Hello, dear loyal blog followers!   Thank you for your patience in my long stretch of "quiet"....it's been a YEAR!!! Since the pandemic hit, I've been immersed in the world of medical/psychiatric work, leading a counseling program at a college local to me in the Bay Area.  I also have a small private practice.  You can imagine that things have been extremely busy with this global trauma of a pandemic, racial injustices, and political unrest.  As always, I continue to be honored and privileged to serve the clients I work with.  I just wanted to shout out a Happy Spring.  My goal is to be more interactive, getting back into writing and staying connected with projects that are trauma-informed and social-justice informed work.  I've continued to take continuing education in advanced level EMDR work, expressive arts training, and trauma informed modalities.  So much of my work in the last year has been targeted to college age students, some of our most vulnerable people on the planet right now.  I love the work I do, and I am excited that a new chapter is about to be upon us, as a post-COVID world unfolds before us (crossing fingers and toes) hopefully in the very near future.  There is a light at the end of the tunnel, and we can now see it!  Gratitude for your patience.  I will check back in again and share the latest projects I am working on shortly.  Cheers!  Andrea :)

As a licensed clinical social worker, one of my code of ethics is to uphold the high standards of social justice and racial equality.  To be a trauma-informed psychotherapist is to be a socially-justice informed psychotherapist. You can't have one without the other.  I stand in support of my BIPOC clients, colleagues, friends, neighbors, and community to denounce systemic racism.  I pledge to commit daily to the work of being an anti-racist.  As a white woman, I know that my privilege has shielded me from the pain and suffering our BIPOC community has endured for centuries.  As an apprentice to being an anti-racist ally, I hereby commit to the daily lifelong work of joining the forces to dismantle systemic racism.  " If you are neutral in situations of injustice, you have chosen the side of the oppressor." Desmond Tutu

As you many of you know, my practice has moved to the Bay Area. I am the lead counselor at Cal State Maritime Academy in Vallejo, where we provide counseling for students. RIght now, we are under shelter-in-place orders, so converting our work to remote-counseling.  As with my private practice clients, I will continue to provide webcam/telephonic services. Stay tuned for some more updates and resources as the world moves increasingly to electronic communications, now more than ever. Be safe and well.  Here is my latest Psych Central Blog Post, entitled, Hunkering Down: 4 Brain-WIse Ways to Cope During COVID-19. 

Thank you to all of you who follow me on my website here. I wanted to share some exciting news! My private practice is moving to the Bay Area this summer! I am currently providing web-based online therapy where appropriate, as well as life coaching services. I will shortly announce the location of my private practice office for my in-person clients and those who wish to pursue trauma-informed EMDR therapy. I got certified in EMDR last March! Woo Hoo!
​Stay tuned for more details...

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"You are going to need therapy." Gwendoline Christie (who plays Brienne of Tarth) , After Game of Thrones Season 8


***WARNING: MAJOR SPOILERS AHEAD***
Like many fans of the HBO series, Game of Thrones, I am utterly stunned. The entire series ended last Sunday. And yet here I sit, transfixed and puzzled by the outcome.  Overall, I feel that the last episode tied together what needed to be concluded, although I wouldn't say it was the most graceful or neatest of outcomes on the TV screen.

I have blogged several articles regarding narcissism and psychopathy and how these conditions manifest in the Game of Thrones series. I feel this epic drama demonstrates, like no other cinematic work of art, how narcissism and psychopathy exists in families, nations, politics, and interpersonal relationships. Although perhaps at times exaggerated and grossly graphic, no other drama has so skillfully demonstrated through superb acting and plot development what can happen when extreme hubris takes over families,  countries, continents.

As a trauma-informed therapist, I took comfort in the observations that many characters evolved past trauma and actually survived what would be considered insurmountable obstacles to transcend adversity.
Specifically the characters of Sansa and Arya Stark represent what to the psychology world embodies post-traumatic growth and resilience in the face of adversity (Schneider, 2017). Prolific trauma-informed writer and author, Shahida Arabi, states that "as a result of her traumas, (Arya) gains wisdom and skill sets beyond her years which many adults in the show are still struggling to obtain" (Arabi, 2019).

