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Trauma Recovery - Sessions With Dr. Matt: Narratives of Hope and Resilience for Victims with PTSD

Trauma Recovery - Sessions With Dr. Matt: Narratives of Hope and Resilience for Victims with PTSD

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Trauma Recovery - Sessions With Dr. Matt: Narratives of Hope and Resilience for Victims with PTSD

Länge:
602 Seiten
16 Stunden
Freigegeben:
Dec 14, 2018
ISBN:
9781785358890
Format:
Buch

Beschreibung

Trauma Recovery: Sessions with Dr. Matt conveys hope and resilience for trauma victims. Written by a psychologist with 35 years of clinical experience, and a survivor of childhood sexual abuse. Between compellingly-written scenes of group, individual and family therapy, the cognitive-behavioral science of PTSD and its treatment is explained. The book movingly describes the collaboration between therapist and clients as they strive to get unstuck from trauma-ravaged lives. Reluctant trauma victims who have avoided treatment or who are having trouble processing life’s catastrophes will find in these pages a “fly-on-the-wall” perspective of how therapy can help. Useful information about overcoming obstacles in treatment is provided while fears about facing trauma are allayed, motivating the reluctant victim to finally seek treatment. The book will also greatly inform motivated patients by providing a thorough, scientifically-sound understanding of PTSD’s nature and treatment. This book should be in every trauma therapist’s office and placed in the hand of each of their PTSD patients.
Freigegeben:
Dec 14, 2018
ISBN:
9781785358890
Format:
Buch

Über den Autor

Matt Jaremko taught clinical psychology at several universities throughout his career, and ran an independent practice of clinical psychology for over 25 years. Throughout his career he engaged in stress and trauma research, publishing in over 30 journals. In addition, chemical dependency and family therapy was a point of focus in his clinical practice. He lives in Dallas, Texas with his wife.


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Trauma Recovery - Sessions With Dr. Matt - Matt E. Jaremko

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Prologue

The Internal Dialogue of a New Patient Being Sick and Tired of Being Afraid and Stuck

Fear. Raw, exhausted, angry and anguished. Fear.

I’m here. If hell exists, it surely feels like this.

I called this doctor because if I didn’t, I wasn’t sure that I would still be here—that is, alive—today—to be parked outside this psychologist’s office, staring through my rain-spattered windshield, catching random glances of the steps that will transport me from where I am, in the darkness of the pit, to hope.

My hands are shaking so hard that I may not be able to open the car door, and the bones in my legs seem to have disappeared along with the courage I had this morning when I was looking forward to this, to relief, to the possibility of hope. All day, I have thought of nothing but this appointment, and with every passing hour, my chest tightened and my stomach churned. My arms feel heavy. My nerves are shot. My chin quivers even though I’ve made up my mind not to cry anymore, because that’s a joke, and both my chin and I know it.

I unfold the paper with the appointment info on it and look at it for the—nth time today: Scott Matthews, Ph.D., Clinical Psychologist. Today’s date, 15 minutes from now.

The paper’s starting to look like it’s been in the rain: the day I made the appointment, my teardrops smeared the ink, and new ones threaten to make Matthews look like Matt—which is kinda weird since that’s what my friend told me she calls him: Dr. Matt.

I wonder if it’s possible to throw up when fear is all I have inside me?

What is he going to ask me, and should I tell him everything? What will he think of me if I do? He may not even want to help me once he gets to know me—if I tell him everything. But if I don’t, how will the hurting stop?

Maybe my friends are right; maybe my mother-in-law is right; maybe that article I read about getting over bad stuff is right; maybe I don’t need to be here after all: I can just think about something else and make up my mind that it won’t hurt anymore and…and…dammit, if I cry, I’m gonna have to go in there looking like I’ve been crying and nobody walks into his office while they’re crying, do they?

The thing is, none of those people telling me Just get over it know what it’s like inside my head. They don’t, and it pisses me off that they all think it’s that easy; that I can just snap my fingers and it will stop hurting to be…me.

I close my eyes, inhale a shaky breath, and exhale a sob past the fear clutching my windpipe. When I open my eyes and regard myself in the visor mirror, I fully expect to see handprints on my throat.

There are none. It’s all in my head.

But that’s the problem: I can’t get it—the stuff that makes my life a living hell—out of my head, which…How did I get to this place? To—to here, where my mind is my enemy. I sort of remember being happy, what that felt like, and I’ve tried for so long to use some elusive emotional muscle memory that will snap me out of this and elevate my—my—SELF—from the dark pit I find myself in every day, from the moment I wake and remember that hell is real. This pit has claw marks, and my fingers are raw from attempting to escape it. But I’m tired, and I have no more will to try on my own.

I need help.

It’s a house. The doctor’s office: it’s a house; I think it’s called a Victorian, with a steep-pitch roof, and the first floor is rounded on one side. The trees in the front yard nearly dwarf the house. The place just screams permanence. Rose bushes nearly overtake the wrap-around porch on one side, and ivy climbs a trellis on the other. Doesn’t look that scary. Come on, now, just take a big breath and open the car door. Feet on the ground. See, that wasn’t so hard. Next goal: make it to the front door.

Wait! The door’s opening, and a lady is coming out, followed by a gray-haired man. They must be together—no, she’s leaving—and he’s turning to go back inside.

