Request an appointment by clicking here or by calling 704-444-0087
DR. JAN NEWMAN
Before becoming a clinical psychologist and trauma researcher, like many people, I viewed trauma as a wholly negative experience. I had been a lawyer before and without realizing it, I had witnessed trauma as part of my job, but I didn’t understand what that meant. And I certainly had never been asked to help a person work through it.
Back then, I had no idea that there was a growing body of research to suggest that psychological resilience and growth in the wake of trauma is the rule rather than the exception. I also did not know how witnessing this growth in others would transform my life and inspire me the way that it has.
In my first year of training for my Ph.D. in clinical psychology, I was assigned an adolescent client who had experienced profound, complex trauma. I had been heavily trained in the assessment and treatment of trauma in the classroom, but this was the fist real trauma client I had ever had, not a clinical case study from a book. Understanding something intellectually and translating it “in the room” are two very different things. Psychology is both a science and an art.
I was not only a psychologist in training but also a mother. I felt a deep sense of responsibility for this child and his wellness and recovery.
The Paradox of Pain
Fortunately, my clinical supervisor had over 30 years of experience in working with trauma. He was very confident in me, yet he sensed that I was hesitant. I confessed to him that I really didn’t want to do anything that would cause another person pain. I felt a deep conviction to help this child and told him, “I don’t know that I can live with failing this child. He’s already been failed so many times before.”
My supervisor smiled thoughtfully. He explained to me (again) that all growth involves pain. Yet most suffering in life is not caused directly by that pain. Suffering comes from the avoidance of pain, and what you give up to avoid it.
To help my clients, he said, I would have to “touch the fire,” so to speak, just like they would, and it wasn’t going to feel like sunshine and rainbows. Yet they would feel my belief in them, so I couldn’t blink.
He also told me that my reverence for the case assured him that I was exactly the person who should do it.
(When I became a professor and clinical supervisor myself, this was something I also noticed. My students who were concerned about the client first were already one step ahead.)
Why We Need Both Joy and Sadness
He quoted an excerpt from Kahil Gibran’s, the Prophet on Love and Sorrow: “The deeper that sorrow carves into your being the more joy you can contain. Only when you are empty are you at standstill and balanced.”
He simplified it to the analogy of a carved, wooden cup noting that “the cup that holds our joy is often carved by our sorrow.”
He meant that joy and sadness are inversely proportional to one another. If you want to know how much something matters to a person, observe how much its loss or potential loss causes them sadness. Joy and sadness are opposite sides of the same coin. Sadness is like a bright highlighter for what truly matters to us. (This is one of the great messages of the surprisingly well-researched and neuroscience-based movie, Inside Out).
In the end, my client experienced a complete transformation. Throughout and at the end of treatment, his scores on trauma measures like the PTSD Checklist, DSM-5 Version for Children and Adolescents (PCL-5) showed a highly significant reduction in his symptoms of post-traumatic stress disorder (PTSD). We were in a residential setting, so you could also see the transformation in the way he walked, talked, and interacted with his friends, his teachers, and other staff.
Yet, while our worked produced joy and meaning, it also produced sadness and pain. We both felt it. Years later, when he was in college, and I was then working as a psychology professor, he reached out to me and shared the impact of our work on his life. He had accomplished great things in his life and had strong relationships with others. He had also made an incredible impact on mine.
Why Pain is the Cost of Admission to a Meaningful Life
I realized that the pain and sadness that he had to walk through was part of the journey. It was the cost of admission to a meaningful life. Every relationship he chose after those first ones, which had been so painful, but should never have been that way, would scare him. Yet he had the confidence to “touch fire,” when it really mattered – not because he “believed” in himself enough. That’s not really confidence.
Confidence is doing the thing and witnessing yourself doing it. Showing your brain that you can walk through the fire and live and eventually thrive. That’s a behavioral neuroscience process called habituation that happens through exposure or “touching fire” for a reason that matters.
