The Price of Inadvertently Telling People I am NOT The Therapist They Are Looking For by Nikki Gordon, LPC
When I launched my private practice in the middle of a global pandemic, I was well aware that unprecedented times would call for unconventional measures-at least when it came to getting the word out that I was now a solo practitioner. Fueled by my passion and drive for all things trauma, I plunged headlong into the business world, fortified by caffeine, sarcasm, and an amazing cheering section of fellow professionals. If anything was going to get this done, we were going to have to get it started and I wanted to be sure that my message was heard far and near, so that those who wanted to do the trauma work knew where the resources were. I was certain that my message would be well received, being a member of a community that is infamous for the amount of trauma that has shaped its demographics-much to my chagrin, I may have been a little overly confident in how that message would land, and I was made aware of that one evening when I received an email from someone who had heard my first attempts at spreading the news; an underwriting campaign on the local public radio station. “I heard your ad, and I want to do trauma work but not with you because of the other populations you work with, so can you refer me to someone else? You must know people”. I was baffled by the statement of ‘other populations’-I work with trauma survivors! Domestic violence, sexual assault, human trafficking, PTSD, first responders, law enforcem……….oh. Oh boy. Ah, so that’s it. There’s that “other population” you speak of. Law enforcement. One more time for the people in the back-I WORK WITH LAW ENFORCEMENT.
It never occurred to me when I approved that ad copy, or when I wrote my website, or drafted my Psychology Today profile, that someone would read those five little words and decide that I was not worthy as a therapist. It did not cross my mind, that when I put out there via a brief statement of populations that I work with, I would be inciting vitriolic ire that would inflame someone’s righteous indignation to the point of denying themselves their own healing. Instead of working with someone educated and experienced in healing the very thing that tortures their own soul, they would choose the alternative simply because I have held space for men and women that have seen horrors that the rest of the population cannot begin to fathom; that my chair has held the officer that holds their head in their hands while they take a deep breath to steady themselves, because they just interviewed a victim and they’re working to process what they were just told and not vomit; that I have stood in below zero weather behind a long line of officers and first responders as they lined the street waiting for the hearse carrying their slain brother, in case one of them needed me.
In those moments, they deserved compassion as much as anyone. In those hours, and days, and weeks, their brains witnessed, and didn’t process, and didn’t resolve trauma, the same way anyone else’s would. Trauma is an injury-the working definition of trauma is a wound. My charge, my mission, my work, is to recognize and support the healing of those wounds. They did not stop being human, or experiencing the impact of trauma, because of their chosen profession. This concept seemed firmly rooted in the Occam’s Razor principle - the simplest, most obvious explanation is the one we should go with. That explanation is that I am a trauma therapist, and they had experienced trauma.
You see, there is this concept called dialectical thinking that we have lost sight of. When we address something through a dialectical lens, we are examining diametrically opposed pieces of information, or opinions, and working to find a middle way, often holding that two things can be true at the same time. I can acknowledge that policing in America needs new policies and procedures in place to eradicate institutional racism AND I can provide critical incident services for a department. I am able to denounce police brutality and demand reform AND engage in EMDR therapy with a suicidal officer diagnosed with PTSD. I continue to advocate for changing how mental health crises are addressed and ceasing to use our law enforcement agencies as social workers and therapists AND hold space for the people that have witnessed the very worst of what one human can do to another.
It is a slippery, dangerous slope that we start descending down when we become so convinced that we possess everything we need to reject out of hand anyone or anything that does not strictly adhere to our beliefs. Even more destructive is when we begin to use that belief system as judge and jury, accepting and rejecting entire human beings based on our own snap judgements. Rarely are things what they seem on the surface, and you miss a lot of life along the way when you narrow your field of view to only those things that enhance your confirmation bias.
