Category: Trauma

childhood trauma. developmental trauma. Children can experience big T or little t traumas.

Recognizing Childhood Trauma

Published on by kshanmuk

The term “childhood trauma” may stir up different emotions in you. You might feel cautious in referring to your experiences with this label. Yes, childhood was not a happy time, but does it count as “traumatic?” On the other hand, you might feel clear about this label. You are aware that childhood sucked. There were plenty of horrible moments, and without a doubt, you were left feeling scarred.

So, what exactly is childhood trauma? Why do people raised in similar circumstances grow up with very different perspectives of an event? How come you’re not as overwhelmed as your siblings when you went through the exact same situation? How can you tell if your past is affecting you today?

I hope this post will provide some clarity to these questions.

What is trauma?

Trauma is the negative beliefs, emotions and physical distress we become burdened with after surviving an awful experience. Trauma is the meaning we make of these painful events. These burdens shift how we see ourselves, our relationships, and the world around us. How “awful” an experience seems varies for each person. The following questions demonstrate some factors that can change an experience from manageable to traumatic:

Ask yourself the following:

Childhood trauma. Experiencing and witnessing traumatic events.
  • How old were you when these traumatic events happened?
  • How often did you experience emotionally painful events while growing up?
  • Were you scared for your safety or the safety of your loved one?
  • How did you make sense of things? Were questions left unanswered?
  • Who was around to help you? What level of community and supports were available?
  • How long did it take before the world felt “normal” again?
  • What other inequities did you have to manage during this time (e.g. health, low income)?

The same situation that is considered traumatic to one person may feel manageable to another. Trauma is subjective in this way. Age, support systems, community resources, number of traumatic events, and physical safety are just a few factors that can impact one’s experience of childhood trauma.

Is it traumatic “enough”?

Big T traumas: war, natural disasters, sexual abuse. Treating and recognizing childhood trauma

In trauma-informed therapy, we often use the terms “Big T” and “little t” trauma. Big T trauma refers to big ticket events that no one would question as damaging and painful. It’s the events you see on the news and social media that are objectively awful. We’re talking about events like war, natural disasters, murders, and sexual abuse.

Little t traumas, on the other hand, refer to the smaller scale events that leave a mark on our system. We hurt and react when we think back to these moments, but not everyone would label these experiences as distressing. Little t traumas can include: witnessing fights in your neighbourhood, experiencing endless sarcasm from your parents, or loneliness in high school. These little t moments are subjectively awful. But, because they are not quite as obvious as Big T events, they tend to get minimized. While little t traumas create emotional scars, they are often dismissed or pushed away. Individuals with numerous little t traumas may feel anxious and insecure without recognizing the influence trauma plays in their current emotional well-being.

At the end of the day, when trauma happens as a child, we don’t question whether it’s Big T or little t events. We just know it’s horrible and we feel awful about it. As kids, our minds are set up to be egocentric. It’s not personal; it’s a developmental fact. We look at the world from our eyes and only see our influence in a situation. Irrespective of Big T or little t events, kids personalize. They question who they are, what they did, and their level of responsibility in having “caused” this awful event. They don’t recognize the flaws of adults. Instead, they make up stories about how they pushed the adult to act in a horrible way. For kids, it doesn’t matter whether it is traumatic “enough”. If it hurts, a child walks away carrying that emotional burden.

Is it PTSD?

Childhood trauma takes place during the early years of our lives. If addressed (e.g. through nurturing and support, healing in the home, processing through therapy), it can get better. If ignored, these adverse childhood experiences can exacerbate to mental health struggles like PTSD. There are several persistent symptoms that need to be present with a diagnosis of Post-traumatic Stress Disorder. However, any one of these features can influence your sense of safety and well-being.

Symptoms of PTSD:

Types of SymptomsExamples of Experiences:
Persistent re-experiencing of the traumanightmares, unwanted memories, emotional distress, flashbacks, unwanted thoughts, unwanted reminders, physical reactions
Persistent avoidance of the traumaavoidance of reminders and thoughts related to the trauma
Persistent negative thoughts and feelingsdifficulty remembering key details about the trauma, negative thoughts about oneself, negative thoughts about the world, blame of self/others for causing the trauma, mood changes, less interest in pleasurable activities, feeling alone/isolated
Persistent high reactivity and alertnessirritability, aggression, risky behaviours, hypervigilance, increased startle reactions, difficulty concentrating, sleep disturbance

How do we survive childhood trauma?

Irrespective of how awful we feel after trauma, we still keep living. When we walk away from traumatic events, we learn to protect ourselves through whatever means possible.

Internal Family Systems therapy recognizes that our subconscious gets divided into different parts during a traumatic experience. This is a normal and adaptive process. Our mind starts to compartmentalize and split in order to cope.

During a traumatic event, there are parts of us that become burdened with negative beliefs and emotions. For example, these parts feel overwhelmed with shame, vulnerability, self-hatred or guilt. These parts may hold negative beliefs, such as: “I cannot protect myself, I am a disappointment, or I cannot trust anyone.”

firefighter and manager parts in IFS help to protect exiled feelings and emotions. Coping with childhoot trauma.

Because these are painful emotions and beliefs, we try and push them away. Other parts of our subconscious help to avoid thinking about these painful parts so that we can function in our daily life. They protect by preventing us from getting triggered or soothing us once we have been triggered.

Our system finds unique and creative ways to protect. For example, if you learned that other people are not safe, your system may protect by avoiding social connections, turning down dates or never asking for help. Unfortunately, when these burdens get triggered (e.g. your classmate makes an insensitive comment), your mind finds ways to self-soothe. This could be done through hours of playing video games, becoming explosive or angry, or numbing out through substances. While our protective parts attempt to help, they often create new consequences.

We don’t stop protecting ourselves in this way once the traumatic event is over. We are often triggered. Any moment that shame, vulnerability or some semblance of our traumatic experience shows up, our protective parts react. The only way to stop these patterns from taking over is to address the childhood trauma.

How do we treat childhood trauma?

Treating trauma goes well beyond a small paragraph in a blog post. Healing can come in various forms, and should include both personal and systemic changes. Some ways to treating childhood trauma include:

treating childhood trauma through personal and systemic change
  • Improving parent-child relationships: e.g. repair past injuries, apologizing for harm done, receive parenting support.
  • Increasing access to positive role models: e.g. through peer mentorship programs
  • Creating healthier communities through systemic changes (e.g. addressing racist, homophobic or ableist policies)
  • Improving neighbourhood safety
  • Improving access to social services (e.g. education, transportation, medical)
  • Better access to trauma-informed care (e.g. ease of entering rehabilitation and addictions services, availability for mental health support).
  • Teaching and practicing social and emotional skills (e.g. repairing conflicts, learning how to calm down)
  • Participating in health-promoting activities (e.g. access to nutritious meals, encouragement for physical activities)
  • Participating in therapy
  • Practicing self-compassion

Reach out

Therapy is one form of healing path for childhood trauma. Through use of trauma-informed therapies like Internal Family Systems or EMDR, we can work through old wounds in a safe and effective manner.

If you are curious about the above information or would like support processing your own traumatic experiences, reach out.

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi
photo of person s hand with words

Starting trauma therapy? Tips to support those initial fears

Published on by kshanmuk

It’s normal to feel a bit nervous when you’re connecting with a new therapist especially when you’re starting trauma therapy. This is the person you intend to tell your vulnerable history, and pray that they know what to do with all that information. The idea of opening up to share your lowest times can be an aversive factor in starting the work. I hope the following tips will provide you comfort and guidance as you consider starting trauma therapy.

Acknowledge the hesitation

starting trauma therapy. nervous. anxiety

There are parts of you that are cautious of opening up. Why wouldn’t they be? If you are nervous, there is a reason for this caution. So take a moment and pay attention to the thoughts and feelings showing up right now. What are those cautious parts of you needing in order to feel safe? Here are some questions to consider:

  • Is your anxiety asking you to go slowly?
  • Are these cautious parts of you concerned about becoming overwhelmed?
  • Are these parts worried how your therapist will react once you share your experiences? Have you been shamed by others in the past about this experience?
  • Does your system need time to feel safe and build a relationship before it feels willing to open the door to the past?
  • Are your anxieties worried about what they will find out if you start this process?

