A New PTSD Treatment
A patient and therapist report on a promising new therapy for PTSD.
Posted October 2, 2018
This is an intimate first-hand report from a patient and a therapist about a new treatment for PTSD.
FROM THE PATIENT, Judith Fein:
Sometimes I think that the human species is an Edsel. The Edsel was a much-hyped car produced by Ford, and it was a spectacular failure. The model simply was over-hyped and didn’t work. That’s how I began to look at human life here on planet Earth: The model doesn’t work. You suffer as a child, and then you spend your adult life suffering because you suffered as a child. And you spend a good chunk of your adult life looking for a way to cure your suffering, which is a result of your earlier suffering.
Every time someone pinned the diagnosis of PTSD on me, I felt a vague wave of hope wash over me. If there is a diagnosis, there must be a straightforward solution, right? Over the years, lubricated by waves of hope, I tried every treatment I could find: psychotherapy, hypnosis, EMDR, tapping, cognitive behavioral therapy, exposure therapy, avoidance, meditation, medication, relaxation, visualization, exercise, exorcism, breathing, yoga, herbs, supplements, homeopathics, gymnastics, body work, acupuncture, and a bunch of other modalities that worked a bit, or didn’t work a whit, but I was stuck with those four letters: PTSD. I even tried removing the “D” from the diagnosis; I had post-traumatic stress, not post-traumatic stress disorder. What was disordered was my life, not my reaction to it.
I don’t need to vomit up the sordid details of having a mother who was extremely physically and emotionally abusive and sadistic. I fought back verbally, and never let her get the best of me. On the outside, I was fine; confident, sassy, popular. But inside of me, things were going awry. I didn’t get my period for 13 months. I stuffed my face with Cocoa Puffs when I wasn’t allowed to eat at home, and put on 25 pounds. My father, who went along with my mother’s program, sometimes beat me, and banned me from talking on the phone during my teenage years. But unlike my mother, who didn’t speak to me for the better part of a year, he spoke to me and listened to me and, on rare occasions, he stood up to my mother on my behalf. So I had one partial ally. But just as I was exiting my teen years, my father, who had never been sick, developed an aggressive brain tumor. The neurosurgeon, who had the warmth of a block of ice, tried to remove said brain tumor, but it was too late. He cruelly said he didn’t know if my father would be a vegetable, and then turned on his spanking-new heels and left. End of discussion.
I traveled back and forth from college to watch my father transform from a vigorous, highly intelligent man to an old person who had a huge lump coming out of the side of his head and watched cartoons. Within a few months of getting sick, he was dead, and there was nothing between my mother and me. After she broke my glasses on my face and told me I had killed my father, I figured it was time to leave home by getting married. I married my mother, but in male form. And I moved away to Europe for nine years.
So there I was, moving forward with my life on the outside, laughing and joking, helming a theatre company, writing plays, traveling around Europe, making friends. But inside, I was starting to unravel. I developed phobias, had a persistent nervous cough and digestive disorders. I was afraid to eat. I lost an enormous amount of weight. I divorced my abusive husband, ricocheted between puppy-dog, kindly men who adored me, and those who were cold, withholding, and unloving, just like Mommy dearest.
When I moved back to the U.S., I bounced between professional success and personal trauma, and developed panic disorder and a host of other anxiety disorders. I couldn’t fly, I was a medical phobic, and I suffered terribly. I stopped hiding my internal distress, actually became candid about it with a few friends, married my soul mate, and was sincerely open to any kind of treatment that would help me. I figure I spent about half of my income over the course of my adult life on trying to get free of what plagued me.
Which brings me back to Edsel. As I write this thumbnail story of my emotional life, it seems like a failed model. Not only was I tormented, but I blamed myself and became quite skilled at self-laceration. I felt helpless and hopeless.
Not too long ago, I heard about a new treatment called ART (Accelerated Resolution Therapy). I refused to let myself think it could help me, because whenever I was hopeful, my hopes were dashed and I became sorely disappointed. I learned that there were about 1800 therapists trained in the U.S., mostly on the East Coast (I live in the Southwest), and more trainings were underway. I spoke to ART experts who told me about evidence-based studies and a 70 percent success rate, which is very high for PTSD. And I found a therapist, Dr. Hernandez, who agreed to see me for a sample session. He had a lot of experience working with the military and civilians and was one of the top ART trainers and therapists. I expected him to look like a latter-day Dr. Freud, with a herringbone jacket, a pipe, and probably a hat.
