Daniel Oakes: Trauma

[Mark Rippetoe]

Criticisms of The Contemporary Approach To Trauma | Daniel Oakes

[vk60187]

To me, the worst thing about a trauma, is when a victim starts doing to themselves, emotionally, what was done to them. If one was verbally abused, one starts having angry self talk when they make a mistake, becomes hard on themselves. This is the real tragedy, in my opinion.

I like a website called whywesuffer.com as they have an interesting take on why we suffer. These truths (I believe they are true in my case) are hard to accept, because there is a tendency to blame others (often the blame is warranted), however, as long as we remain victims there is little progress. And it's possible to remain a victim for their whole life.

[JFord]

Criticisms of The Contemporary Approach To Trauma | Daniel Oakes

A few years after 911, I attended a grand rounds lecture by a psychiatry professor. He cited data from a study randomizing surviving post 911 victims to usual care vs intensive survivor group therapy. 6 months out, the group therapy patients did WORSE with respect to return to work, disability pay, psychological, and somatic complaints.

The investigators theorized that the group therapy patients, by reliving the trauma they’d experienced over and over again in their groups' stories week after week laid down maladaptive neural pathways much like the adaptive pathways laid down by learning a new skill (such as squatting?)

It’s as though the group therapy consolidated their angst, depression, and anxiety following the event.

Unfortunately, I was never able to locate the actual paper(s) but these results seem very plausible to me. What’s interesting is that I’ve spoken about this work to almost every psychiatrist that I know and none of them believe these results or conclusions.

A friend of mine was driving and was in a minor fender bender with her 10-year-old daughter. Although there were no injuries, it was strong enough for her airbag to deploy. To her, this implied that the accident was life-threatening and she developed some of the symptoms of PTSD: compulsive thoughts, hyper-vigilance, insomnia, anxiety, depression, etc.

Her 10-year-old? Nothing. In fact she was more worried about her mother’s response to the incident than about the incident herself. Because I was a medschool professor at UCLA she asked me if I could find her an academic psychiatrist. I called my favorite one and told him the history and although he agreed to see her, he chastised me for my advice to her prior to calling him of “just deal with it.”

She suffered for at least a year…from the trauma of having an airbag deploy. I wondered what would have happened if she'd taken my advice.

Thank goodness she didn’t put her daughter in therapy as well.

[mbdonner]

I'm a psychologist, psychoanalyst and psychotherapist. Dan has done a good job describing examples of bad psychotherapy and the treatment of trauma. Psychotherapy, like coaching, has a lot of incompetent and poorly informed providers. In the examples cited by JFord, fundamental errors were made by the treating clinicians. If a child or adult is not showing symptoms, "treating" them doesn't help and can make things worse. In a model known as "Critical Incident Debriefing", automatic "treatment" used to be the standard, and there is research that demonstrates it makes things worse not better.

However good psychological treatment does not actually involve immersing the patient in their trauma, but teaching resilience, helping the patient see how their previous trauma is influencing their interactions with others, and helping to more effective ways of living in the world. Just like in coaching, there are therapists who are taught to provide "silly bullshit" and some that are taught how to help strengthen and prepare the patient for a more effective life. I see some people who were profoundly shaped in negative and positive ways by their life experiences. Those shaped negatively have life-long problems with relationships and their ability to function effectively. Like a good coach, I have to teach them good form, show them how to function more effectively, undo the effects of years of bad patterns of behavior, and where necessary, work around their limitations. I don't think anyone here would say, "if you have had a bad coach, don't ever get coaching." You would try to help them find a good coach. Psychotherapists are no different, and just like with coaches, it is hard for the average person to know the difference. What Daniel Oakes wrote about is bad psychotherapy, but not all psychotherapy is bad.

[Mark E. Hurling]

Makes you wonder how our forebears managed through famines, infant mortality, wars, floods, etc.

[gadders]

I follow a guy on instagram who does some pretty cool cartoons but he makes no secret of the fact he is in therapy and has issues with his parents from when he grew up. I read his output and I don't want to minimise his issues, but I can't help sometimes thinking to myself "Have you tried thinking about these issues less?"


I swear dwelling on stuff and overthinking does people no good at all.

Psychotherapists are no different, and just like with coaches, it is hard for the average person to know the difference.

Any suggestions on how people can tell the difference? Or red flags to look out for?

[mbdonner]

It's hard. People describe themselves as "trauma therapists" often want the patient to focus on the trauma. I think a good therapy should help you to understand how your past trauma affects you and your relationships today. Understanding the ways you have been influenced by your experience will help. Ask the therapist their approach. If they can’t explain it in a way that makes sense, it's probably not right for you.

[mbdonner]

They managed, just like people managed to get strong without barbells and Starting Strength. Some got hurt, some didn't get a lot stronger, some did just fine.

[Joel Chapman]

Makes you wonder how our forebears managed through famines, infant mortality, wars, floods, etc.

They probably did martial arts, right?

[Mark E. Hurling]

They probably did martial arts, right?

Some of mine drank, a couple ended up in prison, and some just carried on in silence quietly and lived their lives uneventfully.