I wondered as I read these comments/questions, how absolutely genuine a person's concern for their clients must be for them to have this depth. But, as I read on, it seemed to be the very questions 'I' have, and I indeed wondered what exactly drew the attendee to your program. Had it been interest in helping others to heal, and/or something akin to 'physician heal thyself'? It sounds like your conferences were as powerful as they needed to be in order for your state to move forward in the effort of rape recovery therapy.

I read these questions, and all of them are appropriate to my current status. But two of them are absolutely intriguing me, (well, maybe three), but I am interested in what YOU said, HOW you answered them.

The two most compelling to me are the one about early life/family dynamics...and, when someone has done so much therapy they know it backwards and forward...

I can tell you, when you know what you know...but you feel what you feel, a sense of failure isn't far behind. I am hugely intereated in what YOU said. I hope you will share with us how you handled these questions, or, if you had hasitation with any of them, I hope you will explore them WITH us. As surely as these practitioners have questions, those of us who have suffered the trauma are asking them too, on a much deeper level.

Oh, and the question about managing triggers you aren't even aware of...have they been reading my old journals, LOL! THAT very thing is so enormous....so gigantorific....so...I can't think of a term BIG enough!!

I have always thought that it was a thing only I get so engrossed in, a way I decided to describe what was happening to me, and perhaps I made a bigger deal of it than was necessary. But, when your trigger rides in on a breeze...or perhaps IS a breeze, or a minute scent, or some weird de-ja-vu thing going on, but you find yourself THERE all over again - how exactly are we failing ourselves to NOT have control over THAT kind of thing????

To put it in texter-tot, (my own term for you texting youngun's out there) jargon....OMG! That is in all caps, and very bold---OMG! This is the question of the century for me. I believe this triggering of this horrific life event, when you are in a peaceful place, an otherwise comfortable state of mind, yet 'it' jumps up and slaps you right back to 'there', well, THAT is the most horrifying, today I can think of. All my grounding techniques have failed me at certain times in my healing-phase existance, and THIS is exactrly the thing that led me into the hospital last year. It frightened me so badly I feared I was losing this battle, AND my mind. Yes, that is what describes it best - I believed 'it' had finally stolen my mind.

Oh Matt, please DO share here in RAR how your discussion moved from the question, to the answer. I know there may be no finite answer to these questions, no 'one way' that will work for us all. But, in therapy I ask many of these same questions of my therapist, and he has been so helpful to me, yet, here I am struggling. I crave the answers to so much bouncing around in my head, screwing with my life. If your discussion content could alleviate a fraction of that distress.....WOW!

I would also like to see answers to many of these questions.

I can give you my own take on the last one. The moments where my dr, Kerry, or Catherine have been tender are the ones that truly influence change in me. I still remember Kerry putting her hands around my face while she was crying, making me look her in the eyes, and her saying, "You're so beautiful Martine. You deserve so much." I remember her taking me aside and telling me I could never kill myself because of how much it would impact her, and how much she cared about me. I remember her telling me that it was all she could do not to take me home with her at the end of the day and show me how life is supposed to be.

Therapist or not, she's a person and I love her. I am not afraid to say that. I still keep in touch with her every few weeks. I would do so more if she had the time. But those moments, those precious moments of being human - those are the ones that make life worth living for me, those are the ones that I hold on to when I'm struggling. They are my reminder of hope.

Hi, Matt, Congratulations on your training events.

One (well 2 actually) questions for me in particular stuck out in your post.

*How does a therapist respond to the client who is suspicious of the therapist's motives for being in this work? (example: "Are you doing this just for vicarious intrigue into our life pain?")

This situation is one I have met on occassions in my agency work. Working with families of sudden and traumatic death, I often first meet someone very early on in their grief. Why would you want to do this, who are you to think you can possibly know how I feel? I want this to have happened to you so I don't feel so isolated? are implicit questions behind the original question. Delicately finding out what their question is and Validating the importance of these thoughts is often where we begin and can be an indicator of how they feel about the therapy and the therapist on the whole.

and
How should a therapist handle times when s/he has made a blunder with a client, and wants to manage the issues but doesn't want to ruin their credibility as a competent professional with the client?
~ Congruence, surely the only way to work with a blunder is to own it even if it risks the "credability" of the therapist. Without that how can work continue? It is about the client and their needs have to be met first and foremost anything about the therapist must come second. Supervision surely needs to be sort out by therapist before the next session and exploration in themselves as to how and why the blunder came about. (Rant over)

Glad though it has gone well, there is little training here either, it all gets put under trauma and even then it is not compulsory, however even if I were to to do something I wonder how seriously a newly qualified counsellor with limited working hours would be taken? I don't know, but I might have to find out!

