Secondary Gains and Trauma Treatment-Dr. Arielle Schwartz

A Compassionate Approach to Care

Holistic Transformation Dr. Arielle Schwartz

This post addresses a difficult subject matter in regards to secondary gains in the treatment of chronic pain and illness. Hopefully, you will find that I bring a compassionate lens to the topic. A view that recognizes the frustrations that can arise when complex psychological factors are not addressed in trauma treatment and a perspective that does not blame the client.

Traditionally, the term secondary gain has been linked to clients who exaggerate physical symptoms of pain or illness or who fail to improve in treatment in order to receive certain advantages such a financial or housing support. However, clients who malinger or create factitious symptoms are actually quite rare. It is much more common that secondary gains aim to attend to deep unresolved attachment wounds or they are a way to achieve recognition of legitimate suffering. A concept closely related to secondary gains is the understanding that coupled with these gains are their related losses. Such losses are the genuine needs that are not being met in the client’s world currently.

“If you feel frustrated that your symptoms of pain or illness are not going away it can be valuable explore secondary gains sensitively and compassionately. This post attends to the importance of recognizing secondary gains in a way that does not blame you, the client. The goal of identifying secondary gains is to provide clarity about trauma targets that need to be addressed in order for treatment to be successful.”
-Dr. Arielle Schwartz

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EMDR Therapy and Somatic Psychology Dr. Arielle Schwartz

Mind and Body in Trauma Treatment

EMDR Therapy and Somatic Psychology Dr. Arielle Schwartz

Image credit: Neuthaler

Effective trauma treatment requires a holistic way of addressing cognitive, emotional, and somatic symptoms. Traditional therapy attends to the cognitive and emotional elements of traumatic experience, the somatic experience is often left out of the room. EMDR Therapy uses a structured protocol for the treatment of post traumatic stress and related emotions, beliefs, and sensations. The traditional EMDR Therapy protocol already includes somatic awareness; however, interventions that enhance embodiment amplify body awareness in treatment.

“Therapists trained in the combined use of EMDR Therapy and Somatic Psychology have advanced tools to work with post traumatic stress. This post describes the importance of working within the “window of tolerance” to avoid re-traumatization in therapy. Read on to learn the difference between top-down and bottom-up processing. This post concludes with a practice of listening to your body for better self-care.”
Dr. Arielle Schwartz

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Yoga for Chronic Pain-Dr. Arielle Schwartz

Based on the Principles of Therapeutic Yoga

Dr. Arielle Schwartz Therapeutic Yoga

This post is part-two of a series on therapeutic yoga for chronic pain. Part-one provided the science behind the mind-body-pain connection and explored the role of the brain in pain, how trauma exacerbates chronic pain, and why we need to move to heal. In this post, I apply the principles of therapeutic yoga to working with chronic pain conditions such as fibromyalgia, migraines, or back pain.

Yoga is a comprehensive and holistic approach to healing mind and body that involves meditation, breath awareness, spiritual inquiry, and living an ethical life. The word yoga is translated as “union” or to join together the mind and body through disciplined self-awareness. In most yoga classes, a teacher guides you to move with the breath, to focus your mind in the moment, and to cultivate a sense of curiosity about yourself. Within therapeutic yoga, personal inquiry becomes your greatest teacher. There is a decreased emphasis on the directives of an outer teacher guiding the outer shape of a posture and an increased focus on sensory awareness guiding intuitive, healing movements.

“Chronic pain experiences are often debilitating and can be life changing. It is common to feel powerless and overwhelmed. It is important to have predictable practices that offer relief for body, mind, and spirit. The principles of therapeutic yoga for chronic pain provide you with guidelines for your practice.”
-Dr. Arielle Schwartz

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Chronic Pain Relief-Dr. Arielle Schwartz

Reclaim your Body from Pain

Chronic Pain Relief Dr. Arielle Schwartz

When you sense and feel your body you are better able to take care of yourself. It’s sounds simple, right? We are more likely to recognize if we feel hungry, thirsty, need to go to the bathroom, or need to rest when we are attuned to our sensations. Try it by taking a deep breath. Are you able to notice any areas of stiffness or discomfort in your body? Do you sense a desire to adjust your posture to better support your spine or to create a feeling of opening across your chest?

