Sunday, August 28, 2016

Below is a link to my thoughts on a recent article in THE NEW YORK TIMES about self- help groups for individuals who hear voices.  I thought the article did not cover all bases.

Please let me know what you think about it, maybe on the Huffington Post's comment page.
Thanks for reading.

Wednesday, July 27, 2016

How I became a trauma therapist 

may benatar


For two years I spoke to a nearly mute woman.  Much of the time I was just trying to guess what she was feeling and reflecting it  back to her.  I just talked.  I didn’t really know what was wrong.  I knew that she had a history of sexual abuse but I did not know who had abused her, the nature of the abuse, or details of the family she came from. I had only the vaguest notion what the issues were for her or why she wouldn’t talk.  I didn’t know what she needed.  I just talked.
Later she told me, much to my surprise, that a (imagined) little girl hid behind my chair while we were in session, a split off, very separate, part of her.  Her terror and her trauma were personified by this mute child. This was my first highly dissociated client. But I did not know it at the time.  I didn’t know it for a long, long time.
Frances came to me in the early 80’s after I had attended an inspiring conference in Boston on the psychology of women.  The counseling center where I was on staff paid for a colleague and I to attend the conference at Harvard University.  One paper on sexual violence against women stood out among the many wonderful talks.  Judith Lewis Herman asked of the 900 (mostly) female psychotherapists how many had been mugged.  People raised their hands.  She went on to say that she could not ask for a show of hands of victims of sexual violence, rape or childhood sexual abuse,  as victims of these crimes are stigmatized.    The victim is the one left with the shame, silenced by the shame, damaged by the shame.  The perpetrator is mostly unknown, mostly unmarked. 
This paper turned out to be life changing for me; it was a key moment in shaping my identity as a psychotherapist.   My colleague, soon to become my friend, and I stood together during the break sipping tea, munching croissants and sharing bits and pieces of our life story, intimate pieces.  We were moved by both the paper and by Judith Herman’s tribute to her recently deceased mother who had been scheduled to deliver a paper at this conference as well.  At the break there were dozens of women flocking to the pay phones to call their mothers.  Women and mothers were being honored and the wounds of women were being witnessed in an open and even welcoming way. 
Both the women’s movement of the 70’s and the anti-war movement of that time had both fueled the interest and investigation of the twin issues of  the trauma effects of war and violence against women.  Judy Herman inspired me to carry the torch and the impassioned message to the mental health staff with whom I worked, the town in which I lived, the people that I knew.  Eventually I taught this material to graduate students but it started with my presentation at a staff meeting.
At the time I was a member of a mostly male staff at a pastoral counseling center.  This material was new and perhaps not particularly welcome to that group.  I brought my experience of the conference and Herman’s meticulously researched paper to the staff.  I was excited about what I had learned and somehow empowered by it as well.  I was taken aback when I got a lot of questions like: “Is this really true, that one in three women have been sexually abused by the age of 18?”   In the early 1980’s the notion that large numbers of women and children might be victims of sexual trauma and suffering from its aftereffects was not quite mainstream.  I distinctly remember one staff member asking me, chuckling, “how could one actually rape one’s wife?”  In other words is it rape if you are married?  I could linger on my outrage, but I won’t. 
The upshot of that presentation was that I became known as the resident “expert” on sexual abuse. 
Frances was referred to me shortly after that staff meeting.  A staff member who was seeing a couple learned in the first session or two that Frances had a history of sexual abuse.  He referred her to me.  “We have someone who is an expert on sexual abuse,” he told Frances. I knew the truth: no one on that all male staff wanted to touch this.  But I was new at the counseling center and I was game.  
It actually turned out to be very challenging.  The marriage that had brought her into the treatment, failed rather quickly.  We didn’t talk much about the marriage or the sexual abuse history.  We didn’t talk about much.  She barely spoke to me for 2 years.  Frances was young,  mid-20’s, tall, thin, and sad. Very sad.  She held herself  tightly, rigid with suspicion. When she did speak her sentences were short and typically unrevealing.  The “shame” that Herman spoke of seemed to leak from her pores.  She looked terrified.
Frances cancelled appointments more often than not.  Maybe I wasn’t busy at the time, and I certainly was interested in her and drawn to her sadness, her silent suffering, so I called her each time she cancelled.  She always showed up the following week.   She asked me, many years later: “Why did you always call me?”  Truthfully, I have no idea.
But pursue her I did.  I think back on that time and wonder how I managed all that silence.  I did strive to “know” her in some way even though she was too frightened to tell me who she was.  I knew enough not to let the silence stretch on.  So I talked about fear, her fear,  about safety and how unsafe it might have felt to her to be in the office with me.  Her gaze was either downcast or wide-eyed. 