I think he saw me. I’m tempted to dive back into my car and drive away, but instead I force myself toward the man, who is waiting at the top of the steps.

To my surprise, my wobbly legs are able to carry me across the small parking lot, onto the sidewalk, and up to where this slightly built man wearing a crewneck T-shirt, jeans, and boots is waiting for me. He smiles, and his eyes—they’re this clear, cornflower shade of blue—are kind.

He extends his hand. I’m Scott Matthews. Most folks call me ‘Dr. Matt.’

I manage to introduce myself—I kind of choke on my own spit—but if he notices, he doesn’t say anything. He just invites me in, and I follow him.

My insides are vibrating with fear. But as we pass through the reception area, a woman behind a tall counter smiles and says, Hello.

Dr. Matthews stops to introduce us. This is my practice partner, Leslie Treviño. Her office is that way—he gestures toward a hallway—and mine is just over here. The place smells faintly of lemon, and even though this home is a therapy office, its homey décor is welcoming.

The wood floor creaks as Dr. Matthews leads me to his office. He excuses himself a moment, and while I’m waiting for him, I look at the artwork on the wall.

Three framed cross-stitched pieces read, Little and often make much, Hope is the opposite of fear, and Success is survival. We’ll all tuff it out.

The floor announces his return, and Dr. Matt joins me at the artwork. Ready to get started?

I read the words aloud, even though my voice shakes: Hope is the opposite of fear.

Dr. Matt smiles. One of my patients made that for me.

Do—do you think it’s true? That—that if a person has hope, they can be—not so afraid?

He nods. I do. He moves to his office and holds the door open for me.

If I have a choice, I say, I choose hope. I follow him in, and I tell him my story.

Introduction

Overview

Exposure to traumatic events has become the black plague of the twenty-first century: it’s everywhere! It is generally believed that 70% of all people will experience a traumatic event in their lifetime (Sidran Institute, 2016); 20% of those will go on to develop Post-Traumatic Stress Disorder (PTSD). Thus, recovery from trauma has become a major health and human services issue.

Trauma Recovery: Sessions With Dr. Matt addresses recovery from trauma in a unique dual format. First, the book is a non-fiction treatise of the scientific and clinical understanding of the formation of PTSD and its treatment. At the same time, the book is a fictional depiction of seven individuals being treated by a professional psychologist for PTSD secondary to a variety of traumatic events. The fictional sections of the book are used to illustrate the scientific and clinical non-fiction material presented. The combination of the scientific and clinical concepts with emotionally charged human examples is meant to yield a more complete understanding: one that leads the reader to take the action required to recover from traumatic experiences.

While exposure to trauma results in strong negative emotional and behavioral experiences, PTSD happens when the trauma victim gets stuck in a cycle of negative emotion and harmful avoidance behavior to the exclusion of pursuing and/or approaching meaningful and valued life activity. Some who experience trauma will eventually say they are stronger for having been through such a life-changing event, while some remain stuck in misery. It is important to know how and why some trauma victims don’t experience this post-traumatic growth. This book carefully outlines why some trauma victims get better—even stronger—and some don’t.

In fact, it is because of the nature of being stuck that trauma victims with PTSD find it very difficult to seek and complete treatment. Their lives remain in a suspended negative state of fear, shame, anger, isolation, and hiding. These patients think no one can understand them and nothing can be done to help them.

Fortunately, modern psychological treatments are highly effective, but victims first must be convinced to come out of hiding and seek the truth about how their lives have changed. Trauma Recovery: Sessions With Dr. Matt convinces those victims in a unique and effective manner.

Beth Fehlbaum: Meeting Dr. J.

Co-writing this book with my former therapist, Dr. Matt Jaremko, is the end of a long journey of recovery from childhood sexual abuse. When I entered treatment, Dr. Jaremko compared the journey we were undertaking to a barefoot walk from Texas to Alaska, then back to Texas, while encountering all the weather along the way.

He wasn’t joking.

I entered therapy at the age of 38 because the life I was living could not continue as it was. It hurt too much. I hated myself too much. The shame that coated me from head to toe was too much for me to bear any longer, and my attempts to soothe myself with food created an eating disorder that endangered my health.

Starting at age 21 and continuing for at least ten years, I’d seen four or five therapists, some for just one session and others for several. I sought help when the anxiety, guilt, and shame that plagued me night and day were so severe that I couldn’t function. I couldn’t put my finger on the reason I was troubled, but I was certain of one thing: I was worthless.

No matter how much help I sought, however, any time the counselor nudged me toward acknowledging What Happened In My House when I was a child, I told myself lies: my stepdad is a different person now…I’m a self-centered baby for even thinking about what he did to me…I should just leave it all alone…I have no right to bring up history that is long over…Everyone in my family-of-origin has moved on, so what right do I have to upset everyone by dredging up the past?

And, by far, the most powerful of all the lies I told myself: It’s all my problem.

In the early 2000s, my husband, Daniel, sought counseling for relationship issues (with me, duh!) and it just so happens that when he asked me to find a therapist for him, I chose a clinical psychologist at random from our insurance’s list of providers: Matt E. Jaremko, Ph.D.

