Past traumatic experiences can have profound and long-lasting impacts on the lives of survivors. After experiencing trauma, people often feel extremely alone and unable to find others who not only relate to their experience, but who also understand all the different ways those traumas continue to impact them today. Group therapy is often used with survivors of trauma to combat feelings of isolation by providing a safe and supportive environment with other survivors. Some trauma group therapies dig deep into members’ trauma histories to process and restructure the memory of traumatic experiences. In this post, however, we will look at a different form of group trauma therapy: present-focused therapy.
 
It may seem counterintuitive to have a trauma group in which members don’t discuss their trauma stories, but that’s exactly what present-focused group trauma therapy does. By focusing on the current day-to-day impacts of trauma that survivors experience, this type of group helps members find ways to move from the past to the present, discover ways to cope with trauma reactions, and explore new ways of relating to themselves and those around them — all within a safe and collaborative group setting.
 
While every survivor’s experience is different, there are a number of common ways that trauma may impact someone’s daily life. When we think of trauma responses, we might immediately think about some of the “classic” symptoms such as being easily startled or experiencing intrusive memories of the trauma. While these are both very real responses to trauma, survivors also often experience profound changes to how they think about themselves, relate to others, and understand the world around them. Some common issues that survivors experience include:
 

• Anger
• Distrust
• Shame and guilt
• Need for control over situations and relationships
• Feeling emotionally numb

 
One of the most powerful aspects of group therapy is that the group becomes a microcosm of the group member’s world, and the issues members face in the world start to play out within the group itself. By staying in the here-and-now, present-focused group trauma therapy provides members a safe place to examine these issues, receive feedback and problem-solving strategies from other members, and explore new and healthy ways of relating to each other.
 
Ultimately, members of a present-focused trauma group can expect:

• A time-limited group experience (groups often meet for 8-12 sessions)
• A safe, judgment-free space in which all members work to avoid potential triggers for acute trauma reactions
• Psychoeducation on the different ways trauma can impact survivors’ daily lives
• A collaborative environment in which members help each other problem-solve the issues they face in their daily lives and explore healthy coping strategies
• Feedback from other members on their strengths and areas of growth
• An exploration of new and healthy ways to relate to others
• To accept the impact of past traumas while learning how to focus on the present and define the future in their own terms.  

Self-Care if You Are Working from Home
Designate a workspace. Explore designating a separate space in your home that is only for work. If you are in a small space and cannot do this, another option is creating some visual changes when you are “at work” versus “at home” to remind yourself that work has ended.
 
Hold boundaries. For most people, now is not the time to loosen up on your work-life boundaries. If you didn’t check your email during weekends or after 5:00 before, try not to now. If you are already in the habit of working 24/7, maybe ask yourself if that is working for you in the current situation and explore what boundaries you need right now.
 
Take breaks. If you can, make sure you are still taking your lunch break or start taking a lunch break. Even if you can only get away for 5 minutes, take some time away from your computer and give your mind a chance to reset while you refuel your body.
 
Self-Care If You Are Also Parenting
Practice self-compassion. I know I already mentioned self-compassion, but I want to mention it again. Maybe your kids are getting more screen time right now than is the norm, maybe they aren’t learning as much as they did in school, maybe there are other things that are slipping for which you are beating yourself up. You are doing the best that you can in a very hard situation. Acknowledge yourself for that! And when you can’t be kind to yourself, reach out to another empathetic parent who can help you be kind to you.
 
Practice mindfulness. I know this is another repeat. Remember that mindfulness is being present in the moment. When you can, try to be present with your kids, whatever it is you are doing in that moment. This type of mindfulness can open up mundane interactions to be more intentional and meaningful.
 
Take breaks. If you are able, try to take a break and have some alone time. This might mean you have to recruit your partner and trade times alone, or it may just have to be the time you have after your kids are in bed. You deserve some time just for you.

Mindfulness and Self-Compassion Resources:

• SomeCOVID-19 Specific Mindfulness: https://mailchi.mp/01c0e1a7bdb0/coronasupport
• Free Access to some of Headspace’s Content During COVID-19: https://www.headspace.com/covid-19
• Self-Compassion Resource with Mindfulness Activities: https://self-compassion.org

 
Reliable sources of information regarding COVID-19:

• Philadelphia City Government COVID-19 Resource Page: https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/updates/
• CDC COVID-19 Resource Page: https://www.cdc.gov/coronavirus/2019-ncov/index.html

 
Parenting:
New York Times’ Parenting During COVID-19 Collection: https://www.nytimes.com/spotlight/parenting-kids-coronavirus

Emotional Self-Care
Do something you like. A lot of activities are restricted right now, but not all. Maybe re-read your favorite book, have a dance party in your kitchen to your favorite song, do a puzzle, knit, take a bath, listen to music, sit on your front steps and listen to the birds, write, create art, cook, bake, play with your pet or child, color, read poetry…
 
Laugh! If you can, find something that always makes you laugh. It could be clips of your favorite late-night host or comedian on YouTube, your favorite Shakespeare comedy, your favorite video of your two-year-old imitating your partner, a comedy podcast – anything!
 
