Blogging on Good Therapy

written by Debra L. Kaplan, MA, LAC, LISAC

Click here to contact Debra and/or see her GoodTherapy.org Profile

Not too long ago, a client who I was treating for prescription drug abuse, looked at me and said, “It’s my desperate need to silence my feelings that drives me to want to use.” She went on to describe what it felt like to live in her skin. “It’s as if the people in my life are at the controls of this rollercoaster called my life and I’m trapped and I can’t get off. I like or hate the ride based on how I feel about them at that moment; in my mind you’re either with me or against me. But I can’t fire them from the controls!”

Unbeknownst to this woman she was verbalizing what was part of her underlying issue—Complex Post Traumatic Stress (CPTS). For the uninitiated CPTS, is classified as long-term traumatic stress that may impact a healthy person’s self-concept and adaptation. The exhibited symptoms range from struggles with mood (depression, manic-depression, anxiety); fear of real or imagined rejection or abandonment, and a spectrum of addictive, self-defeating behaviors including; bulimia, anorexia, compulsive spending, sexual compulsivity, and, perhaps self-injury.

Historically speaking the condition was branded Borderline Personality Disorder or BPD and was intended to delineate the line between psychosis and neurosis—although that is no longer the case. Research and newer advances in studying chronic trauma and its effects on developing self concept and psychological organization have yielded a more accurate approach to characterize the exhibited constellation of symptoms.

No doubt the recurring bouts of emotional instability wreck havoc in the life of an individual struggling with this issue. Along with the ups and downs of the emotional rollercoaster comes the struggle and confusion about ones identity. An individual with CPTS often times struggles with a persistently unstable self-image and like a house of mirrors, ones identity is rendered illusive, distorted and warped by a seemingly endless maze of curved, convex or concave mirrors that reflect confusing images of ones sense of self.

Those who are familiar with CPTS know all too well the chaos and havoc brought to bear upon a relationship. In my experience working with trauma complicated by the constellation of emotional dysregulation, I have often likened the displays of impulsive rage to that of a cluster bomb. From one furious mass come multiple smaller sub munitions. In a fashion not too dissimilar to a cluster bomb’s defensive and offensive use in war, the rageful, emotional explosions neutralize any threat of real or imagined relational rejection, abandonment or disapproval by a loved one.

While this metaphor might resonate as downright ludicrous it is not far from the truths of those that struggle with CPTS and those that relate to a loved one’s emotional volatility ready to blow at the slightest internal or external provocation. I believe this metaphor plays directly to the core issue. Those who struggle with CPTS live an endless rollercoaster of defensive and offensive measures summoned to thwart the slightest hint of shame and pain brought on by rejection or abandonment be it real or imagined.

Loved ones that are idealized one day are devalued and rejected the next and relegated to the role of enemy all perhaps because an act of parting was taken as an act of betrayal. Some who struggle with borderline personality have co-occurring mood disorders that might exacerbate internal stressors to the point of experiencing brief psychotic episodes.

Individuals with CPTS often verbalize feeling wronged, misunderstood, and empty which provokes the internal mood to reach “broil”. And as is often the case the trigger be it internal or external prompts attempts to self medicate overwhelming emotions with alcohol and chemical dependence, self injurious behavior notably, intentional acts of self-mutilation (cutting, burning, wrist slashing) and even suicide attempts.

Historically speaking, the prognosis for CPTS has been poor. Sadly, yet from within the therapeutic community, clients who present with these symptoms are often branded unmotivated, hard to treat, or worse, non-compliant. But despite what has been written it is the current belief, and one that I genuinely embrace, that a consistently supportive therapeutic relationship can and does become the healthy foundation from which a client begins to experience trust and a sense of safety. Much is still unknown about the traumatic condition but continued advances in neurobiological, genetic, and social research have helped lead to new posited treatment modalities and psychopharmacological interventions, both of which have proven to be more successful in generating enduring and positive change.

So, is there a way out of this maze and insanity? The answer is yes and the path begins with a gradual acknowledgement of the problem and the willingness to accept ones own self. But, you ask, what happens when one does not acknowledge the presence of a problem and therefore, is in denial? Clearly this undermines all progress toward positive change.

One of my favorite lines with reference to denial was delivered by the young hero, Ricky Fitts, in American Beauty: “Never underestimate the power of denial,” Ricky stated explaining how he could own and display an abundance of material items purchased “only” with the meager income of a waiter all the while living under the vigilant and oppressive rule of a homophobic and domineering ex-marine father. In this cinematic example, Ricky’s father’s denial regarding his son existed due to the father’s need to shield himself from his worst fears about his son’s perceived sexuality and by association, about his own. An individual’s need to shield themselves from unacknowledged and overwhelming feelings exists until such time when one is psychologically ready to see themselves as they really are and not who they want to be.

Support for an individual’s attempts at breaking through denial is imperative for enduring progress to occur. The presence of any psychological struggle or distress does not mean one is a bad person. In this particular case, CPTS does not mean he/she is bad. They did nothing to deserve it, much like a very young child does nothing to deserve the onset of childhood diabetes. However, the individual is now living this reality of rollercoaster emotions, unstable relationships, addictions, and feelings of emptiness. The cold harsh fact is that there is a pattern of self-defeating behaviors and unstable self-worth that is not likely to change unless that person does his/her own changing.

As is with all physical or emotional distress there is a moment in time when the “status quo” is no longer acceptable. The chaos or unmanageability of a situation begins to point toward asking for help and taking action. Perhaps the adage—being brought to ones knees, applies here. An ensuing adjustment period in which one comes to terms with a new reality may not be immediate, but that new perspective might arrive with a sobering blow through the denial or with the quiet realization that a life is eroding beyond ones grasp. Arriving at a place of self acceptance can be realized perhaps only as a result of small, at times, imperceptible steps. In recovery speak it is progress, not perfection that guides us “I am not a problem, but my behavior has become problematic!” It is then that I ask my clients, “which would you prefer to be—resolutely right or resolutely happy?”
When we are living a life that no longer results in satisfying outcomes despite our greatest efforts, then it is time to look inward and ask the hard questions. “What am I doing that is no longer working and harder yet, what am I prepared to do about it?” Truthfully, until that moment of self introspection and committed motivation, there is little if any enduring change that will occur. But, the path out of the House of Mirrors and away from the emotional rollercoaster is worth the price of admission toward your new life.

©Copyright 2008 Debra L. Kaplan, MA, LAC, LISAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Debra and/or see her GoodTherapy.org Profile

This entry was posted on Monday, January 14th, 2008 at 8:24 pm and is filed under Psychotherapy: Specific Issues Treated and Changes Made. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.