Most of us are familiar with post-traumatic stress disorder. PTSD (deservedly) gets a lot of attention, largely focused on soldiers returning from service. But trauma comes in many forms, and most people have experienced it in one form or another. In this episode, learn about the differences between PTSD and other forms of trauma, how to identify it, and what can be done about it.
About Our Guest
Robert T. Muller, Ph.D., is the author of the psychotherapy book, “Trauma & the Struggle to Open Up: From Avoidance to Recovery & Growth,” which focuses on healing from trauma.
Dr. Muller trained at Harvard, was on faculty at the University of Massachusetts, and is currently at York University in Toronto. He has over 25 years in the field.
TRAUMA SHOW TRANSCRIPT
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales and our guest today is Dr. Robert T. Muller and he is the author of the psychotherapy book Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth, which focuses on healing from trauma. Robert welcome to the show.
Dr. Robert T. Muller: Very, very glad to be here.
Vincent M. Wales: We are glad to have you. So the word trauma is thrown around a lot these days. What do we really mean by that?
Dr. Robert T. Muller: Well, so there are different kinds of traumatic experiences but they all are based in the fact that something clear has happened to the person in the external world. Something that overwhelms their normal coping abilities and this can be a natural disaster, of course, but it can also be an event that occurs in the home. It could be something like physical or sexual abuse from a caregiver or various kinds of assault. And these are experiences that are overwhelming and most people who go through these overwhelming experiences don’t end up with post-traumatic stress disorder or various kinds of consequences. But a number of them do. and when they do and they’re left with these feelings of great distress and that’s what we refer to as trauma. The feelings that are left in the person that affect them, that affect their choices, that affect their relationships, that affect the way they engage in friendships following an overwhelming experience. And it’s hard, it’s very, very tough for people to deal with.
Gabe Howard: You know, outside of people who work in this field, the only really thing that they understand about trauma is post-traumatic stress disorder. That’s like the closest that the general public gets when you’re talking about trauma. Where does PTSD fit in? Can you kind of help people understand that?
Dr. Robert T. Muller: So the term PTSD we see in the psychiatric literature, and by PTSD we mean that the person has a disorder after a traumatic event post-traumatic stress disorder. So that means that they are continuing to suffer and by disorder we mean that their mental health is suffering and that they’re experiencing symptoms of re-experiencing the event, flashbacks. They may remember and have memory intrusions, memories of the event. And that’s very severe. They also have startle responses where they’re stressed very, very easily and by stress that can be very overwhelming stress. They also have problems with mood because they often feel depressed because of these traumatic experiences. And then finally they try to stay away from the things that remind them about whatever happened. So we see post-traumatic stress disorder in Vietnam vets, Gulf Wars vets, vets who’ve come back from Afghanistan, for sure. So we can also see these symptoms in victims of domestic violence and people who have been to experiences even who haven’t gone to war. So PTSD refers to the psychiatric language that’s used to describe the symptoms that many people have after a traumatic event. So that’s what it’s really meant by PTSD.
Gabe Howard: Thank you so much for that. And just to clarify, you can be traumatized and not develop PTSD. Is that correct?
Well you can be. Yeah. So here we get into a little bit of different words can sometimes mean similar things but when we talk about someone who is traumatized, they have all kinds of symptoms. They may not have exactly that cluster of things that I mentioned that we call PTSD but they’re going to have very similar experiences. There’s something called Complex PTSD and that’s a little bit different. Complex PTSD refers to people very often who have had traumatic events happen in childhood and in relationships. They feel betrayed by people who have who they thought were going to care for them the most. And when people have complex PTSD, very often what they have are huge problems in relationships. So, they’ve been hurt by somebody, they may feel tremendously abandoned by someone who they trusted. And then in life and in relationships, they now struggle to trust and they often really question other people. They question whether they can really trust them and they have a hard time with developing relationships because they feel scared. There are many feelings of fear that come over them. Shame, feelings of shame are common in complex PTSD. So, complex PTSD can take longer to heal than PTSD. If treatment for PTSD tends to be something more like six months to a year, treatment of complex PTSD can be two, three years, maybe even four years something like that. Pretty common. So those are some distinctions.