This may sound simple, but, truth be told, for many people it’s really not that simple…especially if you have a history of trauma or chronic pain. You might find it very difficult to tune into sensations. It might feel safer to avoid feeling your body because you never know when you might feel the next uncomfortable, aching, or burning sensation.

“If you have a history of trauma or chronic pain, you may need to relearn the art of listening to your body in a safe and slow manner. This post is part one of a two-part series on chronic pain relief and explains the science behind the mind-body-pain connection. Read on to learn the role of the brain in pain, how trauma exacerbates chronic pain, and why we need to move to heal.”
-Dr. Arielle Schwartz

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Businesses in Bloom Podcast-Dr. Arielle Schwartz

An Interview with Dr. Arielle Schwartz

This interview on the Businesses in Bloom Podcast with Juliet Austin looks at topics of my personal journey as a psychologist and author. Within, I share stories of my own work-life balance as a wife and mother of two. If you are building a psychotherapy practice and are curious to learn more about how social media, website support, and cultivating a successful business, check this out.

Dr. Arielle Schwartz

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EMDR Therapy for Complex PTSD-Dr. Arielle Schwartz

Is EMDR Therapy Appropriate for C-PTSD?

EMDR Therapy

Quite regularly I receive inquiries from clinicians and prospective clients asking me if it is appropriate to use EMDR Therapy for complex PTSD and childhood trauma. My short answer is yes, EMDR Therapy is an incredibly valuable therapeutic for treating C-PTSD; however, this powerful modality typically requires careful modification to attend to dysregulated and dissociative symptoms that often accompany early developmental abuse or neglect.

EMDR Therapy is an 8-phase treatment modality that systematically allows clients to process traumatic material and resolve lingering emotional, mental, and somatic distress. This post describes some of the most common modifications as related to the 8-phases that allow clients and clinicians to work together safely using EMDR Therapy for complex PSTD.

“Chronic, early developmental trauma memories are often preverbal and tend to be accompanied with dissociative symptoms. Therapists must emphasize the importance of resource development and careful pacing of EMDR Therapy so that clients feel safe in the present moment. You achieve successful treatment outcomes when you slowly build tolerance for the emotions and body sensations that accompany traumatic memories. The once overwhelming symptoms of C-PTSD can resolve as the client learns to turn toward pain and suffering with greater awareness and compassion.”
-Dr. Arielle Schwartz

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Preventing Therapist Burnout-Dr. Arielle Schwartz

Embodied Self-Care for Therapists

Preventing therapist burnout Dr. Arielle Schwartz

This post focuses on the importance of self-care for therapists who work with trauma. Without a commitment to self-care, maintaining a practice focused on the treatment of PTSD can have a significant impact on the mental, emotional, and physical health of the therapist. You can think of this impact as existing on a Burnout Continuum that begins with relatively mild caregiver stress that builds over time progressing into compassion fatigue, vicarious trauma, secondary trauma symptoms, and, in the worst case, into complete burnout. Trauma counselors, such as those who practice EMDR therapy or Somatic therapy, need to have sufficient support to process the mental, emotional, and physical weight of the traumatic material that they are exposed to. Otherwise, it is common to begin to feel weighed down by the heaviness of this work and, as a result feel tension in the body, fatigue, and emotions of anger or resentment.

Clients with trauma often come in with extreme states of high or low arousal. They might be trembling with anxiety and panic, flattened by depression and despair, or numbed by dissociation. The psychophysiology of these states can be induced in therapists. When therapists recognize that they have joined with the physiology of the client they are better able to engage their boundaries or explore valuable self-care strategies. In addition, we must remember that therapists are people first. We come into the field of trauma work with our own historical wounds and injuries. This work tends to flush to the surface personal unfinished business such as unprocessed traumatic memories or attachment related material.