Everyone has reasons for hesitating, and it’s important to make space and create safety for those fears. When it comes to trauma therapy, sometimes going slow IS moving fast. Parts of you may be frustrated that you’re working at a glacial speed; however, taking the time to process slowly may be the safest option. There are safe ways to process traumatic memories without reliving or re-experiencing the events. The point of therapy is not to trigger you. Therapy should not make you reenact horrible events that you have already survived. It’s more about dual awareness: your system will slowly learn to talk about these events knowing that you are safe in the present moment.

You get to lead

This may sound obvious, so humor me as I clarify this point. Most folks come into therapy with the goal of “feeling better”. However, there are parts of their life that are an open book to review and many topics that are completely forbidden. This is fine! However, let your therapist know these boundaries. You may have experienced an eating disorder as a child. Perhaps you survived a sexual assault. You may be grieving the loss of a parent. Despite knowing this history, you may not want to open the door to these topics. Your therapist should be respectful of this boundary. At the end of the day, you are the boss in therapy. This is your life, and this is your wellbeing. You get to decide what feels most important to address. There will be times as you start trauma therapy when you realize these old wounds keep coming back. When this happens, your therapist will be honest with you and point out the value in addressing these topics. However, you are ultimately in charge of deciding whether this issue is worth exploring.

Your feedback matters

You can let your therapist know when something is not working. This may feel very unsettling, but protecting your therapist’s feelings provides only short-term relief. It doesn’t actually help you in your recovery. That isn’t fair to you, and your therapist may not be aware that you are going through this internal battle.

You can ask questions, clarify where treatment is going. When it comes to starting trauma therapy, many folks are not clear on how therapy works, or what a session will look like. You are welcome to ask at any point in time about your questions. Whether it’s been a few weeks, or a few years, it’s fine to clarify! Therapy is meant to be a safe space to build a relationship. It should feel safe to ask questions or voice uncertainties.

Therapy takes time

This may seem obvious, but it’s an important factor to consider with starting trauma therapy. You may have seen TV shows where a sassy, brilliant therapist says some profound statement and the client walks away completely changed. This isn’t really the case in real life. Sure, you may learn more about yourself at each session. You may also have a deeper patience and openness to those difficult parts of you. Therapy is about having a better relationship with yourself. Having insight into your internal system is helpful and can absolutely make you look at the world differently. Understanding what all of your “problematic symptoms” are trying to do can help you shift to appreciating these parts of your personality. However, as with every relationship, it takes time. It takes time to build this understanding about yourself. It takes time to start to trust yourself.

Therapy is not forever.

Sure, therapy can sometimes take a few years to work through old wounds and feel regulated. You may continue more for the sake of check ins and maintenance work. But, this does not have to be a permanent arrangement. You are at the lead of deciding when your goals feel complete. The beauty of working in private practice is that clients can reach out when they want to work on something, and can leave when they feel this has been adequately addressed. If you hesitate to start trauma therapy because you fear you will be ongoing, please know that this is not the case. Your therapist is forever working him or herself out of a job. That’s the point of our roles. We support you in creating internal leadership so that your emotions can show up, express themselves, and feel safely supported by you.

Don’t settle

Just because you start with one therapist does not mean you are stuck with him/her forever. Research shows that the relationship matters. The quality of the relationship you have with your therapist is a solid predictor of how treatment outcome (irrespective of the type of therapy that is offered). What does this mean for those who are hesitant to start therapy? Ask yourself if you feel truly comfortable with the therapist. Is your clinician hearing you and understanding your needs? Do you feel judged? While you may not enjoy vulnerability, does it feel safe to be vulnerable in front of your therapist? Is there compassion? Your therapist should have a positive regard for you. If not, this isn’t the right fit.

Reach out

 If you have any questions about the above details, reach out for a free consult. Starting trauma therapy could finally provide that relief you’ve been searching for.

Take care,

Kasi

Schedule a free Consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Considering trauma therapy? How to tell if EMDR is right for you

Published on by kshanmuk

If you have been searching for trauma therapy, chances are that you have come across the term “EMDR”. While there are many types of therapy that can address trauma, EMDR has become well known in the counselling world as being an excellent and fast option for processing difficult life events. But how do you know if EMDR is right for you? I hope this post will provide you more clarity and answers.

What is EMDR?

What is EMDR and how do I know if EMDR is right for me?

EMDR stands for Eye Movement Desensitization and Reprocessing. Many clients come to counselling expecting a traditional talk therapy session. They may expect to share lots of details about their lives, and have the therapist ask stereotypical questions like, “How does that make you feel?” EMDR is not at all like this.

EMDR involves the use of bilateral stimulation (BLS) to process traumatic events. BLS is a fancy way of saying that a therapist will be adding some visual, auditory or tactile prompts during therapy. For example, you may be asked to follow a ball moving across the screen or listen to audio prompts. A shift starts to occur when you combine these sensory inputs while also thinking of a traumatic event. The understanding from EMDR creator, Francine Shapiro, is that this combination activates an adaptive neural network in your brain. What we see is that EMDR clients feel calmer when they think about these disturbing situations. To learn more about what an EMDR session is like, I’d encourage you to read this earlier post or watch the following video:

Why use EMDR?

EMDR has been proven to work quickly in processing disturbing events. This is especially the case for those who have survived a single traumatic event (as opposed to complex trauma where a person has survived years of distressing circumstances). This therapy can be used irrespective of when the trauma occurred, be it yesterday or 50 years ago. EMDR has been effective in meeting the needs of diverse clientele regardless of age, race, gender and other identifiers. Beyond past events, this therapy can also help clients work through fears of a similar trauma happening again in the future.

How to tell when EMDR is working:

For clients who have had success with EMDR, they will notice several indicators to healing:

How do I know when EMDR is working?
  • Clients can speak and think about these traumatic events more calmly
  • Clients notice a change in their thinking pattern. Negative beliefs are transformed into more compassionate and positive perspectives. For example, a client who initially believed “I should have done more” may shift into thinking,”I did the best I could.”
  • Clients notice improvements of PTSD symptoms (e.g. intrusive thoughts, flashbacks, nightmares, anxieties, hypersensitivity).
  • Clients’ physical pains starts to ease. They can speak about the trauma without feeling tense, clenching their muscles, or experiencing other signs of constriction.

What prevents EMDR from working?

While all of this sounds great, there are some factors that can affect whether EMDR is right for you. As with any therapy, there is no guarantee that one approach will be the miracle cure. While EMDR has a high success rate, the following points should be considered:

1. Readiness:

Before starting EMDR, clients have to be open to addressing a painful part of their lives. While this may sound obvious, I want to emphasize how incredibly hard it is to sit with memories and thoughts that you have worked to avoid. Avoidance is a natural way to manage anxiety. If we find something frightening, we protect ourselves by staying away. As with any form of therapy, readiness involves taking the chance to stop avoiding in order to address these fears. This is much easier said than done.

2. Learning to work within our window of tolerance:

For EMDR to be the right approach for you, your therapist has to ensure that you are prepared. The goal of this therapy is to process disturbing events without overwhelming you. This means being able to think about these events without feeling emotionally hijacked. The point of EMDR is not to relive the trauma, but to recognize you are in a place of safety while thinking of a difficult past experience.

IS EMDR right for me? Trauma counselling online and in Kitchener, ON

If you go beyond your window of tolerance, the work will not feel safe. Your therapist will be monitoring how quickly or slowly to take trauma processing based on your emotional state. There may be pauses in treatment to help calm your system (e.g. deep breathing, relaxation exercises, calming visualizations, distress tolerance skills, etc). You may spend several sessions focusing on these calming skills before beginning BLS. This does not necessarily mean that EMDR cannot be used; however, there may be a delay in starting trauma processing.

3. Complexity:

Complex trauma and complex mental health (e.g. personality disorders, addiction) can take time to heal. Even with a fast approach like EMDR, clients may spend many months or years working through painful memories. You may have to spend a significant amount of time addressing these other mental health needs before starting to work through traumatic events. This does not mean that EMDR therapy is not helping; however, clients must be patient to work through these additional needs.

