Understanding How PTSD Can Become Post-Traumatic Growth Part One: Trauma’s Role in Robbing the Victim of Important Life Values by Matt E. Jaremko

In the early 1980’s, my Monday evenings were spent as co-leader of an open-ended therapy and support group for Vietnam veterans at the Memphis Vet Center, a storefront clinic and service center housed in downtown Memphis. The Vet Centers were the VA’s program to make services more intimate and available to veterans separate from the larger VA hospitals

Group sizes ranged from 3 to 20 participants, homeless vets alongside retired officers. Most attendees came to only a couple of sessions, but there was a sizable block who were “regulars” attending dozens of sessions in the 3 years I was involved leading the group.

Most group participants had psychological and behavioral problems associated with Post-traumatic Stress Disorder. But as I listened to them talk about themselves and to each other, the most valuable lessons I learned from these veterans had more to do with their strengths than their weaknesses. First, one of the biggest tragedies of their military experience was not necessarily the PTSD symptoms of heightened anxiety, moodiness, nightmares, flashbacks, shame and/or horror of having witnessed or committed horrible acts.  For many, the worst outcome of serving in that war was being robbed of the value system they believed prior to their service.

Most Vietnam veterans volunteered in order to contribute to a cause they thought noble and worth their sacrifice: to protect a democratic way of life by providing a check on Communism. Unfortunately, after serving, many vets concluded that their sacrifice had been wasted by politicized leadership agendas and military tactics that made little sense. The veterans were disillusioned because they began to see they were being used by their country, rather than serving their country.

Moreover, when those combatants returned home, their patriotism was attacked and shamed by the process of citizens involved a war-protest movement.  Home was a place in which the vets no longer fit. They were hurting, alone and bitter about what they had seen and done. The ideals upon which they had decided to serve had been shattered. In the resulting “values vacuum,” only the misery of powerful PTSD symptoms was left.   Additionally, they were rarely taught how to replace or renew the compromised values system.

A second thing I learned from those Vietnam Veterans was the importance of the “platoon”, usually a squad of 10 or 12 men. Even though together for only 13 months, the bond that quickly developed among the platoon was very powerful and motivating. It was not uncommon in the group sessions to hear men talk about how much they cared for the others in their basic small unit. In fact, often it was only other vets these men felt comfortable with and/or trusted.

I came to realize the healing power in those small groups. The Memphis Vet Center Monday Night Therapy and Support group became a “platoon” where vets could work with each other to rediscover or replace their lost values. Once they accomplished this values clarification, many found more strength to cope with the symptoms of PTSD because they became more receptive to learning the cognitive and behavioral skills helpful in rebuilding life after trauma.


Traumatic Experiences Change What Victims Consider Valuable/Important In Life

Since those days at the Vet Center, I have been honored to be involved in the treatment of many other folks who had traumatic events in their lives, including Childhood Sexual Abuse, motor vehicle accidents, crime victimization, natural disasters and sexual assault.  A common feature of these trauma survivors is this loss of belief in previously-held values. Values can be defined as life activities or behavioral outcomes considered important, even vital, in a healthy life.  A partial list of values considered essential to healthy living would include but not be limited to perseverance, respect, honor, love, sacrifice, truth, freedom, compassion, bravery, kindness, wisdom, safety and trust. Clarity about what is important in life is often changed for trauma victims. Like the combat veterans’ loss of guiding patriotic values, survivors of Childhood Sexual Abuse (CSA) spend the first 8–10 years of life learning trust, only to find that it was no more authentic than a politician’s promise. Many battered spouses go through life in fear for their physical safety, only to have such fears confirmed by violence, thus eliminating a valuable sense of security. A vacuum is formed where once there was a strongly-held belief about an important feature of life. Without a sense of knowing what is important in life, trauma victims find less motivation to engage in the hard work of facing unpleasant symptoms. Avoiding the constant negative symptoms becomes their main focus of life.

Even a brief examination of the history of humans shows an incredible capacity to cope with the most dire of circumstances when focused on values meaningful to the culture or social group at large. In the absence of those values, coping with hardship is greatly reduced, maybe even non-existent. Individuals have sacrificed much, even their own lives, when pursuing the “higher good.”  But when not clear about that great good, victims tend to remain stuck in self-preoccupation. The values vacuum must be addressed to find increased motivation and strength in coping post-trauma. Since the main method by which we learn values in the first place is through social interaction with important people in our lives, group process is a powerful mechanism by which victims can examine changed values systems and begin to renew and replace them.

Rates of Trauma and Overcoming It

A recent study (Kilpatrick, et al, 2013) reveals that over 80% of 3000 people surveyed report having experienced a major trauma. 80%! These traumas include physical or sexual abuse-53%; death of a family member due to violence-51%; natural disaster-50%; accident/fire-48%; witnessing physical or sexual assault-33%; and combat or warzone exposure-8%.

Most victims of trauma (including most veterans of military combat) “get over it” in 12-18 months. But 20% don’t. They develop PTSD. What is the difference between the 80% who adjust and the 20 % who can’t “get over it”?

An entire article can and should be devoted to the complicated concept of “getting over it.” For starters, even if victims can get past the trauma, their life narrative is forever changed. Plus, somewhere between 40-60% of folks who have a life trauma end up eventually saying that their life is better for it: an outcome called post-traumatic growth (Calhoun and Tedeschi, 2103).

In fact, if one thinks about it carefully, a good question to consider is WHY IS THERE NOT MORE PTSD, if over 80% of people report having had trauma in life?  My experience with Vietnam veterans and other trauma survivors has led me to the conclusion that folks who “get over it” address the destruction of their values system in some kind of group interaction, formal or otherwise.


