DBT for trauma-need advice

[mary_poppins]

Hey, all. I went to a trauma T yesterday and she said she is doing a combination of DBT and CBT for trauma healing. She also uses some somatic work (breath work).
I talked to her and she seemed empathetic and nice, HOWEVER, I am not sure I like her trauma approach.
She said she's going to draw my family history to see my origins and my parents' own abusive background and realize the integenerational trauma I was born into -which will help with the healing.

I have done this before with a therapist and it didn't really help. I know how much abuse there is in my extended family and in my parents' generation. But I don't see how this knowledge helps with trauma.

I am looking for an experienced IFS t now but it's so hard because this country doesn't seem to be very knowledgeable about IFS. I'll have a short chat with an IFS t this week so maybe I'll get lucky.

Anyway, please chime in with your opinions. Do you think DBT helps? I really don't want to use any CBT methods at all and I read that DBT has at its core a CBT mindset. (dealing with negative thouhgts and changing them)

[Call Me Cordelia]

I agree, I don't think CBT is that helpful with trauma because its core belief seems to be, "When you know better, you do better." The thing with trauma responses and emotional flashbacks that plague survivors is that the experience overrides your rational brain. It's something much deeper than CBT can reach, in my humble opinion. It can work when you aren't in a trauma response, but when that happens forget it until the flashback passes. And I was in flashback almost constantly for a while there.

IFS deals a lot with attachment wounds and is closer to the source, so to speak. It's also relatively new on the scene, like EMDR was perhaps when I began therapy. EMDR was incredibly effective for me. It was my CBT trained therapist who referred me to it, recognizing her tools weren't enough for me. I have read a lot about IFS but not worked with a therapist in that mode. The thing with IFS that stands out to me is that it's you "inmost self" that brings harmony to your relationships with your various parts, whereas in other modes relational trauma is healed primarily by means of some other relationship. Flashbacks would be described as firefighter parts taking control and you can work with those parts directly.

I'm interested to hear how it goes with the IFS t.

[Rebel13]

Hi mary_poppins, I'm always so glad to read your updates.

I really like DBT. I haven't used it extensively, but in my opinion it tries to bring together CBT or cognitive approaches AND body-focused approaches like mindfulness/meditation, self-soothing/emotional regulation etc. Over the past couple of years I've come to believe that this kind of trauma affects all three levels -- body/neurology/physiology, emotions, and thinking. My problem with CBT was that I started there. It seems like the body-based approaches like breathing exercises (there are lots of others also) to calm the nervous system need to be worked on AT LEAST simultaneously with other attempts at emotional regulation.

Now that I have the ability to calm myself physically, the training I already had in CBT to reframe thoughts can actually kick in, along with using the emotional regulation tools, since thoughts influence feelings and feelings influence thoughts.

I agree with Cordelia that cognitive approaches can't get through if the body/nervous system is in fight/flight/freeze. The body is revving up to run away from an existential threat and all resources are directed to the muscular and cardiovascular system and away from the brain, so we literally CAN'T think, and the CBT approaches might help in the moment but they don't stick.

This is why emotional flashbacks are different from the flashbacks people have with PTSD where they have sensory memories accompanying their flashbacks (sounds of bombs exploding, images of a car crash etc.). Cumulative, repeated trauma especially at a young age means we are in that survival state so often, while our neurology is still developing, that our brains don't create the regular type of memories of those experiences.

I don't know if I'm explaining myself well. I hope others chime in with their understandings. I think what I'm trying to talk about comes from Pete Walker's work and  polyvagal theory (I love this chart of nervous system arousal) and maybe it was Robert Sapolsky's book "Why Zebras Don't Get Ulcers" where I learned some of this stuff?

Anyway, I think lots of things help, and can help. I can see that the relational aspect of the therapy has helped me a lot -- for example, once I was late for a session and I was doing the fawning/apology thing, and she said, "Don't worry, I know that your being late doesn't have anything to do with me." (I have a few moments like that with different therapists over the years that I hold onto like gold nuggets because of the amount of relief and peace that floods me when I think about them.)

I don't have a lot of experience with IFS but Cordelia's mention of the "inmost self" bringing different parts into alignment  is similar to my recent experiences trying to communicate with "inner little me" and get her to trust me (whatever the other part/parts of "me" is/are) after so many years of self-abandonment.

So, my point is, I don't think there's any one approach that is "right" or "better" -- a lot of things have helped me, and you absolutely get to use the approaches that feel right for you and feel like they are helping you. I've come to see how important self-determination is for those of us who were raised in environments where we could never really express or live out or sometimes even acknowledge our own feelings, wants, needs etc. because we were supposed to be responsible for keeping other people calm and regulated so they didn't hurt us. It has been so helpful to me to work with a therapist who provides options but lets me choose (even when I really, really wish she would tell me what the "right" decision is sometimes!).

Keep on keeping on!