4. Current life stressors:

Is EMDR right for me? Learn about this form of trauma therapy

Are there current life stressors that are getting in the way? It is hard to focus on a past trauma if you are thinking about current financial struggles, work demands, or a recent arguments with your partner. When life feels unsafe or stressful, you may have a hard time focusing on the past. It is understandable that current needs keep distracting you. In these types of situations, you may need to pause EMDR, and address what changes need to occur today to help life feel more stable.

5. Fear of recovery:

This is a difficult point to make because the majority of people want to get better and the title insinuates that a person is avoiding healing. That is not my intent. There are a lot of changes that will happen in your life because of recovery. This may include embracing new routines after years of living a certain way. It may involve returning to work where there are old triggers and difficulties waiting. Perhaps recovery involves acknowledging that your parents were not kind or well-intentioned people. There is an understandable fear of what recovery might mean for a survivor, and those fears need to be supported and addressed prior to opening old wounds.

Is EMDR still right for me?

Trauma is a fact of life. It does not, however, have to be a life sentence. Not only can trauma be healed but with appropriate guidance and support, it can be transformative.

Peter Levine

While the concerns mentioned above may influence your therapy journey, EMDR can still be the right approach for you. It is best to speak with your therapist about these influences in order to problem solve. The solution may be to do EMDR in a slower manner to prevent overwhelm. Alternatively, your therapist may use a combination of other therapy styles (e.g. Internal Family Systems therapy, DBT) to address other mental health needs alongside trauma healing.

Traumatic events happen to every individual, and we cannot prevent it from taking place, unfortunately. While some recover on their own, many of us experience lasting symptoms from traumatic events. If you continue to be plagued by a traumatic event, reach out for support. EMDR may be the therapy you are looking for.

All the best,

Kasi

schedule a free consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

PTSD and trauma. Do I seek help? Kasi Shan Therapy offers counselling support in Kitchener, Ontario

Should I be concerned about PTSD?

Published on by kshanmuk

If you have survived a traumatic experience, it’s natural that you are feeling worried about how to proceed. You may have many concerns running through your mind: How long will I feel this way? Am I supposed to seek treatment? Is it normal for me to feel like this? Whether it’s an unsettling birth experience, a difficult pregnancy, a sexual assault, or any other traumatic event, we are left feeling vulnerable and distressed. This post is for anyone concerned about experiencing posttraumatic stress disorder (PTSD). I hope the following information will provide you some clarity and empower you to seek the support that best meets your needs.

What is PTSD?

PTSD is a mental health diagnosis that occurs after an individual has survived or witnessed a traumatic event. What qualifies as a traumatic event differs for every individual. Whatever the circumstance, the individual experiences a significant threat to their physical, emotional or psychological safety, or the safety of a loved one. The situation is so distressing , that the person feels unable to cope.

In working with prenatal and postpartum parents, I see a lot of caregivers who have experienced trauma in the following circumstances:

Is it PTSD? What to do about trauma. Kasi Shan Therapy: counselling in Kitchener, ON
  • Prenatal Loss: e.g. stillbirths, miscarriages, unsuccessful IVF treatment
  • Unplanned pregnancies and abortions
  • Domestic violence, affairs, or marital separation
  • Pregnancy complications: e.g. infections, preeclampsia
  • Early labor or NICU visits
  • Unexpected health complications: e.g. positive screening for trisomy 21 or 18, car accidents

Not every traumatic experience leads to PTSD. There are many components that can influence your healing. Having resiliency factors (e.g. coping strategies, support from loved ones) can greatly improve how you process and move forward from this experience. Having a relatively safe life and limited trauma prior to this event can help us trust that the world is a safe place once again.

Depending on whether the traumatic event was a one time incident (e.g. mugging) versus a repeated event (e.g. ongoing civil war) can impact your healing. When it’s a one time event, our system is better able to see the situation as an anomaly. When there are repeated infractions, we struggle to see the world as a safe and predictable place, and there is increased risk for PTSD.

During a traumatic event:

PTSD versus trauma. what to do after a traumatic event. how to recover from trauma. Kasi Shan therapy: online counselling. Kitchener, Ontario

During a traumatic situation, our survival system kicks in automatically. We are outside of our window of tolerance because this event was unexpected, and our nervous system is experiencing a threat to our well-being. Without conscious effort, our traumatized mind shifts to a state of flight, fight or freeze. We try and escape the situation as quickly as possible, or we try and attack and fight our way forward. If neither option works, we fall into a state of shock or freeze response. When safety is returned, most of us can calm down. However, for traumatized individuals, it’s like their mind is still hooked in that place of danger, and they continue to respond in a flight, fight or freeze manner.

Symptoms of Trauma

A traumatized individual will show symptoms such as:

What should I do about trauma? Being aware of PTSD. Kasi Shan Therapy. Online therapy. Counselling in Kitchener, Ontario
  • Hypervigilance: a need to assess for constant threat. This involves a high degree of alertness for anything related to the disturbing event.
  • Reliving the traumatic event: e.g. through flashbacks, memories, dreams or intrusive thoughts
  • Avoiding reminders of the disturbing event: this can involve avoiding even the most basic connection. For example, a mother with birth trauma may avoid going to hospitals or visiting medical professionals. She may refuse to talk about her birth experience or listen to others’ birth stories. In the hardest of scenarios, she may avoid any interactions with her newborn.
  • Increase in negative thoughts and feelings: e.g. numbness, guilt, shame, anxiety, irritability, hopelessness. The traumatized person often feels the world is unsafe or unfair. He or she may be cautious about trusting others.
  • Hyperarousal: Feeling on edge, jittery, difficulty relaxing
  • Dissociation or impaired memory recall: In some cases, the individual may forget parts of the trauma, or have blocked out this entire event.

Usually, we experience these symptoms right after a traumatic event; however, some individuals have a delayed onset.

When is it “normal” and when is it PTSD?

Posttraumatic stress disorder. What does it mean, and how do you get help? Kasi Shan Therapy. Online support. Kitchener, ON

The majority of us have survived a traumatic situation. In the beginning, we feel jittery, hyperalert, and avoidant. This is normal. There are parts of our system that are scared of a similar event happening again. In order to ensure safety, these parts will assess for danger and remain hypervigilant of repeat offences. During this time, you will likely experience a lot of distress. However, trauma symptoms tend to dissipate on their own within a month without any major influence. Short-term therapies, medication, and support from loved ones are effective tools that can help with this transition.

In order to have a diagnosis of PTSD, you must experience continue to experience trauma symptoms a month after the traumatic event. These symptoms may last for months or years following, and they cause significant impairment in the person’s daily life and relationships. If you are concerned about experiencing, PTSD, you can take the Posttraumatic Stress Disorder Checklist (PCL-5) as a self-assessment. Any scores approaching 40 warrant a conversation with your family doctor or a mental health professional.

What can I do if I still feel traumatized after a month?

I encourage you to seek therapy as soon as you feel ready to process the traumatic event. While counselling is not meant to be triggering, it can be hard to revisit a difficult memory. If you feel too overwhelmed to even think about the traumatic incident, your system may benefit from extra support to manage this anxiety first. This may involve medication, or specific counselling strategies focusing on distress management.

There are many different counselling approaches that can be used to process traumatic events. Some well known options include: include cognitive processing therapy, sensorimotor psychotherapy and narrative therapies. The following three options are services that can be provided via Kasi Shan Therapy.

Eye movement Desensitization and Reprocessing (EMDR)

EMDR. Eye movement desensitization and reprocessing. treating traumatic events. Kasi Shan Therapy. Counselling in Kitchener, ON and online.

EMDR is a powerful approach that divides a traumatic experience into smaller, manageable chunks to slowly process each part of the incident. Typically, the work starts with either the first or worst part of the memory, depending on what feels manageable for you. In EMDR therapy, we use a process called bilateral stimulation to help process traumatic memories (learn more about how EMDR works). IN EMDR, with each passing of bilateral stimulation, the traumatized individual starts to feel some distance from the traumatic event. The event feels less personal, and there is a continued lowering of distress level. An individual quickly moves from negative beliefs and high distress to more positive beliefs about themselves, less fear when thinking of the memory, and calmness in the body.

