In trauma science, moral exhaustion differs from fatigue or depression. It isn’t physical depletion; it’s ethical depletion. The empathic system has been overdrawn for too long without replenishment. The brain, especially in individuals with prior trauma histories, internalizes witnessed harm as a personal moral debt. Over time, the nervous system equates continued participation with betrayal of conscience.

Professionals in trauma-dense environments—first responders, crisis clinicians, homicide investigators, social workers, environmental advocates—live inside an endless exposure loop. Every day brings another case, another loss, another systemic failure. Training demands composure, but composure isn’t immunity. Eventually, the human drive to repair collides with evidence that repair may not be possible. That collision marks the beginning of moral exhaustion.

Those with early trauma histories reach this threshold faster. Childhood harm teaches the brain that control equals safety. When confronted with systemic cruelty, injustice, or ecological destruction, the nervous system recognizes the same helplessness it once survived. The result is ethical hypervigilance—a relentless drive to prevent harm paired with the conviction that nothing one does will ever be enough.

Behaviorally, moral exhaustion can resemble depression, but its tone is distinct. It sounds like:
“I’m not sad—I’m done.”
“I still care, but I can’t care this much anymore.”
“I don’t hate humanity. I just don’t trust it.”

These aren’t signs of weakness. They’re signs of saturation. The brain is conserving empathy by rationing it. Left unrecognized, this state can slide into withdrawal, cynicism, or what forensic psychologists call preventive morality—the belief that the only ethical way to stop harm is to stop participating in creation, caregiving, or advocacy altogether.

For trauma-exposed professionals, awareness becomes the first form of intervention. Recognizing moral exhaustion requires blunt honesty about what the work has taken. It means admitting that the same empathy that once fueled competence can become corrosive when unbalanced by restoration.

Supervisors and colleagues should learn to identify the early markers:

• Persistent sense of futility or disillusionment despite competence

• Emotional numbness paired with rigid moral judgment (“right” vs. “wrong” thinking)

• Withdrawal from peers or formerly meaningful work

• Physical symptoms triggered by exposure reminders—racing heart, nausea, dread before routine tasks

Addressing moral exhaustion is not about “more self-care.” It requires moral recalibration—a structured reflection that restores coherence between values and capacity. This may involve consultation with trauma-informed peers, spiritual mentors, or ethics boards—not as discipline, but as containment. The goal isn’t to erase despair; it’s to normalize it as a signal of conscience doing its job too well for too long.

In forensic and environmental fields, recalibration often means redefining success. Instead of measuring worth by eradicated harm, success becomes measured by sustained integrity. For clinicians, it may involve temporarily stepping away from front-line roles to teach, mentor, or write—positions that still serve justice but allow the empathic system to breathe.

Moral exhaustion is not failure. It is the mind’s plea for congruence. Those who have seen too much of the world’s cruelty are not broken; they’re running on moral credit that has yet to be repaid. The work ahead is not to toughen but to rebalance—to remember that compassion was never meant to be a lifetime without rest, only a practice done in shifts.

Sources:

American Psychological Association — Moral Injury and Secondary Trauma in Helping Professions (2023)
National Center for PTSD — Ethical Fatigue in Trauma-Exposed Occupations
Figley, C.R. — Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized (1995)
Journal of Occupational Health Psychology — Empathy Regulation and Moral Depletion in Caregiving Roles
Oxford Handbook of Forensic Psychology — Preventive Morality and Systemic Burnout

Dr. Mozelle Martin

Dr. Mozelle Martin is a retired trauma therapist and former Clinical Director of a trauma center, with extensive experience in forensic psychology, criminology, and applied ethics. A survivor of childhood and young adulthood trauma, Dr. Martin has dedicated decades to understanding the psychological and ethical complexities of trauma, crime, and accountability. Her career began as a volunteer in a women’s domestic violence shelter, then as a SA hospital advocate, later becoming a Crisis Therapist working alongside law enforcement on the streets of Phoenix. She went on to earn an AS in Psychology, a BS in Forensic Psychology, an MA in Criminology, and a PhD in Applied Ethics, ultimately working extensively in forensic mental health—providing psychological assessments, intervention, and rehabilitative support with inmates and in the community. A published author and lifelong student of life, she continues to explore the relationship and crossovers of forensic science, mental health, and ethical accountability in both historical and modern contexts.

www.InkProfiler.com

What am I feeling? It has been four to five years since the concept of a trauma disorder made an appearance and a diagnosis in my life; I am sixty-eight years old. A diagnosis of CPTSD, a trauma disorder, was made by a Clinical Psychologist. Admittedly, it is tough to be diagnosed with a disorder that hasn’t even been acknowledged to exist as a diagnosis in our land of the DSM.

I grew up in the sixties and sought out therapy in the late seventies or the first year of the eighties. Psychoanalysis still held sway with many of the powers that be back then. Psychoneurosis was the culprit I suffered from back then. It’s funny how the term lost favor over the decades, yielding to trauma disorders, but still, personality disorders have survived to our present day. Sometimes, it seems the baby was gleefully tossed out along with the bathwater regarding psychoanalysis as a legitimate source of intellectual understanding of the human mind. I suppose it is neither here nor there today, but I’ve just wanted to make a point: “Don’t completely whitewash the utter genius our forefathers handed down to us. Without them and their astonishing insights and mind maps of human suffering, we would be lost in the wilderness.” Returning to where I started, “What am I feeling?”

My lungs begin to clench, which makes filling them nearly impossible

As of the last year or so, I have been taking a new tactic when I experience what I’ve learned to call a CPTSD flashback of an earlier emotional state. My feelings at the moment can come upon me, often unexpectedly, as a raw state of gut-ugly, unexplainable psychological pain. What am I feeling? What is coming over me? Is this a panic attack? My lungs begin to clench, which makes filling them nearly impossible. My psychic state becomes that of being paranoid, unable to confront others in the moment. I typically feel as though I want to curl up into a fetal position and rock myself to make it stop, to make it go away. How would that look at the kitchen table or in the classroom? WHAT AM I FEELING?

If I take various medications, often this emotional experience is awakened, causing me to quickly get off the meds. I am extremely sensitive to this nearly unbearable feeling state that lives perpetually within me, but it is often held or kept out of my emotional experience. My behavior subconsciously knows this emotional upheaval is lurking below, and that sets the stage for other “diagnoses” that manifest from within. What do I feel?! I can no longer escape this question.

I can’t know what others are feeling or describe their experiential moment. Hell, I can barely describe what “I” am feeling. I cannot put a definitive finger on what comes over me. My present inclination is to label the torturous burden I have lived as “REJECTION.” Perhaps it is a state of abandonment emanating from the earliest memories of an internalized, living, traumatic experience. But as keenly and consistently as this energy is regurgitated and re-lived within me, it has to be an emotional experience I endured repeatedly. Repeated emotional states of being touched to the depths of what it is like to be flat-out rejected as a child. Wouldn’t you think? Why else would I know this lifelong, usually unconscious “terror” as a built-in framework of my inner emotional life? Where did this feeling that overtakes me come from? What am I feeling, and why am I feeling it?!

(RSD Rejection Sensitive Dysphoria. I hope to finish soon an essay regarding Rejection Sensitivity and the state of Rejection dysphoria that many come to live with. Until then, if you relate to suffering from a feeling of rejection, look up RSD as used in psychology).