Within a couple of months of working with Dr. Jaremko, Daniel successfully learned the tools he needed, and I attended his end-of-counseling session. I’m not sure why I chose that time to do so, but I blurted out, I was sexually abused as a child.

It’s not like Daniel’s wrap-up session flung open my mental floodgates, suddenly making me aware of what my stepfather did to me from the time I was 8. The trauma I’d experienced hung over my life like the raincloud that follows Eeyore, and even though I pretended it didn’t matter, the scars left by Childhood Sexual Abuse (CSA) are not whooshed away like a child’s breath scatters dandelion seeds.

That October evening in Dr. Jaremko’s office, I will never forget his softly-spoken words and how he leaned forward in his chair: Bless your heart. If you ever decide you’d like to get help, I can help you.

I can only describe what happened about a month later as breaking. I did some batshit crazy stuff, lost my mind, and collapsed, inside and out. My family realized how damaged I was, which only made me more horrified and ashamed.

You know how it is when you remember where you were when you did something life-changing? I still recall making the phone call for my first appointment with Dr. Jaremko: I was too much of a wreck to teach, so I took the day off. My younger kids were at school, and I sat on a bed…stared dully at the dresser mirror after I dialed Dr. Jaremko’s office number and listened to it ringing…then my reflection was blurry, because the moment his receptionist answered the phone, I started crying. After setting a time to meet later that week, I slid to the floor and sobbed for what felt like hours.

Broken: so very tired of hating myself, and immeasurably frightened of trying therapy again.

A few days later, Dr. Jaremko—I would come to affectionately call him Dr. J.—and I began that metaphorical walk to Alaska, then back to Texas. Our journey was the hardest, scariest, most life-affirming, challenging, toughest, most illuminating, comforting, harrowing, most caring, humbling, fulfilling, steadying, life-altering, transformative experience I have ever known. Dr. J. was my teacher, guide, re-parent, safe person, and sounding board. He remained steadfast, and we completed that journey to which I owe my life. I wish for all people in recovery to have a talented and dedicated therapist. About a decade after completing my recovery journey, Dr. J. and I began to write this book so others might plan and begin similar journeys of their own.

Beth Fehlbaum

Mabank, Texas

Dr. Jaremko: Caring and Science

While there is no question that the relationship between client and therapist is an integral part of psychological treatment, those needing such treatment don’t have to wait around for a larger-than-life person to come along and rescue them from the chaos of their lives. Just as important—perhaps more important—is the body of knowledge that behavioral science has acquired about trauma and recovery. Therapists often get into the field because they care about others, so it isn’t that hard to find a nurturing person to help guide one through recovery from exposure to trauma. An equal or even more important part of finding effective treatment for Post-Traumatic Stress Disorder (PTSD) is the development of a sound scientific understanding of trauma. Scientific advancement in clinical psychology over the past 40 years has resulted in the formulation of reproducible sets of treatment procedures that offer relief and enrichment to trauma victims. Since trauma research shows that as much as 40% of trauma victims report growth in their lives after the trauma is eventually processed (Young, 2007), something else may be going on with trauma victims who develop PTSD.

Dr. Patricia Resick of the Duke University Medical School and her colleagues at the Veterans Administration found that PTSD is a disorder of being stuck in the pain, shame, and avoidance behavior of normal reactions to experiencing trauma (Resick, Monson, and Chard, 2017). Over the past 20 years, these clinical researchers have shown in many studies that a structured treatment program, Cognitive Processing Therapy, helps victims become unstuck, so that they can go on with their lives in meaningful and productive ways. In this book, we will present many of the procedures that Dr. Resick and others have used to help victims.

While Beth points out that her therapist (me) saved her, it’s more complete to say that a caring person with knowledge of accurate science and technology helped her get unstuck from years of being trapped by destructive feelings and avoidance behavior, a major component of which is lying to others as well as oneself, usually by hiding important information from others. Beth learned the skills of healthier cognitive processing through our work together, and her life got much better. The thing that saved her life was her effort, guided by me, her therapist.

More importantly, it is entirely possible for others (like you, dear reader) to find that the powerful combination of a caring person plus scientifically derived knowledge can result in being able to construct a better life by finding ways to face the fears and emotions that paralyze victims.

Our goal with this book is to plant this seed in your mind: Hope is possible and can be manufactured by caring and knowledgeable people. Enjoy our attempts to enlighten.

MEJ

Dallas, Texas

Beth Explains the Difference between Dr. Jaremko and Dr. Matt

To be clear, there are two Dr. Matts: my co-author, Dr. Matt E. Jaremko, who is a clinical psychologist, and Scott Dr. Matt Matthews, a character based on Dr. Jaremko.

Our book’s namesake is the fictional Dr. Matt.

Confused? I’ll explain.

Nearly a year into my treatment with Dr. Jaremko, I coped with overwhelming emotions as I always had: by writing. I churned out a continuous stream of poems and essays, most expressing unbearable grief and volcanic rage. It was as if my mental and emotional scars were oozing with infection, and the only cure was to write in a way that scraped away the layers of denial, down to the marrow of my bones.

I shared my writings with Dr. Jaremko—and only him—because he was the only person in my life whom I could saddle with the black-and-white evidence of pain, horror, and desperation that I was absolutely boiling with, 24/7. I kept a lot from my husband, who was heavily carrying the parenting load for our three teen daughters, because I was struggling so much to keep doing my life, while my mind was flooding with memories.

