing domestic violence, injury experienced by a family member, separation from parents, life‑threatening medical conditions or medical procedures (e.g. surgery), physical and/or emotional abuse, childhood neglect, natural disasters (e.g. hurricanes, earthquakes, floods), or witnessing someone else being traumatised. It can also be caused by ongoing, relentless, chronic stress and anxiety, such as enduring deprivation, living in a crime-ridden neighbourhood, battling a life‑threatening illness, or living in a war zone, military combat area or a concentration camps.
Psychological trauma is also often caused as a result of developmental trauma, that is, traumatic experiences that were repeated often during childhood (often interpersonal in nature and happening within a close relationship with someone well known). This can include abuse and adverse childhood experiences that were chronic and cumulative such as sexual abuse, physical abuse, physical and emotional neglect, living in care (adoption or foster care). It can also include witnessing domestic violence, parental substance misuse, separation or incarceration, or mental illness. Developmental trauma can also be caused by harassment, embarrassment, abandonment, abusive relationships, rejection, co-dependence or bullying. Additionally, long-term exposure to situations such as extreme poverty, in particular during childhood, have the potential to cause psychological trauma.
Developmental trauma (sometimes called ‘relational trauma’) is the most common form of trauma and often has a pervasive effect on the development of identity and the self during childhood and adolescence. Developmental trauma shapes adult identity in such a way that the sense of self is often shattered, which often results in low self-esteem and confidence, self-loathing and self‑depreciation. What it is more, developmental trauma has a much more pervasive and long‑range influence on people’s self-concept, on their sense of the world and on their ability to regulate their emotions, because it happens during a period where the child’s brain hasn’t fully developed. People that have experienced developmental trauma during childhood therefore often develop distressing problems as adults and/or have poor mental health.
It is worth mentioning that nobody can choose whether a distressing or threatening childhood experience or event will be experienced as traumatic or not. It depends on the nature of the actual event, how long it lasted, how you were able to cope with it at the time, the resources that were available to you, how others (in particular parents) around you responded and coped, the after‑effects and further consequences of the event, your age and level of understanding when it happened, and other factors outside of your control.
Symptoms of psychological trauma, PTSD & dissociation
Trauma can affect people in many different ways. Overwhelming traumatic life events or experiences of unrelenting stress can have a profound and lasting psychological and physical effects. It is quite common for some people to have a fragmented sense of self, to feel their self-efficacy impaired, to have a damaged sense of safety and trust, as well as often having difficulties with regulating their emotions. In cases of developmental/relational trauma, people’s ability to relate to others (friends, partners/colleagues) may be impaired and they may therefore experience attachment difficulties, in particular when it comes to creating and maintaining meaningful and intimate relationships. It is not uncommon for people trauma to resort to drugs and alcohol as a way of self-medicating or to escape the symptoms of trauma. However, this can often result in the development of various addictions, which in the long run only makes the symptoms harder to deal with.
Post-traumatic stress disorder (PTSD) is a general term, which is often used to describe the symptoms that some people experience after having been traumatised, in particular in war zones. Some people also have recurring experiences of the trauma (both in their bodies and minds). They might develop a range of symptoms such as flashbacks and nightmares, especially when they are exposed to situations and events that remind them of the original traumatic experience. Additionally, their autonomic nervous system might be constantly on alert, which may cause them to be in a state of hyper-arousal and hyper-vigilance, causing them to feel constantly irritable and reactive or jumpy, as well as causing regular panic attacks for some people.
Dissociation or Dissociative Identity Disorder (DID) is another term used to describe one or the possible symptoms from having experienced repeated traumatic incidents, especially during childhood trauma. Dissociation, which can happen either with or without the development of PTSD, is characterised by a sense of detachment and disconnection from ones’ mind and body and/or from the world around you. There is often a feeling of things and the self being unreal (derealisation) or not being quite right. There is also a sense of emotional numbing and a general sense of being unable to connect with emotions (positive or negative), often accompanied by a feeling of ‘inner emptiness’. Another symptom of dissociation can be a temporary dissociative amnesia where you may have ‘gaps’ in your memory or not be able to remember what just happened, or significant events or people. It is very important to note that dissociation is an entirely normal response as one way our body protects us from the emotional, psychological or physical pain of traumatic overwhelming experiences, by ‘switching off’ consciousness and cutting off the information from the conscious mind. Simply put, it is a way of surviving something that could otherwise be too painful or threatening to bear.