IT IS NOT JUST ME WHO IS IN AN EMOTIONAL CRISIS

Was it okay for me to be different as a toddler and a growing boy, whether I was or wasn’t “different”? Were the raging assaults with “the belt” and the open hand truly appropriate to the moment’s punishment? Where did my mother’s rage toward me come from? I now know it was not I who caused her emotional rage; it was her own flavor of “What Am I Feeling” that hypnotically commandeered her emotional moment… driving her to assault me. As an adult, my mission is to seek and find the answer to what I feel. I know I’m not alone because one thing I’ve learned about us humans is that when I am feeling something, IT IS NOT JUST ME WHO IS IN AN EMOTIONAL CRISIS. It is me suffering the way others who were treated like me are also experiencing. I’ll bet that too many of us suffer the experience of WHAT AM I FEELING, yet we can’t bring ourselves to tell the familiar story. It feels too shameful, that toxic feeling of brutal shaming for feeling damaged (Toxic Shame).

If you are suffering, please don’t think you are alone. If you feel it, it is because that is how a human feels when they are mistreated in their youth. How could it possibly be our fault when we were such helpless children? You can’t argue with that. It was not our fault.

Cover Image created with AI

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Jesse Donahue

*Copyright notice. All writings copyrighted and registered with the Library of Congress.

Therapy has helped improve my self-understanding as well as writing skills through journaling and essays. Although this writing journey began in later years, it has led to 70+ essays oriented around issues with CPTSD – a trauma disorder.

My writings, which include therapy notes, poems, novels (unpublished), and essays, are all a part of my ongoing personal therapy. Initially, the essays, intended for my therapist’s eyes only, began with exposing my thoughts, fears, and feelings, or the lack of, onto paper, a journal of therapy notes. Then, with fear overcome and via a personal decision, I shared them with the readers. *My thanks to Paul Michael Marinello, the editor of the CPTSD Foundation. My intent is to encourage readers to recognize traits in themselves and find (if desired) a therapist when they are willing and ready for that step. For some of us, it can be a long and challenging process, over extensive periods, to awaken to the unconscious issues that cause us to act out in life. Our behavior may seem like dancing to a buried, invisible cause we cannot directly see or confront. It is my sincere hope that my insights will assist the reader in the process toward reaching a deeper self-understanding.

Bringing the unconscious out into the light of self-awareness, understanding, and acceptance fosters self-love and the process of change.

 Jesse B. Donahue

*Type a keyword into the foundations search engine. (Jesse, Heart, Personal, Twelve, Bugaboo, etc.) Or, Type Jesse Donahue at The CPTSD Foundation on a Google search.

Published with the CPTSD foundation. Top 10 essays in order of number of views:

1.  ** Personal Honor, Integrity, Dignity, Honesty
2.  ** The Heart of the Matter
3.  * The Smoldering Embers of C-PTSD
4.  * The Hidden Bugaboo (Parts 1-4 of 4)
5.  Twelve Days Without Coffee
6.  Learned Helplessness
7.  Cast Out of Eden by Toxic Shame
8.  *Codependency – Overriding the Monster of Self-Hate
9.  The Emptiness of Yesterday
10.  Surfing the Light Through the Darkness

I had a weird tension in me about it

Like other techniques, we also employ the idea of a “safe place,” where he helps me anchor into safety before we do any deep work or regressions. I have always used the same safe place since I have been seeing Dr. Gabe: the beach in front of my grandma’s house, now our second home. As we began chatting at the beginning of the last session, I realized I was feeling a little hesitant about “going to my safe place” because, in reality, this was where I had broken my wrist a few weeks prior, and I had a weird tension in me about it.

So, all the things we normally do and go through to work through deep-seated trauma from the past, we went through the same process on the trauma of breaking my wrist. That was our starting point. First, I re-experienced the crack of my bone that I heard and the onset of the fear I experienced. I was scared and alone and had no way back up the small cliff I had descended to the rocky shore. (I am quite good in emergencies, and this was no exception. I simply trespassed onto a neighbor’s property, used their private staircase, and thanked them later for using it.  They have offered for me to use their stairs down any time I need to since I won’t be going down or up on the climbing rope for a while at least. It’s when the emergency subsides, and the adrenaline rush crashes that emotion tends to overwhelm me, and I cry and shake and get embarrassed at my reactions.)

As we followed my subconscious, it led me to the scene in my home when the ambulance arrived.  Fire truck, too. There must have been 15 people all congregating around me. People were sticking my veins for an IV and missing. Pandemonium. My parents happened to have just arrived at our home because we were all going out to dinner. When I called my husband, John, and told him I had broken my wrist and was coming up the neighbor’s stairs, my parents were already there. I was still somewhat in shock, and the pain was amplifying exponentially from moment to moment. I just needed a minute to process everything. I wanted to see my husband, hug him, and figure out the best thing to do. I was still evaluating how badly I had been hurt. My dad took over and called the ambulance without my knowledge or approval; he just did it. Ultimately, I am glad I went to the ER that night and that I did so in an ambulance, where they were able to administer pain medication during the hour-long drive to the hospital. But all of a sudden, I saw the pattern clearly of how my father always made “executive decisions,” as he sometimes called them, and put situations in front of me where he had already made a decision and effectively removed the element of my own choice from me. Over and over from a young age until it seemed normal.

But I have a voice today. Sometimes, I still have to speak up forcefully to get my dad back in check, and I do know he means well and cares – and I am truly grateful for that. But it was ultimately nice to recognize how pervasive that pattern had been in my life and how and why it has taken me a lifetime to speak up for myself and make my own best decisions. It still amazes me how we think that trauma is about one particular thing, and then we do the work and find all these other things mixed in and attached in ways we hadn’t ever even realized before.

And my safe place is safe again.

Photo by Annie Spratt on Unsplash

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Adina Lynn LeCompte

Adina Lynn LeCompte is a sixth-generation Californian. After having lived in varying parts of the US and abroad in Florence, Italy, she has come home to roost, splitting her time between the Central Coast and the Foothills of Yosemite. She holds her Bachelors of Arts from UCLA (Language & Linguistics), her Master of Arts from Middlebury College School Abroad / Universita’ di Firenze (Language & Literature), and studied 4 years in the MDiv program at Naropa University in Boulder, Colorado. Over the years, she founded several successful local businesses and worked as an interfaith hospital and hospice chaplain.

Adina is a working writer, an award-winning poet, and is working on her upcoming book “Spilling Ink: Write Your Way Into Healing”. Additionally, she has designed an interactive transformative workshop by the same name that uses writing as a tool for healing from trauma, especially abuse and grief. She is also co-author of several compilations of poetry with her husband, John LeCompte, who is also a writer. (“With These Words, I Thee Wed: Love Poetry” was published in 2023.)

Her most recent exciting endeavor is being a part of the Bay Path Univeristy’s MFA program in Creative Nonfiction, with an emphasis in Narrative Medicine.

writeyourwayintohealing.com

Psychotherapy is where most people find validation. This piece will focus on validation in psychotherapy and how it can change your life.

Is Psychotherapy Helpful?

A paper published in the early 1990s stated they could find no difference between subjects who received treatment and those who did not. Ever since, much

research in response to that paper has shown that 75% of those who receive therapy show some benefit, with 91% stating they are satisfied with the quality of therapy they received, with 84% saying they are satisfied with their progress.

However, after having said all of that, psychotherapy has its drawbacks. For one, it can dredge up long-forgotten memories that might not need to be unburied. The emotional turmoil that one goes through when reliving a fantom from the past is palpable.