Dr. Hernandez arrived in a t-shirt and jeans. He held out his hand and said, “Hi, I’m Diego.” He was my kind of guy—open, honest with himself about himself, willing to dig deep, non-judgmental, curious, multi-faceted; we got down to work. Over the next few days, I had numerous sessions with Diego. In cases of “simple” trauma (if there is such a thing), healing can happen very fast. When the trauma is more complex, as mine is, it may take more sessions.
It seemed to me that the treatment incorporated many things I had been exposed to before—but they were combined in a different way. There was a lot of EMDR-like eye movement, but instead of going over the memories, I was able to actively engage with them. There were elements of Gestalt therapy, body-centered therapy, a dollop of psychotherapy, mindfulness, and breath work. The astounding thing is that I didn’t even have to tell Diego what my traumatic memories were if I didn’t wish to. The process was extremely creative and used metaphors that I came up with, and some that Diego suggested. I pretty quickly got to the feelings I had that were much deeper than the feelings I knew I had. I didn’t cry or get very emotional. I think I have, over the course of my adult life, cried my eyes dry. During an ART session, I just became a vulnerable, needy kid who wanted her mother’s love and didn’t understand why her mother was so cruel. Trust me, I had never felt that as a kid. I was too busy surviving and anticipating what would come at me next.
After each ART session, I had little memory of what had transpired. And during the day, I didn’t think about the therapy at all. But at night, I started having a lot of dreams, which is unusual for me. I generally recall a handful of dreams in the course of a year, but I began to remember, and write down, two or three dreams a night. They were pretty intense and very rich in metaphors. Like in one dream, my right leg fell into a hole up to the top of my thigh, and no one could get me out of the hole. In the associations I wrote down, my husband was able to. In another dream, I was on a beautifully manicured and very spacious large green area with gently rolling hills. I put my folding chair down three times in three different holes to tamp down the earth so that it became part of the grassy knoll. I was trying to make the earth level and fill it in.
After I wrote down my dreams and my associations with the dreams upon awakening, I didn’t think about ART or dreams or anything else until the next night, when I went to sleep and started having the intense dreams. After about six weeks, the dreams started to be about my current life. I told Diego about a few of the dreams. He explained that when you have PTSD, your dreams are processed in the subcortical part of your brain—the amygdala—where fight and flight take place. When you heal, your dreams become more a way of processing your daily life in the frontal cortex. It was actually happening to me. I didn’t have to DO anything special to make it happen. It was occurring naturally as a result of the ART sessions. And, in general, I was much less anxious and phobic. I didn’t go out much or do a lot of socializing. I listened to what my body was telling me, and what it needed to heal.
But I still had an intractable phobia I wanted to work on. So I had another prolonged session with Diego. This time, when he asked me to notice what was going on in my body while we were doing the EMDR-like movements, I felt that my lower jaw jutted forward and was locked tightly. I had never before felt any sensation like that in my lower jaw. I knew right away it was anger. Sheer rage. My jaw stayed like that for hours. And I was able to interact with memories that made me angry. In one case, I fought back physically against a cruel, judgmental, and thoroughly unprofessional doctor by turning the tables on the aggressor. I did it in a safe way, in my imagination, while doing eye movements. And I became aware, in a flash, that my parents, the doctors, it was all the same thing: The people who were so supposed to care for me mistreated me. I never felt safe; I never knew what it was like to feel safe. I was always on high alert. The ache in my jaw lasted for two days. I must have been very, very angry. I also recall that, during one session, I spontaneously visualized my mother as a juicing machine from which I was trying to extract love; not a drop came out. I had to laugh from the image.
I asked Diego how I could measure success. He says that there is a lessening of symptoms and resolution of memories. The memory of the traumatic events doesn’t go away, but it has been modified through ART therapy, through imagery, through imagination, and I have interacted with it, instead of it being an unchanging lump that clogs up my life.