Changes to One’s Life Narrative

PTSD is a disorder of “being stuck” in a never-ending cycle of avoiding the unpleasant experiences, believing and/or trusting in nothing once-valued and a lack of belief that something can be done to change this cycle (self-efficacy).

In order to overcome the effects of trauma, a victim can’t just learn new skills to cope. The altered values system must be addressed. The sad fact of the matter is that traumatic experience drastically changes one’s life narrative. The purpose and meaning of the life traumatized are shaken to the core.

The narrative of a life can be going along great, maybe even according to one’s life plan, and then WHAM!—a trauma happens, and the narrative changes. Before trauma, a glimpse of the internal dialogue might be summarized as “Everything is okay/I’m in charge/I like my life/ I have hope/this is fun, if not hard.” After trauma, however, it becomes “The hurt is unbearable/I can see no end to it/I can’t do anything to stop this pain/others don’t understand/nothing matters anyway/my life is awful/I’m awful/HELP/leave me alone.”

That changed narrative must be re-written to include a new story line, one that rediscovers or replaces the lost value system. The second half of this two-part article examines the process of how one’s internal dialogue creates a life narrative and how that life narrative can be changed so that post-trauma reactions can become post-trauma growth.

We hope you begin to investigate this approach to trauma recovery through rearranging social interaction in healthy and progressive ways. Our new book, Trauma Recovery: Sessions with Dr. Matt is one way to visualize such a journey in that it describes in detail the narratives of seven trauma victims whose interactions with a therapist and each other achieved the needed changes to recover from trauma. While the book is on sale at Amazon and other booksellers, both Matt and Beth are committed to making a copy of the book available to anyone who is not able to afford its purchase. We can be contacted through our website, drmattbook.com.

“Trauma Recovery: Sessions with Dr. Matt” featured on The Psych Files Podcast!

Here’s the podcast of an interview with Matt E. Jaremko about Trauma Recovery: Sessions with Dr. Matt. The Psych Files is an award-winning Psychology Podcast. Matt was honored to be interviewed by Dr. Michael Britt.
About the discussion, Dr. Britt said, “I have to say I was moved. What you’re doing in this therapeutic process makes a lot of sense to me and I’m happy to help get your words into a lot of ears. I hope people who need help are motivated by the episode.”
Our book is available for pre-order on Amazon and will be shipped on December 14, 2018. WE HOPE YOU WILL SHARE THIS POST ON SOCIAL MEDIA. THANKS!

When holidays like Mother’s Day hurt, and hope that they won’t always do that

I used to have to “write out” Mother’s Day in the form of a post– like– a long blog post or a poem or some kind of reflection. And I didn’t do it this year…unless you count this one, but the purpose of this is a lot different than those sorts of gutteral “I’ve gotta get this out to prove to myself I will get through this day”-posts.

It’s been roughly a decade & a half since my life imploded and I lost my mom when she chose my perpetrator and playing “Let’s Pretend Nothing Happened to my Daughter at the hands of my husband”–instead of continuing to have a life that included me, my husband, and our daughters–and for the longest time, Mother’s Day (and every other holiday and my birthday and her birthday) was absolutely devastating to me.

My mental state would decline: I’d have a hard time not crying, I had memory problems–especially being super-spacy. Stress sometimes still makes me lapse into memory problems, but not nearly as bad as it used to.

I learned over time to get REALLY QUIET and plan non-stressful situations for myself instead of trying to distract myself by trying to fill my house with a bunch of people. We had smaller get-togethers of just my husband and kids and maybe a couple extra people instead of inviting a bunch of people over. I did that at first–trying to go big–because I was so used to holidays being a big deal. I felt like I needed to try to replicate the environment my kids were used to when we were part of my extended family, and I was always ravaged with guilt for taking that from my kids by “causing” this upheaval in their lives–and eventually I learned that this thinking was ridiculous and unnecessary because WE WERE ENOUGH. I learned that in part because my husband and daughters TOLD ME THAT: we ARE more than enough.

I learned that I needed to be able to “be”–warts and all–spaciness and mental illness and all–instead of trying to pretend to be normal on rough days like Mother’s Day. I wasn’t fooling the people closest to me by pretending anything, anyway. I think they preferred me to be myself instead of the hot mess I became otherwise. I learned to cope by making to-do lists and finding solace in nature and generally working my ass off in therapy to learn a new way to be.

When somebody asked me the other day HOW I could tell when I was healing from the ravages of trauma from Childhood Sexual Abuse and–even more so, I think–from the grief, shock, and loss that hit me like a tsunami (I’m talking suicidal ideation like you wouldn’t believe) when I entered recovery and needed my mom to acknowledge what happened under her roof–but she wouldn’t and still won’t– I said I could tell I was healing when I began to notice the ABSENCE of pain where it had been before: like, when I got through an entire day without feeling like crying once, or I didn’t feel like I was wired with anxiety for a large chunk of a day, or I didn’t think about my mom even once that day or wonder how in the HELL a mom can know that stuff is happening to her daughter and REFUSE TO TALK TO HER DAUGHTER about the pain her daughter was enduring as a result. I won’t say I DON’T ever have painful thoughts any more, but they are so rare that I acknowledge them and let them go on by rather than allowing them to invade my brain. I have anxiety disorder, and I’ve learned to just say to those thoughts, “Oh, there’s an anxious thought. Hm. No reason for that other than my disorder. Carry on.”