Therapy helps to relieve the client’s symptoms and functioning, and studies have shown it can reduce disability and mortality and reduce the need for inpatient care. With psychotherapy, you might also experience decreased psychiatric relapse, leading to milder symptoms than just medication alone can treat.

Most people who enter therapy have no idea what a ride they are in for.

Many go seeking advice, which they will not find. That is not a function of psychotherapy. However, most seek to alleviate the pain and suffering they have lived with their entire lives.

Why is Validation Necessary?

When you enter therapy for any disorder, including complex post-traumatic stress disorder, you probably don’t know what to expect from your therapist. If you are looking for a therapist to tell you step-by-step how to heal, you will be waiting a long time. That is not what therapists do.

Instead of telling you what to do, which would be significantly harmful, a therapist will listen with empathy and watch and listen for the places you need healing. The therapist will be watching for body language and verbal words to measure how you feel about what you are speaking about.

The therapist reads verbal and body language to help them relate to you on your level and show that they believe in you and your healing. Even if the therapist disagrees with what you are saying, they will signify through their body language and words spoken back to their client that they have heard and understand where you are coming from.

Without validation, you cannot get anywhere on your healing journey because you need someone to understand and accept you unconditionally.

The Therapeutic Alliance

The therapeutic alliance, a term first used by Zetel in 1956, is an essential foundation for the relationship between therapist and client. The therapeutic alliance is a collaborative and trusting relationship also known as a working alliance.

The working alliance is a partnership between therapist and client that helps them to achieve agreed tasks.

The concept of the therapeutic alliance dates back to Freud’s day and is considered an essential component in psychotherapy. The therapeutic bond is strengthened by affective elements such as respect, liking, trust, and a sense of collaboration between the therapist and the client.

The therapeutic alliance depends on some elements much like those described below.

The transference/countertransference relationship. Transference occurs when a client subconsciously projects their feelings about someone onto the therapist, and countertransference is when the therapist subconsciously directs their feelings onto their client. Transference and countertransference involve both the client and the therapist. The patient draws their therapist into the role of someone in their internal world. To further complicate things, therapists have their pasts and lived experiences, which color their responses.

However, a good therapeutic alliance allows for these human responses and doesn’t normally interfere with therapy.

The developmentally needed/reparative relationship. This type of relationship is a corrective experience a therapist provides their client. This relationship is meant to help repair the client’s deficient parenting, the abuse they might have lived through, and if the parents were overprotective. Just about any subject can be broached in the therapeutic alliance.

The transpersonal relationship. This element describes a human-to-human relationship with one person affecting the other and can include healing or spiritual healing. The transpersonal relationship also refers to the feeling one gets after visiting your therapist. When you have formed this element of the therapeutic alliance, you have reached the point where you are familiar with your therapist and want to continue care.

How Does a Therapist Foster a Budding Therapeutic Relationship

Whether you go to treatment and try to improve your life, drop out, or do not go, you will always find validation in the therapist’s office. There are several components to the therapeutic relationship that are helpful to know when considering going into therapy.

Those components should be present after you give your new therapist time and may include the following.

• Unconditional acceptance as you are where you are in life.
• Mutual trust and respect
• Professional intimacy. This component is the therapeutic relationship between a therapist and a client. Professional intimacy fosters closeness and self-disclosure, such as telling your life story or telling the therapist about abuse you may have survived.
• Unconditional acceptance.
• Unconditional Positive Regard.
• Genuine interest.
• Attending and listening
• When necessary, silence.

The therapist takes all these tools and those they learn as they practice to help you feel validated.

How to Tell If Your Therapist is Validating

The first thing you will notice if you are not a good fit with a therapist is your lack of progress. You should not measure your progress by how you’ve healed by leaps and bounds. Instead, measure your progress by how you feel overall about your chances to reach the goals you and your therapist agreed upon.

Here are a few more questions you can ask yourself.

• Does my therapist listen with empathy? Or do they direct their attention away from you to do something else?
• Does my therapist accurately reflect and acknowledge what I am saying?
• Can my therapist state aloud what I am saying in nonverbal emotions?
• Does my therapist ask follow-up questions to confirm what I have just said or thought?
• Does my therapist use phrases that are easy to understand and show they comprehend what I am saying?
• Does my therapist seem genuine?
• Am I treated with dignity and respect?

When asking yourself these questions, remember that treatment, like anything good, takes time and effort on your part and your therapist’s. You may need to seek someone else if neither of you meets the other’s expectations.

However, if you find a helpful and highly validating therapist, you should consider keeping them because therapists are in short supply in the United States.

Ending Our Time Together

Feeling validated is critical for all humanity, and psychotherapy is one way to gain it. When I entered therapy, I had no idea what my journey would be or how long a road I was about to embark upon.

My first therapist, Paula, was great at forming a therapeutic alliance with me. She took over teaching me what my mother did not, which changed my life. For me, psychotherapy brought enormous validation, first that I was not crazy, and second that I could stop all the flashbacks and learn tools to cope.

Armed with unconditional personal regard and a strong belief that I would get well, Paula never gave up on me, validating my reality and lead me to discover a new way of thinking and living.

If you are considering psychotherapy, I strongly encourage you to do it now that you know what to expect. Go in with an open mind, willing to discuss your history without reservation or fear. The therapeutic alliance that will form will change your life forever.

If you are a therapist reading this piece, remember that if you do not believe your client will get well, they won’t. Your body language and demeanor will tell on you.

Either way, attending psychotherapy with a good therapist can help you to find the answer to the question you seek and aid you in living and living well.

“The most important progress and success can’t be seen. If you can validate yourself internally, then external validation becomes a byproduct.”
– Brittany Burgunder

“Trauma is personal. It does not disappear if it is not validated. When it is ignored or invalidated the silent screams continue internally heard only by the one held captive. When someone enters the pain and hears the screams healing can begin.”

– Danielle Bernock

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com

However, sometimes rejection goes very deep and begins in early childhood.

This article will focus on rejection and how going to a therapist can change your life forever.

It Often Begins in Early Childhood

It is no secret that children rely entirely on their parents for protection and daily needs. What happens to children when their emotional and physical needs are not met? They grow up feeling cold, alone, and rejected by those they should have been able to count on for everything.

Parental rejection is the absence or withdrawal of love, warmth, and affection by parents who are self-absorbed and not interested in their children’s emotional or physical health. There are four different types of parenting styles leading to neglect and abandonment.

Hostile and aggressive. In a hostile parenting style, one parent tries to undermine their child’s relationship with the other parent. These parents often view their children as possessions and cannot or will not appreciate the child’s needs. Parenting aggressively can be physical or psychological, where the parent uses punishments, yelling, and other hostile parenting patterns.

Cold and Unaffectionate. This parenting style is called uninvolved parenting or being neglectful. These parents are viewed as cold, uncaring, and poor at differentiating their child’s needs and activities. A cold and unaffectionate parent may have a confusing relationship with their children and do not set healthy boundaries or sometimes do not discipline them.

Neglectful and indifferent. These parents are uninvolved, and their parenting style provides low to no parental support, control, and attention. These parents also do not focus on their children’s needs but ignore their children completely or encourage them to “toughen up.” This parenting style also involves not setting boundaries or appropriately disciplining their children.

Indistinguishable rejecting. With this parenting style, children believe their parents do not love them even if there is no history of overt neglect, unaffectionate, and aggressive. An approach to control and structure characterizes this parenting style. Rejecting parents do not demand much from their children, are unresponsive to them, and apply little control over them. These parents are often dismissive and neglectful.