Furthermore, Sansa evolves to ascend to the role of Queen of the North, despite profound obstacles, including sexual violence and abuse on all levels by more than two power-hungry, pathological men in positions of political power. Joffrey, Ramsey and Littlefinger could all be easily diagnosed with psychopathy, and they have all profoundly impacted Sansa as overt and covert abusers. Sansa is the epitome of transcendence in the face of debilitating trauma.
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All that being said, it is with tremendous chagrin that many of we Daenerys Targaryen fans grieve the fall of this heavily lauded character. The Mother of Dragons, The Breaker of Chains. Khaleesi, etc....fell from grace as she succumbed to her darker side and incinerated not only her enemies but a good portion of innocents who inhabited King's Landing.  For the longest time in the series, it appeared Dany would be the salvation of Westeros, freeing people from the tyranny of dictatorship and evil. Unfortunately, her character's arch rapidly descended into hubris, megalomania, and malignant narcissism, which bordered on paranoia and psychosis...and she fabricated a fantasy illusion of what freedom and safety meant to the people of Westeros, favoring a authoritarian, autocratic, fascist rule (Hurley, 2019).

Yes, women (and men) can be psychopaths and narcissists, dictators and actors masquerading with the facade of humanitarianism. Perhaps this twist stung particularly hard for survivors of abuse of any form. Daenerys Stormborn, for many, represented an omnipotent champion of resilience, post-traumatic growth, and assertion. She survived rape. an arranged marriage by a deranged brother, miscarriage, and many near misses of her death by various self-serving and pathological people and circumstances. Unfortunately, her character arch took her to a place of fantastical and delusional stolen power, greed, and grandiosity, resulting in the senseless immolation of many unknowing innocents.

Game of Thrones brilliantly shows us how pathological narcissism and psychopathy, an unbridled quest and unquenched thirst for power and control, precariously teeters on the brink of collapsing groups of people, families, countries, an entire continent, if not a world. Given the imbalance of our current circumstances on this planet, I believe George R. R. Martin (and HBO showrunners Benioff and Weiss) do a brilliant job of illuminating where our work remains as fellow human beings...to unite, collaborate, empathize, transcend, solve, evolve....our differences...that we may strive for and live in peace and harmony.


Resources:
Domestic Violence Hotline: 1-800-799-7233 (U.S.)
National Sexual Assault Hotline: 1-800-656-4673  (RAINN.org)


Retrieved from: Schneider, Andrea (2017): https://blogs.psychcentral.com/savvy-shrink/2019/04/post-traumatic-growth-in-game-of-thrones-sansa/
Retrieved from: Arabi, Shahida (2019): https://blogs.psychcentral.com/recovering-narcissist/2019/04/5-powerful-lessons-arya-stark-from-game-of-thrones-teaches-us-about-complex-trauma-survivors/
Retrieved from: Hurley, L. (2019): https://www.cinemablend.com/television/2471884/the-game-of-thrones-writers-after-years-of-great-work-deserve-better-than-this-petition
Martin, George R. R. (2011), Game of thrones, Batham.


(This post was originally published in the author's blog, From Andrea's Couch) 

I am so excited to announce that I am now an EMDRIA approved EMDR therapist! Please see my many articles posted here on this blog, as well as at my blog, The Savvy Shrink, on PsychCentral. Cheers!

Hello, readers. Thanks for following along on my blog. I hope you have a restful and relaxing holiday season.  A reminder that my weekly blog articles can be found on  Psych Central The Savvy Shrink.  In addition, I have a podcast, also entitled The Savvy Shrink on MHNR Network.  In other news, I have been working away on EMDR certification while also contributing to and creating other projects that will be unveiled in the new year.  WIshing you and your's a wonderful and restorative holiday season. Perhaps think about constructing a Vision Board for the new year. Here's to a wonderful 2019...see you then on my blog here and other publications.   

"Someone who has experienced trauma also has gifts to offer all of us- in their depth, in their knowledge of our universal vulnerability, and their experience of the power of compassion."- Sharon Salzberg

What a week. You'd have to be living under a rock if you haven't at all tuned in to the tumultuous news cycle in the US. Those that are survivors of trauma (specifically sexual assault and other forms of abuse) are incredibly triggered, and those that provide psychotherapy for trauma survivors are, well, ..busy (understatement). It is a time of tremendous shifts, it's a time of political divisiveness and upheaval, some say greater than that of the era of the Civil War. I don't doubt that. And it is through adversity that profound transformation and transcendence can and does occur (cue in silver linings here). 