Well done to you, glad it has gone well

Deb

*How do I know if my sexual behavior is just the result of "unusual" personal preference, or a reflection of trauma-based behavior?

Two Thursdays ago, I finally got it. I asked my therapist to sit next to me instead of in front of me and with that, either he was at the top of his game just coming back from a conference or my brain decided to work this day. He said rape is isolating in itself Barb and from there you isolate yourself from others, by not talking about rape or anything else for that matter, you keep people at arms length (I'm thinking this is good, what he's telling me) so he goes on to say that isolation brings lonliness, which lonliness isn't bad but isolation is (hes drawing a diagram for me because of my processing difficulties after a stroke in 07) so, he said with that isolation (never letting anyone in) I crave intimacy, not necessarily sexual, but closeness, and while I'm craving this intimacy, I get a phone call (for sex) so I let him come over and after its over, I feel regret, shame and guilt and so I isolate myself some more and it all starts from the rape and goes in this cyclical circle, over and over again. Now many of you may have realized this, it only took me forever, it was the first time I walked out of there and got it and had some energy. Just thought I'd share. It felt so good to finally get something. Hope you all are doing well and have fun at the retreat.

"How does it feel to the client...." I am impressed with whomever asked that question, because it is so....selfless. I know there is so much more to therapy than feelings, but, how it feels to 'us', the collective recipients of care is so varied, but so necessary to consider. That there is a legitimate dynamic behind the feelings is important and appropriate to acknowledge, and to know that therapists/counselors recognize that fact is so comforting to me. It takes us away from being 'subjects' to being 'people'...we don't always feel like that you know, like people. We dutifully present ourselves week after week, and oftentimes it feels like we are tagging along as the carcass that holds the disease intact. Sorry, that may be too much ME and not so much anyone else -- the carcass holding the disease comment I mean. But, as years pass, and the ride toward healing seems to stretch out in front of you, you tend to begin to feel like you ARE sick, like something in YOU is what made this all possible, and the rape was just an inevitable consequence of something in your fabric.

I am ashamed to admit it, but just this past week I asked Dr. Chandler what was the longest time he has had one person in therapy, to which he said "16 years". I hate it for 'that' person, but, it was somehow a comfort for me to not be the one in it the longest, to actually fall far short of that spanse of time. I then had to wonder how long for me? You see, rape isn't our only issue. Rape may be the precipitating factor to our need to be sitting in the therapist's chair...(you know, that thing that used to be the "psychiatrist's couch"), but other things enter into our minds as we work toward healing. At times, the simple fact that I am actually IN a therapist's chair, that I actually have need for his services -- that fact alone makes me feel like I must be weaker...sicker...different. After all, not every person who has been raped is in therapy, so what is wrong with me that I wasn't strong enough to battle this on my own?

I know you know it, but we come into therapy with so much, and "rape therapy", or "trauma therapy" is the thing it is labeled, but "life" is what we are trying to manage, and sometimes, I wonder if my therapist realizes just how huge it is that I am there, in that chair, pouring out the truths of my life, to him - at all.

Sometimes, it is the weight of that fact alone that threatens to smother me. I simply wonder if the depth of what a horrific gang rape did to a 12-year-old girl can ever be realized, and what it really means that I am sitting in THAT chair.

For clarity's sake...perhaps these 'questions' should have their own individual discussion threads.

This seems to have sparked quite a bit of interest in us Matt :)

*Borderline personality disorder and complex PTSD - what's the current state of scholarship?
What does that mean?

Yeah Mayday..I wondered that as well, like, I wondered if what they meant was 'how is it a person deserves the diagnosis of BPD vs complex PTSD....and, if I read that and deciphered it correctly...I wondered if there wasn't a kinder what to say it, like....how can [we] distinguish the traits seperating BPD and complex PTSD...because, for me, 'scholarship' is an earned thing.......and makes the response a bit painful. I suppose I just don't like the phraseology here, not so much that I didn't 'get it'...again, just ME being overly sensitive. I know there has to be a way to tell the distinctness of complex PTSD from a person with BPD, and a therapist/counselor/physician certainly needs to know this distinction and be able to readily apply it, but....I don't like the fact that they used the term 'scholarship' here. I earned a Science scholarship to help pay for my Nursing education....I didn't 'earn' my PTSD.