Believing their parents reject them, many of these children suffer significantly, and the lack of appropriate care and love leaves the child physically and psychologically underdeveloped.

Childhood Trauma and the Fear of Rejection

Childhood trauma is like poison to a developing brain. Trauma repeatedly floods the child’s brain with hormones usually reserved to flee an enemy causing brain damage to some areas, such as the amygdala and hippocampus, to name a few.

The effects of rejection during childhood have both short-term and long-term effects on the child’s psychological adjustment. Below we will examine many of the effects children being neglected or abused experience.

• Social Adjustment. There has been found a correlation between peer rejection and parental rejection. Also, rejected children are more likely to have problems with social adjustment as teens. These children are said to have less empathy, helpfulness, and generosity.
• Researchers have found that across all countries and cultures, children who experience rejection develop the following personality traits:
• Lower self-esteem
• Anger
• Hostility
• Emotional instability
• Coldness
• Problems with behavior. Parental rejection is related to many behavioral issues in children, including delinquency, conduct disorder, and directing their feelings outward toward others and their social environment. These children, when grown, have problems with drug use, binge drinking, and forming close relationships.
• Children who experience parental rejection are more likely to suffer from student bullying and victimization. In contrast, some children who feel rejected and have parents who are indifferent and hostile often grow to be bullies.
• Academic performance. It is well known that children perform better in school if they have a positive outlook on school when their parents are actively involved in their education. Lack of parenting involvement negatively affects the performance of children and increases the child’s overall well-being.
• Mental health issues. Research has indicated a positive correlation between children’s mental health and parental acceptance. Because childhood rejection leads to feelings of low self-esteem, hopelessness, and helplessness. There is also a correlation between childhood rejection and self-injury. Chronic childhood rejection may lead to mental health challenges like complex post-traumatic stress disorder.

How Does Fear of Rejection Affect Our Adult Relationships?

Adult relationships are built on mutual understanding and building trust between two people. Survivors of childhood neglect and abuse have a horrendous time doing either. Survivors are afraid to open themselves to someone else because they fear being rejected as they were when they were growing up.

Survivors often withdraw from others rather than risk reaching out and holding back from expressing their feelings. They are ready to abandon others before they can abandon them. As a survivor, you fear the strong emotions that accompany loss. But because loss and grief are parts of life that cannot be avoided, you probably fear the worst, iterating in your mind that loss is always wrong.

The fear of rejection is often rooted in the belief that you are not good enough and that giving that person the power to make us feel our emotions is dangerous. There is an enormous fear that the other person may want to see our bodies or that they may feel superior to us. Both fears resound from early childhood experiences when your body was violated and showing emotion meant paying a horrible price.

How to Recognize if You Are Afraid of Rejection

Sometimes the last person to know you are living out the effects of rejection is you. It is easy to pretend you were utterly unscathed by what happened to you as a little child.

It is critical to see the rejection of the past so that we can find ways to help ourselves heal. We must accept that our childhood was far less than ideal and that we did not deserve nor did we do anything to cause the lack of love and attention we received.

Below are some signs that you experienced rejection trauma as a child. The list is not all-inclusive but is meant to guide you to research more yourself. If you recognize yourself, do not panic; you can and will heal if you want to and are willing to work.

• You think others are saying or thinking negative thoughts about you.
• You apologize all the time, even when no apology is necessary.
• You find it incredibly difficult to get close to people.
• You have little to no trust in anyone.
• You don’t know how to accept compliments.
• You are constantly questioning yourself.
• You are a people-pleaser.
• You are a chameleon.

One other tale-tale sign that you were rejected as a child is your state of mental and physical health. Emotionally, you may have received or will eventually receive a mental health diagnosis such as complex post-traumatic stress disorder or another psychiatric diagnosis.

Physically rejection and the trauma it causes make you more likely to be obese and, as a result, have other physical problems. That’s right; your heaviness was not your fault.

Psychotherapy Can Help with Childhood Rejection

Psychotherapy is a valuable tool in healing childhood rejection. The therapy experience for childhood rejection issues will not take a few weeks, but possibly months, and for those in need, years. However, it is one of the primary ways to overcome the deep-running emotions plaguing your adult life.

Therapists are trained to deal with the consequences of childhood rejection and any accompanying mental health issues you may have developed. Having a good therapist may help you explore potential reasons for your rejection and reassure you that you were not at fault.

Unfortunately, children, now adults, harbor internalized messages and the belief that there must have been something wrong with them. There was not. There was absolutely nothing wrong with you; your caregivers were at fault.

Therapy can help you replace negative thoughts with more positive ones, such as “You are loveable and easy to love.” In therapy, you can also work through behaviors that isolate you because of aggression or fear.

Ending Our Time Together

Rejection is challenging because it arouses so many feelings of helplessness and hopelessness. Speaking about it in this piece was not meant to do so; it was written to help you see there is hope and therapy may be your best bet for healing.

There are many types of therapy out there, and it is up to you to find a therapist who will fulfill what you need in one of them.

I have been in talk therapy for years; it has saved my life and helped me heal tremendously. When I began therapy, I thought I was going insane because I kept having memories of abuse and rejection come out of the blue in the form of flashbacks.

I was horrified. What were these apparitions that kept me afraid and filled with dread? Once in therapy, I understood that the visions of past abuses were real and part of my history. After many years in therapy, I have found peace and have a life beyond what I would have had I not pursued therapy.

My hope for you is that you will find the help you need and heal.

“When you give yourself permission to communicate what matters to you in every situation, you will have peace despite rejection or disapproval. Putting a voice to your soul helps you to let go of the negative energy of fear and regret.”
― Shannon L. Alder

“Every time I thought I was being rejected from something good, I was actually being re-directed to something better.”
― Steve Maraboli

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com

HOW DO YOU FIND A GREAT THERAPIST should be answered first.

Traits of a Great Therapist

Not all therapists think alike or have the traits you might seek, so you will need to evaluate them carefully. Most therapists will allow you one office visit to determine if their qualifications are a good fit or if you wish to move on to another therapist. It is important to note that, initially, you might not like your therapist all that much or you might like them too much. Both are reasons to regroup and try to put the therapist in perspective.  To help you figure things out, there are nine valuable traits that make a therapist great.

1. A willingness to validate their clients. Validation, in this sense, means that the therapist believes in your ability to grow, change, and heal.
2. The therapist tries to understand your world. You and your new therapist have many differing traits, including religious beliefs, minority or majority status, sexual orientation, and family of origin dynamics. A great therapist seeks to lay aside their own biases to work well with you.
3. They do not feel they are or act superior. A great therapist does not believe they are superior in intelligence, economic affluence, and other areas. Such a therapist treats clients with dignity and respect.
4. A great therapist has deep self-knowledge and understanding. These counselors look at themselves realistically and exude confidence. They have undergone psychotherapy themselves as part of their training process.
5. Great therapists have firm and clear boundaries, which are vital for each client’s healing process and as protection for themselves. A reasonable boundary is a limit set to keep the therapist from being manipulated or violated.
6. A good therapist isn’t afraid to challenge you. Upon entering therapy, many clients have confusing and ineffectual beliefs about the world around them. These challenges buck against what clients have learned about themselves and their current thoughts. For example, your therapist will introduce you to shades of gray if you suffer from black-and-white thinking.
7. Therapists who are good at what they do would never, ever allow a sexual relationship to form between you and them. The therapeutic alliance is personal and intimate, and sometimes clients mistake caring for love. A good therapist squashes any budding sexual relationships and sometimes must refer you to someone else.
8. Great therapists have a deep-seated interest in each client’s healing abilities. Their disbelief that you can heal will show in their body language and how they treat you. If you find that your therapist is stuck in terms of how to help you improve, it is time to search for a new therapist.
9. A great therapist is also trauma-informed, meaning they understand, anticipate, and respond to your issues and expectations based on your trauma history. They understand the needs of someone who has been traumatized and are aware of trauma’s consequences and how it affects your life and relationships. A trauma-informed therapist seeks to do no harm, avoids re-traumatization, and does not blame you for your trauma responses.