Politics aside, we must collectively focus on how to heal the traumatized brain. In the latter three posts, I wrote extensively about the brain mechanics of trauma. I shared information about our wonderful amydalas, hippocampi, prefrontal cortex, and hypothalamus, among other miraculous brain components. We know how the brain scatters traumatic material in different parts of our grey matter, rendering a cohesive narrative approaching impossible for the healing individual. Brain-wise interventions, including EMDR (Eye Movement Desensitization and Reprocessing), help the traumatized survivor to develop an adaptive resolution to their trauma in which the "held charge" of the trauma  (hyperarousal, hypervigilance, intrusive flashbacks, freezing, numbness, etc), can be desensitized and reprocessed in a cohesive manner (van der Kolk, 2015). 

Let us know turn our attention to how we can help our precious craniums heal in the aftermath of trauma. Follow along with me as I discuss five ways to help the traumatized brain heal:

1) See a psychotherapist who is strengths-focused (not victim-shaming/blaming), trauma-informed (has had extensive advanced training in evidence-based modalities to heal conditions like PTSD, C-PTSD), and who is competent and compassionate.  It is imperative to work with a mental health professional who is not only licensed in their field (psychology, social work, counseling) but also has advanced clinical training in trauma recovery. Treating conditions like PTSD, C-PTSD, depression and anxiety fall under the category of clinical intervention. Therefore, you need to work with a licensed mental health professional who has the training to address these conditions. Life coaches, although helpful, are not trained to address clinical conditions. It is unethical for a life coach to attempt to treat any of these clinical conditions, as it is out of their scope. Life coaches can provide psychoeducation, coping skills, and resources. Psychotherapists ( PhD, PsyD, LCSW, LMFT, LPCC), do the clinical interventions addressing the delicate nuances of trauma.  You would not see a vitamin consultant to deal with a cardiac bypass condition.  Within those qualifications, the practitioner must also be strengths-focused, client-centered, and empowering for their client. 

2) Physiological release is vital.  Those of us in the field of trauma recovery are intimately acquainted with the seminal writings of Bessel van der Kolk (2015) and Francine Shapiro (1992), as well as others including Lenore Terr, Judith Herman, Peter Levine, Pat Ogden, Cathy Malchiodi, among many more. When humans experience trauma, the event is "held" in a somatic (physical) part of the brain that is not accessible to verbal (higher order) understanding or meaning-making of the event. Therefore, interventions often need to begin with "bottom-up" processing (van der Kolk, 2015) where physiological release can safely take place, and after which the verbal/cognitive parts of the brain can then make sense of what happened. Some interventions can include trauma-informed yoga, somatic experiencing psychotherapy, EMDR therapy, exercise in a safe place (i.e. nature/hiking, with safe others), ,mindfulness based practices, deep breathing and progressive muscle relaxation, expressive arts utilizing major muscle groups, music and dance therapy, and other trauma-informed modalities.

3) Expressing the "held emotion" of the event(s) allows the processing and release of traumatic loss to unfold. Behind every traumatic event is a loss of some kind (whether literally to death, to abandonment, separation, a dream, safety, control , self-efficacy)...allowing the client to go to expression of loss, grieving the loss(es) inherent in the traumatic circumstances, is essential to healing. A "safe, holding environment (Winnicott, 1992) allows this expression to unfold, which may come about in expressive arts, journaling, narration of story, music/drama therapy, EMDR, somatic experiencing, and other trauma-informed modalities.  

4) When a survivor can release trauma physiologically and emotionally, then they can access their higher order reasoning and understanding of the traumatic event(s). At this point, the survivor can "narrate" their story, either verbally, in written form, or in a visual journal. By cognitively connecting the dots in a solid, cohesive understanding of the chronology of events, the client is able to store the traumatic material in a more adaptive fashion that does not activate the amygdala but instead allows the hippocampus to appropriately file away past events and current triggers. EMDR therapy is magnificent for this type of reprocessing and transcending trauma (Shapiro, 2017).