Vincent M. Wales: Thank you. Gabe and I are both very familiar with abandonment disorder and that sort of thing, attachment disorders. And there seems to be a very clear relation there with complex PTSD?
Dr. Robert T. Muller: For sure there is. There often is that for sure. There are feelings of abandonment very often and people with complex PTSD, and there are attachment problems. So, by attachment, that means that in times of distress they have difficulty turning to others who if you had a secure, what’s called a secure attachment, you might have an easier time turning to the people who feel, you know, should care about you. You know you might do that more easily; you might turn to them and ask for help and feel comfortable with that. But when people have what’s called an insecure attachment, and this is very common in complex PTSD, they have a great deal of difficulty turning to those people, who really you would think that they could turn to, their husbands, wives, their friends. They have a hard time turning to them because they feel very very frightened very often that people are going to just going to let them down. It’s a very very challenging disorder to treat. But it’s important for a therapist who works with people like this be what’s called trauma informed. Where they know about the effects of trauma so they can help people like this manage and find their way through their trauma.
Gabe Howard: Trauma informed care is something again, coming up more and more in mental health circles. Can you explain what trauma informed care means?
Dr. Robert T. Muller: So, there are many conditions that are related to trauma. It’s not just trauma therapists who come across people who have trauma histories. Family doctors very often will come across people who come in complaining of migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, immune system kind of disorders, stress related disorders. All of those are greatly exacerbated in people who have trauma histories. So it’s very important for family doctors. It’s very important for teachers, actually, to be trauma informed because you may see a kid in your class who appears like they have ADHD. They can’t sit still, they’re irritable, and that may also be a reaction to trauma. And I’m not saying that every person with all these disorders has a trauma history. I’m not saying that. Most of time people have migraines not because of trauma. But, if you do have a trauma history, all of those conditions can be greatly exacerbated. And so it’s very important for professionals who work interpersonally with people, family doctors, chiropractors, dentists, temporomandibular joint dysfunctions can be a symptom of trauma. Teachers, nurses, it’s very important for them to be trauma informed. For them to understand about the different manifestations of trauma. And there are many very often the immune system because of the stress of trauma the immune system has been affected. And that makes you more susceptible to a variety of different disorders. That’s why you need to be trauma informed.
Vincent M. Wales: Now for someone who has a pre-existing mental illness, whether it’s bipolar, or depression, or what have you, how are they affected by trauma? Is it any differently than someone without those issues?
Dr. Robert T. Muller: Yeah. Yeah. So trauma exacerbates other kinds of conditions. People have, let’s say, a family history of depression or family history of bipolar illness and then very traumatic thing happens to them. That can exacerbate other problems that they have. So it’s very difficult to disentangle this symptom is caused by this and this is a symptom caused by that. It’s impossible really to disentangle what’s caused by what. But what you do want to do is you want to work with people if you’re doing therapy with an individual who’s been through this. You want to work with them in a way where if somebody has bipolar illness where you get them seeing a good psychiatrist who can prescribe the right medication. But then if they have a trauma history that doesn’t mean that that’s it. That medication is all of the treatment. No. Somebody has a trauma history, they’ve got to find a way to talk about what’s happened to them. And that’s very difficult when you’ve been through trauma. It’s hard to talk about. And so good trauma informed therapies will work with a person in a measured, paced way to help them slowly feel comfortable. We’re starting to talk about what happened. And that can be very, very challenging.
Gabe Howard: It’s interesting. As someone who lives with bipolar disorder, I know the importance of being able to tell my medical team, whether it’s a psychiatrist, or a social worker, or a psychologist, you know, what’s going on inside my head, what my challenges are, what I need help with. It sounds like you’re saying somebody who just has a trauma background really needs to respond the same way. They have to be able to explain that to their medical team in order to get the right care.
