Psykoterapi och ekoterapi – med fokus på trauma

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Fastän jag inte är färdig ännu med min psykoterapiutbildning, så har jag redan lång erfarenhet av att jobba med människor i utveckling och människor som vill förändra sina liv. Och jag känner mig mycket väl rustad att möta, stötta och hjälpa människor som upplevt olika slags trauma i sitt liv, framför allt är jag mycket kunnig inom området barndomstrauma, sexuella trauman, dissociation och det som med en paraplyterm kallas neurodivergens (ND), men som jag ser som vilken upplevelse som helst av att inte ”vara som andra” och ”inte passa in”.

Nu har jag gjort cirka hälften av min psykoterapiutbildning och tar emot övningsklienter under handledning. Jag erbjuder psykoterapi både i mer traditionell tappning (inomhus) och ekoterapi (eller ekopsykoterapi som är den längre benämningen) utomhus, och jag erbjuder både ”på plats” psykoterapi, just nu i Malmö, på ViduNova Traumaexpertiscentrum, och online. Och jag erbjuder psykoterapi både på svenska och på engelska.

Jag jobbar eklektiskt och integrativt, men har min bas i transaktionsanalys (TA), ekoterapi/ekopsykologi, upplevelsebaserat lärande, ”expressive arts” och mindfulness – och inte minst – jag har alltid jobbat traumamedvetet, traumasensitivt och jobbar nu också traumafokuserat.

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STRUCTURAL DISSOICIATION

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I remember when I first encountered the theory of structural dissociation – through a therapist I saw a few times and the book she recommended to me “Coping with Trauma-Related Dissociation” (2011) by Suzette Boon, Kathy Steele, Onno van der Hart. The last author – I just recently learned are not allowed to practice psychotherapy anymore, due to transgressions? I will not judge that; I do not know enough about it to have an opinion on it.

But what I do have a lot of opinions on is the theory itself, and how it is used.

I was told in therapy that she (my therapist) only wanted to talk to the “main-me” – the ANP (apparently Normal Person) – that felt insulting on so many levels. Firstly – apparently?? It sounds like the person (me) is abnormal – that I just appear to be normal and that I just appear to be a person. Secondly, and more importantly, if a part of me initiates taking the whole of me to therapy to process trauma – and is refused a voice – how on earth is that going to be understood, by me? And how do you think it felt to me, to come to therapy and be told I am not only “just an emotional part” but also that the therapist then does not want to talk to me??

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TO RATHER BE BAD AND FEEL GUILT AND SHAME THAN TO FEEL POWERLESS

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My mind is used to “going inside”, to re-write my role in different kinds of outer events and situations. Note the difference, I am not re-writing the actual event or situation, I am re-writing me. We all have individualized coping strategies, but our actual choices of defense when being subjected to abuse, violence and trauma, are quite limited. Boiled down, we change our own role, other’s roles or the event or situation itself (meaning we change our perception of ourselves, others or our surroundings, of “reality” in different ways).

My strongest defense have always been to dissociate, meaning I mostly re-write myself. It does impact how I see others, but I am not actually re-writing them, just seeing them through my own re-written story. This might sound strange or complicated. Bear with  me – I will give you an examples and share how this ties into the title of this blogpost – why it has always been easier for me to be the “bad” one and feel guilt and shame over that – than to feel powerless. And how that sense of powerlessness was fortified in me by the ones whose intentions where to help me - by pointing out everything that was "wrong" with me. Never asking me if I had been wronged.

When I was 25 years old, I decided to share my story about how my father had abused me when I grew up, with my mother. I invited her home to me, just telling her I wanted to talk to her about something important.

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DIFFERENT KINDS OF DISSOCIATION

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How people dissociate is probably as different as anything else. What I describe in the poem below is my experience of one way I dissociate. These days – I can stay around and experience the experience of dissociating – kind of a contradiction in terms (since dissociating for me fills the function of not having to be around). But I stay – and experience it. When I started doing that – it was absolutely terrifying. So, I fled it – into my mind and other versions of me. But I have practiced. A lot, and now I can stay in it. It still makes me feel inadequate. I cannot control it. Only be in it – work with it – anchor myself to the best of my ability. Most people would not pick up on any of what goes on for me.

It feels like failing. Like I let fear govern and control me. When technically I know I am safe. What really helps me out of it – is being with someone I feel very safe with, and whom I can anchor “in”. But I have learned that is not okay. That I need to be able to anchor myself – so I keep on practicing.