5) Spirituality helps make meaning of the nonsensical.   And I don't necessarily mean a religious institution. A mindfulness based practice of meditation, connection with nature and safe others, meditation, creativity, prayer, all allow a survivor to transcend and make meaning out of adversity (Malchiodi, 2018).  Survivors may also connect with safe others along the healing journey who are concurrently healing and evolving through trauma-informed modalities (psychotherapy, meditation, expressive arts, etc) that allow a connection and a decrease of isolation. In turn, communion with safe others allows healing to occur (i.e. support groups, individual psychotherapy). That which is witnessed and validated ceases to exert dominion over the well-being of the individual.

Retrieved from https://www.trauma-informedpractice.com/

Shapiro, Francine (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols,        and procedures, 3rd Edition, The Guilford Press.

van der Kolk, Bessel (2015). The body keeps the score: Brain, mind and body in the healing of trauma, Penguin Books.

Winnicott, D.W. (1992). The child, the family and the outside world (classics in child development), Perseus Publishing.

"Although the world is full of suffering, it is also full of the overcoming of it." - Helen Keller


**This article is Part 3 of 4 in a series entitled The Nuts and Bolts of the Traumatized Brain - See Part 1 here, Part 2 here**

Continuing the discussion of the human brain and the subsequent impact of trauma exposure, today's article will focus upon five additional tidbits of information. Prior articles (see above) have addressed the role of the amygdala and hippocampus in trauma and trauma recovery. Moving forward in learning about the neurobiology of our miraculous cerebrums, we know that the body interprets trauma as a life-threatening event(s). Therefore, different parts of the brain fire up to respond to the perceived threat (real or imagined).

11) The HPA Axis is a hormonal/nervous system connection in the brain that lights up when the saber-toothed tiger is attacking (i.e. a present day trigger or perceived/real threat like a car accident, rape, abuse, reminder of prior trauma, etc.). The aforementioned HPA Axis is activated by stress and trauma and consists of the hypothalamus, the pituitary gland, and the adrenal glands.  

12) The hypothalamus acts as a Command Center of the brain, communicating with the pituitary gland to release hormones, which in turn activate the adrenal glands to release hormones. These hormones include cortisol, opiates, oxytocin, and catecholamines, and they are released in varying amounts to ready the body to respond to trauma in "fight, flight, or freeze" response. Cortisol works to ready the body to have the energy to respond to the perceived threat; opiates reduce physical pain; and oxytocin reduces psychological pain. 

13) As mentioned in the prior articles in this series, the hippocampus and amygala work together to process the trauma. However, with the HPA Axis producing the "neurological soup" described above, encoding, processing and storing information goes haywire during a traumatic event. The amygdala remains activated while the hippocampus goes "offline" and stores traumatic material in scattered "file cabinets" of the brain, rendering processing of the traumatic event, at best, difficult and memory consolidation impaired. 

14) The area of the brain associated with language in the left frontal region, Broca's Area, gets shut down during trauma. A flashback or trigger shuts down this part of the brain, rendering the survivor incapable or at minimum, very impaired, with their ability to assign words to the experience of trauma (van der Kolk, 2015).  Brain-wise psychotherapeutic interventions (like EMDR) help the brain to synthesize and organize the traumatic material in such a way that the brain is able to store the traumatic material in an adaptive fashion, whereby the "charge" of the limbic system lowers. In turn, the higher order executive functioning skills of language, focus and concentration go back "online" to assist the survivor with narration of the story and thereby mastering the traumatic experience (Herman, 1992). 

15) "Bottom-up" processing of the trauma(s) involves helping the brain move into the action of recovery and getting unstuck from looping back to the state of being viscerally frozen in trauma (van der Kolk, 2015). Such interventions are designed to soothe and calm the limbic system and can include EMDR, sensori-motor therapy (i.e. somatic experiencing), expressive arts, music, meditation, trauma-informed yoga, prayer and mindfulness based practices, among others. Talk therapy (which requires a functioning prefrontal cortex that is back "online") comes only after addressing the somatic components of trauma recovery.

The last article in this four part series will address interventions that help with healing the traumatized brain. 


Retrieved from : https://sapac.umich.edu/article/neurobiology-trauma September 25, 2018

Herman, Judith (1992). Trauma and recovery: The aftermath of violence from domestic abuse to political terror; Basic Books.

van der Kolk, Bessel (2015). The body keeps the score: The brain, mind and body in the healing of trauma, Penguin Books.