Matthew "Matt" Lindgren, LMFT

smiliu:

How to Regain Control of Your Sex Life after Sexual Abuse: A Sex Therapist’s Guide
By Vanessa Marin, XOJane.com

Trigger warning: This article is about sexual abuse. Please exercise caution in deciding whether, when, and where to read this piece. This advice isn’t going to apply to everyone, and I unfortunately can’t address every aspect of the healing process. I strongly recommend seeking personalized support if that’s an option for you.

Understandably, those who have experienced the dark side of sex can sometimes forget that sex does have the potential to be incredibly joyful and pleasurable.

I love being a sex therapist because I get to help people discover how much fun sex can be. Unfortunately, sex also has some really dark shadow sides. Human beings are capable of hurting each other in the most unimaginably awful ways. What’s even worse is how frequently abuse occurs. We’ve all heard the numbers — one in every three or four women will experience sexual abuse in her lifetime. I’ve worked with a lot of sexual abuse survivors. 

Sexual abuse of any kind or degree has the potential to dramatically affect your sex life. Being sexually abused can lead to fearful response patterns, chronic pain conditions and health issues, a low or nonexistent sex drive, and a feeling of disconnect from your body. It can eradicate your ability to enjoy sex altogether.

Understandably, those who have experienced the dark side of sex can sometimes forget that sex does have the potential to be incredibly joyful and pleasurable. See if you can tap into even the slightest ounce of hope that you could develop a better relationship with your sex life. Think about possible goals. How do you want your sex life to be different from what it is now? What do you want sex or intimacy to feel like for you? Some of your goals may feel obvious, but the simple process of setting them can be an act of reasserting yourself.  

One of the ways I start working with a new survivor is to talk about the messages that get sent to your body when you’re being sexually abused. The messages vary based on your particular situation, but many of the underlying themes are the same:

●You’re not in control

●Your desires aren’t important

●Sex is emotionally and/or physically painful

●You’re not safe

I see my job as helping women acknowledge the particular messages they received, and working on sending their bodies and minds a new and improved set of beliefs about sex. Here are four of the most common dynamics that I’ve seen, and what you can do to regain control of your sex life: 

You may have developed triggers around sex.
Triggers are words, experiences, actions, sounds, gestures, or even smells that can send you into a heightened state of agitation. The effects of triggers can range from making you feel emotional to making you feel like you’re back in the abuse. 

One of the most helpful things you can do is to start to identify your triggers. What makes you scared, nervous, upset, or uncomfortable? Is it when your partner touches a certain part of your body? Is it when you’re having sex in specific locations or positions? Is it a particular sexual act?

Once you identify some of your triggers, you can start taking active steps to avoid those situations. My clients have reported that even the act of brainstorming a game plan or declaring certain things off-limits helps them feel more in control. For example, you can tell your boyfriend, “it’s really important for me to be able to make eye contact with you during sex. Can you help support me with that?” 

You can also identify a trigger in the moment, like reminding yourself that you tend to feel jittery when someone whispers in your ear. Being able to say to yourself, “OK, this is a trigger” takes away some of the intensity and helps you feel more present.

You may have learned to dissociate during sex.
Dissociation is the experience of feeling separate from your body. Many women report feeling dissociated during their abuse. You may have felt like you were floating up by the ceiling, standing right next to yourself, or far, far away. I tell my clients that dissociation is actually an amazing defense mechanism. Your psyche knew that it was unsafe to be in your body during the abuse, so it got the hell out of there. Unfortunately, dissociation persists long after the abuse is over, and makes it difficult to be present enough to enjoy having sex.  

To start reversing your dissociative tendencies, first learn more about how you dissociate. Which triggers cause you to leave your body? Where do you go? What does it feel like to dissociate? 

