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Therapy in the Danger Zone - Page 4

Joe went into a group with other vets who were violent in their families. Tanya was in a mother's group. Laura and Don were in groups, too. In the vet group and in the offender group he subsequently joined, Joe was forced
to confront his abusive history. He learned to identify feelings in his body that were red flags for his rage or sexual arousal, so he didn't have to act them out. He found ways to verbalize his sense of powerlessness and lack of control and identified means of achieving a sense of mastery that weren't violent or abusive.

Over the more than three years we worked together, I was introduced to the unavoidable reality that successful trauma treatment is a complicated spiral of lessons learned and forgotten
and relearned—a movement toward change that alternates with the magnetic pull to the old and familiar, no matter how dysfunctional it may be. With Joe, Tanya, and their children, every time there was a crisis or another change that needed to take place, I discovered over and over, we had to slow down, restore a sense of safety, and explore what needed to happen to make positive change possible. For example, when Laura started seriously dating someone and spending more time away from the family, Tanya became depressed and Joe's anger started escalating, so they were no longer coparenting. We got together and discussed what Laura's newfound independence meant for everyone else in the family—a conversation that would have been inconceivable in the past. Once everyone's private fears were acknowledged, it became possible to consider what Laura's beginning to move out of the family meant for each member of the family.

I knew the treatment of the family was entering its last phase when, instead of saving all their problems "till we get to Mary Jo's," they began regularly coming to sessions reporting on how they'd already handled their difficulties during the week. Joe and Tanya would describe how they'd dealt with Don's conflict with a teacher or had used the communication skills they'd practiced with me in sessions over and over again to actually resolve a marital dispute. By the time our family therapy together stopped, I'd become a consultant—and an appreciative witness to their progress, rather than a teacher
or interventionist. Nevertheless, Joe's individual therapy took much longer because he had more troubling demons to tame. Before it was safe to remove the support that regular therapy provided, he needed to be able not only to take responsibility for understanding the roots and consequences of his abusive behavior, but also to show that he had the emotional balance and newfound skills to create a new story for himself and his family. The last stage of his treatment was developing his own relapse-prevention plan to identify and highlight what the danger signals that he was reverting back to old patterns were and what he'd do to reach out for help if he found himself slipping.

I learned so much from Joe and Tanya, not only about therapy with traumatized people, but about myself. With them and with many other families like them, I began to realize that, while trauma work isn't for everyone, it was a calling for me. Even though many nights in my early years as a therapist, I woke up startled, wondering how I'd be able to tolerate the awful stories I was hearing in my office every day, I became more and more confident that I have what it takes to help traumatized people confront the past and move forward into the future, however unsteadily. Instead of being intimidated by the intensity and the difficulty of this work, I soon found, when I dealt with less complex and demanding cases, I missed the deep sense of engagement that trauma work provided.

The Reunion

In the years since I worked with Tanya, Joe, Laura, and Don, the field of trauma treatment has seen many important advances. We now know so much more about the neurobiology of trauma and have a vast range of techniques for helping trauma sufferers. We're certainly more able to recognize the constricting patterns of fight, flight, and numbness that trauma leaves in its wake, and to understand which cognitive-behavioral and neurobiological interventions are likely to work best with what kinds of clients, as well as how to combine individual, couple, group, and family modalities in our treatment protocols. But in spite of all our advances, I believe that, from most clients' viewpoint, the healing pathway isn't so different from what Tanya and Joe experienced in the late 1970s, when the trauma treatment field was still in its infancy.

Five years ago, as part of a long-term follow-up project at my center, I contacted Tanya and Joe, Laura and Don. Laura was 41; Don, her younger brother, was 38; Tanya and Joe were both in their late sixties. Although my colleagues and I had been doing the follow-up interviews with clients for many years, I'd never felt like I did on the day this family came in—I was feeling the same anxious anticipation I'd experienced 30 years earlier. Not having seen them since we concluded therapy, I wondered what they'd look like. Had they spiraled back to all of their old ways? I even found myself secretly wondering whether they'd have as special a place in their hearts for me, as I had for them.

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