Grief Over the Death of a Client

One of my clients died and I feel incredibly sad about it.

She was a very special woman.  She was sadistically abused from the age of three and had tremendous strength, courage and  an unshakeable faith, despite all the trauma she endured. 

 

I worked with her for eleven years helping her to heal from all the neglect and abuse she had suffered as a child.  It was a shared journey.  I felt her pain when she suffered and felt her joy when the suffering was transformed.  I shared my reactions so she would know the impact she had on me.  She needed to know she touched my heart and soul, that it wasn't just a job to me. That is what made it possible for her to feel safe enough to reveal her pain to me.

 

I learned so much from her.  She was one of the most traumatized clients I have ever worked with and I kept having to expand my toolkit to be able to help her.  I was grateful for her willingness to try new things with me.

 

At one point in our work together I was feeling stuck about how to help her overcome a particular obstacle and was searching for new approaches to try.  She was desperate for relief from her suffering but was trapped in her self-blame and shame.  That is what motivated me to go for EMDR training seven years ago.  I will always be grateful to her for her role in that. 

 

This amazing survivor had just recently stopped having flashbacks and was looking forward to the next chapter in her life.  Then she was diagnosed with brain cancer.  It seemed so incredibly unfair.  Yet she faced this new obstacle with such grace, accepting whatever God had planned for her.
 

First she fought to survive, then when her chance of survival was so low and her ability to function was deteriorating, she chose to go into hospice and die with dignity. I learned another important lesson as I struggled to catch up with her and accept her decision so that I could be there for her and say goodbye.

 

She wanted others to learn from her experience overcoming childhood trauma and had wanted to write about it, but the brain cancer made that impossible.  So she asked me to tell her story. This is one way of honoring her request.

Watershed Moments in the Fight for Justice for Survivors of Child Sexual Abuse

Last week brought three watershed moments in the fight to bring accused pedophiles and their protectors to justice. Penn State assistant football coach Jerry Sandusky was convicted on 45 out of 48 charges of child sex abuse. Monsignor Lynn was convicted on 1 out of 3 charges of covering up abuse by pedophile priests in the Archdiocese of Philadelphia, Pennsylvania.  Brooklyn District Attorney Charles Hynes charged four Hasidic Jewish men with attempting to intimidate a witness in a child sexual abuse case after the D.A. was besieged by accusations of long-term deferential treatment of Rabbinic leaders who protect those accused of child sexual abuse in their Brooklyn Orthodox Jewish community.

The Washington Post June 22, 2012:

Former Penn State assistant football coach Jerry Sandusky leaves court in handcuffs after being convicted in his child sex abuse trial at the Centre County Courthouse in Bellefonte, Pa.

Photo by Mark Wilson/Getty Images

The New York Times June 23, 2012:
Monsignor William J. Lynn, walking into court before the verdict reading. Monsignor Lynn was the first senior official of the Roman Catholic Church in the United States to be convicted for covering up child sexual abuses by priests.
Photo by Matt Rourke/AssociatedPress

The New York Times June 22, 2012

The Brooklyn district attorney, Charles J. Hynes, who has been facing public criticism about his handling of sexual abuse allegations in the Williamsburg Orthodox Jewish community, on Thursday charged four men with attempting to silence an accuser by offering her and her boyfriend a $500,000 bribe, and threatening to take away the kosher certification of her boyfriend’s business.

Photo by Robert Stolarik for The New York Times

How appropriate that this all comes during PTSD Awareness Month, since post-traumatic stress disorder is such a common disorder for child sexual abuse survivors. Today has been designated as National PTSD Awareness Day by the United States Senate. Let's take a moment today to celebrate these watershed moments that can help child sexual abuse survivors feel more hopeful that our society is beginning to take their plight more seriously and hold abusers and their protectors accountable for all the suffering they have caused. 


Loss of hope is a common consequence for sexual abuse survivors that were not protected by the people that they trusted, whether it be coaches, clergy, law enforcement, teachers or family. Hopelessness makes it harder for survivors with PTSD to follow through with seeking help.  Renewed hope that there is justice in the world may be just what PTSD sufferers need in order to feel more hopeful that they can trust someone to help them to heal.


What do you think? What are your reactions to the above court cases? Do you have a different perspective that you would like to share?  I would love to hear from you.