When you see a person experience tremendous sadness, it is not an endpoint. It can be the beginning. The depth of that hollowed-out part can be filled with that much joy and hope in the future.
My experience working on that case was so life-altering that it dramatically changed my path for training and further study. After that, I sought advanced training in my doctoral residency at a renowned center of excellence for the treatment of trauma in children, adolescents, and adults, ran a research and treatment program for trauma treatment, published my quantitative research on clinical outcomes in trauma-informed treatment in peer-reviewed journals, trained and supervised other clinicians in this work, and have focused much of my clinical practice on trauma ever since.
I remain incredibly grateful to that first client and all of the others I have worked since then. I am honored to bear witness to their pain, courage, and growth.
“The deeper that sorrow carves into your being the more joy you can contain. Only when you are empty are you at standstill and balanced.” – Kahil Gibran, The Prophet
That experience also taught me to rethink everything I thought I knew about trauma. Here is what I have learned.
Resilience is the Rule Not the Exception
Most people who experience traumatic events do not go on to develop posttraumatic stress disorder (PTSD). There are factors that put people at increased risk for PTSD. Often, the metaphor of a wound is used. In Greek, trauma also means wound.
If that wound can be healed through social connection, engagement, and other protective factors, PTSD is less likely to occur. If those protective factors are missing and instead the individual experiences more traumatic events, then recovery is often blocked. Therefore, PTSD is often described more as a problem of recovery.
“Posttraumatic growth is the positive change experienced as a result of the struggle with a major life crisis or a traumatic event.”
A growing body of research also indicates that people who have experienced traumatic distress can not only “survive” trauma but also thrive in its wake through a phenomenon known in psychology as posttraumatic growth (PTG). In 1996, psychologists and professors at the University of North Carolina at Charlotte, Richard Tedeschi and Lawrence Calhoun, published a measure of PTG – the Posttraumatic Growth Inventory.
What is Posttraumatic Growth?
PTG is defined as “the positive change experienced as a result of the struggle with a major life crisis or a traumatic event.” Although this phenomenon has been discussed in spiritual and religious traditions and philosophy for thousands of years, researchers are now studying PTG systematically.
In fact, a recent review from Wake Forest University found that as many as 70 percent of people who have experienced trauma experience PTG in at least one area of life.
The research indicates that people who have experienced PTG tend to experience growth in one or more of five general areas:
They appreciate life more.
They can see new possibilities in their lives.
They experience closer, more connected relationships.
They have an increased sense of personal strength and empowerment.
They have a deeper sense of their spirituality.
According to leading experts in PTG, there are several critical elements that pave the way for PTG in the aftermath of trauma.
To heal trauma and PTSD, it is important to understand what it is. Trauma has a tremendous impact on our brain and our beliefs.
Most people have never learned about emotional regulation. It is critical that people understand that there is nothing wrong with them or their brain. Typically, the brain is doing what it was hardwired to do in a crisis situation: fight, flight, or freeze.
Our brain is hardwired for survival. The autonomic nervous system, specifically, the sympathetic nervous system and other neural systems are heavily involved in survival. Often, I call this our “don’t get killed machine.” Ultimately, nothing really matters if you don’t survive. Your autonomic system acts through much faster pathways than the part of your brain that helps you do your taxes, finish a math problem, or analyze a report. In this sense, your feeling brain takes priority over your thinking brain.
Limbic System and the Role in Trauma by Dr. Russ Harris
These systems developed thousands of years ago when external threats such as wild animals, threatening tribes, etc. were much more common. Today, most of us are more protected from external threat, yet our brain reacts similarly to internal and external threats that are much more complex and less dangerous.
These systems can fire when we get a threatening email from a boss or in-laws or when we catch someone’s eye in a meeting, “Does she think I said something stupid?” and everything in between.
Our fight-or-flight system or sympathetic nervous system was made for this. (Based on current research, the entire process is much more complex than this, but what follows is a helpful and straightforward way for many people to understand it.)