Dr. Robert T. Muller: Well the thing with trauma is that people, a lot of professionals are not trauma informed. And so what ends up happening is that you get people going in for symptoms. So somebody with a trauma history, a typical kind of presentation. I’ll just give a name, Susan. Susan was raped let’s say in university. She experiences all kinds of difficulty in classes. She then goes and sees her doctor, gets put on an antidepressant. Is O K for a year or two on this antidepressant. And then, she starts to date again and then whoa. All these symptoms start to come back. She starts to experience confusion. She experiences other symptoms like headaches. She goes back and gets sent to a specialist. Then she says she has difficulty with her eating. Then the question of what? Does she have an eating disorder? And so what you end up with is this smorgasbord of different professionals. You know, this person specializes in depression, that person specializes in eating disorders, this sort of person specializes in migraines and whatever, trying to treat this person. And you don’t have a coherent treatment plan. And it’s because none of these professionals actually sat down and said, “Tell me a little bit about what happened in your life for the last five years. Walk me through it. What’s happened? Anything important? Tell me about it.” And if you do that with people, you can look for this. Sort of sitting down where you can say OK. Yes. Look at this. This person’s had these depression symptoms and this eating disorder seem to have really gotten a lot worse when dot dot dot. And then you could start to put the pieces of the puzzle together. And so you’re not just treating for this disorder or that disorder or the other disorder, but you develop a coherent plan to help the person find a way to start to deal with the underlying trauma that led to a variety of different responses. So that’s where it’s really important to be trauma informed.
Gabe Howard: We’ll be right back after these words from our sponsor.
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Vincent M. Wales: Welcome back. We’re here with Dr. Robert T. Muller discussing trauma. There’s a therapy relationship. What’s so important about that?
Dr. Robert T. Muller: Well it’s really, really important, the therapy relationship. And in trauma work, that’s absolutely true. It’s even true in other kinds of psychiatric or psychological problems. Research on outcomes of mental health problems and treatment strategies, what we find is, that regardless of the school of thought that the clinician uses, let’s say people go to see a cognitive behavioral therapist, or the person goes to see a psychoanalyst, or the person goes to see a Gestalt therapist, you name it. Regardless of the school of thought, the one thing that seems to run throughout therapy is the benefits of having a good, strong psychotherapy relationship. And so this means that if you’re a cognitive behavioral therapist, it might be that the person got better in part because you help them look at their underlying thoughts and how their thoughts affect their feelings and how to help them change their behaviors and they’ll improve their feelings. Maybe. Maybe that’s a piece of it. But it also is the case for research what we know is that if you do that in the context where the two of you are really working together and feel like you’re on the same page then therapy will be much more effective. So this is true for all schools of thought of therapy and psychoanalysis and everything else. And so this therapy relationship research shows is really important. So what does that mean? That therapist and client are working together, on the same page working toward similar goals. The same goals really. You have to have similarity of thought around the goals and there’s a sense of warmth. There’s a sense that the client feels that their therapist gives a darn. That they really do actually care. And that the therapist gets it. That the client has to feel that the therapist gets it and is listening and paying attention. These are really important skills. And you know, Carl Rogers in the 1950s really honed in on this. And since then we’ve come up with all kinds of therapies. And I’m not saying these other therapies are not helpful. I’m just saying that going back to basics is really important. That the skills that Rogers taught around empathy turned out to be, in fact research shows, they’re very important. This is really the case with trauma therapy. When you’ve been traumatized and you’ve been traumatized most often when people feel in relationships that they’ve been hurt, then they might work with a therapist and think my therapist doesn’t like me, or my therapist is going to abandon me. My therapist is judging me. And it’s understandable that you’d feel this way as a client. If you’ve been hurt, when your trust has been violated, you’re going to be very cautious for good reason in relationships, and you’re even going to be cautious around your relationship with your therapist. You don’t know whether your therapist is just trying to manipulate you. In all fairness, you don’t know. And so it’s very important for the therapist to be attentive to these kinds of relational issues and trauma. Are my client and I are on the same page? And that sort of thing.