Oh gosh...now I have this fear that the response might be something like...."Yes, the phraseology might have a bearing on the perception of the discussion content, BPD per se....and, the fact that such exception was taken indicates, in and of itself, that BPD must be considered..."

(This is my attempt at a humorous deflection from my 'issue' with the 'scholarship' thing, lol) I do admit I read it and was perplexed by the phrase, but....really, it didn't upset my day. My response to it kind of did though....sorry 'bout that you guys. In my mind....onto the page.....:0)

I do not claim to be any authority on the subject. I've read a decent amount of studies and journal articles regarding complex ptsd, and have been told by someone at princeton that they felt I fit the diagnosis. The only thing that has really stuck out to me is that BPD is characterized as a personality disorder. As the way you're made up regardless of life circumstances. But I am sure there is plenty of debate that traumatic circumstances plus biology lead to a predisposition to develop the disorder.

Complex PTSD can be another way of saying that all these things have happened, and have affected me, but it's not the core of who I was before the trauma. It's how I had to respond in order to survive.

I am wondering, from THIS side of the desk...if a therapist/counselor/physician has a kind of bleaker picture of thos eof us with PTSD than say....us? I mean by that, that we as clients HATE to 'fit criteria'. We want to be people who have had trauma, and that our response to that trauma is a natural, and normal, rational response to an irrational act against us, (does that even make sense to anyone but me?). I would that it were not so, but, this is who I am. I want to be viewed as a person with responses that perhaps others don't possess, but have it understood why this is true for me. Accept ME with my 'flaws', and help me overcome what is viewed as 'abnormal' in the clinical setting, but, please don't think of my label first.

I also hated the phase where we wore names on our asses...I tend to lean toward the generic...no name dropping hype for me...so, maybe that's where I get it. lol.

I believe I am respected and understood in my therapist's office. I don't think that is so amongst the general population....boy, this topic got side-tracked a bit. But, this is the kind of discussion I like. I like it because there is more than one person who is a clinician here, and they will take our fears and see them in others who may not be able to voice them, so, maybe this is a help to some we do not know. I hope so.

If I were to address your colleagues as if one of them had actually posed these questions, this is what I'd want them to know:

I have triggers I can't identify. They creep up on me and I am in full-blown panic before I even know it is coming, so, that you, as a clinician wants to prevent that, I thank you. I don't expect miracles, and I know you are trying your best. I understand we are walking through this together, and some of what I present, you may not have an answer for. I'd rather you admit that, than to pretend you can help, and not have a clue as to how. Tell me the truth, I'll respect that. I will accept that you are searching on my behalf much easier than you telling me what you think I want to hear. I will make a covenant of honesty with you, as long as you will do the same. Know that I am afraid of failing in your eyes. Know this adds to my inability to divulge deeply painful things, and encourage me to do it anyway, by confirming your respect for me.

I can't speak with authority to any aspect of the questions posed here, except those that allow for the victim's perspective. I am a woman. I was raped by two men, and a woman. I don't know if my reaction to that offense is any different than a man's would be, but I know men are raped too, and, gender aside...the sexual nature of the offense aside - if rape is about control, then having control stolen must have similar effects on the person having said control stolen.

If you as a therapist/clinician cannot fathom my extreme shock, and the effect of that shock on my entire existance, don't try to force it. Lead me elsewhere and do not feel like a failure. I love music, but I cannot play one single instrument. It doesn't diminish the music, unless I force a person to listen to my ill-fated attempts to play. I still love music, and if I don't attempt to play it, the world will not suffer any loss. Likewise, you love serving those with a need for mental health services, that rape isn't your forte doesn't diminish your worth in the clinical setting, don't force it, others will step up, and your worth will be better exhibited in other fields. Thank you for admitting you may NOT be the best person to help me - thank you for THAT honesty.

Borderline personality vs complex PTSD...that you question the difference, or how to detect the subtleties that the general populace of clinicians might overlook, that makes me more comfortable in the integrity of the mental health care system. I WANT you to know as much as you can in order to make a proper diagnosis, but, know how uncomfortable a 'label' is to many of us. You see, 'this' was thrust upon me. That I am a victim fighting to gain survivorhood - that this is even a need in my life, that was thrust upon me. Don't lose patience with me when I am resistant, when I bristle at the harshness of this work of recovery. Know I want it desperately, but, at times I will tire of the struggle, and I will want to lie down and rest. I'm not giving up, nor am I giving in - I'm just weary.