In the brains of most people, the amygdala sounds the alarm in the body. The hippocampus and other neural structures prioritize the encoding of traumatic memory so that we can replay those events to help us remember how we survived. Often, those memories are fragmented and incoherent. At times, if the trauma is intense enough, the parasympathetic nervous system can induce a “freeze” response, which is designed to protect the person in a very dangerous situation. In this state, the brain is dumping endorphins and natural painkillers into the body and visual and perceptual differences are often noticed. Many survivors of trauma will experience dissociation. This can range from anti-lock brakes version where there’s a staggered freeze and perception of being “zoned” or “checked” out or the full out flop-drop, immobilization response if I would bump into a grizzly bear on a trail version.
The hippocampus and other memory centers have encoded the memory. After the traumatic event, when the brain detects similar sensory information in the environment, it will trigger an autonomic nervous system response – whether it’s fight or flight or freeze. This is unconscious and automatic.
In addition to encoding and replaying memories that we would rather not have, initially trauma often shatters survivors’ beliefs about: self, world, and others.
For example, one common belief that most of us hold is known as the “just world” hypothesis. In general, this is the belief that good things happen to good people and bad things happen to bad people. If something happens to us, then our default assumption can be. . . “Well, based on the rules, I’ve been taught, then I must be bad.”
The following core domains are areas where people with PTSD or other traumatic stress disorders often have negative beliefs about self, world, and others:
Safety
Trust
Power/Control
Esteem/Efficacy
Intimacy
Another common belief is that we have control over our lives. And human beings are HIGHLY reinforced by seeking control to gain certainty and ever-elusive “understanding.”
However, one difficult reality for the brain to accept is the inherent lack of control involved in being human.
We can control our choices, behaviors, and words, but we really don’t have complete control of much else. We can possibly influence the behavior of other people and outside systems with our behavior, but we can’t control what others think, feel, or do on a dime. We also have almost no control over many issues such as others choices about vaccination or the economy. The pandemic taught us in spades just how little control we have.
The Importance of Figuring Out What’s Within Your Control
Things that We Can’t Control but Can Possibly Influence with Individual Behavior
Our thoughts, urges, feelings, sensations, and memories (Based on the neuroscience, we can’t “get rid” of these which disagrees with what most people have told us our entire lives and we will be playing whack-o-mole for life)
Our home environment, marriage, family, workplace, or school
Things that We Can’t Control, But Can Potentially Influence
What other people think, feel, or do or making them NOT think, feel, or do
Note: While other people’s thoughts, feelings, or behavior could be something we could influence, but it can’t be the primary goal. Focusing solely on outcomes and not behavior and effort is problematic generally, but if those outcomes are primarily under external control it can be incredibly frustrating.
Then there are those things that we can’t control or influence such as the spread of coronavirus, elections, political unrest, social media, etc.
For those things we can’t control or influence, what is left is the process of acceptance, and by acceptance, the last thing I mean is resignation. Acceptance is accepting the reality of the trauma and is one of the toughest things a person can do. It’s radical acceptance, and it can feel like the emotional equivalent of walking through fire.
When these assumptions and beliefs are challenges, our mind starts reeling. We begin to rethink our beliefs about who we are, our relationships, and the world we live in.
Most people will use a process of accommodation in which we use prior knowledge to understand the new reality.
In contrast, PTG involves a process called assimilation in which we adapt our views to meet the new reality.
We truly do see the world not as it is but as we are. And with trauma, what happened to you, has become to define who you are and what you believe. Yet there is another way.
Shattered Vase Metaphor
A wonderful analogy is that of a shattered vase.
Imagine that you have a beautiful vase that is priceless to you. Perhaps it was given to you by a beloved family member or purchased on a memorable trip.
You accidentally drop the vase, and it shatters into thousands of pieces. You decide you want to repair the vase. How would you do it?