Once you start building up awareness of your dissociation patterns, you can start slowly building tolerance for being in your body. Focus on breathing slowly and deeply during intimate moments. Get up and shake out when you feel yourself starting to disconnect; movement can counteract the feelings of paralysis. You can also try touching your body, to remind you that you’re in your own skin. Put your hand on a part of your body that feels safe, and practice remaining present for increasing periods of time.

You may have learned to hate your body.
When you learn that your body is not a safe place to be, it’s hard to feel a lot of love for it. It takes a while to change your relationship with your body, but one way to start improving it is to try finding your body’s happy places and safe spaces. Perhaps you feel very present in your own skin after taking a walk on the beach, or maybe you feel safe and snuggly in your bed. Learn the things that feel good for your body, and do them on a regular basis. 

You may have learned that you don’t have a choice when it comes to sex.
This is one of the biggest struggles for my clients. Even if your partner knows about the abuse, you may still find yourself feeling like you’re obligated to have sex with him. A lot of my clients report having a hard time saying no, either because they feel like they’re not allowed to, or because they never learned how to feel comfortable saying it. 

The first step is to start getting in touch with your authentic desires. You have to stop forcing yourself to engage in sexual behaviors that you don’t actually want, and start sending yourself the message that your desires are important. You get to decide what you do and don’t want to do. 

If you’re in a relationship, I suggest taking a temporary break from intercourse. This can be a difficult thing to ask your partner for, but it gives your body the opportunity to relax and start learning what it actually wants. You can also create a period of time where you get to do all of the sexual initiation. Knowing that all contact will be on your terms helps promote a sense of safety and agency.

Next, you’re going to want to practice getting more comfortable saying no. Try saying “no” more confidently in your life outside the bedroom. Reread the part of my first article where I discussed good rejection technique. Practice touching your body and trying to sense when it’s saying “no” or “yes” to touch.

When you start having sex again, it’s important to keep emphasizing your agency. Make the conscious decision about what you want to do in the moment, and use a little self-talk to remind yourself. For example, “I want to kiss him right now, so I am going to kiss him,” or, “I’m choosing to give a hand job because I want to bring my partner pleasure.” 

Perhaps the single most important piece of advice I can give you is to be kind to yourself as you work towards rebuilding your sex life. You’ve gone through a horribly traumatic experience that no one should EVER have to go through. Take care of yourself as best you can. 

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

smiliu:

A Revolutionary Approach to Treating PTSD
By Jeneen Interlandi, The New York Times

Bessel van der Kolk sat cross-legged on an oversize pillow in the center of a smallish room overlooking the Pacific Ocean in Big Sur. He wore khaki pants, a blue fleece zip-up and square wire-rimmed glasses. His feet were bare. It was the third day of his workshop, “Trauma Memory and Recovery of the Self,” and 30 or so workshop participants — all of them trauma victims or trauma therapists — lined the room’s perimeter. They, too, sat barefoot on cushy pillows, eyeing van der Kolk, notebooks in hand. For two days, they had listened to his lectures on the social history, neurobiology and clinical realities of post-traumatic stress disorder and its lesser-known sibling, complex trauma. Now, finally, he was about to demonstrate an actual therapeutic technique, and his gaze was fixed on the subject of his experiment: a 36-year-old Iraq war veteran named Eugene, who sat directly across from van der Kolk, looking mournful and expectant.

Van der Kolk began as he often does, with a personal anecdote. “My mother was very unnurturing and unloving,” he said. “But I have a full memory and a complete sense of what it is like to be loved and nurtured by her.” That’s because, he explained, he had done the very exercise that we were about to try on Eugene. Here’s how it would work: Eugene would recreate the trauma that haunted him most by calling on people in the room to play certain roles. He would confront those people — with his anger, sorrow, remorse and confusion — and they would respond in character, apologizing, forgiving or validating his feelings as needed. By projecting his “inner world” into three-dimensional space, Eugene would be able to rewrite his troubled history more thoroughly than other forms of role-play therapy might allow. If the experiment succeeded, the bad memories would be supplemented with an alternative narrative — one that provided feelings of acceptance or forgiveness or love.