This little foray in the public broadcasting world netted me some new pieces of information-first, apparently, I was successful in letting people know why I’m not the therapist they are looking for-an expensive lesson in more ways than one, to be sure. From an entire month-long underwriting campaign, there was only that single email-but it spoke on behalf of an entire community, and the messaging was the loudest voice in the room. I can assure you, the message was received because there was no mistaking it AND I will continue to place my faith in the humans that I serve, because that it is who I am as a therapist. Now, to move forward deliberately with the intention that those three little letters set, instead of the blinders that those five words apply.
They’re doing it for the attention.
It’s a refrain uttered everywhere, as people attempt to explain why troubled adults, adolescents, and children behave the way they do. Overused and indiscriminately applied, doing it for the attention has bothered me since I was a trainee in child psychology. Surely, humans do what they do for a wide range of reasons. And if someone is crying out for attention, don’t they deserve—need—us to notice? To attend?
Instead, seeking attention from others is all too often reviled. It’s dismissed as indulgent, considered a reward for undesirable behavior, a reinforcement of disavowed emotion. So, we stop being curious about others’ internal experiences — disconnecting from what they know, feel, need, want, fear — and, necessarily, we disconnect from our own. Rather than noticing, bringing attention to what’s happening inside no matter how confusing or intense or messy, we learn to turn our attention away. We numb, avoid, put aside. It feels safer to stop noticing. If we don’t give it attention, we can make it disappear or pretend it’s not real.
Not so in the process of EMDR therapy. There, the words, “Just notice,” are the foundational guideposts.
“Just notice,” we therapists say. “Let whatever happens, happen.” We may repeat this mantra countless times a day-- a reflex woven into procedural memory as we support clients dealing with trauma.
Just notice? The mother wonders, just notice what?, as she stands over the warming bed of her two-pound baby in the NICU. She tries desperately, silently, to notice what the nurse is showing her about her newborn baby’s skin tone. What if I never get it? she thinks. What if my ability to notice what’s important is broken?
“…and let whatever happens, happen,” we say, as the newly bereaved parent of a baby who died at birth looks at us with wide eyes.
“Let whatever happens, happen? I can’t just notice. I can’t trust my judgment. Just look at this baby, who my body failed, who I have failed…”
We say these words because we know that the key to healing begins with simply noticing. Pay attention. Be curious, see what happens next.
But it’s a catch-22. Trauma fractures our natural ability to notice. It disrupts our capacity to access that calm curiosity that allows us to stay connected to what’s happening inside. Bringing our attention to pain, even though it’s uncomfortable, seems to be essential to recovery. It’s as if we need people to be healed in order to access the healing.
Fortunately, as in all relational psychotherapy, EMDR therapists offer our attuned presence as scaffolding and support as people begin to turn their attention to their internal world. With EMDR therapy, we provide precisely the sort of nuanced appreciation for the ebb and flow of thought and feeling, somatic sensation, and memory that parents must bring to their babies and that, especially in the face of disruptions on the road to parenthood, can seem both frightening and out of reach.
It goes something like this:
As you bring your attention to yourself, just noticing, I will help you. I will notice with you. I will notice the subtle changes in your skin tone, as your cheeks redden and clear, as the tears rise and fall. I will note your breathing and breathe with you. I will not turn away from your fear or your pain or your anger. My nervous system will listen to the rhythms coming from yours. I will notice and then you can notice, too.
That subtle sensation, that flickering emotion, it all matters. “Notice that,” we say, inviting gentle curiosity, remaining just as engaged and attentive as when tears are flowing. “What are you noticing now?” we ask. So often, language is elusive but the emotion, the emergent shift, is palpable and so we lean in. “Just notice it,” we say, affirming that it exists even when it can’t yet be articulated. “That blossoming warmth? That stab in your chest? Just notice it. And when you do, when you let whatever happens happen, we will notice together. We will know its truth and meaning together.”
This is how we walk with our clients into the process of EMDR therapy where everything they notice, no matter how subtle, counts, not just the sobs or the searing flash of memory. It’s also how we accompany bereaved and traumatized parents into the new world born in the face of perinatal trauma. We notice the shrapnel causing pain and blocking healing. Just as important, we nourish and support the gradual creation of connective tissue that forms the foundation of a new sense of self: as a parent to this baby within the matrix of relationships, within this family.