Understandably, you’re very upset. In the face of that, your brain tries to combat “doing nothing” with “doing something”.” To balance this, your brain typically will kick into problem-solving mode.
For some people, the belief that the vase is broken beyond repair could prompt them to throw it away all together. In PTSD, avoidance of thinking about the event and trying to push down or compartmentalize thoughts and emotions about it, is actually a main symptom of the disorder and what often blocks recovery. It is called avoidance, and is one of the four symptom clusters under the DSM-5.
Some people might try to salvage it. You would likely try to get glue and put it back together in the original shape it was in. You would use the knowledge you already have to put the vase or the belief back together.
Similarly, when trauma disrupts our beliefs and worldview, we will often try accommodation – using our old learning to make sense of it. As you might imagine, with the vase, it just doesn’t look the same.
Because we’re trying to apply the same working knowledge and learning history pre-traumatic event, ultimately judging the vase by the same standard, the vase is assessed as broken and no longer whole. When the traumatic event is used as proof of negative belief, it is called overaccommodation.
The pathway to posttraumatic growth is more in line with the alternative process of cognitive assimilation.
Going back to the vase for a moment.
What if instead of trying to restore it to the same form as it was before, you really looked at the pieces. It saddens you to see this beautiful vase in shards. Accepting this new reality is deeply painful, yet with acceptance comes new learning. (And beyond the analogy, note that new learning is happening at the neuronal level in the form of dendritic growth and neuroplasticity).
The pieces still shine and sparkle.
You then fit these pieces together to form a new mosaic that others remark is: one-of-a-kind, remarkable, and absolutely beautiful.
You realize that it is actually more beautiful because of its uniqueness, which is actually due to the fact that it was broken.
In Japan, craftsman often repair valuable pottery with gold. This art is called “kintsugi” which means golden repair. The vase is more valuable than the original. As a philosophy, kintsugi treats breakage and repair as part of the history of the object. It is something to be celebrated and emphasized, not hidden or disguised.
As already noted, trauma often causes emotional dysregulation. When working with trauma, this is typically the starting point, after psychoeducation. To learn information, change, and meaningfully connect with others, we have to be within a certain zone of regulation.
If you were gauging emotion based on the physiological symptoms (e.g., heart rate increase, stomach distress, fidgeting, flushed face, etc.) using a scale of 1 – 10 (less intensive to most intensive), it is difficult to learn when you’re at a 10.
“Some things cannot be changed. They must be carried.”
When we start working together, most people are shocked to hear that we aren’t going to start with cognitive or “top-down” techniques that engage awareness and thinking through the prefrontal cortex and other neural systems.
Although healing from trauma does require “top-down techniques” especially relating to memory reconsolidation, those are typically coming later in the process for most people unless their emotion regulation is solid.
It is typically most helpful to start with “bottom-up techniques” that go through the body and the five senses to activate the parasympathetic nervous system and other neural systems that promote relaxation and a sense of safety to carve the pathway for the use of top-down techniques. Typically, when working with trauma, I emphasize bottom-up techniques throughout the process.
Ironically, it’s the prefrontal cortex’s love of problem-solving that is actually causing the problem. Trying to “fix” the trauma does not work. Moving through trauma requires acknowledging that the trauma in fact happened and has shattered your core assumptions and beliefs. You also can’t make it “go away.” Yet your brain tries because it’s trying to help you remember how to survive next time.
Some things cannot be changed. They must be carried.
Examples of Bottom-Up Techniques
Diaphragmatic breathing (e.g., box breathing, 4-7-8 and more intense breathing)
Posture and body movement
Yoga, tai chi
Progressive muscle reaction
Autogenic training
Exercise
Sensory awareness (e.g., “Name five senses meditation”)
Some types of meditation (e.g., “physicalizing” emotion)
Examples of Top-Down Techniques
Defusion techniques (from Acceptance and Commitment Therapy)
Cognitive reappraisal
Cognitive restructuring
Trauma narrative and disclosure
Some types of meditation
“The purpose of disclosure is not a focus on the past. It is to cause a here-and-now nervous system transformation of the experiences the person has encoded in their brain and body. Disrupting this process and re-experiencing the memory while emotionally regulated. . . rewires the brain. This is a real phenomenon in neuroscience called neuroplasticity.”