The exercise, which van der Kolk calls a “structure” but which is also known as psychomotor therapy, was developed by Albert Pesso, a dancer who studied with Martha Graham. He taught it to van der Kolk about two decades ago. Though it has never been tested in a controlled study, van der Kolk says he has had some success with it in workshops like this one. He likes to try it whenever he has a small group and a willing volunteer.

With some gentle prodding from van der Kolk, Eugene told us how he came to be a specialist in the United States Army, how he spent a full year stationed in Mosul, the largest city in northern Iraq, and how his job involved disposing of exploded bombs. It was a year of dead bodies, he said. He saw, touched, smelled and stepped in more bodies than he could possibly count. Some of them were children. He was only 26.

People turn to grease when they explode, he told us, because their fat cells burst open. He witnessed multiple suicide bombings. Once, he accidentally stepped in an exploded corpse; only the legs were still recognizable as human. Another time, he saw a kitchen full of women sliced to bits. They’d been making couscous when a bomb went off and the windows shattered. He was shot in the back of the head once. He was also injured by an improvised explosive device.

But none of those experiences haunted him quite as much as this one: Several months into his tour, while on a security detail, Eugene killed an innocent man and then watched as the man’s mother discovered the body a short while later.

 “Tell us more about that,” van der Kolk said. “What happened?” Eugene’s fragile composure broke at the question. He closed his eyes, covered his face and sobbed.

“The witness can see how distressed you are and how badly you feel,” van der Kolk said. Acknowledging and reflecting the protagonist’s emotions like this — what van der Kolk calls “witnessing” them — is a central part of the exercise, meant to instill a sense of validation and security in the patient.

[…]

Trauma victims, van der Kolk likes to say, are alienated from their bodies by a cascade of events that begins deep in the brain with an almond-shaped structure known as the amygdala. When faced with a threat, the amygdala triggers a fight-or-flight response, which includes the release of a flood of hormones. This response usually persists until the threat is vanquished. But if the threat isn’t vanquished — if we can’t fight or flee — the amygdala, which can be thought of as the body’s smoke detector, keeps sounding the alarm. We keep producing stress hormones, which in turn wreak havoc on the rest of our bodies. It’s similar to what happens in chronic stress, except that in traumatic stress, the memories of the traumatic event invade patients’ subconscious thoughts, sending them back into fight-or-flight mode at the slightest provocation. Therapists and patients refer to this as being “reactivated.” In the short term, patients avoid the pain it causes by “dissociating.” That is, they take leave of their bodies, so much so that they often cannot describe their own physical sensations. This happens a lot in therapy, van der Kolk says.

In the long term, they become experts in self-numbing. They use food, exercise, work — or worse, drugs and alcohol — to stifle physical discomfort. The longer they do this, the more difficult it becomes to remain present in any given moment. “That’s why the guy at the end of ‘The Hurt Locker’ is so utterly incapable of playing with his kid,” van der Kolk says.

The goal of treatment should be to resolve this disconnect. “If we can help our patients tolerate their own bodily sensations, they’ll be able to process the trauma themselves,” he says. In his own patients, particularly those suffering from treatment-resistant PTSD, yoga has proved an especially good way to do this. So has emotional freedom technique, or tapping. With a therapist’s guidance, the patient taps various acupressure points with his or her own fingertips. If done correctly, it can calm the sympathetic nervous system and prevent the patient from being thrown into fight-or-flight mode. Ultimately, van der Kolk supports almost any therapy that involves paying careful attention to patients’ physiological states, like psychomotor therapy, or getting up and moving around through theater, dance and even karate. For patients with acute PTSD from isolated traumatic memories (think car accidents or single-episode assaults), van der Kolk is a fan of eye movement desensitization and reprocessing, or E.M.D.R., in which a therapist wiggles fingers back and forth across the patient’s field of vision and the patient tracks the fingers while “holding in mind” the traumatic memory. Proponents say the technique enables patients to process their traumas so that they pass into memories and stop invading the present. Van der Kolk likes to point out that he came to the technique as a skeptic. “It’s this weird treatment,” he said. “You ask people to remember what happened to them, and you wiggle your finger in front of their eyes and have them follow it. Crazy.” More than 60,000 therapists around the world have now been certified in E.M.D.R., though the practice remains controversial, with critics and supporters debating the validity of each new study. Van der Kolk places his faith in what he sees in his own patients, he says. For them, E.M.D.R. has been a godsend.