Gabe Howard: Who should go to trauma therapy? I mean who is, I know that the answer might be anybody who is traumatized, but you know more specifically, like who is trauma therapy for exactly?
Dr. Robert T. Muller: So very often if you’re holding something that feels like it’s a huge burden that’s something to notice. So pay attention. Pay attention to this question. Ask yourself, am I carrying around a deep burden from years ago? Am I holding on to a secret? A secret that if other people knew, I would feel judged? I would feel that they would hate me? I would feel ashamed of those sorts of things? Am I being loyal to people who harm me? Those are all questions that you can ask yourself. I talk a little bit about this in Trauma and the Struggle to Open Up, the idea of how people, how many trauma symptoms develop, and these themes are really, really big. The themes of secrecy, feelings of betrayal, themes of loyalty to those who maybe you shouldn’t necessarily be so loyal to. But those are the kinds of questions to ask yourself. That is does the thought or some memory about something, does it make you feel sick? Does it make you feel like this feeling of I’m a bad person? You know, when I think about x y z that happened to me, I feel terrible guilt. How could I? How could I have done that? If you’re asking some questions like why me? Or if you’re asking questions of yourself like why not me? Why did X Y Z happen to my brother and not me? Those sorts of questions are very important questions that can be addressed in trauma therapy. And very often people have those questions in association with symptoms. When you know when you think about x y z that I just mentioned, maybe you feel depressed? Or maybe you feel self-loathing or disappointed in yourself? Why did I do that? Why didn’t I help my sister when such and such? When dad was, I don’t know, especially when Dad was drinking the way he was or mom was? Why didn’t I? So if you ask yourself those kinds of questions and you’re pained by it, that might be a sign that getting help, that talking to a therapist around your history is important. Because you’ve been trying to deal with this on your own for so long, and that can feel very lonely, it can feel very burdensome. And you don’t have to be alone in dealing with these things. That’s where I would think of therapy.
Vincent M. Wales: Right. We also have what we call post-traumatic growth. Is that just a fancy word for recovery or?
Dr. Robert T. Muller: Well no. No, it’s related to recovery. I mean people you hope that through trauma therapy people will get back to the way they were before you know they started really deteriorating. But it doesn’t exactly work that way. Recovery is a bit unpredictable. And what happens is as people start to talk about their problems, and start to talk about their history, they start to deal with things in a way that they never dealt with before. And so they start asking themselves questions like I mentioned. Why me? Why not me? Maybe those kinds of questions. Like what’s my place in the world after what happened to me? I thought my identity would be such and such but now I just don’t know. So when you start addressing questions like that, those kinds of questions lead to a re-evaluation of yourself. And so along with recovery, along with feeling better, along with removing, or removing and recovering from these psychiatric symptoms, that you really want to recover from, along with that comes a new understanding as you start to delve into issues from the past. And so that’s where there’s an opportunity for what’s called post-traumatic growth. That through the process of talking about and questioning and dealing with, there’s a reckoning. And that reckoning can help you grow in ways you may not have imagined. You may realize things about yourself that you hadn’t really thought of before. You know, like you may realize things like previously when I thought about such and such, I just felt guilt about what I did. But now, as I think about it now, actually, I was pretty strong the way I stood up to so and the way I did such and such. And I feel, I actually feel proud of myself for that. That may not sound like a big deal, but it can really feel like a big deal if you’ve felt ashamed of yourself for so long.
Gabe Howard: Do you do you think there’s a lot of people who are suffering from trauma who just don’t realize it? And how do we reach those people? Because you can’t exactly go ask for help if you don’t know that you are in need of help, right?
