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Saturday, January 6, 2007


I subscribe to the Psychotherapy Networker e-newsleter and just read a great article by Nancy Errebo, Psy. D. about using EMDR with a returning vet. (This issue has 3 articles on PTSD.)
Two quotes struck me:
"while nightmares and flashbacks are very troublesome and painful, avoidance is by far the most dangerous aspect of PTSD-in fact, it maintains the fear and vigilance and the constant preoccupation with the war. "Avoidance also becomes a way of life," I said and described some veterans I know who'd spent many years avoiding almost everything and everybody in their largely unsuccessful attempts to stay calm. There's no healing without exposure to the memory and the emotions that go with it, I added." [my italics-Patience]
and also:
"the brain naturally tries to process trauma by reviewing experience, but the images and emotions are so vivid that nightmares and flashbacks result. So the opposite, also completely natural, tendency kicks in and the brain tries to avoid the pain by numbing the emotions. At this point, the information can't be processed, and the cycle just repeats over and over again-the natural healing process getting caught in a kind of gridlock. EMDR is designed to break the gridlock and keep the information processing system active so that healing can occur."
This article also mentions EFT, Emotionally Focused Therapy for couples, one of the therapies I think is stupendous. Dr. Errebo wrote an article on that: "EMDR and Emotionally Focused Couple Therapy for War Veteran Couples" in the Handbook of EMDR and Family Therapy Processes. I belong to the International Society for Traumatic Stress Studies, and often go to their conferences. I saw Susan Johnson, the developer of EFT, give a workshop on it, and it was simply wonderful.
A lot of VA's do offer EMDR these days, and it works for many people. Processing the trauma may only be the beginning of recovery, however, if you grew up in a home where there was a war between men and women. EFT offers the chance to make your home a sanctuary instead of a battleground. So does applying the principles of Al-anon to life with PTSD and I'm sure there are other effective therapies, but this is the one that I know about.
Another therapy that I attended a workshop on is ACT, Acceptance and Commitment Therapy. I felt that this was another one that I would like to see in every VA. If you Google "Steven C. Hayes" and "Sonja V. Batten" and "Acceptance and Commitment Therapy" you can find out more from the people who developed the concept. I think it pays to be an informed consumer of mental health and to speak up for what you feel would help you.
By the way, none of the devlopers of these therapies think their way is the only way. When a therapist tells you that their therapy should have worked, that's when instead of feeling like a failure, you need to find a new therapist. The failure is not you. It's different if they say "this doesn't seem to have helped you, so lets try and find something that will, perhaps with another therapist." That is honest, because people are best with techniques they know and love, as long as they don't imply that you failed.
Actually, I think I have to qualify that,too. If you try to do therapy while drunk, stoned, in a food coma, etc (all of which may be the PTSD symptom: efforts to avoid thoughts or feelings associated with the trauma) you can prevent your own healing. It is like the healing of any wound. Pain is involved. You went through hell and healing it will hurt. So you heal in small doses with help. But if you don't feel, you won't heal.
I often say it is good to be able to go in and out of the numbing at will, since the numbing is a survivor skill. But healing is something else, something beyond numbing. When you numb pain, you also numb joy...
And if your pain is intolerable, there are programs like Dialectical Behavioral Therapy, which teach you skills in tolerating painful emotions before you try to do trauma work. I don't know of a VA where they do that either, but I hope it will come.


  1. Thanks for writing about this article. I've been an EMDR therapist for 13 years and am amazed at the clients I get who've had years of therapy, and no attention at all to their trauma. The therapists often instructed them to avoid their trauma. I've been yelled at by the gatekeepers at managed care companies for working directly on the trauma, and helping the clients to avoid it. If you've been trained to see through the lens of trauma therapy, you see the avoidance and the other indications of trauma and can go for it, quickly. Btw, I often use TFT, similar to EFT, as an adjunct to EMDR. It works well to move affect quickly, though it's not as integrative as EMDR. My latest trauma tool is Brainspotting, David Grand's new therapy. It's the next step past EMDR, in my opinion.

  2. Good Work in the write up - Thanks --- but the other side of the coin is that regardless of what works or how well it may work, the level of actual disability suffered is NEVER fully recognized by society and denied by the VA - PTSD vets are just expected to get over it - and any who expect compensation are further demonized by the likes of Drs Satel & Christopher as frauds looking for the welfare dime - is it any wonder that so many try to deny the levels of problems that they are facing? - JUST ANOTHER PTSD VET

  3. God Bless You Ms. Mason (and your Husband).....for your dedication and work. Your book saved my Marriage and Family.

    To all others, Please do not read if you are easily triggered (as I am)....

    I was a nice kid growing up with a good heart. I was very naive and I care about people. I was a combat medic and on top of experiencing what everyone else did, I had the additional responsibility of trying to make everything right when the chips were down.

    As everyone else performed their duties (as I would do if I had no patients), I treated the wounded and during less stressful times grieved that I had a dead Soldier right in front of me who was young. I remember thinking in one of my first instances that I knew a 19 year old kid was dead before his own parents... I wondered where they were, what they were doing and knew that they would be devistated...I then pictured my parents getting the same news.....*##@!!!! was very unpleasant.

    My first medical instructors were Vietnam Vets. One had very bad teeth from heroin use in "Nam" (per him) and the other had anger problems, keeping quiet and to himself.