For example, days like today: Mother’s Day is now associated with my mother-in-law and my relationship with my kids. Thoughts of my mom are no longer laced with “I wonder what she’s thinking today” or all the reasons I don’t have a mom anymore. Today, I talked to all 3 of my daughters and we’re making plans for the summer, and…let’s see: I worked out & finished up some cooking for the coming week and worked on author stuff today (research for a book)…and I went to lay down for an hour and ended up sleeping for 3 1/2. I wasn’t sleeping to avoid being awake and aware of pain, though: I was sleeping because I was sleepy and I chose to let myself rest before I start another work week.
I wasn’t disabled by grief and I didn’t feel like I had an aching hole (if that makes sense) in the center of my being and I didn’t feel the need to “write it out,” meaning, get the pain out by putting it into words instead of keeping it in my head.

So, even though I DID write this post, I’m not thinking of getting this stuff out so I don’t explode and ooze grief all over the place. Instead, I am thinking of those of you who are in the ravages of grief and rage and disbelief because you are in the same position I was in many years ago–and FOR many years. It didn’t go away within the first year of loss; it took many years to be able to get to this point. I am reminded of my former therapist & now coauthor, Matt, saying to me that relationships are part of nature, and that I needed to consider how long it took things like the Grand Canyon to form. I think healing is very much the same way. It happens in its own time, even when people work hard at it. It still may take some time for wounds to heal. I think being betrayed and abandoned by my mom took a long time for me, but I also think they were soothed by the lessons I learned in therapy that made me realize my self-worth regardless of others’ assessments of my value.

But this is one of those moments where I feel like I’m standing on a mountaintop looking back over the road I traveled to get here. I can see my footsteps, and in some places, I can see claw marks where I was crawling–sometimes they’re practically bloody (metaphorically), and the deepest signs of travel–the hardest parts–are when I was unsure I was going to make it at all, much less be able to envision a day like today when I’m just living my life and it doesn’t hurt to do it. In fact, I love my life and I’m really happy and content. Doesn’t mean I don’t have problems or worries–it just means I have the tools to cope with them and regardless, I am aware that I have worth and I am loved.

YOU can get to this point, too. You can survive whatever you are enduring right now–even if it’s the worst pain you’ve ever felt and you are convinced it will be your undoing. Keep going. One foot in front of the other, step-by-step. Hold strong to those in your support system. Talk to them and tell them, “Hey, I’m really feeling wobbly today, and I need to lean on you some.” Figure out what works to help you find calm within yourself.
Some ideas that work for me: Gardening is very soothing to me. Sitting on my porch swing and listening to the sounds of nature–really focusing in on the wind in the trees and the birds–is like music to me–and it also makes me aware of my place in the Universe and for some reason it also makes me think of what we are made of.
And speaking of music, finding songs with messages of strength and hope is balm for the soul–and some songs are just kick-ass for singing really loud and dancing.

If you’re not working with a mental health professional, take the chance and look for one. If you don’t click with the first one, try again. It took me several tries to find the right therapist who guided me through recovery. YOU are worth the work it takes to heal your life.

Check out this site: http://drmattbook.com, for more info about finding a therapist; there’s music there, too, and HOPE for recovery.

Guest Post: When Mom Took Off the Mask

Beth here: with my daughter’s permission, I’m sharing a piece she wrote in honor of Sexual Assault Awareness Month. She reflected on what it was like when I “took off the mask” I wore as a result of being sexually abused as a child and expected to maintain a facade of “everything’s fine.”

When Mom Took Off the Mask
by Mandy Fehlbaum

**Trigger Warning: Sexual Abuse Recovery**

I remember when I was a kid that my mom would go to therapy appointments. Then she didn’t.

We moved across the country when I was 4 – from Texas to Oregon – then back again. I didn’t know why at the time, other than that my parents wanted to try something new, then got homesick and we came back. We even came back to the same house. We got 2 of the 3 dogs we gave away back.

My mom made another go at therapy my first year at college. My dad had started to go to therapy, he finished, then my mom started to see the same therapist on her own. That was when everything changed.

Junot Díaz writes of a mask in his piece, The Legacy of Childhood Trauma.

When my mom went to therapy, her mask started to crack. And, like Junot writes about, it was very uncomfortable. She feared losing everything. EVERYTHING. I think prying the mask off nearly destroyed her. It very well could have had she not worked with the right therapist. Her previous attempts to take it off when I was a kid were not successful. Her attempt to run away from it was unsuccessful.

For many years – for a little over 18 years of my life – my family lived behind the mask, too. As Junot points out, the mask feels like home. You just get so used to it. My sisters and I were born while my mom wore the mask. We didn’t know about the sexual abuse and how my grandmother excused it. We just saw a very loving grandma and a step-grandfather that was a major asshole sometimes.

I do not at all begrudge my mom for wearing the mask for as long as she did. As Junot writes, “It felt good to be behind the mask. It felt like home.” Who wants to rip off something that is so comforting? Who wants to risk losing everything? My mom thought that my sisters and I would choose my grandparents – especially my grandma – over her. Seriously.

I was going through some things today and I found a project I did back in 2000. In any case, I spoke about family values and how one of the values my parents passed down to me was that of unconditional love. I thought it was a shared family value, but my grandparents’ love had an asterisk. It required that the mask stay on. They’d love us as long as wore the mask and denied its existence. Fuck that.

My family and I – especially my mom – live without the mask. My mom took it off. Threw it away. She had spent years now getting her face accustomed to the feeling of the elements. I am immensely proud of her. She speaks her truth to audiences. She writes books to help others.

Most recently, she has a book coming out with her former therapist: Trauma Recovery – Sessions with Dr. Matt: Narratives of Hope and Resilience for Victims with PTSD.

I didn’t write all this to be a plug for my mom’s book. I wrote it because the part in Junot’s piece about there being comfort in the mask really stood out to me. I get it. But, as Junot points out throughout the piece, the mask is also suffocating.