EMDR does not require you to go into specifics of a traumatic event. Instead, clients can express barebone details aloud while still making sense of a unpredictable and nonsensical event. This can feel helpful for those who are not ready to speak about the traumatic event in detail as of yet. In fact, for those who do get stuck in the narrative of a traumatic event, your therapist will keep checking that you are properly processing a memory versus getting retriggered.

Cognitive therapies and prolonged exposure

When it comes to traumatic events, we form negative beliefs about ourselves and about the world. Cognitive therapies help us challenge these beliefs by assessing their validity. We look at whether our assumptions about the world, others, and ourselves are fair and consistent. The therapist and client works to start formulating more neutral or balanced thoughts.

In addition, many therapists will encourage clients to practice in some form of exposure therapy. With trauma, there is a lot of avoidance of the traumatic event. Prolonged exposure involves slowly approaching the activities or individuals that remind us of the traumatic event. This is done at a gradual pace in order to not overwhelm the system, and to help build confidence in our capacity to manage distress and test out problematic beliefs.

Internal Family Systems Therapy (IFS)

internal family systems therapy. IFS and trauma.

IFS recognizes that our system can become divided following a traumatic event. There are parts of us that carry the wound of a traumatic event. We often bury or push this part away from our awareness. These exiled parts typically carry a lot of shame, guilt, fear or overwhelm. Because they are so overwhelming, we have other protective parts that compensate. We have proactive parts that prevent us from triggering these wounds. We also have reactive parts that respond when we are triggered trying to manage the intensity of these exiled emotions.

For example, following a miscarriage, we may have an exiled part of us that believes we are responsible for the pregnancy not lasting. Because this is such a painful burden to carry, we may have proactive parts that do not let us get pregnant again, cancel IVF appointments, or push fights with our partner to prevent intimacy. If another miscarriage occurs, we may have reactive parts that become extremely angry at ourselves or our partners. This part may lash out through verbal attacks, or may cause physical harm onto our own bodies in order to deal with the pain.

In using IFS to treat trauma, we have to work with all parts of your system. Rather than diving straight into addressing the wound, we work with these protective layers first. We focus on building trust and safety with these protective parts. When they have relaxed, we then start to work with the core traumatic wound.

Reach Out

You may notice signs of healing within the first month, and not require additional support. However, if it’s been longer than a month and you continue to express traumatic symptoms, interventions can be helpful. Trauma and PTSD do not have to be a life sentence, and there are ways to help your recovery. If you or a loved one is struggling after a traumatic experience, reach out.

Take care,

Kasi

Schedule a Free Consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

“They’d be better off without me”: Suicide and Postpartum Mental Health

Published on by kshanmuk

“They’d be better off without me.”
“I can’t do this. What am I doing here?”
“How am I supposed to do this everyday for the rest of my life?”

I hear sentences like these frequently in my work with postpartum parents. It is heartbreaking and I know that when someone gets to this place of rock bottom they are feeling helpless and overwhelmed. I’d love for the postpartum months to be an amazing time for parents, but oftentimes it’s not easy. Sure, the baby is cute. But the baby also keeps crying, won’t latch on properly and refuses to take a nap. It’s easy to get caught in a negative spiral of fatigue and insecurities. When this phase goes on long enough, many parents start to have passive or active thoughts of suicide.

Suicidality and postpartum care. Internal family systems therapy. Kasi Shan Therapy, counselling support in Kitchener, ON.

Suicide is a taboo topic, and it’s hard to talk about having these thoughts openly. Unfortunately, keeping our feelings buried tends to backlash for the majority of us. Postpartum depression does not necessarily mean you will have suicidal thoughts. However, when we are vulnerable, it’s not uncommon for our thoughts to shift into this space. Whether we are struggling with our baby, handling new stressors as a result of the baby (e.g. financial burdens, isolation), or addressing our already existing mental health diagnoses in combination with a baby, we want an escape. Suicide provides us one of the fastest option for escape. My hope today is to help you recognize that there are safe ways to support you. We can talk openly about suicide and get you to a place of feeling more at peace so that you no longer feel the desperate need to escape.

Step One: Name it

Mental health sucks. In our culture of independent, pinterest-loving super moms, it’s so hard to say that we’re struggling. The statistics for postpartum depression is 1 in 7 moms and 1 in 10 dads; these parents are not all seeking out help.

I appreciate the strong desire to be independent and feel competent. I have parts of me that also feel adamant to manage on my own. We can play this game for a long time and test our limit of how much we can handle. However, there comes a point when we recognize that even our best efforts are not actually effective. Despite going for a walk, eating well, or calling a friend, at the end of the day, you still feel bleak and beyond help.

Postpartum support for suicidal thoughts. Online and in person counselling in Kitchener, ON.

The first step in getting better involves accepting that you’re struggling with postpartum mental health. This is not your fault. When it comes to postpartum moods, there are so many lifestyle changes and hormonal changes that are beyond your control. This is not just a matter of will power. If you truly could manage to get through these months with determination and grit, I promise, you would have done it. However, if you realize that something is still feeling off, name this. Acknowledge that there is a part of you that is really having a hard time and is feeling helpless. This part deserves the space to talk, process, and recover.

Step Two: Reduce isolation

Suicide and postpartum care. Internal family systems therapy to help work through suicidal ideation. Kasi Shan Therapy, counselling support in Kitchener, ON.

There is a reason that we have the saying, “it takes a village to raise a child.” Childrearing should be done with support, and in our culture, we don’t often have the network nearby. In line with our independent values, we are not always comfortable reaching out to these village members.

In encouraging a stronger support network, I ask that you reach out to any means of support that you feel is genuinely helpful and compassionate. This may include contacting family members, friends, neighbours, support groups, mental health counsellors, health care professionals, really, anyone who you feel safe around. If our loved ones are unaware of how much we are struggling, they may not recognize the need to offer help.

Suicide and postpartum care. Internal family systems therapy to help work through suicidal ideation. Kasi Shan Therapy, counselling support in Kitchener, ON.

I know that some of us do not have the best support team. Sometimes our family members cause more harm than good. Their offering of help may come with judgments, criticism, or other consequences that make you feel worse than when you started off. Sometimes our family members become overwhelmed when we share our mental health struggles. Ironically, you may end up spending more time consoling them that your own needs are not addressed. In these situations, I encourage you to reach out to a local therapist (if financially feasible), or to find a non-profit counselling agency. Connecting with postpartum programs (e.g. Pregnancy and Postpartum Mood Disorders Program, Stork Secrets, Postpartum Support International) can help you find safe others that truly understand and are capable of helping with thoughts of suicide.

Your internal system

In Internal Family Systems Therapy, we recognize that our internal system is divided into parts. There are parts of us that are carrying wounds from the past (e.g. abandonment, betrayal, shame). These parts of our personality are often pushed away because they are too painful to acknowledge. In pushing away, we form protective layers. There are managerial parts of our system that work to prevent these wounds from getting triggered. These manager parts can appear as perfectionists, hard-working, critical, or conflict-avoidant. Their roles in our system is to run our day-to-day functioning without having our deepest burdens and wounds show up.

As I said before, when we push our feelings away, they tend to backlash. At some point, we get triggered. At these moments, we have reactive parts of our system that take over. They work to get rid of these vulnerable feelings as quickly as possible (e.g. drinking, anger, suicide). Ironically, whether our parts are playing a reactive or preventative role, there is a protective intent to help you from being overwhelmed by your wounds.

Step 3: Meet the key players of your internal system

Suicide and postpartum care. Internal family systems therapy to help work through suicidal ideation. Kasi Shan Therapy, counselling support in Kitchener, ON.

In therapy, I work with clients to get to know all of the parts involved in pushing you towards or protecting you from suicide. We work on skills to separate from these intense emotions so we can observe them, hear them out, understand their fears and concerns, and have a better relationship with them. Can you imagine how you would feel if, when sadness took over, you could actually have the capacity to listen to it calmly without becoming overwhelmed? That is the beauty of IFS. When we can step back and listen to our system, we can begin to hear the fears, concerns and protective intent of even our harshest emotions. We are able to access those underlying wounds and support their recovery so that the rest of your system does not have to work so hard at preventing or reacting to triggers.