[mary_poppins]

I agree, I don't think CBT is that helpful with trauma because its core belief seems to be, "When you know better, you do better." The thing with trauma responses and emotional flashbacks that plague survivors is that the experience overrides your rational brain. It's something much deeper than CBT can reach, in my humble opinion. It can work when you aren't in a trauma response, but when that happens forget it until the flashback passes. And I was in flashback almost constantly for a while there.

IFS deals a lot with attachment wounds and is closer to the source, so to speak. It's also relatively new on the scene, like EMDR was perhaps when I began therapy. EMDR was incredibly effective for me. It was my CBT trained therapist who referred me to it, recognizing her tools weren't enough for me. I have read a lot about IFS but not worked with a therapist in that mode. The thing with IFS that stands out to me is that it's you "inmost self" that brings harmony to your relationships with your various parts, whereas in other modes relational trauma is healed primarily by means of some other relationship. Flashbacks would be described as firefighter parts taking control and you can work with those parts directly.

I'm interested to hear how it goes with the IFS t.

Thanks, Cordelia. IFS is very interesting and I have a nagging feeling daily that I can connect with some of my parts-example, I am connected with the manager, the firefighter part really well, due to my apprehension and anxiety but the exhiled parts are so deeply burried that it's hard to reach. I think recovery it's when we reach and make peace with the exhiled parts of ourselves.

I have decided to not go for the DBT therapist, although she is really kind and understands NPD. The search continues, though.

[mary_poppins]

Hi mary_poppins, I'm always so glad to read your updates.

I really like DBT. I haven't used it extensively, but in my opinion it tries to bring together CBT or cognitive approaches AND body-focused approaches like mindfulness/meditation, self-soothing/emotional regulation etc. Over the past couple of years I've come to believe that this kind of trauma affects all three levels -- body/neurology/physiology, emotions, and thinking. My problem with CBT was that I started there. It seems like the body-based approaches like breathing exercises (there are lots of others also) to calm the nervous system need to be worked on AT LEAST simultaneously with other attempts at emotional regulation.

Now that I have the ability to calm myself physically, the training I already had in CBT to reframe thoughts can actually kick in, along with using the emotional regulation tools, since thoughts influence feelings and feelings influence thoughts.

I agree with Cordelia that cognitive approaches can't get through if the body/nervous system is in fight/flight/freeze. The body is revving up to run away from an existential threat and all resources are directed to the muscular and cardiovascular system and away from the brain, so we literally CAN'T think, and the CBT approaches might help in the moment but they don't stick.

This is why emotional flashbacks are different from the flashbacks people have with PTSD where they have sensory memories accompanying their flashbacks (sounds of bombs exploding, images of a car crash etc.). Cumulative, repeated trauma especially at a young age means we are in that survival state so often, while our neurology is still developing, that our brains don't create the regular type of memories of those experiences.

I don't know if I'm explaining myself well. I hope others chime in with their understandings. I think what I'm trying to talk about comes from Pete Walker's work and  polyvagal theory (I love this chart of nervous system arousal) and maybe it was Robert Sapolsky's book "Why Zebras Don't Get Ulcers" where I learned some of this stuff?

Anyway, I think lots of things help, and can help. I can see that the relational aspect of the therapy has helped me a lot -- for example, once I was late for a session and I was doing the fawning/apology thing, and she said, "Don't worry, I know that your being late doesn't have anything to do with me." (I have a few moments like that with different therapists over the years that I hold onto like gold nuggets because of the amount of relief and peace that floods me when I think about them.)

I don't have a lot of experience with IFS but Cordelia's mention of the "inmost self" bringing different parts into alignment  is similar to my recent experiences trying to communicate with "inner little me" and get her to trust me (whatever the other part/parts of "me" is/are) after so many years of self-abandonment.

So, my point is, I don't think there's any one approach that is "right" or "better" -- a lot of things have helped me, and you absolutely get to use the approaches that feel right for you and feel like they are helping you. I've come to see how important self-determination is for those of us who were raised in environments where we could never really express or live out or sometimes even acknowledge our own feelings, wants, needs etc. because we were supposed to be responsible for keeping other people calm and regulated so they didn't hurt us. It has been so helpful to me to work with a therapist who provides options but lets me choose (even when I really, really wish she would tell me what the "right" decision is sometimes!).

Keep on keeping on!

Rebel13, thanks for your detailed response.

I'm glad DBT helped you. I know it combines mindfulness with CBT but I really have an aversion to anything CBT.
Therapist said she will do CBT with me and I am against it.

I will check your links and Pete Walkers' information.

Well, in my case I am looking for someone who also does somatic experiencing in combination with either IFS or another trauma method (EMDR) but did not have any luck.

Therapists I met were either dismissive, some did not have a lot of empathy, others didn't respect boundaries and with many of them I could not connect. I have a new meeting on Wednesday with a lady who does IFS and focuses on cPTSD, hopefully it works out.

Thanks again.

[Rebel13]

Wishing you the best!