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When Therapy Just Isn't Working

February 14, 2017

People seek out a therapy for a host of reasons, the most commons of which are current depression and anxiety. When you feel like you can't get out of bed anymore to face the day or you're having panic attacks at work, you may find yourself researching therapists in your area in an attempt to help you heal from these challenges. 


Most therapists are oriented as talk therapists. Cognitive Behavioral Therapy (CBT) is one of the most common types of therapy and most therapists use some form of CBT in their work. The research is there. CBT has evidence that it's effective for these issues and so many others. It stands to reason that a CBT oriented therapists will be able to help you learn to manage your depression and for many people it does.


What happens when CBT just isn't working for you? What happens when you start to feel like therapy is only helping you keep your head above the water? For many people, this scenario leads to shame and a sense of hopelessness. Thoughts of not being "fixable" or wondering if you just aren't doing enough to heal may creep in, exacerbating the very symptoms for which you came to therapy. What happens then?


Often times, our symptoms come from painful past experiences. You may feel depression in your every day life without realizing that it's a symptom of a trauma that you experienced early in your life. Research indicates that an estimated 70% of adults have experienced a traumatic event at least once in their lives. This often looks like abuse be it physical, sexual, emotional, or otherwise. It can look like surviving a natural disaster, witnessing violence, experiences related to growing up in a household with addiction or homelessness. It takes a variety of forms, but the result is often the same.


People who have experienced trauma in their lives are more likely to struggle with depression, anxiety, anger, insomnia, chronic health conditions, nightmares, flashbacks, self blame and shame, panic attacks, changes in appetite, difficulty trusting others, mood swings, headaches, backaches, stomach aches, addiction, and just in case these symptoms are not enough let me assure you that the list goes on.


It can be easy to assume these symptoms are based in your current life but when you have suffered a traumatic event, these symptoms are often unresolved remains of your past experience. When this is the case, resolution and healing come from dealing with the root of the problem. In situations like this talk based therapies like CBT are akin to taking Tylenol for a fever caused by Leukemia: It may have some immediate effect but not a lasting one. Professor of Psychiatry at Boston University Medical Center and President of the International Society for Traumatic Stress Studies, Dr. Bessel Van der Kolk is quoted having said, " ...Cognitive behavioral therapy (CBT) has accumulated the most research support, even though we know that the whole cognitive part of the brain shuts down when people are traumatized, triggering the primitive survival part of the brain. So using CBT with trauma is like telling somebody with an amputated leg to take up running. It can certainly give people a sense of perspective on their coping options when they’re in the right frame of mind, but it has limited value with severe trauma."


The vast majority of Graduate counseling programs do not teach specific curriculum on treating trauma so it is up to the student, the new or seasoned clinician to learn for themselves about the impact of trauma and how to help clients heal. On the other side of that, the most common therapy taught in graduate school is CBT which appears to account for the reason that the majority of therapists utilize this modality when treating someone for depression regardless of the presence of a traumatic past. Meanwhile, clients are often left with the hopelessness that they will never be able to do any more than manage current symptoms and that true healing is not a realistic future.


This begs the question, is true healing possible? Is there a solution other than managing symptoms; is real resolution possible? For that, we again turn to Trauma expert Dr. Bessel Van der Kolk who advocates for trauma specific therapies for the healing of trauma symptoms. He advocates for therapies like Eye Movement Desensitization and Reprocessing (EMDR), Neurofeedback, Somatic Experiences, and other body based interventions like psychodrama and yoga for the healing of trauma. These interventions have the ability to help with regulating the nervous system and rewiring the brain toward health and healing. For more info on EMDR, check out my web page here.


How does this relate to individuals who have been in therapy but struggle to manage symptoms? It may be important to consider finding a therapist who has additional training in treating trauma. It is possible that the type of therapy you are receiving may only be effective for managing symptoms, so if your goal is resolution it may be time to find a trauma specific therapist. Of the therapies recommended by Dr. Van der Kolk, the one with the most research support is EMDR, though all of the therapies listed above have anecdotal support as a trauma therapy. When researching a clinician, look for individuals with training in EMDR or other trauma specific therapy.


One important message to remember is that if you have been in therapy and haven't made progress, it does not mean you are hopeless or "unfixable." Consider that the work you have been doing may have reached the limits of it's effectiveness and a trauma specific therapy may be necessary to help you reach resolution.


If you are looking for trauma therapy, please reach out. I will walk through it with you and together we will help you find the resolution you are seeking. I hope to hear from you.

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