He writes:
“Every year, I feel less like the dead, more a part of the living. The intrusions are fewer now, and when they come they don’t throw me completely. I still have those horrible dreams every now and then, and they are still foul as fuck, but at least I have resources to deal with them… I think of all the years and all the life I lost to the hiding and to the fear and to the pain. The mask got more of me than I ever did. But mostly I think about what it felt like to say the words—to my therapist, all those years ago; to tell my partner, my friends, that I’d been raped. And what it feels like to say the words here, where the whole world—and maybe you—might hear.

“Toni Morrison wrote, ‘Anything dead coming back to life hurts.’ In Spanish we say that when a child is born it is given the light. And that’s what it feels like to say the words, X⁠—. Like I’m being given a second chance at the light.”

So, this Sexual Assault Awareness Month, I want to say that if you’re still wearing a mask, that’s okay. You’re not ready yet. But when you are ready, I’ll be here. We’ll be here. And we’re ready to meet you and accept you as you are, in the light.


Trauma Recovery: Sessions With Dr. Matt is now available for pre-order!

We are thrilled to announce that our book, Trauma Recovery: Sessions With Dr. Matt is now available for pre-order! More stores will follow, but these are the current sites showing the pre-order info:


Trauma Recovery: Sessions with Dr. Matt conveys hope and resilience for trauma victims. Written by a psychologist with 35 years of clinical experience, and a survivor of childhood sexual abuse. Between compellingly-written scenes of group, individual and family therapy, the cognitive-behavioral science of PTSD and its treatment is explained. The book movingly describes the collaboration between therapist and clients as they strive to get unstuck from trauma-ravaged lives. Reluctant trauma victims who have avoided treatment or who are having trouble processing life’s catastrophes will find in these pages a “fly-on-the-wall” perspective of how therapy can help. Useful information about overcoming obstacles in treatment is provided while fears about facing trauma are allayed, motivating the reluctant victim to finally seek treatment. The book will also greatly inform motivated patients by providing a thorough, scientifically-sound understanding of PTSD’s nature and treatment. This book should be in every trauma therapist’s office and placed in the hand of each of their PTSD patients.

How Does One Identify an Experience as a Trauma?

By Matt E. Jaremko and Beth Fehlbaum

Our title might sound somewhat nonsensical. Of course, if you have experienced a trauma, you will know it. However, admitting that you have experienced trauma may not be as straightforward as you might think.
Folks can tend to underplay the extent to which they deserve care and attention. It’s almost as if these reluctant victims think, “Oh, I’ll be all right. Let someone else use the help and support.” Additionally, some victims might underplay the extent of trauma experienced because it could keep them from having to face ugly stuff. Sadly, there are those among us who have been trained well to follow rules that delay or avoid self-care. Under defining or failing to admit traumatic experience(s) could hold one back from getting needed help.

Photo by Oscar Keys on Unsplash

It was not uncommon in Matt’s years as a clinical psychologist to hear a client conclude that he/she had never really figured such and such event in the past had been traumatic. But after examining such under-defined life experiences in juxtaposition with the symptoms they had been having for years, these folks came to realize: “Yeah, that event was truly traumatic, and I wish I had started working at recovering from it much sooner.”

The criteria mental health professionals use to diagnose disorders (DSM V) states that a traumatic event is any occurrence that involves actual or threatened death, serious injury or other threat to one’s personal integrity. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, we present fictional accounts of the lives of seven victims with the following traumatic histories: childhood sexual abuse, attempted rape, being in an explosion in combat, being in a mobile home destroyed by a tornado, driving while in a motor vehicle accident in which the passenger is killed, and being a first responder to a multi-fatality terrorist shooting in a church.

Rates of Trauma in Modern Life

Most folks would agree that the experiences depicted in our book are life-changing traumas. A recent scientific research article described a survey that asked a carefully selected representative sample of over 3000 respondents if they had experienced trauma in their lives, (Kilpatrick, et a., 2013). 87% said they had!

In order of most-to-least common, the study listed the actual traumatic event and the percent of respondents who reported it: Physical or sexual assault (53.1%), Death of family/close friend due to violence/accident/disaster (51.8%), Disaster (50.5%), Accident/Fire (48.3%), Witnessed physical/sexual assault (33.2%), Threat or injury to family or close friend due to violence/accident/disaster (32.4%), Witnessed dead bodies/parts unexpectedly (22.6%), Exposure to hazardous chemicals (16.7%), Work exposure (11.5%), Combat or warzone exposure (7.8%).

Photo by Matthew Hamilton on Unsplash

These are startling numbers because they conclude that almost everyone is exposed to traumatic events. But if that is the case, why are we all not walking around like thunder-struck basket cases? The answer may lie in a concept known as “objective” trauma versus “subjective” trauma.

Objective Versus Subjective Trauma

If we asked a 100 people whether they thought being raped at gunpoint was traumatic, all would say, “Yes!” But if we asked the same 100 people whether experiencing the divorce of their parents at age 12 was traumatic, we might get an affirmative answer less than 100 times. Be that as it may, it could well be that at least some of the children of divorced parents consider the family disruption to be traumatic. In one case (brutal rape), the definition of trauma is based on the set of objective facts that surround the event, but in the other (divorce), the definition of trauma is subjective to the person experiencing it.

Photo by Beth Tate on Unsplash

Trauma must be defined by the experience of the survivor. Two people could undergo the same event and one person might be traumatized while the other person remained relatively unscathed. It is not wise, for example, to determine an event as not traumatic because no one was physically injured. Perceptions of an event can vary greatly from one individual to the next. It is impossible to assume that the meaning of an event that is distressing for one person will be same for another person.