My dreams are infrequent now, and mostly about current life. Details of past traumas are getting blurrier, and I don’t feel triggered if I think of most of them. In some cases, I can hardly call up the memories. I am still getting symptoms, but they are less intense and of shorter duration. Many of the past traumas seem…somehow….far away. And this change has happened rapidly, over the course of a few months.
I am hopeful. Things are moving. Maybe I’m not a complete Edsel after all. I asked Diego if he would be willing to write his version of my treatment, from a clinician’s point of view, as I am purposely eschewing anything technical. I simply wanted to share my experience with you, and to tell you, if you or anyone you know is a post-trauma sufferer, there is hope.
FROM THE THERAPIST, Diego Hernandez. Psy.D. :
I am often amazed at the human capacity for sacrifice, love, and to face adversity. This may sound like a trite statement from a trauma therapist. One whose days are spent swimming in the waters of human suffering, much like the line from the U2 song "Until End of the World": “In my dreams, I was drowning my sorrows, and my sorrows, they learned to swim.” Working with trauma is like helping someone to swim. There is a great deal of danger and intensity, but relief is found reaching the shore under their own strength.
I have been a therapist long enough to understand that most of us become therapists because of our own acquaintance with suffering as much as we do because of our experience learning and growing from our circumstances. In this work, I have a privileged window into the intimacy of suffering, which, for us trauma therapists, creates an imperative to take great care to maintain a commitment to our own work. Because as a therapist we can only go as far with another as we are willing to go within in our own work. Our ability to work with difficult emotions is largely dependent on the broadening of our own emotional experience and relative comfort in working with difficult emotions. In spite of the place suffering holds in the range of human experience, I do not believe life is suffering. Likewise, I feel it is a childlike notion that we could ever live in such a way as to avoid all suffering.
Sometimes suffering comes from the most unlikely places, like an idea or belief. The type of suffering the Buddha described as the suffering that emerges from our inability to accept our experience in the world as it is. I believe at the heart of traditional psychotherapy, we address existential themes of meaning, existence, and belonging. While such a didactic approach can help with these larger questions of life, I believe the traditional psychotherapeutic “talking cure” has been less than optimal in addressing the trauma that remains in our body as the unintegrated memory of difficult experiences. From the firefighters at Ground Zero, to those who stood in horror and disbelief in the falling ash, from the young Green Beret captain in Afghanistan grieving the loss of his brothers, all the while gearing up for every mission, laying it on the line for the one on the left and one the right. To the children driven by biology to grow and test their own way in the world, all while suffering at the hand of those entrusted with their care. We live in a world with suffering, yet I do not believe suffering is inherent to our nature.
Suffering is one aspect of our existence and sometimes that suffering comes from the very systems of the body designed to keep us alive. This system activates under any threat from failure to death and holds on to that experience as a quick reference for future danger. Once the danger is passed, we will continue to use those experiences as points of reference and will revisit them when we sleep or when things are quiet as our body tries to move those events from temporary storage to the permanent storage we call the past.
Accelerated Resolution Therapy is a therapeutic intervention based on the findings of neuroscience that some experiences are stored differently in the body and that in order to metabolize them and move them to long-term storage they must be processed. This processing takes place through relaxation and engaging the resources of the parasympathetic nervous system to sort through the memory and work towards a resolution. It is the resolution in Accelerated Resolution Therapy (ART).
For the past eight years, I have worked at the University of South Florida (USF) and with various Veterans groups and organizations like ART International, to study the efficacy of ART, refine the technique, treat Veterans, and train therapists. While ART has its roots in NLP, EMDR, and Gestalt re-scripting, it is focused on the experience at the root of trauma. To date, ART has received recognition as an evidence-based therapy in 2015 by Substance Abuse and Mental Health Services Administration (SAMHSA). As part of the research team at USF, I have co-authored and contributed to 12 different peer-reviewed publications. I am presently the Clinical Director for a USF pilot study funded by the National Institute on Aging to examine ART for complicated grief with Hospice with a protocol based on the average number of sessions in our published research; three to five. As Judie mentioned, in my experience the average number of sessions tends to be a bit longer with developmental trauma. Childhood is a time where deprivation or an abundance of suffering impacts development in such a way that it influences how our body, particularly the nervous system, becomes a lens to view and experience life from that point on. With abuse and or neglect there tend to be more events and themes to address. After these experiences have been resolved we address how to go forward without the major presence and influence of those experiences. At its core ART focuses on the experience of the event, which allows one to resolve that experience and produce a new narrative. This narrative emerges out of the work instead of from the therapist. It is a tremendous shift from addressing the symptoms in a medical model to addressing the story and its impact on the individual. At times I feel like the importance we place on symptoms is as disconnected from what people need as a family of four around the dinner table with all of them on their cell phones.