Today I would know so much better how to do this then I did then.  Today I would  consult what was going on in my own mind and body for clues for how she was feeling: where was I tense?  did I notice pain or strong sensation one place or another within me?  did my breath quicken? was how unmoored I felt in that situation a reflection of how lost she felt? how was my posture mirroring hers and what did it tell me about what was going on?
In retrospect I think she probably was as bewildered as I, as to how to proceed.  Today I know that there is an invisible force that we call “resonance” that tells us a lot about our companions if we “listen” in the right way. There is resonance between us all.  Today therapists are more familiar with concepts having to do with interpersonal energy and silent communication, right brain to right brain.  Affect is communicated silently.  We just have to listen differently.  But, alas, all that knowledge was decades away, way into my future as a clinician.
At that time my chatter was more about not leaving her alone with her fear and dread.  The content was less important than that there were words of some sort.  I was groping for a connection, some thread, a bridge that we could construct together.  She never became much of a talker, always dropping in and out of therapy at critical moments in the treatment.  But we did construct a bumpy bridge over time and most importantly, the little girl, who I did not initially know  was there,  listened in to what we were doing together and grew.
Frances started and finished college, the first in her very large family to do this.  She became a professional and a single parent.  She did a good job of raising her son, alone, and providing for herself.  She bought and restored a house.   She survived a severe illness, and a near fatal car accident and rehabbed herself from both.
In the years to come I was to treat several more severely traumatized women who had many sequestered part-selves.  Frances and two others remained in treatment for decades.
Like most therapists of that time I did not  recognize the phenomena of multiple self states until it screamed in my face.  I was among the throngs of therapists who believed that Multiple Personality Disorder, as it was then known, was a rare condition.  I remember saying to a client who was a criminal lawyer and felt that many of her imprisoned clients had “multiple personalities,” that that was “highly unlikely, it’s a very rare condition” I stated with authority.  Ha!
Today the idea of multiple selves does not make us uneasy.  This was not always so. When I was starting out in my work with individuals with much early trauma in their life histories, over 30 years ago, the concept of multiple self-states was not part of common/shared wisdom.  Today we have a Pixar movie about animated self- states in the head of a joyous 11 year girl, Inside Out
Today we easily grasp the notion that there is the work-self, the part that shows up at home, distinct from the part that shows up at parties, or sporting events, or with intimate friends.  My daughter, like many of us, has three different voice mail messages: work, home, cell phone.  At work the pitch of her voice is low, she is professional, deliberate and someone to be taken seriously.  On her cell she is casual, the pitch a little higher.  The home voice mail  sounds like a different person altogether: peppy, cheerful, the pitch at least an octave above the work email.  That woman/girl is young, energetic and fun.  This is both different and not different from having multiple selves.  Each voice mail message conveys the circumstance and the  state of being that she occupies in each setting. My daughter has easy access to each “self -state.”  She remembers what is going on at work when she is at home, and if she has to take a work call at home, amidst preparing dinner and directing the children, she can do so fairly easily. There is fluidity. 
The difference between individuals who have sharply segregated “selves” that cause the kind of serious problems that lead them into therapy and more functional individuals is that the former do not have easy access to all the states that my daughter, described above, has.  Some “parts” go to work, some parts parent, many parts hold the trauma memories, not all the parts go to therapy, at least initially.  Frequently the parts do not know each other, or only some do; communication across the system is typically poor.
In Dissociative Identity Disorder (the new designation for Multiple Personality Disorder) parts of experience, the really awful bits, are sequestered in sections of the overall personality so that literally the left hand doesn’t know what the right hand knows.  Tommy the rock opera, written in the 60’s captures some of what this looks like.  Tommy, was a Rock album by The Who, a movie, and a musical on Broadway.  Tommy is a traumatized little boy who becomes deaf,  mute, blind and a wizard at “pinball”.   A boy who cannot see becomes a champ at a sport where participants generally have keen sight. 
Tommy was born with all his senses intact.   When quite small he witnesses the  murder of his father at the hands of his mother’s lover.  The boy is the only witness.  The mother sings to her son:
You didn't hear it
You didn't see it.
You won't say nothing to no one
ever in your life….
You won't say nothing to no one
Never tell a soul
What you know is the Truth.

Little Tommy manages to go blind, deaf, and mute to conform with the pleas and commands of his parents,   But he holds to the truth deep within.  It turns out that there is a great way to do this: its call “dissociation.”
Sickness will surely take the mind
Where minds can't usually go.
Come on the amazing journey
And learn all you should know.

And I did, I went on the journey and it changed me.




Wednesday, April 6, 2016

Posted this awhile ago on Huffington. About my father and a lost history of trauma.



http://www.huffingtonpost.com/may-benatar-phd-lcsw/disappeared-david-trauma-_b_8239002.html