Photo by Chris Lawton on Unsplash

The same goes for “objectively lesser” traumatic events, such as the divorce mentioned above or psychological abuse from a spouse. Using a subjective definition, many events perhaps people consider not to be traumatic should, in fact, be considered traumatic to some people.

Divorce has been mentioned: how about financial ruin and bankruptcy? After the market crash in the 1930’s, suicides were all too common among those who lost their fortunes. Speaking of the 1930’s Great Depression, prolonged unemployment and poverty probably caused trauma to many families. In a similar vein, countless individuals and their families facing major medical issues such as cancer are being exposed to traumatic events.

In a recently published book entitled Supernormal, Meg Jay brilliantly proposes that most people experience serious adversity in their lives, both as children and as adults. One might think of these life adversities as “traumas inside the home.” They include alcohol/drug abuse by parents or siblings, neglect by parents, overbearing parental expectations, suicide of a family member, even major arguments and disagreements over political issues. These days, there is even serious mention of such a thing as President Trump Stress Disorder! I guess that would be ptsd (without caps!)

Thus, trauma takes many forms, and there are vast differences among people who experience the same trauma. So, in order to define trauma, it is best to examine the similarities and patterns of responses across the variety of stressors and victims who experience them.

Dimensions of Trauma’s Strength

There are several dimensions that have been shown to make traumatic events more or less intense. These dimensions might be considered when attempting to determine whether one’s life has been disrupted by trauma.

The effects of trauma are more likely to be worse if any of these factors are true: the trauma was caused by a human; it was experienced repeatedly; it has the quality of any of the following: unpredictable, multifaceted, sadistic, undergone in childhood, perpetrated by a caregiver, and a lack of support or negative consequences from disclosure.

Photo by Cristian Newman on Unsplash

When it is another human that caused events leading to trauma, rather than a natural disaster, for example; the average reaction across victims will be worse. The recent mass shooting at a Texas church will no doubt lead to worse trauma reactions than the floods caused by the hurricane in the same state a few months before. But, once again, any one individual in either catastrophe could have a larger or smaller reaction to either of these tragedies.

The sexual assault victim who has been raped more than once will no doubt have more trauma to process than would someone who has been victimized one time. Incest victims who have been violated many times are typically more devastated than a child who had a single episode of being molested.

Repeated exposure to trauma clearly makes things worse. The effects of repeated trauma will be especially ‘hidden’ if what is repeated has been generally accepted to be ‘mild’ by the social group(s) in which it takes place. A youngster verbally abused (e.g. being called ‘stupid’) repeatedly might have an unrecognized trauma, until effects accumulate to form the symptoms of PTSD discussed below.

Being unable to predict when extreme stress is going to happen is often a predictor of whether PTSD will be severe. Consider refugees who must leave home due to war. Such folks might be in camps for unknown lengths of time with no control over even the most basic human factors. PTSD is more likely to be severe in such individuals.

In a similar vein, if events are so devastating as to consist of several distinct traumas, the stress reaction following them will be more intense. An individual in a motor vehicle accident is no doubt traumatized, but even worse so when a family member dies in the same accident. It should also be noted the age at which the trauma happens is important, with children more vulnerable to the development of post-traumatic reactions. Thus, a kidnapped child whose parent is killed trying to save him or her will be in for a long and difficult recovery process. Related to age is adversity or trauma caused by being raised by abusive or neglectful parents, and being around an abusive sibling all one’s life can cause enough cumulative stress that the effects are traumatic.

Photo by Igor Ovsyannykov on Unsplash

Finally, it should be noted that the reactions of people in the victim’s support system can add to the intensity of post-trauma reactions. Let’s say someone who was supposed to be trustworthy, for example, a stepparent, sexually abused a child, but when the abuse was disclosed, the biological parent was unsupportive or even dismissive. Such events predict intense PTSD symptoms with a very difficult course of recovery.

In summary, any event that combines the actual or perceived existence of two or more of the above dimensions will most likely lead to more intense PTSD and should be recognized as such so that appropriate treatment planning can begin.

The Symptoms of PTSD

Following an analysis of the nature of the stressful events, it is important to list and examine the symptoms being displayed by the victim. For PTSD, such a symptom list will contain 5 categories: re-experiencing the event, excessive effort to avoid anything to do with the event, negative emotions (anxiety, fear, anger, guilt, shame), social and occupational self-defeating activity, missing purpose and/or enthusiasm or meaning in life.

If these symptoms are observable, then a PTSD reaction is taking place, even if an “objective” assessment indicates otherwise. Becoming stuck in PTSD is so destructive to life, it should be identified and remediated as soon as possible. “Over-diagnosing” this condition harms little, but much is gained by catching it in a timely manner.

To illustrate the idea of a “subjective” instance of PTSD, let’s consider a fictional case. Paula is a 20-year-old junior in college. While attending a college fraternity party, Paula and her dorm mate got mixed up in an unpleasant exchange with some males at the party. These males ‘cornered’ the women in an upstairs bedroom for more ‘private interplay’. The males started coming on very strongly, making suggestive overtures, and actually groping Paula’s dorm mate. Two of the males disrobed and began to expose themselves. Paula reacted by freezing up, quite unable to respond. Her roommate, however, kicked one of the boys in the exposed genitals and started screaming loudly. Another young woman came into the bedroom, and the episode was broken up before the situation got worse. (As if it wasn’t already bad enough).

After the event, some of the girls in Paula’s dorm had occasion to talk about the event and similar events. Much to Paula’s surprise, a number of the other women in her dorm had had experiences like hers, a number of times. They seemed almost “immune” to it. Paula’s roommate appeared to have no visible reactions after the event.