All of it, every single nuance, counts.
“My baby only spent a few days in the NICU,” said one father to me in response to a call for interviewees for our book. “Are you sure you want our story?” “Our baby died,” whispered another. “Do you really want to interview us?”
It’s a common concern that parents express to therapists. Does it count? Does our experience really matter? Even if my baby is fine now, or if there are no marks on my body to prove that we’ve walked through the fire or no living baby to parent after all we endured? Do I have permission to notice what this means to me, how it actually feels? And if I do notice where it hurts, can I show you? Will you pay attention?
So we sit across from the families who land in our offices-- parents unmoored from what they used to know about themselves, about babies, pregnancies, and the way the world is supposed to work when you’ve followed all the rules, and we pay attention. We notice and most importantly, we trust what they notice. We show them with our engaged, calm presence, staying out of the way but staying.
If we’ve been fortunate to become a parent to a full-term, healthy baby, conceived, gestated, and born without incident, it can be challenging to learn to decipher these signs of dislocation and the consequences. When the road to parenthood has been pitted with earthquakes and storms, parents cannot trust in what once seemed natural and easy. Without that steady sense of “I can figure this out,” or “everything will be okay,” parents feel unmoored and may desperately turn to others to steady themselves.
They often turn to professionals, like us.
And yes, they are doing it for the attention.
And in fact, they benefit when we pay attention-- when we see them as they are, validate their experience of their journey, acknowledge their pain, and accompany them as nonjudgmental witnesses. Our attention is what helps them learn to notice both the obvious and the nuanced and let what happens happen. Our attention is what helps them regain feelings of confidence and competence. Gradually, they begin to believe in themselves as parents, including, “I can learn to read this baby’s cues,” or, “I can trust my sense that something is wrong (or right) with myself or my baby,” or, “My pain counts even though other parents are experiencing a grief and fear I can’t even fathom.” Or even, “I feel love and hope and joy even though strangers glance at my baby and turn away,” or, “I am a loving parent even though my baby died.”
Our attention validates these truths. Noticing them guides our clients to turn their own attention back to their lived experience in all its mess and meaning. Only then can they weave together the strands of their experience, appreciating them all as part of a larger whole.
Addiction is a dissociative response. Sounds like common sense, right? For many years we’ve operated in our practices fueled by this assumption. As individuals in personal recovery, the link between unhealed trauma/dissociation and addiction has been blatantly obvious. Even when we share our work with people on developing this new model of Addiction as Dissociation, we are met with a great deal of, “Well yeah, obviously.”
Yet the reality is that no contention in the literature has been directly made addressing this link… until now. The connection between unhealed trauma and addiction has been well asserted, with giants in the field like Gabor Mate, Bessel van der Kolk, and many others speaking to this link. What about dissociation? Dissociation comes from the Latin word meaning to sever. When an experience or a moment becomes too overwhelming for a person’s system to handle, we have a tendency to sever from that present moment, or from our core self. Dissociation is a very normal response of the brainstem that can activate when we are met with overwhelming distress. Dissociation can be adaptive (e.g., spiritual pursuits, proper use of guided imagery, daydreaming, the Netflix binge when you need to decompress) or maladaptive. When the manifestations of dissociation are maladaptive, they are likely to cause functional impairment. The various signs and symptoms of addictive responses can be examples of this phenomenon. Moreover, maladaptive manifestations of dissociation result when traumatic experiences or stressful events have not been processed and reconsolidated.
Both of us have been working very hard in 2019 to scour the literature and create a model that we are now calling Addiction as Dissociation. Regardless of your adopted stance on addiction (e.g., a disease, a response to trauma) or whether you even like the word (i.e., you may prefer behavioral compulsivity), this model will likely be relevant to your practice. We’ve prepared a table version of the model that you can examine in this blog. You are welcome to share it and we also value your comments on what resonates and what may still need refinement. Our scholarly paper that fully supports the contentions and flow of the model is currently under review and we will keep you posted about the more formal debut of this model to the world.
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Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.