I understand this may sound unbelievable to many people. After all, you may have experienced suicidal thoughts for months and come to terms that you are “just an anxious mess” or “a pathetic parent.” Therapy can help shift this outlook. You are more than your anxieties, depression or other extreme parts.

Step Four: Address your coping mechanisms

In therapy, we take a close look at the patterns that your parts take on when they are active. We pay attention to what triggers your extreme emotions. We look at all of the coping mechanisms that are used to manage these extreme emotions.

Suicide and postpartum care. Internal family systems therapy to help work through suicidal ideation. Kasi Shan Therapy, counselling support in Kitchener, ON.

For many postpartum parents, their biggest fear is feeling incapable of taking care of their baby. When this fear gets triggered, these parents respond in anyway or form to self-soothe. Some of parents turn to drinking to help these thoughts calm down. Others look to their partners, parents or loved ones to take over, and avoid any time alone with their infant. Some parents get caught in a spiral of self-hatred, focusing on criticising themselves for being incapable. In therapy, we look at all of these coping mechanisms without judgement. These are the strategies that have kept you going all of these months, and we want to work with each piece respectfully, and discuss opportunities for change.

Change comes in many different ways. Each parent is unique and I don’t want to give generic advice when your needs may be significantly different from the next person. What’s important in understanding our system is that we learn to slow down to get to know these key parts better. We want to build trust that these coping mechanisms no longer have to be employed to keep us safe. We want to have permission to address those underlying wounds so that you have permanent healing.

Suicide is a quick fix for a problem with many alternative solutions

When it comes to postpartum care, I get that suicide is a fast response. We are struggling and we want the struggle to be over. Ending our life would be the fastest option out. While this may be true, this is a decision you can never take back. Before any part of you makes that ultimate choice, it’s important to ensure all of your alternative options are tested. The struggle in this request is that we may need some time to try out these other options. Your suicidal part is taking a risk in working with me. Rather than having a quick fix, I’m asking that we make some permanent shifts so that life does not feel so miserable.

If you would like to talk further, please feel free to reach out.

Take care,

Kasi

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Working with unwanted feelings

Published on by kshanmuk

When I am feeling anxious, unhappy or generally lousy, I hate the idea of mindfully noticing these unwanted feelings. There is intense resistance to “sitting with” or accepting my emotions. During these low moments, I have zero understanding or time for my feelings. My only goal is to get rid of them. I imagine many others feel the same way. When it comes to our harsher feelings, they can be intense, and often cruel. These parts of our personality know exactly what to say to make us want to crumble.  

I struggled for the longest time with Internal Family Systems therapy in telling me that my emotions, my critical voice, or my less healthier coping behaviours are not bad. IFS encourages that every part of us is welcome (to learn more about IFS and parts work, read this post). I struggled to accept this viewpoint when I felt every part of me was, in fact, not welcome. Parts of me could be a jerk some days, and there was no way I was going to cater to that nonsense. For those with anxiety, depression, or other mental health struggles, I’m sure you can relate to how badly you want to get rid of these unwanted feelings.

My own turning point

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For me, my willingness to change my perspective came from recognizing that pushing away my unwanted feelings wasn’t actually getting rid of the pain. When I wanted to deny my urge to eat another slice of pizza, that part got louder. When I pretended I wasn’t feeling angry with my family, that part made sure it vented in my head. Wishing parts away rarely works in getting rid of the pain, or having them stay quiet.

It’s too hard

I get that it’s really hard to do therapy. It’s hard to sit with our emotions. It’s hard to create space for these distressing parts of our personalities to talk and voice their feelings. Can you imagine allowing those parts of you that are suicidal or have urges to self-harm to actually be given the space to talk? Understandably, there is fear in letting these voices have space because, what if it creates more distress, more extreme behaviours, or more danger? 

I had these fears as well. I didn’t want to hear any of my anxieties. They were annoying and they would make me feel lousy all day. Who would sign up for that willingly? However, IFS teaches us a way to work with these parts of our personality safely so that they do not take over. There is a way to do the work carefully and slowly, so that other parts of your system do not get overwhelmed. We can continue to hear these parts of our personality, understand their fears and intents, build a better relationship with them, and negotiate for space or a shift in coping strategies.

There’s no way I can get better

Working with unwanted feelings. Kasi Shan Therapy: Kitchener ON, Online counselling.
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Sometimes, we’ve lived with these unwanted emotions and behaviours for years. Some of the clients I’ve seen have gone to various therapists and tried different coping strategies to help with their healing. Understandably, if they feel stuck, they are pretty certain this is an unchangeable and fixed part of their living experience. They are confident that nothing will help, and there’s scepticism that healing can happen.

I felt this way as well. For the longest time, I’d focused on traditional talk therapy, using modalities like CBT and DBT. These are incredible counselling approaches that work for many folks. Coping skills, working through exposure treatment, and recognizing unhelpful thinking patterns are effective for treating many struggles. However, when we focus on treating just our thoughts, we are forgetting the rest of our body.  Our body, ironically, is what carries traumas.

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.

-Bessel van der kolk, “The body keeps the score”

You experience feelings throughout your body. Sure, you can challenge your thoughts, you can try new behaviours, you can learn ways to cope. But for many of us, this isn’t enough. Knowing how to do a thought record isn’t enough. We want our emotions to catch up to what we know. In order to do that, our therapy styles cannot just focus on thoughts, but has to include experiential change. This means constantly returning our awareness back to the body and the system to see how it is affected by these interventions. Healing involves taking the time to notice our physical sensations, and understand what these subtle cues are trying to communicate.

This is the only way I can survive

Working with unwanted feelings. Kasi Shan Therapy: Kitchener ON, Online counselling.
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Sometimes it can feel scary to let go of our current coping mechanisms. If you know that the only way you can manage your challenging family is by having a few glasses of wine at the end of the day, it is going to feel incredibly hard to give that up. I have clients who are cautious of telling others about self-harming behaviours because they fear repercussion or worry they will be shamed into stopping. The thought of changing our patterns can prevent many of us from starting the work.

For anyone who has hesitated to reach out for help because of the need to stop a specific coping mechanism, please know that this does not have to be the case. My job is not to tell you to stop drinking. I understand that there is a part of you that feels drinking is the only way in which you can survive this current hardship. However, if we were able to explore the underlying fears related to your family, would you have to keep drinking? What are you actually protecting by drinking? If you were no longer feeling threatened by this fear, would you need to keep coping in this way? Drinking patterns, and other coping mechanisms, can slow down if underlying fears are addressed. Once your system no longer feels threatened, it no longer has to survive by turning to wine.

I don’t want to know

Working with unwanted feelings. Kasi Shan Therapy: Kitchener ON, Online counselling.
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A common reason that I see clients hesitating to do trauma work is that it will involve looking at the past. One of our strongest survival mechanisms is denial. Going back to a painful period in time can feel like we’re asking for trouble. It hurts to revisit difficult memories. We may feel cautious of how we will see our loved ones after exploring what those memories mean and how they have impacted us.

With EMDR, IFS, or any other trauma-based treatment, the goal is not to discover a big, bad secret from the past. However, with trauma-based treatments, we can become aware of details that we’ve kept hidden from our conscious awareness. When these details come to light, we have options. Clients can chose to share these details with me, or they can keep this awareness inside. Clients can decide whether this knowledge requires intervention. There are options to bring in new coping mechanisms or more self-compassion. We can work towards understanding the impact of these moments and unburdening our system of these wounds. Finally, clients can chose to keep doing what they’re doing and pretend this awareness does not exist. There is no set agenda for how we move forward. We know the pain is there, and we shift to addressing this pain, only when you are okay to go there.

Reach out

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Part of me was nervous about writing this article. I can talk nonchalantly about being a perfectionist, but acknowledging that I can also have messy feelings is hard. The fear of others’ judgements prevents us from reaching out (even though our system is desperate for help and relief). At the end of the day, hiding has not helped us feel better. Talking to a therapist who you feel is safe and effective is one way towards healing. If you have any experiences with the above battles and wish to talk, please don’t hesitate to reach out. 