In one of our sessions, Dr. J. said, You know, you’re very talented. Why don’t you try writing a novel?

Even though I’ve been a wordsmith of feelings ever since I could hold a pencil, I learned pretty quickly that writing a novel is not something I could just do by opening my emotional veins and leaking all over a page. I spent the fall and early winter attempting to craft characters and dialogue, but I remained stuck inside a vortex of unanswerable questions: "How could my mom choose my perpetrator over me?…How does a mother know this stuff happened and not seem to care?…Why don’t I matter to her?"

I still remember the moment when, frustrated with my lack of progress, I decided to step outside myself and allow someone else to ask those questions. I began to imagine the moment a sexually abused teen tells her mother what her stepfather has been doing to her, and the mother does not do anything to protect her from him. I knew all too well the girl’s response: it’s like her heart and sense of worth break into shards of glass.

Sounds familiar, right? I know what you’re thinking, but…the difference is, this imaginary girl does something I never did (until I met Dr. Jaremko, that is): she tells someone—in the girl’s case, a teacher—what is going on at home, and the teacher contacts Child Protective Services. Action is taken to protect the girl. At that crucial moment that made all the difference in her life, the girl became more than a vague placeholder to me. Ashley Nicole Asher, age 15, was born on the spot, and—although I had no idea at the time—so was my career as a professional novelist.

I created a world for Ashley where she is removed from her mom’s home and placed with her father, David (a man she’s had no contact with since infancy) in Patience, a small Texas town. And it just so happens that Ashley’s dad and stepmom find an experienced clinical psychologist for her: Dr. Scott Matthews—whose patients call him Dr. Matt.

Cue the obvious conclusion: I based this character on Dr. Jaremko. I disguised his age, appearance, and what his office building was like, but other than that, the portrayal is mostly spot on.

Ashley’s story is fiction, although many of her experiences of abuse are similar to my own. As I wrote, I was able to more objectively observe her agonizing quest to find answers to those impossible questions, and I was a fly on the wall for her intensive therapy sessions with Dr. Matt. For example, a central conflict of the book is Ashley versus self, as she struggles to perceive herself as her therapist does: a courageous person who has what it takes to stay the course, even when it’s scary as shit. It’s no coincidence that the title of the book is Courage in Patience.

I learned that not only could I share what I wrote with Dr. Jaremko, but I could also talk to him about anything—and—in spite of the shame and self-doubt that shackled me, his opinion that I was a brave, resilient survivor remained intractable. (Not that he didn’t tell me when he thought I was out of line or off course: he has no patience for bullshit from anyone, and he doesn’t dish it out, either.)

Upon completion of the novel, Dr. J. told me that what I’d written was very good and could help a lot of people. I decided to go for it: I found a literary agent, and she sold Courage in Patience to a publisher. Next, I wrote Hope in Patience, and, two years later, Truth in Patience. About the time I wrapped up writing the third book, I knew that I was nearing the end of my metaphorical journey from Texas to Alaska, and soon after concluded my therapeutic relationship with Dr. Jaremko.

One thing’s for sure: it’s not a future I could have forecast when I started that journey. I would never have dreamed that I could not only survive, but thrive, and that many years later, I’d be co-writing a book with Dr. J., using the character I based on him—Dr. Matt—as a vehicle for helping others on their trauma recovery journey.

Trauma Recovery: Sessions With Dr. Matt: A Convergence of Storylines Toward Hope and Recovery

This book could be categorized as creative non-fiction, a term literature experts use to describe writing that presents non-fiction material through the aid of fictional storylines. We took two characters (Dr. Matt and Ashley) from Beth’s The Patience Trilogy—Courage, Hope, and Truth—and created a group therapy scenario led by Dr. Matt and attended by Ashley—she’s now 19—and several other members, to illustrate how recovery can and does happen. Of course, our characters are amalgams of people we have known and with whom we have worked. We could not present cases about real people for confidentiality reasons, but we can describe the therapy context and process in a realistic manner by using the literary license provided by creating storylines. Although these are all fictional characters, please think of them as actual people. The situations they survive, their struggles, triumphs of reclaiming their lives, and potential for thriving are all realistic. Our purpose in using this unique amalgam of non-fiction and fiction is to deepen the understanding of PTSD and allow for a fly on the wall perspective of observing the recovery process. Our narratives of seven individuals struggling through the process of trauma recovery allows the reader to get an idea of what the various possibilities of recovery might look like. To the victim, the actual trauma is only the first part of the story. What comes after it is a narration yet to be composed. Recovery requires developing a new and healthy narration of one’s life (Meichenbaum, 2012). Hopefully the reader can obtain inspiration here for his or her own recovery storyline.

Preceding each of the first six chapters, you will find the backstory for a fictional participant of Dr. Matt’s Thursday Night Group therapy sessions. These sections are easily identifiable because they are in italics, and when fictional scenes are embedded within a teaching chapter, they are also in italics.

Group Member Backstory # 1 Ashley: The Road to Patience Is Paved in Pain

From the time her stepfather began molesting her as a young child, all of Ashley Nicole Asher’s energy went toward avoiding the horrid facts of her life.