I used to be very ashamed of my dissociation. Of how I leave my mind and enter this pure state of sensing – and how when I try to come back – I sometimes can not find where I left off, and don’t know what we were talking about or doing. I have learned to stay in my blank space – not panic – and orientate myself. Leave people waiting. Even letting them see my distraction. Hear the stammers. Hear the pauses when I search for words. Returning to mind is not easy. But it is how we “human” right? We exchange things through our minds. We talk with each other. Reaching to each other’s senses seems not to be okay.

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DISSOCIATION, EYE-TRACKING, VISUAL IMAGERY, PROCESSING, EMDR…

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The holiday winter season is one of my least favorite times of the year. But I have for each season become better at dealing with them, since I decided to reclaim them, and build my own traditions around them. So, I got a bit surprised when this year, I did not do so well. But in a new and unexpected way. I do think it is a step forward, as I am again learning new things about myself (and possibly about how severe childhood trauma “works”, or what people with severe childhood trauma can experience).

I am neurodivergent as well (forever will the professionals debate whether I am “just” traumatized”, or was born neurodivergent (I have an autism and ADHD diagnose, but also a C-PTSD and DID) – I do think this combination of being neurodivergent and having dissociative “difficulties”, or "tendencies" is pretty common – maybe because being neurodivergent makes you prone to dissociate, or maybe it is developmental (including lack of attachment) + abuse trauma – and that gives the same result? It is very hard to as in my case, 55 years later, figure out what is what. I am not sure that is what is important either. I have decided to go with the autism diagnose, as it is helping me understand myself.

But that is not what this text is about. Disputing what is nature or (lack of) nurture – or both. I am mentioning it because this is an intersection of potential mechanisms.

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A DIFFERENT WAY OF PERCEIVING THE WORLD AND “SELF”

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 A fair warning – I am going to get theoretical… but also add my own lived experience to this exploration.

What I am exploring here is if the fact that I highly resonate with a way of being and functioning that seems to be aligning with some of the leading theories behind what autism is, and how I see these theories through my own knowledge and experiences of how I have been reacting to early childhood trauma and how that has formed me, and my perception of myself. But I also explore my reactions to the theories behind severe dissociation, which I have never felt explain my own experiences (like the theory of structural dissociation).

I think I ended up using the defenses I did because they came natural to me. And I have defended myself against trauma with them, but also against everything else in the world that I could not cope with, in the same ways, that is using fragmentation and dissociation. What I say is – maybe they are not only psychological defenses that I came to use through being traumatized, but part of my individual, genetic make-up?

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THE STUFF WE DO NOT TALK ABOUT…

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When am I the most happy? The most grounded? The most me? – Those questions are related…

I don’t know about you. But I am a contradictory… almost always have many perspectives on one thing. Many feelings about one thing. Almost nothing is crystal clear to me. Sometimes it makes me indecisive. There are so many things one can take into consideration – and yes – often they are – contradictory – or lead to contradictory solutions.

Sometimes I am contradictory just because of the above… I shift. I take different viewpoints – all seem valid, more or less perhaps, but still. Sometimes I appear contradictory because I simply have changed my mind. I am an ever-changing human.

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An Overactive Social Engagement System

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If a person is stressed, overwhelmed, out of their window of tolerance, is the answer always to help them engage their social engagement system, on the outside, with another person or being? Is it always external co-regulation that is the best answer?

No. Not in my opinion. Especially not if a person is having an overactive Social Engagement System – as part of their defense strategy. Too much of the good is, is, as always, too much.

Or maybe – what looks like a way too overactive social engagement system is not in fact that? Or maybe it is – it depends on how you define a social engagement system. At least if you talk the language of Vagus, where the social engagement system lives in the ventral vagal complex and dissociation in the dorsal vagal complex.

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WHAT CAN I DO? - Mindfulness – Trauma & Dissociation

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I am a mindfulness instructor – and am currently taking an advanced training in Trauma Sensitive Mindfulness (TSM) with David Treleaven (https://davidtreleaven.com/). I took his basic course during the fall. They are great courses!

I am also a person with severe trauma and I can be highly dissociative (although I am getting to be more and more in charge of my dissociation than the other way around – If you are interested in my thoughts on dissociation and trauma, there is plenty to read in my blog at http://livethechange.se/).

Taking this course simultaneously as the Coronavirus is affecting us all on a global scale – is interesting. It becomes even more interesting for me since I have managed to time huge life transitions to this time period too… Very little is certain in my life, this did not start now – but has been a process. But the resolution of the process is happening right now.

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Dissociation – Association Part 2

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Is dissociation both a defense system and a lack of learned skills of association?