Summarised below are some common symptoms of PTSD and dissociation:
Psychological symptoms (mind)
- Anxiety and fear, panic attacks, agoraphobia, being easily startled
- Anger, irritability, rage and mood swings
- Confusion, difficulty concentrating
- Shock, denial, or disbelief
- Guilt, shame, self-blame
- Isolation and withdrawal from people and social situations
- Feeling sad, depressed, helpless or hopeless
- Dissociation and feeling disconnected from your feelings/body or feeling numb and empty
- Addictions and substance misuse
- Impulsivity and risk taking behaviours
- Obsessions and compulsivity
- Edginess and agitation
- Having a constant sense that you are in danger and being constantly watchful or on guard
- Self-harming or regularly contemplating or attempting suicide
- Hearing ‘voices’ (not the same as psychosis)
- Having a sense of being someone else or being nobody
- Having difficult managing emotions
- Having difficulty exposing positive emotions or finding pleasure
Physical symptoms (body)
- Insomnia, poor sleep, nightmares
- Fatigue, exhaustion, chronic fatigue syndrome
- Racing heartbeat
- Have a range of unexplained medical symptoms (e.g. chronic pain, severe fatigue)
- Aches and pains, muscle tension
- Severe migraines
- Sexual difficulties
- Gastrointestinal problems (IBS or Crones disease)
- Digestive issues
- Skin problems
- Autoimmune diseases
- Tinnitus (ringing in the ears) and hyperacousis (increased sensitivity to everyday sounds)
People that experience many of the symptoms above can also be affected by various psychological difficulties such as: dissociative disorders, anxiety and depressive disorders, personality and mood disorders (e.g. bi-polar disorder, borderline personality disorder), disorganised attachment disorders, attention deficit hyperactivity disorder, obsessive compulsive disorders, addictions and substance misuse.
If you believe that that you have experienced trauma and you are affected by some of the symptoms above, I want you to know that there is no reason to suffer alone and that there is a way to heal yourself.
How I help you heal and recover from trauma: Pluralistic/Somatic Trauma-ptsd and DISSOCIATION Psychotherapy
I have a particular interested in trauma-PTSD and dissociation psychotherapy and throughout the years I have studied many different approaches that work on the mind, body and spirit level, to facilitate healing and recovery. In my trauma therapy work I incorporate a range of somatic (body-based) therapies, such as:
- Battete’s Rochild’s Integrative trauma therapy, which combines Peter Levine’s Somatic Experiencing and SIBAM multifaceted tool that enhances stabilisation and increases association and resolution of trauma memories;
- The Bodynamic ‘running technique’ an imaginal, mind/body integrative treatment for reawakening the flight reflex and reducing hyperarousal;
- The Comprehensive Resource Model (CRM) an innovative and holistic therapeutic approach which incorporates a wide range of breathing skills, somatic embodiment skills, attachment neurobiology and spiritual resourcing in order to increase body-based safety and promote self-healing abilities;
- Dr. Bessel van der Kolk’s Intensive Trauma Treatment Model that integrates numerous treatment modalities (including neurofeedback, EMDR, meditation, yoga, mindfulness, and sensory integration methods such as dance and movement) that have a positive effect on treating trauma and PTSD.
Along with the above somatic (body/mind/spirit) approaches, I also use a range of ‘talking’ psychotherapies specifically suited to trauma work, such as: attachment-based psychotherapy, Emotion-Focused Therapy for complex trauma, Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, existentially informed trauma psychotherapy, Trauma-Focused Cognitive Behavioural Therapy (T-CBT), Person-Centred/Experiential Therapy and Transpersonal and Depth Psychology.
Having trained in all these approaches, along with my experience of having helped many people to heal from trauma, I have the ability to use a range of theories, techniques and treatment models that are based on the most up-to-date research, in order to create effective trauma therapy treatments that are tailored to your specific needs and individual circumstances. Within a warm, accepting and valuing therapeutic relationship, I will guide and facilitate your journey from trauma to positive growth and healing in a safe, caring, individually paced and compassionate manner.
The stages of pluralistic somatic trauma psychotherapy
At the very beginning we will do an assessment so we can understand what kind of trauma you have suffered from (e.g. developmental/relational) and to also find out how you have been affected (symptoms). Based on our assessment we will then collaboratively develop a specialised, bespoke treatment plan.
It is important to understand that the treatment and healing plan will only be successful if you engage with it and if you follow the practices. That is, if you take personal responsibility for your healing. It is also important to understand that trauma therapy can often be a lengthy process and there are no shortcuts nor easy fix solutions; each stage needs to be completed in order to move to the next, as this is paramount to increasing safety! We will usually have a review at the end of each block of sessions, to help you understand and remain in control of your treatment plan.