[Read the entire article here]

Jeneen Interlandi is a freelance writer in New York. Her last article for the magazine was about the involuntary psychiatric commitment of her father.

Illustration by Matthew Woodson / The New York Times

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content 

nprglobalhealth:

Phone App Might Predict Manic Episodes In Bipolar Disorder

There are smartphone apps for monitoring your diet, your drugs, even your heart. And now a Michigan psychiatrist is developing an app he hopes doctors will someday use to predict when a manic episode is imminent in patients with bipolar disorder.

People with the disorder alternate between crushing depression and wild manic episodes that come with the dangerous mix of uncontrollable energy and impaired judgment.

There are drugs that can prevent these episodes and allow people with bipolar disorder to live normal lives, according to Dr. Melvin McInnis, a psychiatrist at the University of Michigan Medical Center. But relapses are common.

“We want to be able to detect that well in advance,” McInnis says. “The importance of detecting that well in advance is that they reach a point where their insight is compromised, so they don’t feel themselves that anything is wrong.”

Early detection would give doctors a chance to adjust a patient’s medications and stave off full-blown manic episodes.

McInnis says researchers have known for some time that when people are experiencing a manic or depressive episode, their speech patterns change. Depressed patients tend to speak slowly, with long pauses, whereas people with a full-blown manic attack tend to speak extremely rapidly, jumping from topic to topic.

“It occurred to me a number of years ago that monitoring speech patterns would be a really powerful way to devise some kind of an approach to have the ability to predict when an episode is imminent,” says McInnis.

Continue reading.

Photo: Manic, sad, up, down. Your voice may reveal mood shifts. (iStockphoto)

newyorker:

Cartoon by Ward Sutton. For more from this week’s issue: http://nyr.kr/WqSOMI

ucsdhealthsciences:

Old Advice Anew: Don’t Just Talk, Walk

It’s never too late to start exercising or reap the benefits.

Erik Groessl, PhD, associate professor in the Department of Family and Preventive Medicine at UC San Diego School of Medicine and director of the UC San Diego Health Services Research Center, is a co-author of recent study in the journal JAMA that puts hard numbers to the old admonition that staying active through the golden years helps ensure there will be plenty of golden years.

In the Lifestyle Interventions and Independence of Elders (LIFE), he and colleagues across the country recruited 1,635 sedentary men and women, aged 70 to 89, who had physical limitations but were still able to walk 400 meters, a quarter of a mile. The participants were then randomly assigned to either an exercise or an education (talk/no walk) group.

The “just do it” exercise group embarked upon a structured, supervised moderate-intensity program of walking and weight training while the education group attended regular workshops on health- and aging-related topics.

At the end of 2.6 years, those in the exercise group were about 26 percent less likely to have a persistent mobility problem, defined as being unable to walk 400 meters in less than 15 minutes.

“The take home message is that mobility, independence and quality of life can be maintained through regular walking at a brisk pace,” said Groessl, who is currently studying the health benefits of yoga on patients with back pain. “The results don’t surprise me, but we were lacking definitive data for the most elderly.”

The advice to exercise holds true to all of the whippersnappers out there in the blogosphere as well. Almost one-third of the world’s population is now overweight.

“Despite what people are told about diet and exercise, the message is not getting through,” said Groessl, who is conducting a follow-up on the cost-effectiveness of LIFE exercise programs for the elderly.