Most things I read about dissociation is about how it is/can become a maladaptive coping strategy and later a defense system to handle trauma (or possibly everyday stressors, e.g. boredom or feelings of powerlessness).

But dissociation is so much more – as is its counterpart association. So how do we understand “normal dissociation”? How do we understand how maladaptive dissociation emerges and becomes a pattern of coping (outside the range of “normality”)?

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DISSOCIATION – ASSOCIATION

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Dissociation and Association – are two sides of the same coin. Or you can say – they are in each end of a spectrum. A spectrum we all move along on a daily, hourly, momentarily basis. But try to imagine the spectrum as circular – or spiral shaped – not linear. There aren’t really any ends. Dissociation and association move in and out of each other – and at times part of you are more associated – or is free to associate – and other parts of you are more dissociated – or free to dissociate.

We all associate and dissociate – and we all have parts. Some parts of us other parts of us are more prone to ignore – dissociate away – or more strongly associate with. Some parts of us more easily dissociate or associate in themselves.

Does this sound complicated? It is actually rather simple, but it is of course nuanced. The confusion I think stems from when people talk about dissociation (very few talks about association) – most people talk about different aspects of dissociation, undefined and un-nuanced – and try to fit it into a pre-existing model. Not to on purpose confuse, of course, the study – and the “treatment” – of dissociation – is fairly new. Hence all the misunderstandings, misconceptions, mix-ups, simplifications – and a strong wish to fit it into a paradigm or system. Which in my opion potentially shuts out other ways of seeing it.

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TIME IS NOT LINEAR…

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Why bother about your past? Can you just not leave it in the past and “move on”? Who wants to focus on the past anyhow – it is over, done with, can’t be changed?

Or can it?

TIME IS CIRCULAR

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The Wheel of Tolerance

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I am learning to write from my own perspective and experiences only. Acknowledging that they are not universal. I am also learning no to be ashamed of them, or to be ashamed or feel like a “misfit” because I do not fit into the common theories about how a mind works, or is supposed to work, neither in psychologically healthy – nor unhealthy states. Neither in the everyday life, nor in traumatic situations (or in reliving them).

I don’t like labels. I have been heavily labeled all my life. It has never been helpful to me. I have stopped trying to squeeze myself into existing theories and models. With that said – on to the topic of the Window of Tolerance – or as I call it – to better fit me and my experiences the Weel of Tolerance, I want to share my perspectives and thougts.

The window of tolerance assumes you can only be in one state at a time. It says either you are in your window – or out of it. Either you are in fight, flight, freeze or fawn, but not in two or several states at the same time. It does not acknowledge either (as I understand it) that you can go into freeze, then out of it again into e.g. fight. It pictures freeze as the “end station”, the last resort, a place we go to when all other options are exhausted. It also states that there is no choosing in going into either of these states.

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Authenticity – Being Trauma Informing...

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If you have been traumatized and deal with consequences from that, how can you show up authentically in the world? Despite the fears you have, the psychological defenses you use against these fears? How can you maintain being YOU?

Today I had two appointments. One for a business network meeting, and one for a screening at the hospital.

The business meeting had a change of rooms today, which meant we were going to be really crammed, with very little space and the probability for bumping into somebody, or being bumped into were high. It meant an all-over higher degree of closeness. This is something I have a hard time coping with, so I announced to the leaders of the meeting that I would take part in the meeting, standing in the doorway. I assured them I was perfectly fine with that, during my business presentation I also brought it up. I did not explain why, just told them this was hard, but that this solution worked fine for me, and that I was okay being me, in this situation.

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What is dissociation?

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(From an” expert…” on dissociation – from the lived “inside” perspective – a VERY short introduction)

There are multiple ways of dissociating. You can dissociate from your body, from your mind, from your emotions/feelings, from your memories, from the environment, from time, from parts of yourself (ego states/identity) – from one of these, from several – in different combinations – or from all of them – at once and for shorter or longer periods of time… And the process of dissociation can be all from completely unknown to you – to completely known. It can be a seemingly 100 % involuntary action to dissociate and a 100 % deliberate action – and everything in between.

Dissociation is the opposite of association. You dissociate to keep things, events, situations in your life apart. Because kept together they would overwhelm you. Everybody dissociates. Maybe you daydream, procrastinate, plan your dream vacation, play computer games, shop yourself happy. Everything you do to keep yourself away from your current state – inside – or outside – of you – is dissociation, but the focus is on the inside – the outside situation is often just a reflection of your inside situation. Dissociation is you – hiding from – you.

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