If you find a therapist with at least most of the traits listed above, work with this therapist. Good therapists are hard to find, especially in remote areas.

Traits that Tell You That You Need to Leave

There are times when it becomes necessary to leave the therapist you have chosen. While this transition is challenging, especially since you have invested your time and energy in the therapeutic alliance and have shared your intimate secrets, the situations below indicate that you must say goodbye to your therapist:

• You feel judged and misunderstood.
• You feel too overwhelmed.
• You feel you are not getting better under their care.
• You leave appointments feeling defeated and invalidated.
• You must repeat stories because your therapist cannot remember what you said.
• You cannot afford therapy anymore and need to seek therapy you can afford.
• You don’t feel safe, motivated, or comforted by your therapist.

There are also positive reasons for leaving your therapist, including the following.

• You feel you have developed all the tools you need to move on.
• You feel you have reached the goals you were working on.

You may discuss your departure with your therapist in person or you can send an email, letter, or text, but don’t leave your therapist wondering what happened to you. Therapists do have feelings, and a good therapist treating severe PTSD or conditions such as dissociative identity disorder long-term will be left wondering what went wrong.

When Your Therapist Leaves You

A therapist must leave you for many reasons, including pregnancy, family illness, or retirement. No matter the reason, because you have invested hours and hours telling them about your situation and wishes, a therapist’s departure stings.

Most of the time, your therapist will begin preparing for their departure as soon as they decide to leave. If your therapist is getting ready to retire, they will know sometimes a year ahead. Your therapist must tell you as soon as possible so that you can begin the difficult task of mourning the loss and finding a new one.

Your therapist may spend the rest of your time together concentrating on their leaving instead of the therapy that would typically be offered. It is best if you and your therapist decide not to begin exploring new issues because you will not be able to integrate that experience long-term.

Remember during the leaving process that your therapist is a human being with needs. If they are retiring, they need to rest. Some therapists have worked for decades treating clients and listening to their problems. They deserve to leave their practice.

You might experience a feeling of great loss due to your therapist leaving. Because it is a serious loss, you may find yourself experiencing the five stages of grief. You may want to increase your exposure to friends or family at this time or find a hobby that will give you a distraction while you are searching for a new therapist.

Whatever you do, do not decide to try to heal on your own. It won’t work. You will just end up with a mess that only a great therapist could unravel.

Finding a therapist

Finding a therapist is difficult today because there is such a shortage of therapists, psychologists, and psychiatrists. This shortage leaves potential clients on long waiting lists, which is not helpful, especially if you have feelings of self-harm or destruction.

One helpful thing in finding a therapist is having an idea of what it is you want from them. Do you have a specific problem, such as needing to lose weight or wanting to work on childhood issues? Have no fear; knowing and understanding what you want from a therapist is not critical, as many begin treatment just knowing they don’t feel emotionally well.

You need to examine how much you can pay. Will your insurance cover what you need? Will you need to pay as you go out of pocket? Most insurance requires a referral from your doctor. If you find you cannot afford traditional therapy, you might try therapists who exist only online. Their rates can be much lower than in-person therapists.

You can also reach out to your county mental health facility as they often offer sliding-scale rates.

It is vital to check with your insurance company and determine what mental health benefits they cover.

Where to Find a Therapist

There are many ways you can find a therapist. You can go online and get help from many therapeutic opportunities. While you won’t be meeting a therapist face-to-face, telehealth is popular with many people as an alternative for reaching help that is located many miles away.

Consider calling your insurance company to ask who they recommend you see in your area. That phone call can save you a lot of headaches, and you can be sure the therapist you choose is in-network.

Many find-a-therapist sites can help you narrow down who you want to see. These sites are as follows.

Good Therapy

Mental Health Match

Psychology Today

Better Help

These free websites can help you enormously in your search for the perfect fit for your therapy experience.

Ending Our Time Together

Complex post-traumatic stress disorder, like dissociative identity disorder, is life-altering and cannot be healed by the survivor alone. You need the help of a therapist to aid you in gaining life and moving on from the trauma that caused your problems.

With this article, we have examined the traits of a good therapist. Hopefully, you will use this information to help you find someone who is empathetic and a great listener.

We also discussed what to do when your therapist retires or leaves you otherwise. Losing a therapist is highly traumatic and should not be minimized. Sometimes the pain and grief accompanying losing a therapist can last for years, so your new therapist must be aware of that.

As always, I wish you well in your search. There is a shortage of therapists, but you can find the right person for your care with due diligence.

“Words of comfort, skillfully administered, are the oldest therapy known to man.” – Louis Nizer.

“When we’re able to share with someone who we do feel safe with, we can realize that these things that are happening to us don’t make us unlovable and aren’t anything to have as a huge secret and don’t make our future dark and dreary. Actually, we have a really gorgeous future, and we deserve love and safety.” – Johnathan van Ness.

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com

This article, piece one in a series about psychotherapy, will attempt to answer these questions and offer realistic information to those with complex post-traumatic stress disorder and other mental health conditions.

What is Psychotherapy?

Also known as talk therapy, psychotherapy is a tool to treat mental health issues. In psychotherapy, you will talk to a stranger telling them what is bothering you, and the therapist acts like a neutral person reflecting back to you what you have said. The therapist becomes a mirror helping you to find your own path and answers.

The theme of psychotherapy is to help you identify and change your thoughts, behaviors, and troubling emotions. Sometimes medication is used in consort with psychotherapy to help ease some symptoms that surface during treatment.

Psychotherapy is typically practiced in the office of a licensed mental health professional, one-on-one with the therapist. However, group therapy is not uncommon.

The real work begins once the client and psychotherapist have passed the introduction stage. The client shares their wounds with the therapist to be addressed, and the two begin talking about and sometimes feeling the emotions that go along with the issues the client is facing.

Psychotherapy can be a short string of sessions during and after which the client feels better and can function better in their life. However, some disorders may require that a client be in therapy may for a year or even decades.

Why Seek a Therapist?

There are as many reasons to see a therapist as people seeking or needing one, including serious mental health disorders, relationship issues, stress, grief, anger, and substance abuse.

Mental Health. A mental health disorder can lead to anything from mental discomfort to suicidal ideations. Some mental health disorders a therapist treats are anxiety, depression, and addiction.

Relationship Issues. Any married couple can tell you that sometimes they need help to stay together. There might be marital problems such as infidelity or divorce. But treatment for relationship issues does not end with married couples. Anyone, especially those who survived child sexual abuse, can find themselves struggling with relationships and needing help.

Stress. Stress is usually related to either your job or unexpected life changes. Psychotherapy can give you a place to go when times get rough. In therapy, you can vent all your frustrations and let yourself speak about how you are feeling for one hour without judgment.