You might also be interested in reading my November, 2011 post: "Reflections on the Penn State Sexual Abuse Scandal and a Call to Action". http://andreabgoldberg.blogspot.com/2011_11_01_archive.html

EMDR: An Evidence-Based Treatment for Trauma

Eye Movement Desensitization and Reprocessing (EMDR) was discovered quite by accident in 1987 by Francine Shapiro, PhD.  She went for a walk  in the park and noticed that by the end of the walk she was no longer upset about something that had been bothering her.  When she thought about what had happened, she realized that she had engaged in spontaneous rapid eye movements while contemplating the problem and hypothesized that this had helped her to process and resolve her distress.  She later realized that most people do not spontaneously engage in these eye movements when awake, so she experimented with having people follow her fingers back and forth while focusing on their problems and discovered that it resolved their problems as well. 

In 1988, Dr. Shapiro graduated from using EMDR with "mundane problems" to experimenting with the "highly-charged memories" of people with post traumatic stress disorder (PTSD).*  She had similarly promising results using EMDR with this population.  At the time, PTSD was a fairly new diagnosis (it was first introduced in 1980) and there was no rigorous research about treatment effectiveness, other than studies that came out at about the same time evaluating cognitive behavioral therapy (CBT) as a  PTSD treatment .

There is now a substantial body of research that demonstrates the effectiveness of EMDR for the treatment of PTSD.**  In fact, only CBT and exposure therapy (and to a lesser degree stress inoculation therapy), have as much research supporting their use as a treatment for people suffering from PTSD. Despite this, some clinicians continue to mistakenly believe that EMDR is not evidence-based. 

Other clinicians mistakenly believe EMDR is just another exposure therapy.  EMDR uses brief exposure to the traumatic event, combined with bilateral stimulation (eye movements, tones, vibrations or tapping) and sensory, cognitive, affective and somatic components, to facilitate  adaptive information processing (AIP) and reconsolidation of the traumatic experience.

There are several theories about the role of the bilateral stimulation (BLS). One theory is that focusing on a distressing memory and a neutral visual, auditory or tactile stimulus at the same time helps to keep one foot in the present and one foot in the past to prevent retraumatization and facilitate adaptive reprocessing. Another theory is that the sensory stimulation may help process disturbing events in a mechanism similar  to dream sleep, also known as REM (rapid eye movement) sleep.  A third theory is that the bilateral stimulation activates both hemispheres of the brain to link right brain intuitive, sensory information with left brain logical, sequential, language-based information. Studies have been conducted about each of these theories and research continues to be done to answer our questions about how EMDR works.

What questions do you have about EMDR? What experience have you had with EMDR therapy, as a client and/or as a therapist?  What are your impressions about its effectiveness? Please share your comments and questions below. 

*See the recent article by Francine Shapiro in the Huffington Post online  where she talks about this: http://www.huffingtonpost.com/francine-shapiro-phd/ptsd-military_b_1250202.html)

**See http://emdrnj.com/emdr_research.html for citations and a brief summary of practice guidelines for PTSD treatment from the International Society for Traumatic Stress Studies (ISTSS), the American Psychiatric Association, the American Psychological Association, Cochrane Database of Systematic Reviews,  Department of Veteran's Affairs & Department of Defense (VA/DoD), and the Substance Abuse and Mental Health Services Association (SAMHSA)

A Sexual Abuse Survivor Speaks Out

In response to my blog article about the Penn State sexual abuse scandal, Nancy Smyth commented that people stand by and do nothing, at least in part because they don't understand the tremendous impact that sexual abuse has on children.  Then I received a response from a child sexual abuse survivor who spoke about the impact from personal experience. So I decided to share a survivor's perspective to help us all understand a little more about why it is so important to take action to stop sexual abuse. I am grateful to the author for giving me permission to feature this description of what a child sexual abuse survivor can go through.

"As a trauma victim, I would just like to say we have to do something about sexual abuse in this world. People can't ignore it and turn their heads. It just keeps it going more and more.  "You see, even though they hid it years ago it still happened. The worst part is the abuser  says "if you tell, no one will believe you" and  "this isn't bad what I'm doing; I am supposed to do this to you" and "it's all your fault; you're the troublemaker or you wouldn't be in this position."  So you keep it quiet for as long as you can, thinking you're the bad one, not the abuser. Trying to keep everything to yourself until it has you in such a state that your stomach constantly hurts, you become very nervous, and you have fainting spells."