Virtually all evidence-based treatments for trauma involve either or both of these processes: disclosure with another person “bearing witness” and/or a narrative story about the event.
Typically, this person is a therapist trained in trauma-informed approaches but can also include a loved one who has been coached by the therapist. In treatments like Trauma-Informed Cognitive Behavioral Therapy which is used with children ages 5 – 17, the therapist also coaches and prepares a caregiver or loved one to also hear the narrative (with the therapist present) to facilitate more growth and change for the client.
Acknowledging the event and its impact and what it means will often cause reminders – thoughts, feelings, and memories – of the trauma. If disclosure is made in the context of a safe relationship, then the person can experience that in a totally different environment.
I often tell clients it’s like watching a very scary movie that you actually lived through on a dark and stormy night in a different context – on a bright, sunny day in a light-filled, cozy room with someone you trust. This is one of my favorite parts of working in this field. You are granted the gift to bear witness to the full range of human experience. There is sadness and anger, and there’s joy and laughter, and so much bittersweet. And it’s all welcomed.
One really important part to remember about evidence-based trauma treatment: The purpose of disclosure is not a focus on the past, it’s to cause a here-and-now transformation of the experiences the person has encoded in their brain and body. Disrupting this process and re-experiencing the memory while emotionally regulated with the help of a trauma-informed mental health professional rewires the brain. This is a real phenomenon in neuroscience called neuroplasticity.
Developing a narrative about the traumatic event is a re-authoring of your experience and enhances the accommodation process. The trauma is only one part of the story.
What did it teach you about yourself, the world, and others that has been meaningful?
How has it changed the way you have lived your values? The way you parent, work, or learn? Love others?
What do you envision for your future now?
How can you honor your experiences in the future? What lessons has it taught you that might help others?
This process can help people open up to new experiences and possibilities as well as becoming more hopeful and optimistic about their futures.
Other processes that have been noted as essential to PTG include identifying and valuing the changes that have occurred in connection with the trauma. Often, in therapy, this process is ongoing. People make connections and recognize strengths and interests that are new. Encouraging openness and curiosity can help people transform their relationship with their trauma.
“When we are no longer able to change a situation, we are challenged to change ourselves”
– Victor Frankl
Another core process that really is essential at every stage of the game is values-based action, which will, in turn, lead to other changes. Eventually, there will be momentum, which will enhance self-determination and motivation.
Values-based action means acting intentionally in alignment with your core values that are in play in that moment or decision.
When I’m working with someone, no matter what evidence-based treatment I’m using, I want to first start to understand what and who the individual values.
The person has to walk this why to do this work.
In the traumatic event, choice was taken, so now in this new process, choice is owned, given, empowered, and embodied upfront.
Values that serve as people’s why for doing the work of healing from trauma are many and varied.
Often, people’s reasons involve enhancing their freedom, autonomy, and psychological flexibility. Most people do this work to improve their ability to remain present, open, and accepting in relationships.
For example, reasons for addressing childhood abuse might be “I want to have an authentic and deep connection with my children.”
If we have values at the forefront, then the entire process is one towards alignment and strength.
Dr. Richard Tedeschi, an expert in PTG, notes that people can often do better in the wake of trauma when they find work – volunteer or paid – that benefits others. This can often be helping people close to them or a broader community of people who might have been impacted by similar traumas. These actions do not have to be huge to have an impact. Many people responded to the recent collective trauma of COVID-19 by sewing masks and delivering food to others. Clients I have worked with have volunteered their time in scouting, food banks, community arts centers, and the YMCA.
“In the traumatic event, choice was taken, so now in this new process, choice is owned, given, empowered, and embodied upfront.”