Six years after the abuse began, Ashley made an outcry—a report of the abuse—to her mother, but her mother took no action. The next day, a school friend noticed that Ashley was extremely distraught. After finding a note on a napkin in Ashley’s lunch that asked Ashley to apologize to Charlie for upsetting him, Ashley’s friend put 2+2 together and insisted that Ashley make an outcry to their trusted teacher.

This led to Child Protective Services removing 15-year-old Ashley from her mom and stepdad’s home and placing her with the biological father and his family, whom she had never known. However, just because she was taken from the home where the trauma occurred, she was not necessarily free of it.

Charlie, the molester, was in the Dallas area, at least 100 miles away from Ashley’s dad’s home in Patience, Texas, but when she freaked out, Ashley hid in the pine wardrobe in her room. It was a large dresser with double doors that opened to drawers on the right side and a space for hanging clothes on the left.

To Ashley, this oversized piece of furniture represented a suitable substitute for her closet, which was her hiding place in her family-of-origin’s home. In the dark, small space, she held her breath, just as she did when she watched for light around the door from inside her closet, where she’d pray with every cell in her body that Charlie would not open the door and discover her in the only place she felt safe.

Soon after Ashley arrived in Patience, she received a letter from her maternal grandmother in which the woman demanded that Ashley apologize to her parents for lying about being abused. Her grandmother was previously one of the most comforting people in Ashley’s life, and these harsh words sent Ashley spiraling into self-destruction. Inside the pine wardrobe, Ashley clawed her face and neck, created deep wounds, and dissociated.

When she popped back into awareness, her face throbbed, and her fingertips felt warm and wet. She was inside the wardrobe, staring at her hands, and she was surprised that her grandmother’s letter wasn’t still between her fingers.

TAP-TAP-TAP.

Apparently she’d closed her door when she’d gone to her room. The wardrobe door opened slowly, and her stepmother, Bev, leaned in. Ashley turned her face to the back wall of the dresser.

Ashley?…Honey, I read the letter your grandmother sent you. Don’t pay attention to her. She doesn’t know what she’s talking about. She must not know the whole story. Can you hear me? Will you look at me, please?

When Ashley faced her stepmother, the woman gasped at the self-inflicted injuries.

Ashley’s stepbrother, Ben, who stood in the doorway, asked, What’s going on, Mom? Why’s she sitting in there like that?…Is that…blood on her face?

Ben, please go call your dad. Tell him we need him here.

Bev? Ashley’s voice sounded to her like it was coming from someone else.

Yeah, Ash?

Could you close the door, please?

She did as Ashley asked, leaving the girl covered in darkness again.

Moments later, Ashley’s father, David, opened the wardrobe door all the way and spoke softly. Hey, girl, looks like you did a job on your face. Come on out of there and we’ll get you cleaned up.

Ashley didn’t move. She wanted to do as David asked, but she was so lost inside herself that she couldn’t even show him that she heard him. She questioned herself, knowing the truth about her mother and Charlie, but she experienced a collision between her ability to comprehend it and the horrifying reality of what she had been subjected to endure. She couldn’t stay around when the crashing happened; she had to get away, to get inside herself so deeply that no one could touch her, or at least she wouldn’t feel it if they did.

David scooped Ashley out of the wardrobe, and when he picked her up, she thought he was Charlie. She kicked her legs, clawed at him, looked right through him, and screamed, No! No, Charlie, no! Mama! Mama!

David panicked. Bev, we’ve got to get her some help. Ashley’s going to need a lot more than you and I can give her.

The frightened parents chose an experienced psychologist from their list of insurance providers: Scott Matthews, Ph.D. Soon thereafter, Ashley began treatment with Dr. Matt, and she remained thus for the next four years.

Now 19, Ashley is preparing to leave the safety of her parents’ home and the support of the Thursday Night Therapy Group. She will venture into the world on her own, as a freshman in college.

Chapter 1

Come On In

Take a seat or be a fly on the wall, but either way, you’re about to embark on the journey of your life. Welcome to Trauma Recovery: Sessions With Dr. Matt. If you are a survivor of sexual abuse or assault, please accept our especially warm welcome. We know how scary it is even to pick up a book that deals with the truths of trauma recovery, much less begin reading it.

Trauma Recovery: Sessions With Dr. Matt is a starting place for hurting people who are seeking healing, either on their own or in partnership with a therapist or other helping person. Dr. Jaremko will be your guide, maximizing your understanding of Post-Traumatic Stress Disorder (PTSD) by explaining its origins in easy-to-understand language and offering insight into the process of reclaiming your life from trauma. Beth Fehlbaum will share her insight from the perspective of a recovering person.

We encourage you to read Trauma Recovery: Sessions With Dr. Matt from beginning to end. In these pages, you will find a variety of methods for teaching vital concepts you need to know in order to get the most out of treatment for the recovery from PTSD.

Books, music, movies, videos, and television can be powerful inspirational tools for healing, understanding, and reflecting. At the end of each chapter, we reference a chapter playlist in keeping with our journey metaphor: Songs and Films for the Road. All of these playlists can be found on the website for this book, drmattbook.com. Our recommendation of these implies no ownership: it’s simply good stuff. Take what you like and leave the rest.