Practice self-compassion.  Try to talk to yourself as kindly as you would talk to a friend. We can often be much harder on ourselves than others.
 
Spiritual Self-Care
Practice mindfulness. Mindfulness is simply being in the moment. This is much easier said than done, and it is often so worth the practice it takes. Focusing on your breath or engaging with your senses are a couple ways to do this. There are many other ways to practice mindfulness and many mindfulness resources are making some of their content free right now (see the resources at the bottom of this blog for a few suggestions).
 
Get outside and notice nature. There are many places that you can be outside and stay 6 feet from others. If you are having difficulty accessing outdoor spaces, you can sit on your front steps or even be by an open window for 15 minutes a day.
 
Access your spirituality. This can look different for everyone but try to be in touch with your higher power or access your version of spirituality. You know your belief system best, so you know how to best do this. 

As public health officials and healthcare providers around the country and the world try to slow the spread of COVID-19, most Philadelphians, indeed most Americans, have been told to stay at home. While this is so important for public health, it can be hard on an individual’s mental health. For those who have pre-existing anxiety or depression, or a history of trauma, staying at home and interacting with the realities of this crisis can exacerbate symptoms. Self-care, while not a cure-all, can certainly decrease vulnerability to increased anxiety, depression, and trauma symptoms, as well as help us manage some of the intense emotions that are coming up for so many people right now.
 
Self-care during this time may look different than it used to. Prior to this crisis, many people would go to the gym, socialize with friends, participate in recreational sports, sing in community choirs, and other out-of-the-home activities. While we are being asked to engage in social distancing, these things may not be possible. That does not mean self-care is not possible. The rest of this blog will provide some ideas about ways to engage in self-care right now. However, remember, self-care is a personal thing and it is important to experiment to find out what works for you.
 
Physical Self-Care
Move. As much as you are able, be intentional about moving every day. This could be going for a walk or run outside (while trying your best to stay 6 feet from other walkers and runners of course!), doing an exercise video, engaging in some self-guided yoga or stretching, walking up and down your stairs, chasing your kids around the living room – anything that gets your body moving within your ability.
 
Eat healthy. Try to pay attention to what you are putting into your body. Boredom can be a trigger for many people to eat, drink alcohol, or use other substances. Experiment with noticing if you are eating or drinking in ways that are different. Try to keep healthy food in your home so that when you are hungry you have a healthy option available.
 
Sleep. If you can, try to keep a regular sleep schedule (I recognize this is difficult for folks doing shift work). Even though many people’s schedules have gone out the window being at home, as much as you can try to stick to a regular bedtime and wake up time. We sleep best when our body knows what time we are going to bed and waking up each day. In addition to keeping a regular schedule, sleep is improved by:

• Avoiding caffeine in the afternoons,
• Getting regular exercise,
• Not taking naps,
• Having a regular bedtime routine,
• Keeping your bed a sacred place for sleep and sex (not working, watching television, etc. in bed)
• Keeping the area where you sleep comfy and clean,
• Not looking at screens for at least a half hour before bed (this is a hard one for a lot of people).

If anxiety related to COVID-19 (or anything else) is keeping you awake when you do get into bed, try some deep breathing, counting, or mindfulness. If after about 20 minutes you aren’t asleep, get out of bed and go do something boring (that does not involve screens) until you feel drowsy, and then go back to bed. This is to make sure your bed does not start becoming associated with anxiety.
 
Psychological Self-Care
Limit news and social media. It is imperative to know what is going on right now and the current recommendations. At the same time, it is generally not helpful for people to spend several hours a day reading the news. Try to pick one or two places you will get your updates. There has also been a lot of misinformation being circulated on social media, so check your sources.
 
Pay attention to your thoughts and feelings. When you are able, check in with yourself – notice what you are thinking and what you are feeling. Try naming your feelings. If you are having thoughts that are leading to anxiety or depressed feelings, ask yourself:

1. Is this thought true?
2. Is this thought helpful?
3. Is this thought compassionate and kind (both toward myself and others)?

If the answer to any of the above questions is “no,” try challenging or shifting the thought.
 
Practice gratitude. Explore noticing that for which you feel grateful every day. You might even consider starting a gratitude journal – just write down three things a day for which you are grateful.  
 
Personal Self-Care
Shower and get dressed every day. It can really help your mood to get out of your pajamas, even if you are not putting on normal work clothes, or at least not normal work pants.
 
