The Case of Tommy Continued
By Stephen Proskauer MD | January 26, 2012
After hearing his story, I immediately suspected that Tommy had been misdiagnosed and that his underlying problem was Posttraumatic Stress Disorder. The ages of his hospitalizations were key to his specific PTSD symptoms. At age 8 months when Tommy was first hospitalized, most babies have bonded to their mothers or primary caregivers, are scared of strangers and extremely sensitive to separation from mother. Many have not yet developed full capacity to maintain object constancy, a trust in her continued
existence when she is out of the room. She disappears and reappears from sight, but the infant has no stable inner representation of her when she is outside the field of vision. With this developmental understanding, it is not difficult to understand how separation in the hospital under the care of strangers while drugged and in pain could trigger terrifying catastrophic fantasies, including the permanent loss of his family, irrational ideas that
resurfaced 26 years later to cause panic the night he couldn’t reach his family by phone.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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The Case of Tommy Continued
By Stephen Proskauer MD | January 24, 2012
Tommy had been hospitalized seven times in childhood for sudden and serious medical problems: at 8 months for subdural hematoma following a fall on his head, at 18 months for heart surgery, at 8 years for pneumonia and later the same year for meningitis, at 9 years for a ruptured appendix, at 10 years for a second subdural hematoma after a bicycle accident, and at 11 years for tonsillectomy complicated by post-operative bleeding. Five of
these episodes required surgery and all of them involved sudden separations from his family and were potentially fatal.
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The Case of Tommy Continued
By Stephen Proskauer MD | January 17, 2012
When I first saw him, Tommy did not appear depressed. His primary problems were panic attacks against a background of pervasive anxiety accompanied by shaky self esteem, shyness and irrational guilt, all of which were exacerbated by separation from important people in his life. Tommy came from an intact family and described a close relationship with loving parents. He denied any abuse, but once he recounted his remarkable medical history, the genesis of his irrational anxiety became immediately clear.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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The Case of Tommy Continued
By Stephen Proskauer MD | January 12, 2012
Three years before, Tommy had made a serious suicide attempt while away from home at college, slashing his wrist following a painful breakup with a girlfriend in the midst of other school problems. He was hospitalized, diagnosed as having a Major Depressive Disorder and treated with antidepressants and counseling, neither of which he felt had helped him.
Psychological testing done later suggested the same diagnosis and documented Tommy’s specific learning disabilities.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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The Case of Tommy
By Stephen Proskauer MD | January 10, 2012
Tommy’s story offers a dramatic example of how important developmental cues can be for accurate diagnosis and treatment. Tommy was a 27 year old college student who came in suffering from lingering anxiety two months after a panic attack that occurred while he was on summer break living with his parents and brother. While on a brief visit away from home, Tommy was unable to reach any of them by phone. He imagined something
terrible had happened and began to sweat, shake, and his heart started to race as he terrorized himself with one disaster scenario after another. Overcome with panic, Tommy felt compelled to drive a long distance in the middle of the night to find them, only to discover his family peacefully asleep in their beds with their phones turned off. After this episode, his confidence in himself was so shaken that he dropped out of college for a semester and sought help.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Developmental Issues
By Stephen Proskauer MD | January 5, 2012
In the last century, psychoanalysts and researchers into cognitive development made major contributions to our understanding of the child’s inner life at various developmental stages. I am fortunate to have received training and supervision from child analysts in the clinical application of these developmental principles. A working knowledge of child development is critical to the recognition of subtle differences in PTSD symptoms that
arise from trauma and abuse at different ages. Some forms of PTSD go unrecognized
and untreated, or misdiagnosed and ineffectively treated, when clinicians are not alert to stage-specific symptoms.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Adult State of Consciousness to Help Patients Release Trauma
By Stephen Proskauer MD | December 29, 2011
Psychotherapists use many different methods to facilitate recovery and integration of repressed trauma from intrinsic memory. I prefer the body centered desensitization technique to bring painful and frightening memories into conscious awareness and release the emotional charge on them, along with Voice Dialogue, journaling exercises and Inner Child work to help with integration. I avoid hypnotherapy or drug-induced trances that in my view give over too much control to the therapist and may bring up more emotional intensity than the patient is ready to integrate. I have never needed to override the normal adult state of consciousness to help patients release trauma and integrate it into extrinsic memory. Perhaps hypnosis can be used safely with severely abused patients in experienced hands, but I prefer to proceed at the patient’s pace and trust the bodymind to bring forth whatever memories are tolerable at a given stage of therapy to promote healing. This is consistent with my therapeutic philosophy of empowering the patient every step of the way and maintaining my role as a catalyst and supportive partner in the process. Heroic attempts to force the recall of traumatic memories too often backfire
and are more likely to cause retraumatization than healing.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Topics: Abuse, Big Heart Healing, Consciousness, Intergration, Memory, Multidimensional Healing, Psychotherapy, Therapeutic, Trauma | No Comments »
Psychological Integration
By Stephen Proskauer MD | December 22, 2011
Less emphasized than catharsis in early psychoanalytic theory is the “working through” process native to all forms of psychotherapy that accomplishes the second step of psychological healing: the cognitive retraining required for integration of recovered memories into a mature and effective coping strategy for dealing with present and future stressful situations. Cognitive Behavioral Therapy and other such approaches offer clearly delineated methods for accomplishing this retraining process, especially in treatment resistant psychiatric problems such as Obsessive Compulsive Disorder and Borderline
Personality Disorder. In the former problem, the symptom pattern is often too deeply entrenched to permit effective release of the formative memories. With borderline patients, stress tolerance is frequently too low and the capacity for maintaining a stable therapeutic alliance too fragile to tolerate very much emotional uncovering. Whether or not formally trained in specific cognitive methods, all effective therapists have found their own ways of utilizing the warmth and safety of the therapeutic relationship to teach and model mature coping skills, an essential aspect of treatment for PTSD symptoms following severe childhood abuse.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Identification with the Aggressor
By Stephen Proskauer MD | December 15, 2011
Abused children tend to go on inflicting what they have suffered on themselves or others. Psychoanalysts described this behavior pattern as identification with the aggressor. If we look at the pattern adaptively as well as defensively, however, it might be regarded as a confused and self-destructive attempt to master the trauma by living it out at a later time with adult ego functions now available, in an effort to heal the abused Inner Child. The
bottom line here is that uncovering techniques must be undertaken in a safe and trusting atmosphere in a manner that respects the patient’s psychological fragility.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Premature Uncovering
By Stephen Proskauer MD | December 13, 2011
Therapy can jump the tracks if misguided and premature or aggressive attempts are made to uncover traumatic memories before a secure trusting relationship has been established with a severely abused patient and before the ego integrity of the patient has been adequately assessed. In Connie’s case in Chapter Six Of Big Heart Healing, for example, a previous therapist had attempted to recover repressed abuse memories with hypnosis in a case of severe Dissociative Identity Disorder, resulting in a psychotic breakdown and a serious suicide attempt. In the presence of such severe dissociative splitting, clinicians need to assume unless proven otherwise that the underlying ego structure is too fragile to tolerate direct uncovering techniques.
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Big Heart Healing a Multidimensional Approach to Trauma and Abuse
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Topics: Abuse, Big Heart Healing, Hypnosis, Memory, Multidimensional Healing, Therapeutic, Trauma | No Comments »
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