The Perfect Playlist as Inspiration for Resilience

As stated in the Introduction, the relationship between therapist and client is integral to recovery. For an example of how multimedia inputs can set up and aid the relationship part of the process of recovery, Beth’s story about the first phase of her own treatment is presented below. It shows how the relationship between Dr. Jaremko and her was made strong and collaborative by using a playlist of music relevant to her life: past, present, and future.

Beth: How Music Inspired My Recovery

I sent Dr. Jaremko an email a few months after my therapy started. The subject line: Things I know for sure: (a convergence).

I don’t remember everything I said in the email, but I do recall the essence of it, which was: I am utterly alone. The most important people in my life (that is, my husband and three teenage daughters) have no understanding of what I’m going through. I am in unfathomable pain, and I am angry. My mom doesn’t love me and probably never did, or she wouldn’t have let my stepfather get away with what he did to me, much less choose him now, when she knows how severely it has impacted my life. Why did I even start this journey? I can’t do this. It’s too fucking hard, and it hurts way too much. Besides, Dr. Jaremko is bringing up the idea of facing the truth when I interact with my mother and stepfather. Good lord, the man wants me to give up my lie(s)!

I’m sure I did not say it overtly, but I know for certain that I was thinking it: I’m about to quit therapy, and I’m going to quit it by killing myself.

It’s been over a decade since I, a middle school teacher at the time, sent that email during my conference period in my classroom, yet I can so easily recall the ache in my chest; the inability to see my words on my computer screen, because I was crying. I’d written it because I had to get the feelings out, and Dr. Jaremko was the only person I could tell.

His response to my email: Sounds like an April blizzard on the Canadian high plains. Shawn Colvin wrote a terrific song about it a few years ago, entitled ‘Steady On.’ He pasted the lyrics under those words.

Here’s the thing: I was amazed that Dr. J. even responded to what amounted to a ranting self-pity party. The way he reached out to me was a simple gesture, but nonetheless different from what I had experienced with other therapists.

At my next appointment, Dr. Jaremko handed me a CD of music he titled, Steady On. In addition to Shawn Colvin’s song, Steady On, there were 11 other songs on it.

Over the next few months those 12 songs were a constant in my life. I listened to the playlist as I went to sleep at night, and when I woke with nightmares. In my car, my teen daughters sighed heavily any time I slid the CD into the player. Although I might have said to them, No, it’s my turn to pick the music, the reality was, I am breaking apart, and I need this to soothe myself.

These deliberately chosen songs had an incredibly powerful impact on my ability to recover, because of the way I internalized the messages in the lyrics. I often thought the songs were about me directly, and how uncanny it was that Dr. J. seemed to know me so well that he could pick such applicable songs.

The powerful combination of music and metaphor adds greatly to the behavior change process, and it was no different in my recovery journey. Opportunities for healing that carefully chosen music can inspire are compelling. To give you the scoop on just how inspiring this first CD was for my recovery, we have replicated the Steady On playlist on our website, drmattbook.com. The descriptions accompanying each song amount to a Writing Duet between Dr. Jaremko and me.

I explain why each song on the CD was meaningful to me—a seriously damaged person at the time—and Dr. Jaremko indicates his reasoning for including the song on the playlist. From the day he gave me that CD, I felt less alone and more confident that I was working with someone who knew what he was doing. Dr. J. has since pointed out that he used music tapes and CDs for decades as an aid to help others cope with life difficulties and create new histories of healthy behavior. He estimates that he created nearly a hundred mix tapes, each individually tailored to clients and students with whom he worked.

Music aficionado that he is, Dr. Jaremko has an innate ability to choose just the right song. His expertise calls to mind the main character, Rob, in Nick Hornby’s book, High Fidelity (Hornby, 1995), which was made into a movie (Frears, 2000) in which John Cusack, as Rob, evaluates his life and shares his emotions with others in the context of insisting on the just-right songs to communicate what he was thinking.

Fiction + Teaching = Another Tool for Teaching Resilience

The successful use of therapeutic music that got Beth’s recovery journey rolling is just one example of how therapists try to inspire their clients to take on the huge challenge of facing the truth about their traumatic experiences. To aid your understanding of this challenge, we narrate the stories of a half dozen or so characters who have been traumatized and are stuck in fear, shame, and avoidance. We knew that a component of Beth’s healing—writing about her trauma through the eyes of fictional characters—could be utilized in tandem with teaching the vital concepts needed for recovery from PTSD.

Trauma Recovery: Sessions With Dr. Matt: Step into the Office

The trauma victims meet in Dr. Matt’s counseling office every Thursday evening for an open-ended group therapy session for victims, survivors, and righteously indignant angry folks. Dr. Matt’s consideration for their comfort compels him to hold the sessions at the end of the day. He wants no one else in the waiting area when these traumatized individuals gather.

Because of the open-ended nature of the group, some members come every week, others only once or twice a month, and the membership roster is fluid. In fact, Dr. Matt has a secondary waiting room in his office so that new group members can wait by themselves before their first session, if they prefer to avoid interaction with people they have not met before. He knows that newcomers are already anxious; when traumatized people venture into the brave new world of group counseling, further stress may send their nerves spiking into the stratosphere.