If you believe early-life/parenting issues do not have any effect on my healing from this trauma, take some time away from this work. Perhaps do some volunteer work in some juvenile detention centers, in some programs for youthful offenders, then reassess your conclusions. I am not being snide, I am being as truthful as I know how to be. If a clinician cannot connect a very traumatic and painful childhood to the inability to effectively heal from a trauma such as rape, then again, this may not be your field of expertise. I need you to ask the questions about my childhood, and understand I may attempt to paint it much more colorful and positive than it actually was. It was several meetings with my therapist before I was able to tell him he had made assumptions as to the appropriateness of my up-bringing that simply were not true for me. Once he had the full account of my foundation, much of what I was/am experienceing from my rape has made much more sense to him, and he has been able to help me more effectively. Ask the questions, and listen for the subtle hints at failure to disclose the truth...half answers, veiled comments...dig deeper, I want to share with you, I just don't know how to say it yet.

That thing about wanting mentorship, about seeking professionals to teach you - this is what I would hope could happen, and might help us all. Is it possible to contact the Mental Health Association, in your community, in your state, and nationally, and tell them what you already know. Tell them the vastness of victims floundering in a sea of clinicians ill-equipped in trauma therapy. Tell them YOU demand better on behalf of these clients, and make them listen. Contact your colleagues, and have them join you in petitioning your licensing agencies to provide intensive in-service training for you, for us. When you receive information you find beneficial, share it. If you hear a speaker who is gifted in the area of trauma recovery, in rape-based trauma...shout it from the mountaintops, make yourself heard. Advocate on behalf of me, and every fourth woman you see today, including your wives and daughters, and sisters. THAT is who is affected by rape, and that is who needs your services. Recognize our plight as universal, and determine you will do something about it. If we cannot stop rape from happening, we must be prepared to aid those who will be affected by it. Be there, speak up, speak out - for us all.

I present some dificult situations to you, because they are real, and troublesome for me. Sexuality perplexes me. I was terrified and horrified beyond normal human capacity, and I was a child when it happened. I acted out behaviors I did not understand, and this added ot years and years of self-blame. I don't understand it, and I need your help, but, it is very embarrassing to admit it to you. I need your respect, yet I am telling you every detail of a life that would garner no repsect in the general sense. Understand how huge it is for me to say these things to you. Knwo that, although you have an ability to close down, file charts, lock doors, and go home - this is my life. Know I get no reprieve. Know, that when I say these words to you, they cannot be recalled and put back - they are 'out there', and they reflect me - the person in front of you. Please know how difficult this is. Please know it hurts me to admit these things, and I need your attention. I need your concern. I need your understanding. I need your respect. I need your honesty. I need to know I have not disgusted you with my shame, for I have disgusted myself to share it. Never forget the bravery, the absolute courage you see before you, in me, in my presence in this chair in front of you. Let me know you recognize that courage, and never dishonor it.

I have been in therapy one-on-one, and I have been hospitalized and shared in group settings. There is positives in both arenas for me. In therapy, I get to share with my therapist, and he talks to me, about me, without interruption. In a group, everyone shares, and it is a gifted facilitator who can manage the group dynamic and assure each person their needed time. In fact, it takes such a facilitator to encourage the quiet ones to speak at all. I would have made quite the wall-flower in group had my therapist not noticed I was shrinking into the background, allowing others to share, while I journaled, and squirmed. I was drawn in to the conversation, and I was asked to share specific journal assignements, which I did. But, I wouldn't have offered them up had I not been asked. Know your group. Know their story, know their pain, know their personality, and engage them. Be creative, and be gentle, and cancle appointments ONLY in dire emergencies. Between appointments, we spend hours and hours mentally preparing - honor us with your presence. I can't say I prefer one mode of therapy over another, except that I have more experience with individual therapy, and, when I am challenged for time, I cede the floor, always. So, perhaps group isn't the best for me, because of me.