"Then you get enough nerve to tell but you are too young to know the words, so you make up your own words for it. You tell a police officer that these people are "bothering" you.  Well, all the officer does is to tell them to stop bothering you because he doesn't know what "bothering" means and the abusers made it seem like it was only a joke - all in fun. Then another day you get brave again and you tell a teacher. Now keep in mind you're just in first grade at the time. The teacher just says "that's a very big  accusation you're making on these people; they can get in big trouble for  this. Are you sure you want to say this about them?" Well first of all you have no idea what a big accusation is, except that its a really, really big word. Then you hear the word "trouble" and that is just what the abuser told you from the beginning:  "If you tell, no one will believe you and any way they would say it's your fault; you're the troublemaker." So you just freeze, not wanting to cause more trouble, just wanting to take back anything you said about the abuser at all. And keep silent hoping you won't get hurt again."

"The next thing you do is just try to forget about it. You go through life saying  "ok no one found out about it today so I'm good."  You continue doing this every damn day of your life until you get so scared and sick and put it so far out of your mind you don't even know it happened. Until years later when you start having flashbacks and eventually wind up in therapy. If you're lucky like me you get a good therapist. You start to trust someone with your secrets for the first time in your life.  Then  you remember more about the abuse and you immediately go into denial. Then you go back to believing it happened, but you tell yourself  "it was my fault; I was a troublemaker."  So the abuser still wins because here you are blaming yourself and acting as if the abusers are innocent and it was your fault. So you spend a lot of years in therapy with PTSD*, until the whole thing clicks and with EMDR** you are able to get yourself back together.  But unfortunately the more times the abusers abuse you, the more things trigger flashbacks and you get confused and blame yourself all over again. Then sticking with therapy you get to the point with EMDR where you realize "hey this really isn't my fault." 

"So yes, it is uncomfortable to talk about but just think of how uncomfortable it is for a child or a teen to go through it. Day after day having to keep it a secret until they're sick to their stomach or passing out. Then later on after you blanked it all out of your mind and you don't want to believe it, then it comes back to haunt you.  You question if it's real because you think you would know if it happened. But you don't know until you face it again. PTSD causes a lot of suffering up into adulthood. Sometimes you can't even work if it  is so traumatic that you keep forgetting where you are and feel like a child being abused all over again, right in the middle of the workplace.  So basically your life is ruined but the abusers are so damn sneaky they get away with it."


"Just like Penn State--from what I think I understand, people knew it was happening and didn't care to stop it.  Well how about we stop it NOW!  How many more victims do we have to ruin?  How many victims can't even go to work because no one wants them flipping out in the workplace?  How many victims can't even go to people's homes visiting or to the store because they don't know if they will be triggered, and are actually afraid to go out by themselves?  How many more children, young teens, even young adults are going to be victims of sexual abuse?  Why?  No one wants to talk about it.  Like Andrea said, they turn their  head, don't believe it or simply change the subject.  And if  the victims don't get the correct help they go on forever trying to keep it quiet.  Feeling ashamed, blamed, or hurt so bad they think suicide could be  in order.  Is It fair?"

*Post traumatic stress disorder (PTSD) occurs when traumatic experiences from the past keep intruding on the present.  There are three categories of symptoms:

 Re-experiencing symptoms:

     •Flashbacks; reliving the trauma

     •Nightmares about the trauma

     •Intrusive recollections of the trauma

Avoidance symptoms:

     •Avoiding reminders of the trauma

     •Emotional numbness; hypoarousal

     •Blocking out memories of the trauma

Hyperarousal symptoms:

     •Hypervigilance; always in fight/flight mode

     •Exaggerated startle response

     •Anger outbursts

     •Sleep disturbances

 **Eye Movement Desensitization and Reprocessing (EMDR) is an eight phase therapy method developed by Francine Shapiro to treat trauma. Traumatic experiences can be so overwhelming that the ability to process them and gain perspective is blocked. These traumatic events can get stuck in the nervous system the way they were initially perceived, with the same images, sounds, smells, tastes, and body sensations and resulting emotional reactions, urges and beliefs.  EMDR stimulates the memories and allows the brain to digest them, determining what is useful and necessary and discarding the thoughts, feelings, sensations and physiological arousal that are no longer needed.  New information is linked to the original events and related beliefs, feelings and body-based symptoms using bilateral eye movements, sounds or sensations.  This is believed to jumpstart stalled adaptive information processing  in a manner similar to what takes place during REM (rapid eye movement)  sleep.  Traumatic experiences are reprocessed and put in perspective so that they no longer interfere with day-to-day living. For more information about EMDR, see my new website http://EMDRNJ.com