This past July, I had just returned from co-leading a yoga and meditation retreat in Costa Rica when I jumped on another plane going west to meet someone interested in experiencing ART. I was delivered to Santa Fe by a series of flights topped off with a drive across the desert while listening to the Eagles. I arrived at Judie’s home not knowing what to expect. I was wonderfully surprised to be warmly greeted by this gregarious, intellectually curious, worldly woman with a New York “no BS” toughness. All of which proved to be the case throughout our time together. Judie was upfront about her lack of fondness for BS. She set the tone by stating her interest in experiencing ART without the technobabble and advocating for her needs. Judie defined the terms of this contract, stating that she was interested in the experience to test it out and to do so she would require me to equally remain present, open, honest, and in the moment. She pressed me on finding common ground with my own experience and benefit from ART. As opposed to a typical in-office session, I was in the field, down range in someone’s element. I felt more like Jung or R.D Lang who met with individuals as fellow citizens in life and without the white coat.
Judie was quite upfront about her years of different therapies and worldwide exploration of humanity, healing, and connection. She described a common theme among healers across cultures as movers of energy—which I felt was a fitting description for ART as we help to move experiences from temporary storage to long-term storage. With ART one does not have to discuss the details of an event. While the therapist is a guide they are always following the individual’s lead to guide events toward a resolution. Judie was able to move from recent events to follow themes deeply rooted in earlier childhood experience. The process brought those experiences more into the forefront and we were able to work with themes related to a number of events involving parent-child interactions. Some of these interactions are so basic in nature they are literally written into our DNA and drive development, leading us as children to seek emotional validation and guidance for what to do with them. Most of us manage in life with enough validation and direction to push our limits and explore the world. Others continue to push and explore without that validation and are left to sort through shame and guilt while they try to make the best use of feedback from their own accomplishments. ART allows us to process the intensity of those events and to rescript them according to the needs of the individual. Judie made some profound connections that helped her to review those events through her adult eyes, recognizing her mother’s limitations and cruelty, all while learning it was not her fault for the way her mother treated her.
After our sessions Judie and I corresponded, discussing the content of her dreams. In trauma, much of the information bypasses the body’s natural way to integrate the events of the day within our long-term memory, which we experience as the past. In our experience, early in the process, dreams typically reflect efforts to integrate the very themes of the work in ART and will gradually move to a more balanced processing of today’s experiences. This is something we especially see on retreats for combat veterans. It’s not only amazing to see the distress around events return to an expected level of emotional expression but to see individuals experience the sleep and rest that has been eluding them due to trauma.
I am inspired by those I have had the privilege to spend time with, especially those who share their story in the hope that others can find resolution and peace from the storms of the past. Working with trauma has affirmed my faith in the human spirit. It is a privileged window into personal experiences as well as those of larger events, like working with Veterans and survivors of 9-11. I have witnessed how individuals not only struggle with the pain of loss, abuse and neglect, but there is the struggle to be heard, to be one’s own person, and to risk it all for a sibling or bother in arms. This time with Judie continues to affirm my faith in what is possible. Even as she sorted through her painful events, what emerged was the story of a feisty, brave woman who took on challenges no matter how difficult. She learned from her experiences and continues to openly share that experience and wisdom with others. All in the hope of connecting them to something deeper that can help us become greater than our circumstances. The beauty of this trauma work is that one can move from the details of an experience, to what might or could have been, to simply it has been, to it was. And those memories find new homes in the chapters where they belong. They fade into the past, making room for us to be more present and aware today.
(To learn more about ART: https://artherapyinternational.org)