Grief. Facing a loss and the bereavement accompanying it can significantly affect how you are feeling inside and reacting outside. On the inside, you feel the acute loss as an empty space in your gut, and on the outside, you react by weeping and passing through the five stages of grief. Therapy allows you to mourn without judgment and in a safe place.

Anger. Many people believe they cannot control their anger and that outbursts of yelling or physical behaviors that are unacceptable are common. If you react with anger instead of thinking your options through, you may need a psychotherapist’s services.

Substance Abuse. Substance abuse includes alcohol, all unprescribed drugs, such as meth, AND substances that are prescribed but are not taken as ordered. It is nearly impossible to get sober on your own. You need the help of someone else who can be there when you need them. Therapists can and do help those who live with addiction by helping those suffering from it to understand better what they are burying under the high the drugs or alcohol bring.

Author’s note. People who have substance abuse disorder are not weak or flawed. They are good people entrapped by destructive substances and their brain’s reactions to them.

Different Types of Therapy

There are literally hundreds of forms of psychotherapy, and for the sake of this piece, we shall cover only three of them, cognitive behavioral therapy (CBT), behavioral therapy, and dialectic behavior therapy (DBT).

Cognitive behavioral therapy (CBT) explores the relationship between how a person feels and how they behave. The therapy’s purpose is to teach a client how to control emotions and behaviors.

Behavioral therapy, one of the many forms of psychotherapy, aids one in learning to control their emotions and behaviors. Behavioral therapy has at its base the notion that all behaviors are learned and can be changed. One does this by exchanging potentially destructive and unhealthy behaviors for those that are desired.

Dialectic behavior therapy (DBT) is a form of therapy that is adapted for people who feel intense emotions. The end result of DBT is to help clients understand and accept feelings that are difficult to manage. Acceptance means that the person’s feelings and emotions are valid, and change means that clients need to make positive changes to manage their emotions and move on.

Other therapies include art and music therapy, integrative or holistic treatment, and drama therapy, where the client lives in their adult shoes and goes back in time using their imagination to save themselves as children.

How Therapy Can Help You Overcome

Early childhood experiences of abuse or neglect form complex post-traumatic stress disorder. This mistreatment causes clients to have multiple emotional and physical problems that need addressing.

A few of the physical problems trauma can cause are as follows:

• Headaches
• Nausea
• Chest pain
• Fatigue
• Disturbed sleep
• Being easily startled
• Heart disease

A few of the emotional problems caused by trauma are as follows:

• Anxiety
• Agitation
• Sadness
• Numbness
• Dissociation
• Anger
• Aggressive behavior

Both the physical and emotional symptoms are caused by having no control as a child while someone else abused their bodies and minds.

The best way to overcome these physical and emotional problems that have come from memories and emotions from the past is to learn to live in the now. People who have survived childhood trauma must let go of the past (not forget it, that is impossible) and stop worrying about the future.

Therapy aids you in the process of living in the present and allows the past to become just that, the past.

Ending Our Time Together

I have complex post-traumatic stress disorder and another mental health condition and would not be here if it were not for psychotherapy. Due to the added problems from my second diagnosis, I have spent many years healing myself.

That you heal yourself is critical to understand. The therapist has no special powers over you, nor do they have all the answers you seek. Therapists are simply people with a license trained to diagnose and treat mental health disorders. The therapist’s role is to prompt you to explore a different way of thinking and behaving. You do all the hard work.

No matter your problem, from wanting to quit smoking to learning to handle life on life’s terms, you can find peace of mind and healing in a therapist’s office.

“Be Your Best Without the Stress! Be the director and actor in your movie called My Life.”        — Katrina Radke

“Therapy will take longer than you want, but shorter than what you fear.” – Dr. Paula McNitt

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com

I am not going to lie; I was really skeptical at first. The thought that staring at a pointer would resolve decades of trauma stored in my brain seemed too good to be true. Nevertheless, I adore and wholeheartedly trust my therapist, so I reluctantly agreed to try it.

Our first session was called an intensive, which means 3-hours of therapy in back-to-back sessions. I’m not sure why I thought that was a good idea, but again, I trusted her, so I did. We did three different targets, which will take too long to handle in a single blog, so I will break this into two parts (one target I am not willing to share at this time).

The target I want to share with you today is related to a near-drowning accident that I experienced when I was ~ 4 years old. The gist of the story is that I left the patio at my aunt’s house to feed the ducks (they had a house on the lagoon), and I fell in the water. I don’t remember falling in the water, and for years, I didn’t remember much about it, but the story was repeated every time family got together. After a while, I started having flashes of memories pop up, but they weren’t connected.

I remember being in the water and trying to keep my head above water, but, of course, I couldn’t swim. I remember some teenagers jumping off the pier a couple of houses down from where I was, and I also remember calling out for help. I remember the green-brown water over my head, seeing the light above the water, and thinking I was going to die.

Obviously, I didn’t die, or I wouldn’t be writing this. The story goes that the teenage neighbor girl saw me fall in the water and rescued me. She brought me soaking wet to my aunt’s front door and rang the doorbell. I don’t remember any of that, but I’m pretty sure I was in shock at that point. I am sure I must’ve given my poor aunt a heart attack. Can you imagine her having to tell my mother that I drowned in the lagoon? Thankfully, God spared me.

Amazingly, this incident never caused me to be afraid of water or not want to swim, or even go onto the dock again. As the memories started to surface (pun intended), I became aware of some strange behavior I was exhibiting in the workplace, and I had no idea why I was doing those things.

When I first read The Body Keeps the Score by Bessel van der Kolk, I balked at the part where he talked about how, according to Freud, trauma victims had the compulsion to repeat portions of their trauma as an “unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution.” (Kolk MD, Bessel van der. The Body Keeps the Score (p. 32). Penguin Publishing Group. Kindle Edition.) In my mind, why would anyone want to repeat something traumatic repeatedly?

But that is precisely what I saw…in myself.

At work, I would always stand on the periphery in crowds and was compulsively “trying to get noticed.” I realized that I was trying to make sure I could be seen so that someone could save me.

I also heard myself repeatedly saying, “I’m drowning” at work, which led to being overwhelmed and unable to function. I would get upset when my boss or co-workers didn’t rescue me. It kept coming up in weird ways, so I thought, let’s deal with this target. Sure. Why not?

We started by talking about the sensation I was having in my body around, feeling like I was drowning in emails. Once that was activated in my body, my therapist held up this pointer and moved it horizontally across my visual field until I located the spot that was the most activated and fine-tuned it by moving the pointer vertically. (You absolutely can’t make this crap up. It really works.)

Once we found the spot, all I had to do was stare at this dumb pointer. It does feel dumb to stare at a pointer and think something amazing will happen, but that is exactly what happened. The feeling of helplessness rose to the surface, as well as the words, “I’m gonna die.” There was a resignation that I could NOT save myself. I didn’t know how to swim, and there was nothing I could do.

Then, I could hear the voice of the Spirit of God in my ear, reminding me He was with me, and all I needed to do was to call out to Him…so I did. He told me I was never designed to save myself; that was His job. He showed me that He was the one that sent that neighbor girl to rescue me. He never lost sight of me. He was waiting for me to stop struggling in my own strength to save myself before He sent help. That is exactly what they teach in lifeguard school.

That was super powerful, but my therapist told me to stick with it to see if anything else came up. I could hear this voice saying, “giving up is failure.” Again, I could hear the voice of the Lord speaking the words of truth to me. He said I didn’t give up; I called out to the One that could help me, and He did. He has all the resources I need at His disposal.