I admire professionalism, in fact, I crave it. BUT, I need empathy. I need you to connect with me, not just file me at the end of a session and forget the things we discussed. I know you have to protect yourself, but, I need you to take a few minutes before I enter your office, and remind yourself of what we talked about last time. I need you to let me know you are human too, not some teflon-coated sounding board. I need to see you react sometimes, because, what I am telling you is shocking, it is ugly, it is real, and it is my life. It is okay to gasp, if that gasp is followed by you letting me know it isn't the words, but the known effect of the pain on ME that you are responding to. It is okay for you to care about me. I need a professional barrier, for my sake. I need you to read me well enough to know that human contact is also part of therapy. I need you to realize when I am hurting for a touch, a pat of the hand, a hand on my shoulder, or even a platonic hug. If you have fears about such a thing, talk to me about it, and allow me to tell you if it is, or isn't okay. My therapist has hugged me, or allowed me to hug him, and it strengthened our bond, but never once was it misconstrued, because it was talked about first. Always with an open door, or with a witness, always with consent, and, I am sure it is documented somewhere in my record, because that would simply be careful documentation on his part, and no reflection of his trust of me.

My therapist has even shared an incident from his adolescence that could have turned into a sexual encounter, but he was fearful enough to move away from this person. That he told me this would be perceived by some as inappropriate. But, in the context of his treatment of me, he was able to discern my ability to hear this account, and reason it as a 'close call', and that not one of us is immune from the attempts of unscrupulous people. He used this personal account, not to suck me into his personal life, but to show me that we each have innocence that can be manipulated at times when we are too powerless to prohibit it. He opened his past up to me, allowing me to see him as human. I don't know where he lives, what his favorite color is, or even what type of food he likes best, and that is how it should be. But, I know some things we use as light conversational points, to ease our way out of the heavy topic of rape. If that makes us vulnerable for transferrence/counter-transferrence issues, you couldn't convince me.

I believe my therapist has also made a couple of 'blunders' with me over our time together, I mean, how could he not, he is human first, a therapist second. Mistakes are inevitable in a work that is hugely a practice, such as is all forms of medical care. I believe in the human's ability to falter, and to rise up from it. I think the way we got past this was that he readily accepts his responsibility, and admits it. And he asks how I think we can avoid this pitfall. he valuies my opinion, and he lets me know he respects me. In being so transparent with his expectations, his trip-ups, and his actions he was unaware that caused me distress, he lets me know he is trying. He lets me know I do matter to him. Honesty, on both our parts is essential for this process. He will certaily lose all credibility if he is not able to admit his errors.

I have been suspicious of the motives of some in this quest for recovery, because I grew to be suspicious by nature. Expect it, and state your beliefs up front to new clients in trauma therapy. By doing so, you allay many fears, and you answer the un-asked questions, allowing no time to be wasted on this issue. You will gain my respect by simply telling me, as a matter of introduction, why this work is important to you. Tell me right up front how you feel about victims like me, about how you will honor my truth, how you will protect my privacy. Don't wait for me to ask - tell me so we waste no time on this later.

About those times when you might react, in an emotional way to my life-narrative, please do. I mean, this is a horrible thing that happened to me. I need someone to realize that, to acknowledge it, to mourn it with me. I will respect you more for that. There are times when the simple acknowledgement of how enormous this is settles in on us, it threatens to suffocate us. That you can share that with me, is huge to me. If you sit there stiffly as I tell you the emotion attached to the pain of sodomy, or the terror of being told to "cover your teeth, you bite me and I'll fucking kill you", if you can sit there emotionless, I will shrink away from the emotion too, and that will hinder me. I am not afraid of your care, or your expressions of it. I am afraid I am alone in this, that caring is not available to me from you, or from anyone.

If I could speak to your colleagues, this is what I would say about their questions. AND, I would say a heart-felt thank you. My truth is excruciating. The words are abrasive and ugly. How can you be human, and not be affected by these evil things that happened? How could I ever fault you for trying to help me through this?

More than anything, accept, and acknowledge how absolutely enormous this thing that happened to me is, and how miraculous it is that I am in your office speaking about it. If you can do that, if you can see the courage it takes for me to do this, then you can care for me, and you can help me.

Leitha you are just amazing, simply amazing.

I am curouis as to whether people are suggesting that PTSD cna be misdiagnosed as BPD or whether rape can lead to the development of BPD. I also wonder if BPD is really anything different from PTSD (sorry about the acronyms!) I remember reading a description for BPD once (after I was attacked) and thought it sounds exactly like me and yet from reading the RAR book I can see how my behaviour was not nessicarly unusual given the cirrcumstances. and yet and the scary thing for me is that I was behaving in alot of these ways before I was attacked so I guess I wonder whether my behaviour was the cause or the effect of what happened to me?
I also know that alot of people who are diganosed with BPD have been sexually abused as a child so I wonder sometimes if there is really a difference between PTSD and BPD