Many former clients who served in the military or law enforcement connected with former friends and colleagues who had also experienced trauma.
Other models include other elements, but these are often mentioned as central.
Although none of us would ever want anyone to experience a traumatic or highly stressful event, most of us eventually do.
Some of us could also experience a disruption in recovery, which could result in PTSD. It is important to understand that many people will experience posttraumatic growth and resilience in one or more life domains in the wake of trauma.
There is real hope of not only surviving a traumatic event, but also thriving in its wake.
Resources
National Child Traumatic Stress Initiative
Posttraumatic Growth Research Group, UNC-Charlotte, Department of Psychological Science
Support Groups
RAINN – sexual violence prevention organization
1 in 6 – a support group for men who have experienced sexual abuse
SERVICES OFFERED BY MOMENTUM PSYCHOLOGY
Read more about our some of our psychologists’ approaches to treating traumatic distress and PTSD, vicarious trauma, and trauma treatment.
Dr. Newman is a certified therapist and supervisor for Trauma-Focused CBT (TF-CBT) in children and adolescents and trained in TF-CBT at the University of Oklahoma Health Sciences Center Center for Child Abuse and Neglect and OU Children’s Hospital and School of Medicine.
Dr. Newman and some of our other psychologists are also trained in using prolonged exposure therapy (PE) with acceptance and commitment therapy (ACT) and cognitive processing therapy.
In our online therapy practice, we offer a variety of mental health services. We work with high-performing professionals and their families including lawyers, entrepreneurs, and many more. We primarily work with adults but also work with older teens, college, and professional students so long as we believe online therapy fits their needs. We provide treatment for anxiety, stress and burnout, ADHD, depression, trauma, vicarious trauma, and life transitions. Please contact our office and request an appointment to hear about the many ways we can help you thrive and be successful at work and home.
STAY CONNECTED & INFORMED
For more free resources, please check out the rest of our blog and our resources page, including books, apps, talks, and recent press. You can also follow us on Facebook or Instagram to find more information on psychology, human behavior, and neuroscience. For even more helpful resources, please subscribe to our newsletter!
References
Calhoun, L. G., & Tedeschi, R. G. (Eds.). (2014). Handbook of posttraumatic growth: Research and practice. Routledge.
Joseph, S. (2011). What doesn’t kill us: The new psychology of posttraumatic growth. Basic Books.
Tedeschi, R. 2020. Growth After Trauma, Harvard Business Review available at: https://hbr.org/2020/07/growth-after-trauma
Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of traumatic stress, 9(3), 455-471.
Momentum Psychology’s resources are for informational purposes only and are not intended to assess, diagnose, or treat any medical and/or mental health disease or condition. Our resources do not imply nor establish any type of therapist-client relationship. The information should not be considered a substitute for consultation with a qualified mental health or medical provider who could best evaluate and advise based on a careful evaluation.
Dr. Jan Newman is a Licensed Psychologist and the owner of Momentum Psychology. She received her PhD in Clinical Psychology from Auburn University and her JD from the University of North Carolina School of Law. She is also an executive coach, speaker, podcaster, and author with many peer-reviewed publications. Previously, she served as a professor in a large research university, a director of a treatment program focusing on trauma, and an attorney. As a trauma therapist, she specializes in working with teens and adults who have experienced trauma. She is specially trained in an evidence-based therapy called prolonged exposure therapy (PE) to help clients with traumatic stress and PTSD process and work through traumatic memories. She is also trained in exposure and response prevention (ERP), CBT, ACT, and DBT. Jan believes strongly in the power of therapy through the vehicle of the therapeutic relationship to heal trauma. Her mission is to help support her clients in their journey of healing, self-compassion, and posttraumatic growth to live a rich and fulfilling life.
Client Portal | Privacy Policy | Terms
You have the right to receive a Good Faith Estimate of what your services may cost
©2022-2024. Momentum Psychology PLLC. All rights reserved.