Photo by Melanie Wasser on Unsplash

For Paula, however, things were different. She stopped going out with her friends on weekends. Occasionally, she would wake from bad dreams in the middle of the night about being locked in a frat house with a half dozen naked drunk college males. She was anxious all the time but ashamed that she could not ‘shake it off’ like her roommate did. She even considered quitting school, since she found little meaning in a place where such evil things took place, but everyone acted like they were no big deal.

As we observe this situation, we see two young women at the same event with two highly different reactions. Paula needs help, and she needs it quickly. Unless she gets it, she runs a great risk of becoming stuck in a pattern of internal dialogue in which she thinks it’s not okay, or that it’s even silly or weak for her to react in the way her mind and body have done. The subjective aspects of her life before this trauma and her reactions after it have created a PTSD reaction just as real as any more ‘objectively’ horrible trauma. The victim, not anyone else, best defines trauma.

Paula’s story is a common example of how and why folks who have been traumatized do not seek treatment or avoid seeking more information about trauma recovery. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, one of the characters, Felicia, has experienced a sexual assault much like described here with Paula. Felicia goes for years suffering PTSD symptoms, in part due to an ongoing internal dialogue with herself in which she told herself that she was weak and unworthy of having a normal life.

Let’s examine another example of “childhood adversity” that might not be considered as an objective trauma but results in all the PTSD symptoms. Growing up with a parent who is an active alcoholic is highly stressful. Adult Children of Alcoholics is a self-help recovery movement for such folks. People with this history have life experiences that include all of the dimensions of trauma’s strength discussed above, and many individuals who are adult children of alcoholics have all five of the symptoms of PTSD. However, many such folks would never equate themselves to a rape victim or an incest victim. Nonetheless, their subjective reactions amount to a life full of trauma.

Dr. Patricia Resick, a noted expert in treatment for assault-related trauma, has pointed out the role of becoming “stuck” in unhealthy emotions and beliefs that nothing came be done after victimization. Dr. Resick contends that much can be done to reclaim/rebuild life, and that such work can be basically quite effective once begun, but—to accomplish recovery, one must overcome the stuck points such as those illustrated in this article. Perhaps the first step in that process is being more ‘liberal’ in defining life events as traumatic.

Life Events Sometimes Not Considered as Traumatic

So, here are some examples of life events that tend to not be defined as trauma because folks have, for the reasons cited above, under-defined them or avoided examining these life events with the criteria of trauma in mind. If you have any of the five symptoms discussed above, maybe you should look more closely at this list to see if these events happened to you and might be the cause of your hard-to-account-for symptoms:

1. Repeated verbal abuse by a parent/caregiver

2. Date rape or otherwise unwanted sexual physical contact

3. Experiencing or witnessing domestic violence

4. Victimized by a crime, even a ‘white-collar’ crime where much was lost

5. Living with chemically dependent family members

6. Severe and sustained economic downturn

7. Divorce and separation from your children

You should especially consider the above as traumas if any of the dimensions that add to the strength of a trauma are involved: repeated, happened in childhood, caused by a human—especially a caregiver or trusted person, were intentional, and the reporting of them was discouraged or punished.

Therapy is not necessarily a lengthy, expensive venture. Once you commit to one of several efficient and time-limited cognitive-behavioral treatments, you have a good chance of turning your life around. More information about types of treatment—including names of therapists—may be found at Dr. Resick’s website for understanding and treating trauma: cptforptsd.com

Our book, Trauma Recovery: Sessions with Dr. Matt, points out that 40% or more of people who have experienced trauma end up being stronger and better adjusted after the trauma is ‘processed.” This is called “post-traumatic growth.” In easy to understand language, we present the “the how and why” trauma victims get better, even stronger.

The First Step

Photo by Jenny Huang on Unsplash

If you’re ready to move toward post-trauma growth, we propose that you can begin by taking the initial step toward recognizing your under defined trauma.



Giving Thanks for the Opportunity to Share a Message of Hope and Resilience with Trauma Survivors

Something I’m thankful for: my writing partner and the book we wrote together. I’m sharing the cover with you. It’s the first time it’s been posted publicly.
My co-author, Matt, and I really like this cover because of the light coming into the group therapy circle: providing the light of hope in the face of the indescribable darkness that is being “stuck” in mental illness and desperation.

I think it was spring of 2016 that Matt Jaremko and I discussed writing a book to help trauma survivors. It took us a bit to find our writing groove in terms of both how we could best communicate what we wanted to say that would extend hope and model the power of resilience for traumatized people, AND for us to find the most efficient way for us to write together without becoming frustrated…we initially tried using Google Docs, and, never having co-written with anyone else, I didn’t realize we couldn’t be in the document at the same time. So I was working and Matt was, too, and the page was jumping all over the place…it was not fun. So we dispensed with that pretty quickly and moved to Word and Track Changes, which is the industry standard for working with editors.
Once we found our way to work together by exchanging the manuscript (“The book is now in your hands. I will not touch it until you send the manuscript back to me”), our book began to take shape in a meaningful, rewarding way. Matt and I have such a strong respect for each others’ strengths and abilities. He is, without a doubt, one of the two smartest, most compassionate and caring men I know, with the other being my husband, Daniel. Not coincidentally, these 2 men also comprised my primary support system when I was broken.