“We must take a preventative approach to mitigate therapist burnout by addressing risk factors and responding to early symptoms of caregiver stress. Too much empathy can have negative repercussions. A therapist must first start by resourcing and re-energizing the self. A therapist who focuses on self-regulation during a session can serve as an important model for the client. This process also allows the physiology of the therapist to be an available, present-centered resource for the client.”
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Embodiment in Somatic Psychology-Dr. Arielle Schwartz

The Body’s Wisdom

Embodiment and Somatic Psychology Dr. Arielle Schwartz

Like most of us, I can become disconnected sometimes. For example, when I spend too much time at my computer; after a while I can find it difficult to sense and feel my body (ironically, this occurs even when I am writing about embodiment).

The truth is, it is easy to disconnect from the sensations of our bodies. Why? We are simply taught to forget. Western culture values the intellect—thoughts, judgments, verbal analysis, mathematical abilities, and logic. It is unusual to go to school and have a teacher ask, “what are you sensing in your body?” Rather, most of us were trained to be “good” by sitting still and paying attention to external sources of information. At home, we adhered to family rules and rhythms. Sometimes these external rhythms do not match our personal sensations but we learn to adjust. In situations of traumatic neglect or abuse, you might have had to disconnect from your body to survive.

In therapy, a traditional approach emphasizes verbal processing and cognitive meaning making (talk therapy). However, somatic therapy helps you access additional pathways for healing by focusing attention on the embodied experiences that coincide with the verbal exchange. Somatic psychology centralizes body awareness as a primary healing agent in psychotherapy; taking the therapeutic experience beyond where words can take the client. This allows you to focus on unwinding the stories held within the body.

“Embodiment is the practice of attending to your sensations. Awareness of your body serves as a guiding compass to help you feel more in charge of the course of your life. Somatic awareness provides a foundation for empathy, helps you make healthy decisions, and gives important feedback about your relationships with others. Embodiment in somatic psychology applies mindfulness and movement practices to awaken body awareness as a tool for healing.”
-Dr. Arielle Schwartz

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Complex PTSD Preverbal Memories Dr. Arielle Schwartz

Healing Childhood Trauma

Resources for Trauma Dr. Arielle Schwartz

Early childhood traumatic events include experiences of neglect, feeling like you didn’t belong or were unwanted, or feeling chronically misunderstood. You might have grown up in a family where your parents had unresolved traumas of their own, which impaired their ability to attend to your emotional needs. Or, in more extreme situations you may been exposed to dangerous abuse. Chronic unresolved childhood trauma is referred to as Complex PTSD (C-PTSD).

Psychologist and neuroscientist, Dr. Allan Schore identifies that our earliest preverbal memories are neither verbal nor stored as images. Instead, they exist as motor patterns and sensations. They are blueprints of our earliest relationships represented by psychophysiological arousal and emotion. Even once a child develops language, traumatic memories are often stored in a disorganized fashion. If you experienced childhood trauma, you may feel burdened by physical and emotional pain or feel haunted by fragments of disturbing memories.

“In order to successfully work with preverbal memories, you must find a way to access the somatic experience related to these early interpersonal exchanges. It is important to know that you can heal C-PTSD. Even though the path to healing can feel daunting, remember that all journeys start with a single step.”
-Dr. Arielle Schwartz

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Boundaries and the Self-Dr. Arielle Schwartz

Boundaries and Relationships

Complex PTSD Dr. Arielle Schwartz

This post addresses the role of boundaries as instrumental to healing trauma, especially childhood trauma. Boundaries are the limits that help to define the self. They create the distinction, “this is me and that is you.” Boundaries are meant to be adaptive and responsive to our environment. For example, when you feel safe, your boundaries can be more flexible allowing for greater emotional or physical intimacy with another person. However, when you feel threatened or are unsafe your boundaries become more defined and can help you protect yourself by saying “no, this doesn’t feel good.”

“Without a boundary, you will be more likely to give in to others. With too rigid of a boundary, you risk feeling isolated. Having clear boundaries helps you adapt the level of emotional or physical intimacy in the moment. Healthy boundaries help with decision making and allow you to take responsibility for your actions and thoughts. Maintaining successful boundaries involves accepting the fact that you cannot please others all of the time. They help you ask for what you need, even though you may be told no or risk feeling rejected. Ultimately, healthy boundaries facilitate self-respect and a sense of your own worth.”
-Dr. Arielle Schwartz

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