    ...Small arms fire, Soldier shot, and your out of alcohol prep pads to start an IV. Mud all over your patient and all you have is water from your canteen to try and clean off his arm to start the fluid(keeping things as nice as possible for all and not going any further...) but why were we not prepared for the horrors and most awful feelings ever experienced ?

    Because in a 1985 report to Congress, the VA and DOD are not supposed to coordinate PTSD training until 2007 or later....yep, GAO Report Number; GAO-05-287, VA Health Care.

    Not knowing about that report, many of us recognize that the bad teeth, anger problems and keeping to ourselves is from our personal graduation of the horrific course.

    I went in - in 1982.

    Note: My two instructors SAVED many lives from their experiences down to mine.

    Lets NOT FORGET that a little tiny bit of good came from "Nam".

    First is the awesome Soldiers that trained people like me to continue in the defense of our Nation.

    Second, our emergency medical services (ambulances/medical helicopters with Emergency Medical Technicians and EMT-Paramedics). Veterans from "Nam" came home and started putting it together (or so I was taught...).

    Unfortunately, there is too much BS that goes on for these Veterans from our Government (to include the Gulf War Vets from 1990-1991).
    God please Bless these Vets and our current combat troops that are doing mandatory two three and four year combat tours........These tours are counter-productive to many troops! Remember Merrill's Marauders?.....They were GREAT, but did our Government take care of them or send them to other units when they returned?


    Hint: They did their job and pleased the Gov until no longer needed (my opinion).

    My GT Score was a 120 out of 125 (Military ASVAB Test) where 110 or higher was required for US Army Special Forces (SFQC) as that was soon to be my direction.

    Four Honorable Discharges later (two Regular Army and two National Guard) and tons of jobs in between with many in upper management.......I was finally diagnosed with PTSD.

    That was only a few years ago and I still greive fervently sometimes screaming at the top of my lungs for help with a gun to my head trying not to pull the trigger.

    This feels a bit like a stress letter with no real details...yes, looking for a trash-can because I am litterally nauseous and trying not to cry.

    I have scars myself from bad things that happened to me in Service....physical and mental.

    My last VA PTSD therapist had a PhD and it killed me to go there every week. I was a mess two days before the appt and two or three days after wondering what we would talk about or what would trigger me and yes, I was a test subject for multiple meds that did not and DO NOT work for me.

    Sometimes I had to drink (not mixing), with most times being up for two to three days straight before I arrived. I found that alcohol helped me to open up a little.

    I would show up and state that I was able to go in the bad direction a bit and he had to listen and not interrupt (this after a few months of just staring at each other doing have to try and build trust with your therapist).

    After the third or fourth time, he announced very nicely after a session, that he had to re-assess his boundries and was not sure if he could see me anymore.......well, what am I supposed to talk about then if I cannot talk about what is KILLING ME from my Military experience?

    I was a Cop, a Firefighter and a Paramedic in some of my civilian jobs among other things (never fired but always quitting because I could not do it anymore)....I am responsible and not a drunk at my sessions.....If I was, he had an obligation to keep me from driving home which was not a problem (this is my story, we are all different).

    I must say that the pain is so intense, that I cannot go there for I would curl up in a ball on the floor and bawl my eyes out (crying never helped it just took the edge off a tiny bit to continue my fight).

    I HAVE talked about these things in the beginning of treatment with the VA only to get a comment of "well, it was your job...". Other things you CANNOT talk about. Then what??

    We all have had different experiences but I feel that PTSD is the SAME for all.

    If I am drinking and can talk...good for me but only to the point where I want to blow my brains out. Otherwise, I have this secondary illness called severe anxiety which is caused by the PTSD. If I intentionally think...or more often than not, have an intrusive memory of something bad, I cannot breath and start having severe chest pain, thinking that I am having a massive heart attack........I then panick and wonder if I should call 9-1-1 or wait and see.....meds don't work.....they are like a thin glove while I punch concrete...

    I do not watch the news or listen to the radio due to triggers and any piece of cr*p with no manners in a car has found trouble (me).....I am completely disabled from this and can't leave my home (you must walk away or avoid potential situations because it is so easy...)

    How can EMDR or DBT help's a theory from REMFS (Yes, terminology from "Nam" as far as I know but accurate). Most
    get into psychology to find out what's wrong with them or for easy money to include grants to make a name for themselves and the ones who do care are rare or do not truly understand.

    This section intentionally left blank due to wanting to scream for help.........My wife is here. She is my comfort who deserves so much better. I will gentley teach our children about life and be dilligent in not saying anything if they are not ready yet.

    I've been strongly urged by the VA on several occasions to attend an in-house PTSD program.....but to do what?

    To be in a controlled environment with people you are going through the program with....leading you around blind folded...and later you are being taught how to write resumes?...BS!...I live in an uncontrolled society with car jackings, burglaries and rapes. As far as a resume, I have ALWAYS been called for an interview after submitting mine (been told several times; 100-300 or so responded, only interviewing 5 to 10.......). So what is this program going to do for me and better yet, what does the program say about Vets with TRUE PTSD? You only need to trust people and get a job?

    *Bad Words Placed Here* infinity!

    Did I get ruined by this because I may be a little bit bright and care about people? Is that not the majority of our combat vets?

    What if I went to college first instead of after?

    Thank you for the vent and keep going strong Ms. Mason.


  4. We need all of the assistance we can get to make sure that treatments are effective. Amvets was one organization that pointed me in the right direction

    Timothy Kendrick
    PTSD:Pathways Through the Secret Door
    ISBN 1430313196