Dr. Robert T. Muller: Well this is why trauma education is so important. There’s getting to be more and more education about this. I have an online therapy and mental health magazine called The Trauma & Mental Health Report where you know my students and I, we publish articles and they’re very, very straightforward articles written for general consumption. They’re not academic heavy kinds of articles. And we’re trying to teach people about what happens in trauma. We have a lot of stories. You know for example, one of my favorite stories is A Corporal Speaks: 10 Questions for a Soldier Who Served in Afghanistan. And he tells his story. This corporal who came back and happened to be a Canadian, and who served alongside Americans. And many of the stories relate actually to the American soldiers who he served with. And it’s just a really interesting story. And these stories and so we’re trying to teach about how people struggle with these things in a way that the general public can start to learn. Not just people in mental health or whatever academics who know about this stuff, but that people in the general population can start to learn about this. And I think there’s greater interest. There’s more interest lately I’ve noticed in the topic of disassociation, people who have been through trauma, many of them dissociate. So they check out. They sort of go absent at times, you know. Why do they do this? Because sometimes. emotional trauma can be so overwhelming that they lose focus and lose attention to that and start thinking about some totally different things. And that allows them to feel okay. But you know that can be very very challenging when you dissociate a lot in your everyday life. So there’s a little bit more knowledge about that in the general public. I mean I’m noticing increasingly. So I think it’s, I think it’s really about education. And I think what you guys are doing here with this podcast and other people, other mental health podcasts, are becoming much more commonplace and people are asking these questions. There’s more stuff out there. I think that I think is the way to get people to learn about this stuff.
Gabe Howard: We agree with everything you just said except other mental health podcasts. We’re completely unaware of any other podcast other than this one. Don’t search for them. No, just kidding. I just have a couple of more questions because we’re about out of time. But one is please talk about your book for a moment and where folks can find it. I’m assuming you’re going to say Amazon. And what got you interested in researching and writing about trauma in the first place? I imagine they go kind of hand-in-hand.
Dr. Robert T. Muller: Yeah, that’s for sure. So I’ll do the thing about the book. It’s called Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth. It is available on Amazon and mental health bookstores as well. So there’s a hardcopy and a Kindle as well. So. what got me interested in trauma is not a short answer, but also what originally got me interested is a little bit different than when I realized, you know years later when I worked in the field for a long time. Originally, I just thought it was you know an interesting research topic and my supervisor was interested in it in graduate school. But what I realized in my 40s, was that there was a much deeper unconscious reason, I think, that I really got drawn into it. And I also realized that much more so as I did my own psychotherapy. And that is that my parents were children during the Holocaust. And both of them actually were separated from their families, and I believe to some extent traumatized by the Holocaust to some extent. I would say that their childhoods were shaped in ways that you can never imagine. My father’s father was actually killed. My mother’s parents were not killed they were okay, but they were there. My mom was separated from them. She was only 6 years old. She was separated from her parents for months. And so it was terrifying for a 6-year-old. She had no idea where her parents were and they left her in the care of a non-Jewish woman. Again, this saved my mom’s life, but this was a terrifying experience for her. And so I grew up with stories about the Holocaust and with stories about what it was like to be a child during the Holocaust. What it means to lose your innocence as a child. What it means to lose your childhood as a child. And so those kinds of experiences I think to a very large extent shaped me. I believe that’s ultimately why I went into this. Why I went into this field and why I can connect with trauma survivors I think it’s that experience. That’s a fair answer.
Gabe Howard: Yes. Thank you so much.
Vincent M. Wales: Wow. Well thank you for sharing that story with us.
Dr. Robert T. Muller: No problem.
Vincent M. Wales: That’s really heavy. And thank you so much for being here and for informing us on trauma so that we can recognize it and deal with it when we have it.
Dr. Robert T. Muller: OK. Ok. My pleasure.
Vincent M. Wales: And remember, you can get one week of free, convenient, affordable, private online counseling anytime anywhere by visiting BetterHelp.com/PsychCentral. Thanks. We’ll see you next week.
Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].
About The Psych Central Show Podcast Hosts
Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.
Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.