Group members do not have to pay money for these sessions. Oh, Dr. Matt certainly bills insurance companies (if group members have the coverage for group sessions), but only because he has to pay the air conditioning bill in Texas, where summer seems to last all year. Ask him about his reasoning, and a smile slyly darts across his face. I reckon it’d be re-traumatizing to gather a half a dozen or more overly sensitive people in one relatively small room without conditioned air, to say nothing of how grouchy they’d get. I just might get cranky, too.

One sort of payment, however, is required. Both the real-life Dr. Jaremko and fictional Dr. Matt were inspired by Dr. Donald Lee Whaley, their University of North Texas professor who demonstrated the power of behavior exchange in helping people heal. Dr. Matt asks that group members sign an agreement (behavior contract) wherein they agree that for every four group sessions, they will volunteer one Saturday a month for the Dallas-area Habitat for Humanity. There, they help build homes for their neighbors who are struggling in a different way than they are. As will be seen later, volunteering to produce something concrete appears to be an important part of the treatment process. Group members engage in action outside of themselves and their comfort zone. Many times, these acts of altruism add balance to their lives, increase the capacity to cope with PTSD stress, and build a new life direction. Additionally, because group members often take part in these volunteer opportunities together, they form a bond. Group cohesion is an integral part of healing from PTSD.

Dr. Matt will be the first to tell you that the main event in PTSD treatment is the 12-session structured treatment, or something quite like it, called Cognitive Processing Therapy (CPT). Group therapy such as Dr. Matt offers his Thursday Night Group is not the first step for a person seeking recovery from trauma. It’s important to note that in addition to being in the PTSD therapy group, all of the members have had some form of individual PTSD assessment and treatment from Dr. Matt or someone like him. If they haven’t had the structured form of PTSD treatment called Cognitive Processing Therapy (CPT) (see Resick, Monson, and Chard, 2017), Dr. Matt makes sure they get this 12-session, highly structured training, which provides the initial teaching of coping skills and understanding of PTSD that the group member will need to complete a successful recovery journey.

Thus, the group therapy for which you will have a fly on the wall perspective is a supplemental treatment for PTSD sufferers who have gone through the process of carefully facing the trauma in their lives, learning new ways to think, feel, and act about such trauma, and who have begun to experience improvement in their lives. In this way, the group acts as a way to maintain treatment gains, as well as deal with hiccups and regressions along the way.

A brief listing of the 12 sessions of CPT is in Appendix B, and it can also be accessed from a variety of sources and therapists (Resick, Chard, and Monson, 2016). Some of the treatment steps and exercises used in CPT will be presented in the group sessions that follow. Usually, these therapeutic procedures are repeated within the group context, because one of the members regressed or is going through a rough spot. Repetition is one of the more common ways that learning can be successful, and Dr. Matt’s group members repeat treatment tasks fairly often. Practice does make perfect, after all.

Dr. Matt’s Rules of the Road: What a Well-Run Group Therapy Session Looks Like

The group sessions maintain some structure and a few rules to guide the intrepid sojourners who show up on Thursday nights. Every session begins with Dr. Matt asking, Does anyone have anything they would like to bring up before we begin tonight’s topic?

This query is often all that is needed to pull together previously discussed material. By sharing at the start, group members come to know much about each other’s lives. They express ongoing interest, sometimes sympathetically and sometimes morbidly. Sharing enables members to apply what they have learned prior to the current session, and sometimes this becomes the topic of the day.

At other times, however, the session focuses on a particular PTSD symptom. Dr. Matt begins by teaching about the science behind the symptom, and members may choose to share their experiences with it. It is not unusual to find that what starts out on-topic wanders far from the symptom. He usually allows this free-range verbal activity, unless it is deemed to be destructive avoidance behavior, in which case he gently but firmly calls out the rambling party for behaving in an unhealthy manner in front of all these other sincere individuals who want and need the truth. These confrontations, however, are rare, because the group’s long-timers recognize avoidance when they see it, and they are not shy about nailing the offender.

Still, formal rules are in place to ensure that participants are treated with respect. For example, showing up for therapy while under the influence of mood-altering substances is not allowed. Shouting and cursing are forbidden, and any sort of physical violence toward others is met with immediate dismissal. Should an unruly person refuse to leave, the local sheriff and his deputies are more than happy to be on Dr. Matt’s doorstep within minutes. They’re so grateful for the help he’s given traumatized officers over the years that they’d post an officer on-site 24/7, if he asked them to do so.

The other set-in-stone component is the wrap-up at the end of every session, where each member is asked to finish the sentence: What I got out of the group tonight was… At that time, they can add any other concerns and complaints they have. In this manner, every group member makes at least some contribution to the group process. It’s rare to have someone who does not want to speak at length, because the caring, well-defined environment of the sessions provides the structure and safety that members crave.

In addition, Dr. Matt is usually able to get group members to put a positive and hopeful spin on the eventual resolution of the tough stuff being faced. That’s not to say anyone is allowed to bury his or her head in the sand, but all are reminded that stuff gets better when it’s worked on intelligently.