Warm regards,

Kasi

schedule a free consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi

Understanding Birth Trauma

Published on by kshanmuk1 Comment

You’ve been patient, waited 9 months, and dealt with all of the aches, nausea and fatigue in order to get to your delivery date. You may have an ideal birth story in your mind; many of us do. Some parents imagine a specific atmosphere while delivering (e.g. support people around, delivering at home). Some parents plan pain management strategies (e.g. I want an epidural). Others are keen to have skin to skin contact immediately after delivery. No matter what your plans are for delivery, there is hope that things go smoothly. Unfortunately, birth trauma can pull us far away from our ideal birth story.

Trauma is an unexpected and stressful experience that alerts our system of danger. We become acutely aware of impending harm or threat to our being. A birth becomes traumatic when we are fearful that we, or our baby, will die. Birth traumas happen in about 1 in 4 deliveries. These parents experience feelings of being abandoned, helpless, disrespected, scared, overwhelmed or powerless during their birth experience. Approximately 9% of parents experience their moods worsening into a diagnosis of postpartum post-traumatic stress disorder.

Types of Birth Traumas

There are various complications that can happen during or after delivery. Common birth traumas include:

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.
  • Emergency treatment following birth (e.g. stay in NICU)
  • Stillbirth/neonatal death
  • Preterm deliveries
  • Assistance during delivery (e.g. use of forceps)
  • Unplanned c-section
  • Prolapsed cord
  • Feeling a sense of abandonment or powerlessness
  • Lack of support or clarification during and after delivery
  • Lack of privacy or dignity
  • Physical complications (e.g. postpartum hemorrhage, unexpected hysterectomy, perineal tears, prolapsed uterus)

Following these birth traumas, caregivers begin to notice a change in their own moods and capacities. Similar to post-traumatic stress disorder, survivors can experience:

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.
  • Extreme sensitivity and awareness to surroundings (a.k.a. hypervigilance)
  • Easily startled
  • Difficulty concentrating
  • Change in appetite
  • Memory blocks (unable to remember parts of the traumatic experience)
  • Difficult coping behaviours
  • Intense shame, irritability, or anger
  • Suicidal urges
  • Sleep difficulties and nightmares
  • Difficulty in social relationships
  • Unpleasant intrusive thoughts
  • Flashbacks
  • Pain, sweating, trembling, when thinking of the birth
  • Avoidance of birth reminders (e.g. being with own child, seeing other babies, hearing other birth stories, medical settings)
  • Anger towards medical professional or others involved during delivery
  • Poor attachment with baby

As with any mental health struggle, this is not a matter of will power. You are not choosing to respond in this way. You are not in control of these overwhelming emotions. When traumatic experiences occur, our system cannot always manage. We lean into whatever coping strategies are available to help us survive. Some of these coping strategies are done intentionally (e.g. avoiding the baby), and other times, we have limited control over them (e.g. bursts of anger).

What influences PTSD?

During the first month following a birth trauma, we want to monitor a parent’s well-being. This time is pivotal. Trauma survivors continue to assess the world and whether it is safe and predictable once again. They need to see that this birth trauma is a unique experience, and that it is highly unlikely to reoccur. Grief, anger, anxiety, wanting to understand, and seeking support are all natural forms of processing that tend to occur during this phase. The body’s ability to naturally process and return back to a sense of safety can be influenced by the following factors:

Prenatal Stressors

Prenatal stressors can include miscarriages, unplanned pregnancies, health scares, physical complications, unexpected bed rest, or fertility stressors. During these months of pregnancy, an individual can survive a variety of unexpected hardships, such as financial burdens, divorce, or bereavement. Furthermore, some pregnant couples have lived through a traumatic experience earlier in life (e.g. medical traumas).

It is understandable that these parents enter the delivery room feeling more cautious and nervous. If we have experienced any of these earlier adversities, our nervous system has already been fighting for some time to cope. It is already experiencing symptoms like hypervigilance, intrusive thoughts and nightmares. When we have already experienced trauma, our window of tolerance becomes narrower. Another stressful event can push us past our limit of tolerance.

Interactions with medical staff

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.

The interactions you have with your healthcare team can immensely influence your experience of child birth. How did your healthcare provider connect with you following a miscarriage? Was there space for you to grieve or did your provider seem too busy? Was the physician empathetic or was he or she scornful? If you are already wary of medical staff, how would you feel entering a delivery room?

Deliveries are busy times times, and your healthcare team is focused on moving things as efficiently as possible. However, at a time when you feel vulnerable, it can easily feel like your healthcare providers are curt, dismissive or inconsiderate of your emotional needs. When decisions like C-sections or taking the baby immediately to NICU are outside of your decision making, it can feel like your autonomy and sense of control has been taken away. The medical team’s decision to take these steps are likely valid; however, caregivers are left feeling powerless and confused.

Lack of support

It is natural to want to hide when we are grieving. It is natural for us to avoid others if we feel ashamed or responsible for a difficult birth. Isolation and loneliness tend to worsen our moods. There is so much healing that occurs when we feel someone truly understands and recognizes our pain.

When parents express grief and distress following a birth trauma, many family members do not know how to respond. Our friends and family have good intentions when they reassure with comments such as: “At least the baby is here,” or “Count your blessings,” or “Be grateful for what you have”. These types of comments are, unfortunately, invalidating. A parent continues to feel alone and misunderstood by their support team.

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.

To offer better support, please ask caregivers if it’s okay to be with them during this time. If these parents want to talk, please listen with an open-heart. When we are grieving, our support team cannot fix the past or make the pain go away. However, by offering a safe space for these intense emotions, our friends and family provide us opportunities for healing.

Healing from a birth trauma:

Not everyone requires extra intervention following a birth trauma. Support from loved ones and time can be enough to help someone work through this intense and difficult experience. However, for more complicated situations, like postpartum PTSD, it’s imperative we reach out for help.

Eye Movement Desensitization and Reprocessing (EMDR) is an incredibly effective way to process and heal from birth traumas. This therapeutic modality helps an individual speak about traumatic memories while using bilateral stimulation (e.g. eye movement, audio cues, tapping) for short sets of time. In using this combination, EMDR triggers the traumatic memory network in the mind. Participants notice a reduction in distress and vividness to a traumatic memory. They also notice how the mind works to form connection with other events that have impacted this trauma, or have been impacted because of this trauma. Depending on the complexity of the traumatic events, clients can start to see improvement within 6-12 sessions. If you would like to learn more about EMDR, I encourage you to read this earlier post.

If you are struggling following a birth trauma, please do not stay silent. Reach out to a safe person such as a family member, friend, or a professional. If you would like to work through your birth trauma using EMDR or other effective therapy styles, please reach out.

Warm regards,
Kasi

schedule a free consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi
Feeling stuck in trauma, therapy. Internal family systems therapy

Why am I feeling stuck in my trauma?

Published on by kshanmuk

Even years after a traumatic experience, we can feel stuck in a place of emotional distress. In therapy, I noticed that many trauma survivors would struggle to find self-compassion. They would get caught in an endless loop of self-blame and resentment. Other clients were keen to begin therapy; however, they were easily overwhelmed once they started to talk about the trauma. Many clients felt unable to deal with their past because their current coping mechanisms (e.g. self-harm, substance use) were causing so many problems.

Feeling stuck in trauma, therapy. Internal family systems therapy

These clients are intelligent, capable, and well-versed in therapy lingo. Many of the folks I see can recite CBT and mindfulness principles to me. Despite knowing how they “should” think or behave, they were still feeling stuck. As a clinician, learning Internal Family Systems therapy (IFS) transformed my counselling practice and helped me better understand these stuck points. I hope this blog post will help you recognize what may be affecting your own recovery.