I have lived with this compulsion to try to save myself for five decades. I wouldn’t let people help me because I had to save myself.

I wouldn’t ask people to help me because that was admitting defeat. All this time, I’ve had the complete regimen of resources of the God of the universe at my disposal, and I refused to ask for help because I felt like I had to save myself.

I was absolutely amazed that the compulsion was gone. I mean gone, gone. I tried for a week to re-activate that spot again, and I couldn’t. Wow!! I cannot explain it, but I will tell you that I have already seen evidence of it being gone in how I’ve reached out to people for help and didn’t try to do things on my own. I can’t tell you how many times over the years my therapist would say to me that I don’t have to do this alone, but I still felt like I had to, but not anymore. I feel more open to asking for and receiving help from others. I don’t feel like I have to do it all alone.

It is so freeing to finally realize that the God of the Universe knows exactly where I am at all times. He never loses track of me. He is waiting for me to call out to Him, and He is ALWAYS there when I do. He has all the resources of the universe at His disposal. I was never meant to save myself; that is His job. He really does save…spiritually, physically, and emotionally.

What an amazing experience and that was just the second target of three. The depth that this got to in my brain was truly remarkable. I am encouraged to continue this journey and see how the Lord can use this modality in my healing journey.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Cyndi Bennett

Believer. Leader. Learner. Advocate. Writer. Speaker. Coach. Mentor. Triathlete. Encourager. Survivor.
 
Most of all, I am a fellow traveler on the rocky road called, Trauma Recovery. My mission is to minimize the effects of trauma for survivors in the workplace.

This article will attempt to tackle the connection between addiction and trauma.

What is Trauma?

Trauma is a common experience in humanity. Someone dies, you are in a car accident or a natural disaster, or any event over which you have no control causes this trauma reaction.

Trauma is our minds’ response when we experience a deeply distressing or disturbing event that overwhelms our ability to cope. This traumatic distress causes feelings of helplessness and diminishes our sense of self and control over our emotions.

Trauma and its effects are felt worldwide and do not discriminate. A survey by the World Mental Health Organization found that 1/3 of the more than 125,000 people surveyed in 26 countries said they had experienced trauma. The percentage rose to 70% when the group became limited to those experiencing core disorders as described in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition.)

While these stats are impressive, the percentage of people who experience trauma is probably much higher.

Some people with unaddressed or untreated childhood trauma often suffer from other mental health concerns, including complex post-traumatic stress disorder.

What is Addiction?

Some people consider addiction as being addicted to alcohol or drugs. However, it is much more insidious than that.

Addiction is a neuropsychological symptom where the person has intense urges to engage in behaviors that provide immediate sensory rewards.

Addiction doesn’t only happen to some people in one category as it is universal and can affect anyone of any demographic group. Because addiction is a brain syndrome, no one is safe. If the correct substance or circumstance happens to you, you will become addicted and exhibit addictive behavior.

          Being addicted to something isn’t a weakness or caused by a sinful lifestyle. Those are myths that must be dispelled.

Research has shown that the human brain is hardwired for addiction, given the correct stimulation of its reward center. The neurotransmitter dopamine is a feel-good substance in our brain responsible for repeating pleasing and necessary functions such as procreation.

The brain is also affected in other ways, such as the prefrontal cortex, the center of the brain’s highest functions, by dopamine stimulated by the substance or behavior.

There are a variety of causes and risk factors that aid in the development of addiction, including:

• A family history of addiction.
• Easy access to substances early in life.
• Starting the use of substances when a child.
• Exposure to advertising of substances or behaviors.
• Exhibiting a mental health condition.
• A history of abuse and neglect in childhood.
• Low parental monitoring, neglect, and abuse.

If you read the list above, you might have noticed that almost all the causes of addiction, except the genetic component, are avoidable.

Types of Addiction

One can become addicted to about any substance or behavior. Compulsive behavior, cravings, and lifestyle dysfunctions seriously impact a person’s health, relationships, and livelihood.

Addiction is a complex disease; no matter what, the substance or behavior causes its victims to chase after that pleasurable euphoric feeling while causing damage.

There are two types of addictions: physical and behavioral.

Physical Addiction. Physical addictions are better known among the public and include addiction to substances that are ingested or otherwise put into your body.

The most common physical addictions are listed below.

• Tobacco
• Sugar
• Alcohol
• Opioids
• Prescription drugs
• Marijuana
• Cocaine
• Hallucinogens
• Amphetamines
• Inhalants
• PCP
• Methamphetamine

Physical addictions are further grouped into three categories, alcohol, illicit drugs, and prescription drugs.

Behavioral Addiction. This type of addiction includes any behavior where you lose control over your actions to engage in behaviors that make you feel brief euphoria. The affected person depends on the euphoria from certain behaviors and compulsive actions.

The most common types of behavioral addictions are listed below.

• Addiction to food
• Sex addiction
• Addiction to pornography
• Internet addiction
• Addiction to using computers or cell phones
• Work addiction
• Exercise addiction
• Spiritual obsession
• Cutting
• Shopping addiction
• Gambling addiction
• Video gaming addiction

There are many more physical and behavioral addictions.

Trauma and Addiction: Is There a Connection?

Trauma is considered the root cause of addiction. Trauma in childhood especially leaves adults vulnerable to forming an addiction once a substance or behavior is introduced to them.

The nature of addiction is to self-soothe, to make one’s problems disappear for a while, covered over like a dirty Band-Aid on a festering wound. Unfortunately, there comes a time in every addict’s life when the wound beneath the Band-Aid begins to cause pain because although the person briefly covers over the memories of what happened to them, it is still there when they get sober.

Chasing the emotional and physical pain-relieving euphoria of a substance or a behavior leaves the person experiencing addiction desperately craving to feel that release again.

We are only now beginning to understand the link between addiction and trauma. Childhood trauma does more than make a person more vulnerable to forming depression and other mental health problems later in life.

There is evidence that suggests that it causes specific changes in the brain.

Some researchers at the University of Texas studied 32 teens, 19 of which had experienced childhood maltreatment. Later, using a brain-imaging technique measuring the integrity of white matter (the ‘wiring’ that connects different brain regions), the scans showed that teens who had experienced childhood trauma had connectivity problems in more than one area of their brains.

These changes involve the left side of the superior longitudinal fasciculus (SLF), which is necessary for planning behavior, and the hippocampus, which connects the brain’s emotional processing regions to those involved with abstract thought. This part of the brain is also thought to regulate the brain’s response to emotional stress.

         Simply put, trauma changes the brain by making it unable to regulate how it responds to stress (such as child abuse), setting the person up for an                     addiction.

We are only beginning to explore addiction, which is not well understood.

Current Treatments for Trauma and Addictions

Addiction affects the lives of approximately 20.7 million people in the United States, but only 2.5 million ever receive treatment. Denial is the driving force behind many not seeking treatment, as when you are in active addiction, you rationalize your behaviors and tend to blame your addiction on others.

To be clear, addiction is not a weakness. Instead, it is a brain disorder that has serious long-term consequences. A person experiencing an addiction requires individualized treatments to address the symptoms and causes of their problem.

Psychotherapy, in its many forms, are the current treatments for addiction. There are some pharmaceutical treatments, but these cannot be taken long-term and do not treat the underlying traumatic cause of addiction.

Some other types of psychotherapy that may help a person living with addiction include but are not limited to the following.