Meet Your Traveling Companions: The Members of the Thursday Night Therapy Group

Ashley, age 19, who was sexually abused by her stepfather from age 9 to 15; her mother displayed deliberate indifference to Ashley’s outcry for help;

Hunter, age 32, who woke on the ground in the dark after a rain-wrapped tornado destroyed his mobile home, critically injuring his toddler daughter;

Felicia, age 34, who, at age 14, was nearly raped by her brother’s friend; 20 years later, she is still haunted by it, but needs to come to realize an even darker truth about her youth;

Ben, age 20, who saw combat horrors in the Middle East and returned home a fundamentally different person;

Patty, age 47, who lost control of her car, with her husband being killed when they hit a semi-truck;

Jake, age 30, an Emergency Medical Technician (EMT) who responded to a hate-crime shooting at a local church’s Wednesday night prayer service. The son of a preacher, Jake lost his faith as a result of what he saw.

In addition to this crew, you will occasionally run across one or two graduates of Dr. Matt’s Thursday Night Group. These members no longer attend weekly. Instead, they check in when they need a tune-up: a reminder of what they learned in their journey to recovery. Once in a while, Dr. Matt asks them to attend, because current members need a shot of hope by virtue of seeing a success story.

First, we have Darrell, age 35, who served time in prison for armed robbery. When he was released, he entered therapy to seek solutions for the frequent rages that overtook his decision-making abilities. Through his work with Dr. Matt, Darrell learned new ways of interacting with others. He joined the Black Lives Matter movement and discovered his passion for making a difference through teaching young African-Americans about non-violent protest.

In addition, there is Betty, age 40. Her family-of-origin abandoned her when she began coming to terms with the sexual abuse perpetrated on her from a young age. Betty worked with Dr. Matt and gradually found the strength to rebuild her life. She entered college as a nontraditional student and became a bilingual education teacher, where she puts her native Spanish to work.

Necessary and Sufficient Conditions for Change

Trauma Recovery: Sessions With Dr. Matt is a guidebook—like a road map—not a self-help book. We say this because the PTSD recovery journey is, frankly, hard. It can feel overwhelming, and the guidance of a mental health professional is strongly—and we mean, strongly—suggested.

Science supports our position: researchers who study the effectiveness of psychological treatments often use the concept of necessary and sufficient when they investigate the ingredients of successful treatments (Lambert, 2004).

Baking a cake can serve as an example of the necessary and sufficient concept. Flour and eggs are necessary ingredients, but they are not sufficient to make a decent cake. Also needed are butter and some form of sweetener. But wait! Those four ingredients (flour, eggs, butter, sweetener) are necessary, but not yet sufficient. The cake will be less than successful without salt, baking powder, and milk.

So, a successful recipe for cake has several necessary and sufficient ingredients. The cake only works when all are present. When something is missing, the cake is less than tasty. Successful treatment of recovery from trauma is like that, as well: there are several ingredients that must be present, at the right time, for recovery to take place.

While most bakers are familiar with the components that come together to produce a cake, the most effective combination of ingredients for successful PTSD treatment remains less well known. In this book, however, we are operating on the premise that there are at least four ingredients to a treatment that successfully helps people get unstuck from trauma. Many will rightly say there are more than those we list here, but, based on 30 years of experience treating PTSD, Dr. Jaremko believes that these four ingredients have to be present somewhere in the treatment process for a victim to become unstuck from the patterns of negative emotions and avoidance behavior of PTSD:

1. Finding a guide: A teacher, counselor, or therapist, very familiar with the victim’s unique history of trauma and symptoms, is a necessary condition for PTSD treatment. It’s a big plus when this guide is empathic, collaborative, structured, and has a good sense of timing. Donald Meichenbaum, a highly respected cognitive-behavioral therapist, has written extensively about the role of a therapist in executing core tasks for successful treatment (Meichenbaum, 2013).

2. A critical mass (the minimum amount of something required to start or maintain a venture) of episodes of being truthful with oneself and others about certain details of one’s traumatic experiences, especially if shame is involved. These episodes can be called leaps to truth, and many times, facing truth can—and is—merely a slight change in how one’s life is described. It does not have to be a harrowing, soul-searching descent into catharsis or public confession. More typically, it comes in the form of small but important changes in the truth and authenticity with which the trauma is viewed. The common feature of these leaps to truth is that the victim in some way feels good about having been more brave in facing or telling the truth, while at the same time feeling relieved he/she no longer has to use energy on lying or hiding.

Don’t worry if this ingredient is not clear to you yet. We discuss it in a later chapter about Self-Efficacy, which is the process of believing that one is capable of doing something; for example, a person showing bravery when facing the truth about life. PTSD victims who are stuck are certain they cannot be truthful about their lives. The inflexible belief that nothing can be done has to change in order to overcome PTSD.

3. Learning and using new more effective coping skills is necessary. These skills include, but are not limited to: management of stress, pain, and discomfort, as well as better emotional regulation, social communication, and clearer thinking. As stated, it is not only a requirement that these new skills be learned; they must be applied in increasingly more meaningful life circumstances. Appendix B contains many of these skills as they are taught in Cognitive Processing Therapy for PTSD: A Comprehensive Manual, the 12-session structured treatment used by Dr. Patricia Resick et al. (2014).

4. Group involvement is especially helpful to motivate and maintain the arduous and uneven process of trauma recovery. Many times, the group is just a family-based support system whose members know about the victim’s recovery

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