Stage 1: Safety, stabilisation & regulation
Our first step will be to help you to reinstall an overall sense of safety in your body and mind. This will help you to become more stable and better able to regulate your emotions, so that you will be able, during later stages, to effectively process and integrate your traumatic experiences. We will use a range of body-based awareness, grounding, and self-regulation methods to help lessen symptoms such as panic, anxiety, anger, dissociation and fear. You will learn to notice and observe body sensations or emotions without becoming overwhelmed or hyper-aroused. Traumatic experiences ‘get stuck’ in our bodies and our nervous system so at this stage the emphasis is on allowing your body and your unconscious nervous system to regulate, not by telling what happened but by tracking your body sensations to enable you to discharge excess stress energy and allow your nervous system to re-regulate and repair. At this stage body-based practices such as mindfulness, yoga and exercise can also be extremely facilitative and we will endeavour to help you engage with some of these practices. By finding a way to regulate your emotions you will also become more capable in your day‑to‑day living whether at work or in your other relationships.
Stage 2: Normalisation & psychoeducation
During this stage we will normalise and de-pathologise your experience by giving you information and exploring together how the body and mind (nervous system) responds to trauma and overwhelming events. You will learn about trauma and its symptoms, that it is not a mental health disease but an adaptation; however, your body and your nervous system has not realised that the danger is over and therefore it is constantly trying to keep you safe by being on ‘red alert’ and that is why you are experiencing all those psychological and physical symptoms. This understanding combined with the ‘safety tools’ that you will have learnt from the previous stage will help you to feel safer, less scared and empowered to take appropriate action, to respond to crises and to eventually heal. Most importantly during this phase, you will come to understand that what happened, and what continues to happen to you, is not your fault and that you now have power to deal with it and recover.
Stage 3: Resourcing & strengths building
During this stage we will combine psychotherapy and coaching methods to help you build the inner strengths and resiliencies that you already have, as well as building new strengths and resources that will assist you in the journey of healing yourself. By developing and building these strengths and resiliencies from a position of ‘resource’ within yourself you will become more able to use those inner resources to help you feel safer and less overwhelmed in your day‑to‑day life and most importantly during your therapy sessions. Something that will allow you to start processing the emotions and body sensations that you have been previously avoiding, been detached from or were unaware of. Apart from inner resources, you will also learn to cultivate outer (social and relational) resources such as re-connecting with supportive and caring others around you. At this stage you will also be helped to engage with body practices such as exercise or yoga that will also help you to become stronger both on a psychological and physical level. Additionally, we may also implement resilience training in order to help you to become more courageous. The overall aim of this stage will the trauma. This processing will take place primarily in three different domains; somatic (body), emotional (feelings) and cognitive (thoughts and beliefs).
On a somatic/body level you will process the events before and after the traumatic experience(s) but you will never have to‘re-live’ those events. In a safe and gentle manner you will address on a deeper level the effects of trauma on your nervous system and body. You will become more able to recognise that the body sensations are not threatening, while you will also further increase your tolerance levels; in essence you will start feeling calm and relaxed both in your body and mind. This is going to be a process of increasing awareness, acceptance and befriending your body and its sensations.
On an emotional level, you will become more able to process the emotions and feelings related to the traumatic event(s) and the symptoms that you have been suffering since then. You will become more able to connect, feel and understand your emotions and to see the connections between emotional dysregulation and the states of being overwhelmed and trauma. Anxiety, anger, frustration and hopelessness will lessen as you will begin to befriend [TB1] your emotional experience.
Cognitive processing will allow you ‘make sense’ and understand the original trauma and the suffering and difficulties that you have had to suffer since then. This will happen by examining and reconstructing negative perceptions and beliefs about yourself and transforming them to more positive ones that will provide you with a sense of a healthier self. At this stage, if you wish, we will also process the trauma from a spiritual perspective and look at the ways you have been affected on a ‘soul level’.
Being able to connect and feel more of your body sensations and emotions that arise will not only reduce feelings of being overwhelmed and anxious but it will also help you to connect with more pleasurable body sensations and emotions. This is a process that will lead to an active rebuilding off your sense of inner self as someone that has regained power and agency.
Stage 4: Integration & post-traumatic growth
At this stage, when you no longer feel overwhelmed and you have made sense of what happened to you and why, you will discover a new inner strength and feel more alive and able to engage in the positive aspects of life. Having reclaimed your body, mind and spirit, you will now be in a position to make meaningful changes in your life that are aligned with your core values, needs and aspirations. This will lead to a greater ability to connect with yourself and others and to growth, both on a personal and professional level. As the emotional numbness and body numbness will have subsided, you will be able to enjoy both the ordinary and extraordinary pleasures that life has to offer and you will become able to create new experiences. Essentially you will become able to fully inhabit your inner sense of self in all of its dimensions — emotional, psychological, bodily and spiritual. A process that will enable you to become again the master of yourself and your life.
The trauma that you have experienced is not who you are; it is something that has been done or has happened to you. You do not need to continue suffer in silence ; change is possible and I will be honoured to work with you to help you to recover and heal from trauma. I offer psychotherapy for trauma, PTSD and dissociation in Edinburgh and online.
I look forward to helping you heal and flourish.