Cognitive Behavioral Therapy (CBT). CBT encourages people to question and examine repeated negative thoughts to phase them out, replacing them with healthy ones. People who receive CBT learn to recognize and change their maladaptive behaviors by using coping skills when faced with risky situations (triggers).

Dialectal Behavioral Therapy (DBT). This type of therapy teaches people how to regulate their emotions to reduce self-destructive behaviors caused by intense self-limiting thought patterns. Although DBT works best for severe personality disorders, it is somewhat effective for treating addiction.

Eye Movement Desensitization and Reprocessing (EMDR). EMDR aids people in their recovery from their traumatic experiences and lessens their symptoms and distress. This treatment involves engaging other brain parts through bilateral eye movements while discussing the trauma. EMDR helps the brain’s information processing system to heal and promotes emotional stability.

There are also twelve-step programs like Alcoholics Anonymous that have only between an 8-12% success rate. The bottom line is that addiction is a devilishly tricky disease to treat and has yet to be cured, although it has been arrested in some people.

Ending Our Time Together

People suffering from an addiction have been ridiculed and wrongfully told to pull themselves up by their bootstraps. Such treatment only drives the affected person further into their substance or behavior.

There are no cures currently available for addiction. However, if the trauma that causes addiction goes untreated, the person experiencing it will not do well.

Perhaps to stop addictions in the future, we should advance our awareness of the trauma that our children are going through. Children belong to all of us, and we need to be more vigilant and not afraid to speak up when we see children being mistreated or neglected.

To report child abuse and neglect, please call your local police, sheriff’s department, or a children’s hotline such as the ChildHelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). They are open 24/7, seven days a week, and speak over 200 languages. The hotline isn’t just for reporting child maltreatment; it offers many valuable resources and is an excellent resource for mandated reporters.

Healing takes courage, and we all have courage, even if we have to dig a little to find it. – Tori Amos

Part of the healing process is sharing with other people who care. – Jerry Cantrell

References

Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and post-traumatic stress disorder in an urban civilian population. Depression and anxiety, 27(12), 1077-1086.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/

Sheeren, M. (1988). The relationship between relapse and involvement in alcoholics anonymous. Journal of Studies on Alcohol, 49(1), 104-106.

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com

A few years ago, I was invited to attend a new support group for people diagnosed with complex trauma. I was (unsurprisingly) anxious about going, but hopeful it could help me. When I got there, I expected that nervousness to calm down, but instead, it got much worse. It took every bit of strength in me not to run out of the room. When it was over, I went home and hid under my blankets for three hours.

Eventually, I decided to give the group one more try. I experienced the same terror, and to top it off, I spent the majority of the hour crying uncontrollably. It was such a dysregulating experience that in the days that followed, I deteriorated into a new depressive episode. It was devastating and left me feeling broken and like a walking open wound. Needless to say, I did not return.

A few months later, when I was able to think more clearly, I tried to figure out what had happened. I eventually realized, in my opinion, that nothing had been done to ensure I (or anyone else) felt safe at the outset of the group. From what I recall, we were not given information on what to expect in advance. I remember I was unsure if the leader intended to disclose my story without my permission, and likewise I don’t remember there being a conversation on if it was appropriate for folks to share details that could be triggering. It was akin to being thrown into the deep end with the expectation you’d just learn to swim.

No wonder group had felt so awful, and now I know why. It’s my perspective this group did not utilize a bottom-up approach, and so my nervous system was on such high alert that being there was nearly unbearable. I don’t think the leader was bad at their job, I just think they didn’t consider or weren’t trained in the style I needed.

So, what is the difference between “top-down” and “bottom-up” therapy, and why does it matter?  The first thing you need to know is the words “top” and “bottom” are references to particular sections of the brain and what they are responsible for. It’s also important to know that until recently, most therapy has followed a top-down approach, and as you may have guessed from my story above, this doesn’t always have the desired results.

It’s believed the top section of the brain is concerned with thinking, speaking, and present-day emotional awareness. Top-down therapy typically means working through things cognitively. This involves stuff like thought patterns, communication, decision-making, and problem-solving.

The bottom section of the brain is thought to include the areas responsible for memories, impulses, and survival responses. Therefore, bottom-up therapy works on understanding sensations, education on the nervous system, grounding, mindfulness, and body awareness.

The new school of thought theorizes bottom-up approaches are especially helpful for folks who have experienced trauma, particularly long-standing, developmental or complex trauma. The suggestion is top-down methods often don’t work well for folks with this type of history because it presupposes what needs adjusting is the person’s way of thinking. This does not take into consideration the automatic nature of the nervous system, or in other words, a body that is hardwired to perceive danger where there is none.

In regards to trauma, bottom-up takes into account that the first thing that typically occurs is the body reacting, and then, later on, the mind thinking. To paraphrase Peter Levine: You cannot properly process thoughts if your insides are telling you that you are standing in front of a tiger.

In my case, I could not effectively join the above group until my nervous system felt safe there. Unfortunately, since this did not happen, I could not tolerate it.

So, if therapy or popular “self-help” methods have caused you to feel like your hair is on fire and you need to run screaming from the building, there is a good chance your nervous system has kicked in. If this (or something like it) is a regular occurrence, it’s possible you may benefit from bottom-up methods. I certainly have!

I’ve been with my current therapist for a long time, and she uses a bottom-up approach. This doesn’t mean I don’t ever have discomfort or anxiety in therapy, but what it does mean is it isn’t ignored and we attempt to regulate it.

Recently when COVID-19 restrictions were starting to lift, we went back to in-person sessions after a year of virtual. When I was finally sitting in front of her, I right away felt activated. I trust this therapist a lot, and so I quickly told her how I was feeling. She was understanding and reassured me it made sense because my nervous system hadn’t been in the same space with her for almost a year and it was probably being a bit cautious. This was helpful in taking any of the blame off me. We then did some grounding exercises until I felt more settled, after which we were able to move on. This clearly sounds much better than what took place in the previous story.

If you want to seek out a therapist that does things bottom-up, look for the following training: Somatic experiencing, emotion-focused therapy, eye movement desensitization and reprocessing therapy (EMDR), sensorimotor therapy, art therapy, polyvagal theory, compassionate inquiry, and trauma-informed yoga. There are probably many others, and it’s always a good idea to have a conversation with a provider about how they practice and what theories they follow. You can also look into self-help that uses these methods.

It’s prudent to remember both top-down and bottom-up are valid methods, and in reality, most therapists likely use some type of a blend of the two. Additionally, while folks who have experienced trauma may need to start at the “bottom,” the goal would likely be to work one’s way to the “top” eventually. There are also therapists who attempt to work with one foot in each realm, and this may be helpful, too.

If you have tried therapy in the past and it seemed to do more harm than good, you may feel discouraged or like you are somehow “broken.” I can certainly relate to those feelings. I’ve had the good fortune to have the support that fits my needs and this has been incredibly healing. I’m here to encourage you, that in a similar way, it very well may be a bottom-up approach is what works for you. You are worth it!

 If you’d like to follow along with my journey, you can find me on Instagram as @mentalhealthyxe.

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Heidi Fischer

Heidi Fischer is a mental health advocate who lives in Saskatoon, Canada. Heidi enjoys writing about her personal experience with C-PTSD, Depression, and Anxiety. Heidi is the creator of a popular mental health Instagram called @mentalhealthyxe and can also be found on her website mentalhealthyxe.com. 

www.mentalhealthyxe.com/