I rank our book, “Trauma Recovery: Sessions With Dr. Matt–Narratives of Hope and Resilience for Victims With PTSD,” as one of my “heart” books. What this means, for you non-writer types, is that this book is one of the most personally meaningful to me. It is defining. It IS to come full circle. While I love all 4 of the YA fiction novels I’ve written, 3 of them: Courage in Patience, Hope in Patience, and Truth in Patience, are the most precious to me because I wrote them while in recovery when I was working with Matt Jaremko, many years ago. They are the arc of Ashley, a teen girl who is entering recovery after being abused by her stepdad and neglected by her mom through deliberate indifference. Ashley’s biggest hurdle is facing the truth about her life–about her worth as a person, in spite of being discarded by the person who should have loved her most. She is removed from her stepdad & mom’s home & placed with her father, David, who she does not know at all.
Ashley is a frightened victim at the outset, a person beginning to realize her value in the middle, and a strong survivor capable of advocating for herself at the conclusion. That’s why the books are called Courage (1), Hope (2), and Truth (3). They are set in the small E. Texas town of Patience, and the girl’s therapist is Scott “Dr. Matt” Matthews. Guess who he’s modeled after?

When Matt and I decided to take 2 of my characters–Ashley and Dr. Matt– and place them in a group setting in order to facilitate the combination of fiction and teaching about resilience, we took Ashley, aged her from 15/16 to 19, and made her a member of Dr. Matt’s Thursday evening Therapy Group for Victims, Survivors, and Righteously Indignant Angry Folks. Then we imagined the other members:
Hunter, age 32, who woke on the ground in the dark after a rain-wrapped tornado destroyed his mobile home, critically injuring his toddler daughter;
Felicia, age 34, who, at age 14, was nearly raped by her brother’s friend; 20 years later, she is still haunted by it, but needs to come to realize an even darker truth about her youth;
Ben, age 20, who saw combat horrors in the Middle East and returned home a fundamentally different person;
Patty, age 47, who lost control of her car, with her husband being killed when they hit a semi-truck;
Jake, age 30, an Emergency Medical Technician (EMT) who responded to a hate crime-shooting at a local church’s Wednesday night prayer service. The son of a preacher, Jake lost his faith as a result of what he saw.
Darrell, age 35, who served time in prison for armed robbery. When he was released, he entered therapy to seek solutions for the frequent rages that overtook his decision-making abilities. Through his work with Dr. Matt, Darrell learned new ways of interacting with others. He joined the Black Lives Matter movement and discovered his passion for making a difference through teaching young African-Americans about non-violent protest.
Betty, age 40. Her family-of-origin abandoned her when she began coming to terms with the sexual abuse perpetrated on her from a young age. Betty worked with Dr. Matt and gradually found the strength to rebuild her life. She entered college as a non-traditional student and became a bilingual education teacher, where she puts her native Spanish to work.

We wrapped our manuscript in July, began seeking a publisher in late summer, and by October–and this is remarkably fast to find a publishing “home”–we were offered a publishing contract with a “Mind-Body-Soul” imprint, Ayni Books, and our book will come out in late spring/early summer 2018. The book will have international distribution and be available in both print and e-book.

We began sharing the manuscript with others, asking for blurbs, and we were blown out of the water by what our readers said. Check ’em out.

We invite you to read the Prologue: The Internal Dialogue of a New Patient Being Sick and Tired of Being Afraid and Stuck.

I wrote this Prologue from the memory of where I was when I entered treatment to recover from Childhood Sexual Abuse. At that time, I was 38 years old, the mother of 3 teen girls, and I broke. I could no longer pretend that the stuff I’d gone through as a child and young adult, and in many ways continued to endure as an adult, were not killing me. The pretending was killing me. I was slowly killing myself through binge eating. Efforts to deal with the never-ending anxiety I lived with night and day were futile. Prior to working with Matt, I never stuck with therapy once I was nudged toward being authentic and honest with myself and others about how broken I was. I “clicked” with him and, after Daniel, Matt is the first man I ever truly trusted. Until that time, my understanding of men was that they would abuse me once I began to let my guard down.

This prologue is thoughts of the person prior to entering a therapist’s building when the choice at that time is either get better or die. These are exactly what it was like to be in my head at that time.
Facing the truth about one’s life is a soul-searing experience. For me, the journey to REAL, and WHOLE, was much like the process of birthing a child. It was exhausting, but without a doubt, learning to be resilient and authentic was the most gratifying experience of my life.
This is what we hope will be the result for those who read our book.

Please help us spread the word about our Facebook page. “Like”/”Follow” us, and you won’t miss out on the journey.

Being Tender yet Tough with Veterans

As any subgroup of Americans, military veterans cover a wide spectrum of personality types and pre-service adjustment history. While there is almost universal agreement that veterans should be honored for serving, across the board admiration without constructive criticism may be unwise. Not every hero acts heroically all the time. Sometimes folks with adjustment difficulties need tolerance and tenderness; but sometimes they need toughness and truth. Military veterans are no different. Three points worth considering in detail come to mind.

The alarming suicide rate may not simply be due to cultural and economic difficulty in reintegrating “into the world.” Many times suicide is an extreme case of rage and anger expression meant to hurt others deemed responsible for the pain felt by the suiciding individual. Unfortunately any person having difficulty expressing strong emotion prior to enlisting might likely be at greater risk to demonstrate unhealthy emotional expression after being stressed by military life, especially combat. Help for such predisposed individuals probably requires retraining in emotional intelligence where a certain “tough love” adherence to abstaining from careless emotional and social acting out is enacted. Like a substance abuser needed to work a program of sobriety, emotionally immature vets might need to increase careful self-discipline when attempting to convey strong and complicated emotion.