Healing wounds

Feeling stuck in trauma, therapy. Internal family systems therapy

When it comes to trauma, we develop strong emotions and negative beliefs about ourselves. We carry these wounds with us, not always recognising the subtle ways in which they influence our behaviours and actions. For example, after a rape, a survivor could start to believe “I deserved this”, “I did something wrong”, or “I am unlovable”. She may feel an intense level of shame or fear. If she is carrying these beliefs and emotions, she will develop protective methods in order to adapt. These protective habits ensure that the beliefs and feelings stemming from the traumatic event are never experienced again.

A Parts-led System

Before we dive into the topic, let me give a brief explanation of Internal Family Systems Therapy. IFS recognizes that our mind is divided into sub-personalities; each “part” or personality can be active at different points in time. When I am calm, confident and feeling at peace, I feel like myself. However, there are times during the day when I get triggered and parts of my personality get activated. At work, the therapist-part of my personality likes to coach me in what I should say to clients. When I’m home, my mother-part can narrate all the ways I need to my take care of my child. My self-conscious part gets loud when I am shopping for a new pair of jeans. My over-achiever part can take over when I’m signing up for courses, agreeing to tasks, or managing my calendar.

Having our mind divided likes this is not the same as multiple personality disorder. We all have parts. At various points in time, these parts get triggered and feel the need to push a certain agenda (e.g. attending therapy, avoiding treatment).

Managerial Parts

Feeling stuck in trauma, therapy. Internal family systems therapy

In the IFS model, we recognize that there are two types of protective parts that develop following a trauma. The first type of protective parts are called managers. Managers are the parts of our personality that try and prevent bad things from happening. Managers are proactive in preventing us from feeling the same emotions that we experienced in the time of trauma. They try to ensure safety by keeping our environments and relationships in balance.

A sexual assault survivor may create one or many managerial parts to prevent an assault from happening again. Her managers will try to avoid triggers that bring about similar emotions and beliefs to her experiences following the trauma. For example, she may have a part that refuse to go anywhere by herself at night, a part that turns down dates, a part that numbs emotions, and a part that is fearful of strangers. All of these parts protect her from being vulnerable again.

How do managers affect therapy?

Managers can show up in a variety of ways in the therapy context. From their perspective, they are attempting to the help the client. Bear in mind that these reactions are not always within our awareness. These parts of our personality become triggered and react oftentimes outside of our conscious decision-making. These parts are not intentionally trying to cause harm, but using their own capacity and knowledge to keep us safe.

Before we can start processing trauma, my job is to work with these protective parts of your system. You have survived all these days by using these protective mechanisms. Unless every part of you is on board saying, “Yes! Let’s talk about this!”, it is perfectly natural for some type of blocking to show up.

Common manager blocks:

  • People-pleasing parts: This part tends to agree to all of the therapist’s comments despite not truly believing the therapist’s feedback. It may often accept a task or homework, despite knowing that other parts of the system are not ready to take on a certain challenge
  • Avoidant parts: This manager often misses appointments, or is late to therapy. In attempts to prevent the client from talking about a difficult experience or feeling vulnerable, this part can take over and avoid therapy all together.
  • Achievement-oriented parts: This part tries very hard to ensure that the client is doing his or her best. This part will often read therapy textbooks, learn about different diagnoses, and speak about trauma 24/7, if allowed. Unfortunately, the client can easy become overwhelmed or burned out if this part takes over all the time.
  • Critical parts: This part is often trying to be a cheerleader to the client; however, its words are harsh. The client can feel too distressed by the criticisms to work on the traumatic memory.
  • Denying parts: This part often minimises traumatic events in order to protect the client from truly recognising the impact of these horrific moments. Often these clients will say “it’s not a big deal”, or “that’s just normal at my house.”
  • Socially-avoidant parts: In fears of experiencing another distressing social encounter, this part will avoid any situations in which the client may stand out. This can prevent clients from spending time with friends, attending school, or dating. This socially avoidant part can also avoid situations where the client has to speak assertively or set boundaries.
  • Caretaker parts: This part will often forego the client’s own healing in order to take care of others. I often see this manager role in many postpartum parents as they learn to balance their own needs with that of their newborn child.
  • Intellectualising parts: This part will focus on analysing the situation, or thinking of the right answer versus allowing the client to sit with, or experience an emotion.

Firefighters

fireman standing near fire on building
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IFS explains that there is a second type of protective personalities that they refer to as firefighters. Whereas manager parts are in the role of preventative care, firefighter parts are reactive. They see a fire, and quickly work to put it out. In this way, firefighter parts are extremely helpful. Rather than letting the client feel burdened by traumatic wounds, firefighters are quick to find ways to stifle these intense feelings and beliefs.

Consider an example where an individual has recently been dumped. The impact of this breakup can be incredibly intense, worthy of hours of sadness, loneliness, and perhaps, hopelessness. This individual may also start to develop beliefs about himself following this experience, such as: “I don’t deserve love”, “I am ugly”, or “I am not good enough.” In reaction to this vulnerability, firefighters try to quickly eliminate these thoughts and emotions. They do this through any means, irrespective of other consequences that can arise. For example, this individual may have a part that is angry at his ex, a part that pushes others away when they talk about feelings, or a part that has him moving out of this neighbourhood.

Common Firefighter Blocks:

Feeling stuck in therapy. feeling stuck in trauma. IFS, internal family systems therapy

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  • Cancelling appointments parts: Following a difficult appointment, this part may feel it’s too vulnerable to return to therapy.
  • Angry parts: In response to feeling vulnerable, these parts want a way to feel empowered and lash out through anger, oftentimes projecting on to safe people.
  • Dissociative parts: These parts have the client “check out” during or after therapy. They can also cause clients to forget parts of traumatic experiences. Clients may present as distracted, or they have limited recollection of what happened.
  • Self-harm/Suicidal parts: In hopes of distraction or reducing pain, these parts practice self-harm or focus on suicidal urges.
  • Substance-dependent parts: In order to numb out emotions and thoughts, these parts turn to alcohol and drugs.
  • Food-dependent parts: These firefighters turn to food for comfort (e.g. binge eating, purging, excessive exercise). In hopes to feel some semblance of control, some firefighter parts focus on caloric restriction. Unfortunately, this food-dependent part tends to get push back from other parts of the system (e.g. parts that are ashamed in having to cope this way, part that resents being stuck in treatment because of food).
  • Body sensations/Illness: These parts can take over during sessions through headaches, body pains, upset stomachs, and other uncomfortable body cues. This can make it hard for the client to be fully present during the therapy experience.

Working with a Self-led System:

There is a common phrase in IFS, which is “all parts are welcome”. When it comes to therapy, every part of you is welcome to show up. Your therapist recognizes, like a family, you have various members in your internal system. As with families, each member has a different role, a different set of fears, and (sometimes) a different agenda. In IFS, we are not fearful of these managers and firefighters. Instead, your therapist will focus on the intentions of these parts to keep you safe. By taking the time to slowly work with these parts of your personality, your system begins to build more trust and there are fewer “stuck points”. It is at this point that we have permission to work on our underlying traumas.

IFS believes in the concept of “Self”. This is the true version of you. Not the one addled by anxieties and symptoms, but you at your very core. This is the confident, calm, curious, compassionate version of you that has been hidden due to firefighters, managers, and traumatised parts taking over. In IFS, we work to have a better relationship with our protective and traumatised parts so that there is more space for your true Self to come forward.

Parts-led versus Self-led

When we have a chaotic leader guiding us, our nation reacts with volatility. We become divided with one party screaming that their perspective matters most, and the other side counteracting with the same level of intensity. In similar ways, when our internal system is led by our managers, firefighters, or wounded parts, the rest of our system goes into a fight-or-flight mode. When we are led by Self, the system believes this leader has our best intentions at heart. There is more space to trust, listen, and negotiate.

When there is enough trust between Self and our protective layers, managers and firefighters can step back so that we work with the actual traumatic wounds. This process can take a session, or it can take a few months. The more vulnerable you felt during and after a traumatic experience, the more intensely your firefighters and managers will work to ensure these vulnerabilities are locked away safely. Therefore, therapy can take time in order to build trust with these protective parts of your personality.