Second, it is not accurate to say that services in the VA system are unsatisfactory or unavailable. Well over 85% of veterans report being highly satisfied with help gotten in this system (Even though surveys are oft used for political agendas and there are at times horror stories of care gone wrong). Plus is it not a complete picture to conclude there are unacceptable wait times in the VA system. Since 1979, veterans have been able to use the walk-in, storefront clinics of 300 Vet Centers nationwide to get immediate support, social service and counseling. For over three years in the 1980’s at the Memphis Vet Center I personally conducted a weekly, open ended support and therapy group in which hundreds of men and woman worked through a full range of issues. There is no wait in these “store-front” services, veterans just “walk-in.”  Additionally, there are currently available online and smartphone delivered services for those who suffer from PTSD. Any veteran who wants and needs treatment can get it in a timely fashion.


Additionally the detail, quality and efficiency of treatments available for PTSD is increasingly outstanding. Here’s a website, cptforptsd.com, that explains the treatment in clear terms and provides a searchable list of therapist certified to conduct it.


Finally, it could well be that something else is operating in the lives of those veterans who do not avail themselves of services before taking self-destructive action. Recent efforts by dedicated VA mental health practitioners are focused on discovering the parameters that make veterans reluctant to seek treatment (such as Strong Star, https://tango.uthscsa.edu/strongstar/).  A number of helpful resources are beginning to emerge which address such reluctance, like Donald Meichenbaum’s Roadmap to Resilience for veterans and their families or my forthcoming book with Beth Fehlbaum, Trauma Recovery: Sessions with Dr. Matt. These books provide information about what recovery treatment is like and hopefully give inspiration to overcome the reluctance.

Most experienced trauma therapists know that timing is crucial in successful treatment. Sometimes, tenderness and tolerance is required where authentically “being with” someone without judging helps. Other times, a more tough approach is needed to challenge with helpful truths a person who is stuck in a devastated life. If we agree that military veterans deserve our best support, we probably have to dig a little deeper to determine what they need. In the meantime, welcome back, guys; and Happy Veteran’s Day.

Perseverence + Resilience + Patience = Hope for Recovery

The PTSD symptoms I had were so overwhelming that at times I thought I was losing my mind. I’m not even kidding–and if you ever meet my husband, or my children, who were teens at the time, ask them what Mama was like back then. I’m sure some of their stories would blow your hair back. I’ll never forget when I was in a really bad way and actually got behind my clothes in my closet, like I used to do when I was a child, to hide from my stepfather. My husband, Daniel, stepped in, leaned down, and said softly, “I seeeee youuuuuu…” but didn’t judge me harshly or make fun of me. It’s one of the reasons I love him more than words could ever adequately describe.

Trauma Recovery: Sessions With Dr. Matt helps people like me –like I was at that time–understand what happens when someone experiences trauma, and I love its message that sufferers are NOT crazy or weak: they are incredibly strong for continuing to put one foot in front of the other, even while enduring some very scary shit inside their heads. It’s compassionate, speaks to readers where they are–like Daniel that evening when I was a hot mess, and we let readers know, again and again, that HOPE is possible, and RECOVERY is possible, and we shine that all-important light when it’s so easy for survivors to get lost in the nooks & crannies of their minds. We strongly suggest that readers work with a therapist as they process their trauma, because recovery from PTSD is scary.

Nearly a decade ago, Matt taught me HOW to be resilient and HOW to persevere through those undoubtedly dark days. I wrote poems and essays and short stories and shared them only with Matt: there was no one else I could trust with–saddle with, really– what was coming out of my mind and landing on my keyboard and screen. At his suggestion that I try writing a novel, I imagined the trauma I had endured as having happened to someone else, stepped outside of myself, and began to tell 15 year old Ashley Nicole Asher’s story. With her being “born,” so was my life as a professional writer, although I didn’t know it at the time. All I was doing was following the advice of the man I had learned I could trust with my darkness, and he would be by my side, holding the light.
Trauma Recovery: Sessions With Dr. Matt is a unique amalgam of teaching about PTSD and giving insight into the recovery process and the storylines of 7 members of the Thursday Night Therapy Group. Matt E. Jaremko is the inspiration for the Dr. Matt character in my Patience books, and I patterned the experiences of the main character, Ashley, after my own. All these years later, Matt and I teamed up and took those 2 characters, aged Ashley up to 19, and placed Dr. Matt and Ashley in a group therapy setting. Along with Ashley, group members include a survivor of a tornado destroying his mobile home and gravely injuring his toddler daughter; a woman who was behind the wheel, reached for her phone to check a text, and slammed into a semi, killing her husband on impact; a first responder to a mass shooting at a church (timely, sadly); a soldier who was injured when an IED exploded outside his barracks, killing his best friend; an ex-con who is determined to rebuild his life and make a difference; and a survivor of an attempted rape by her brother’s best friend when she was 14–as well as family secrets she has yet to allow herself to process. She attempts to cope with her anguish by numbing herself with food. And, of course, there’s Dr. Matt, an experienced therapist nearing the end of his career and contemplating what’s next.

Please check out the Facebook page Matt created for  our book, and take a look at our website, Trauma Recovery: Sessions With Dr. Matt too! We also have a blog, Hope for Post-traumatic Growth.
I hope you’ll subscribe to our sites & give our FB page a “Like” so that you get the latest news on our book, which is set to release around late Spring/early Summer, 2018.

And-I hope you’ll read the posts Matt has entered on our FB page so far. He has a lot to say, and he is one of the 2 smartest men I know–the other being my husband, Daniel. I owe my life today to Matt and Daniel’s unwavering support, presence, and holding me accountable to not give up.
Trauma Recovery: Sessions With Dr. Matt is one special book, and it holds a hallowed place in my , alongside The Patience Trilogy.