Your therapist’s parts

The last piece that can create stuck points in therapy is your therapist. As your therapist is human, it is natural for him or her to also have managers, firefighters, and traumatised parts. In order to stay Self-led, I am regularly assessing whether my parts are interrupting the work in order to protect my own wounds. If a part of me reacts, then I am no longer feeling open-minded or curious. Instead, I am deterred by the agenda of my own anxieties.

If a therapist is triggered, this can impact a client from receiving effective and genuine support. Clients may feel that their therapists do not understand, and that they seem impatient or defensiveness. If this is the case, please know that this is not your fault. It may not be your therapist’s fault either, especially if he or she is unaware of these parts taking over.

Shifting away from feeling stuck

When we take the time to get to know our internal managers and firefighters, we build trust with these parts of our personality. We allow space for these parts to assess if it is safe to stop their protective roles. With this trust and safety, they no longer feel the need to react as strongly. We are finally able to move past these stuck points in healing.

If you are interested in learning more about IFS, or if you would like to discuss stuck points in therapy, please feel free to reach out.

Cheers,

Kasi

Schedule a free consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi
What is EMDR therapy and how does it help with PTSD?

What is EMDR therapy and how does it help my PTSD?

Published on by kshanmuk1 Comment

It’s frustrating when you’ve been to therapy for many years and no amount of talking has truly helped you recover from traumatic events. While I practice CBT, DBT and other forms of traditional talk therapy, I have shifted my practice to focus heavily on EMDR to help process difficult memories that seem “stuck”. EMDR therapy, a.k.a. Eye Movement Desensitization and Reprocessing, is highly effective in working through single traumatic events as well as long-term distress (e.g. childhood trauma, bullying, anxiety, depression). In fact, the EMDR International Association boasts that single-event traumatic experiences can be resolved within 3 sessions.

What is EMDR therapy and how does it treat PTSD?

Why can’t I get over it on my own?

During traumatic experiences, your brain is focused solely on survival. It’s not paying attention to nuances. Instead, it is trying to gather just enough information so that it can make a fast decision on how to keep you safe. During this quick processing, your brain stores traumatic information poorly. Rather than processing the event and filing it away as completed and safe, your compromised mind does not communicate properly with the parts of your brain in charge of the flight/fright/freeze responses. Unfortunately, these traumatic memories then get stored with the same emotional duress and physical sensations that took place during the event. Therefore, years later, when we become triggered, we experience the same emotions and physical states that we did during the time of the traumatic event. Because these memories are poorly stored in our brain, it also struggles to make connections with new or positive experiences.

what is emdr therapy and how does it help

EMDR therapy believes that your brain is able to recover from traumatic experiences; however, there are certain blocks that prevent this natural healing from taking place. Consider how your body works to heal a cut on your hand. You don’t have to address the wound; your body will naturally try to heal this wound on its own irrespective of your interventions. However, if there is repeated irritations to the wound, it becomes difficult for the cut to heal quickly or effectively. Your brain works in similar ways to your body. It is capable of healing from trauma; but, if there are repeated afflictions (e.g. negative beliefs stemming from that memory), it makes it harder for your brain to recover. Once these afflictions are addressed, your recovery can take place.

How does it work?

I have to preface that EMDR feels incredibly bizarre at first! If you are used to traditional talk therapy, EMDR will feel a tad surreal. During therapy, your EMDR therapist will ask you to review the traumatic memory in a very unique way. You will be asked to focus on one specific moment within your traumatic memory, and rate the level of distress you experience when you think of this moment. Your therapist will then support you in understanding the negative beliefs you now hold because of this memory. Afterwards, your therapist will ask you to think about the image while also having you pay attention to an object that is moving back and forth (a.k.a. bilateral stimulation). Bilateral stimulation is the distinctive factor in EMDR. It involves getting both your verbal and non-verbal (left and right-hemispheres of your brain) to be activated while addressing a traumatic memory. Bilateral stimulation can be done in various ways like back and forth eye movement, audio cues, or hand-held pulsers.

What does EMDR feel like?

During the time that the bilateral stimulation happens, your mind will wander (and your clinician will encourage this!). Your mind will start to create all sorts of connections stemming from that original memory. You may think of other memories, beliefs, images, emotions, etc. With bilateral stimulation, your brain is making connections between that original memory and it’s impact on other events in your life. Therefore, it’s creating new neural networks in your brain, shifting your original beliefs about that memory. Depending on where your mind wanders, your EMDR therapist will guide you in between sets of bilateral stimulate to choose the next aspect of the memory to focus on, thereby helping the processing move forward.

EMDR can help people of all ages

Why does it work?

There are several theories as to why the bilateral stimulation is so effective in processing traumatic memories. Some believe that it is due to your working memory being taxed because you’re focusing on the traumatic memory and the bilateral stimulation at the same time. Others have argued that it is because the bilateral stimulation is similar to rapid eye movement during sleep, which is a primary time when you process and store information in your brain.

“EMDR Therapy changes maladaptive neural networks by connecting the traumatic memory with new information. The distressing thoughts and emotions are blended with new positive thoughts and emotions; embodied awareness allows frozen sensations in the body to resolve through healing movements.”

– Arielle Schwartz

How else is EMDR different from other therapies?

If the thought of using bilateral stimulation hasn’t made this therapy look unique enough, there are a few other details that may help.

  • EMDR does not require a lot of talking about the difficult memory. Truly, the work is happening in your mind, and your brain is working hard to remove all of the afflicted connections from the original memory. You do not have to explain lengthy details to your therapist, if you are not comfortable.
  • Your therapist will be fairly silent during bilateral stimulation. This builds on the above point that the work is happening internally when you process a traumatic memory in combination with bilateral stimulation.
  • There is a lot of specific ‘resourcing’ exercises used to support your nervous system prior to starting trauma processing. Everyone feels vulnerable when it comes to addressing traumatic memories. To do the work safely, a lot of time can be spent to ensure that you feel safe and confident prior to starting the work.
  • There are no homework assigned. Don’t worry, if you love homework in therapy, we can figure something out! However, the primary focus of the work happens in session.
  • There are no arguments or time spent convincing you about changing your beliefs, thoughts or emotions. Instead, we acknowledge the negative belief that this traumatic memory has fostered, and we let the bilateral stimulation do the work. There is no time spent on thought records, or trying to look at the evidence for or against beliefs.
Here’s a quick video to summarize EMDR

After learning all of this information about EMDR, what questions do you have about this counselling approach? I’m happy to chat about EMDR, and how it may best serve your needs. Please reach out for a free consult to see if EMDR may be a good fit for you.

Cheers,
Kasi

Schedule a free consult
Understanding your window of tolerance. Kasi Shan Therapy offers counselling services in Kitchener, ON and Online.

Understanding our Window of Tolerance

Published on by kshanmuk

A few weeks ago, I wrote Why is everything harder after trauma? In continuing the conversation about trauma’s shift to our nervous system, I came across this great little video that explains the window of tolerance in a very accessible way. For my fellow learners, I hope this piques your interest! For fellow parents, I hope this opens the door to speaking to your teens and children about common signs following trauma.

As a refresher, the window of tolerance is a term that describes our ideal state. It shows the most effective state of arousal where we can thrive and handle daily stressors. When we experience too much trauma or distress, our window of tolerance narrows, and we become more emotionally vulnerable (i.e. more quick to shut down, become angry, etc.)


Knowing more about window of tolerance is only the first step. Let’s bring this to your own experiences. Try this quick assessment to see how you normally respond when you are out of your optimal zone. Check off the symptoms that you typically experience and rate the intensity of these behaviours from 1 (mild), 2 (moderate), or 3 (severe).

Window of tolerance and hyperaroused. Kasi Shan Therapy support individuals needing support with perinatal mental health and trauma.

Here are few simple exercises that you can practice to get you back within your window of tolerance:

  • Mindfulness practice: i.e. Pay attention to your external environment by noting 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
  • Focusing on getting grounded by pushing your feet firmly into the ground
  • Deep breathing
  • Progressive muscle relaxation exercises
  • Exercise
  • Using items that soothe or activate your physical senses (i.e. eating comfort foods, being wrapped in a warm blanket, soothing music, touching an ice cube)

We do not have to be in these states of distress forever. For further information and support, please reach out.

Schedule a free consult
Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Contact Kasi