Stay connected. Friendships and connection enhance well-being. Socializing during this time is difficult. As you are able, try to keep your connections and friendships alive, even while you cannot be face-to-face. Call, video chat, write letters, play virtual boardgames, listen to the same radio station and dance to the same songs, text, send smoke signals (ok – maybe not the last one, but try to keep in touch).
 
Engage in meaningful activity every day. Many people have a lot of extra time on their hands right now (many other people have a lot less extra time on their hands). If you do have a lot of extra time, it can be easy to sink into a bog of mindlessly watching Netflix. Experiment with being intentional about doing something meaningful every day. For some people this could be their work or the parenting they are already doing. For others this could be learning something new, creating art, writing, dropping off groceries for an elderly neighbor, or volunteering to help keep non-profits running through the city of Philadelphia (https://www.phila.gov/2020-03-19-philadelphias-response-to-covid-19-how-you-can-help/ ).

As the coronavirus continues to spread across the United States and the world, many of us are left looking towards the internet for creative ways to meet some of our physical, emotional, and social needs. With the growing government restrictions and orders for social distancing, sheltering in place, and the closing of all non-life sustaining businesses, the opportunity to begin in-person therapy is likely to be extremely limited. This is, of course, occurring during a time when many of us are experiencing unprecedentedly high levels of fear, panic, anxiety and worry, isolation, loneliness, sadness, grief and loss, among other overwhelming and complicated emotional reactions.  Under more typical circumstances, I imagine many folks would be quickly trying to find a new therapist to help them process and cope during these overwhelming times.

​As it currently stands, if someone wants to begin therapy, they are left with understandable questions or  concerns about what it would mean to meet a new therapist for the first time online and to begin working with them in this manner without ever having met them in person, or wondering if this is even a realistic possibility at all. Let me start by saying that, yes, it is possible to begin a new therapy remotely or online.

The aftermath of trauma is often isolating. There may be emotional, cognitive, physical, and behavioral changes that seem confusing. For folks who experienced trauma as a young child, these impacts are at times a part of life as far back as they can remember. Sometimes it can be hard to believe that others who have not experienced these effects can truly understand what you are experiencing as a survivor. Individual therapy is hugely impactful, if not vital, to help heal from trauma. However, having an individual therapist tell you that what you are experiencing is a normal reaction to trauma feels different than hearing another person describe an experience you recognize. This is one of the reasons that group therapy can be so impactful for survivors.
 
One of the best-known writers on group therapy is Irvin Yalom. He identified 11 curative factors in group therapy. All of these factors have a deep, resounding impact on trauma healing in the group setting. However, I want to focus on just 2 in this post: instillation of hope and universality.
 
What is instillation of hope? It is the process of increasing belief that life can be better, or even good. This process is driven by watching the successes of other group members and having one’s own accomplishments recognized by the group. When you bear witness to the healing of others it can help you truly know that healing is possible.
 
Universality is the concept that you are not alone in your suffering. Being in a group with other survivors normalizes your experiences and helps people to feel less alone. When isolation is a part of your daily existence, it can be monumental to be truly seen and heard by another person with a similar experience of walking through the world. 
 
So, at what point in the healing journey does it make sense to participate in group therapy? Groups can play a role at all points in the healing journey, but different types of groups work better at different stages of healing. Acute debriefing groups give opportunities to share experiences of trauma directly after the fact and are most often offered when a community has experienced some type of disaster that impacts many of its members. Support groups are generally time-limited, help survivors cope with the impacts of trauma, and begin to establish safety. Support groups can be found at many agencies in Philadelphia, such as WOAR Philadelphia’s Center Against Sexual Violence. There are also longer-term processing groups. These groups are most helpful later in the trauma healing journey when some baseline ability to handle anxiety and stress has been established. They can provide a space for members to reconnect to the here and now, reconnect to community, further understand and change the way trauma is carried within the self, and make meaning of the traumatic experiences.
​

​Boundaries.  I feel like I talk about them with clients all day long.  I say things like, “How would it feel to try and establish or even consider establishing better boundaries?”, or “Sounds like you put up a good boundary there for yourself”.  They are so abstract and yet they aren’t.  There are actual physical boundaries in this world—the Great Wall of China, the once existing Berlin Wall, and of course the soon-to-be-built, maybe-it-won’t-be-built border wall with Mexico.  But what about personal boundaries?  How do we build these?  And most of all, how do we get the courage to build them and not see them as selfish, but rather self-helping? 
 
How many of you would say that you have a problem with boundaries?  Let me dial it back…how many of you would say that you have a “problem with saying no”?  I just posed this question to group members in the “Shattering the Mirror:  Support and Recovery for Adult Children of Narcissists​” group that I facilitate, and the answer was pretty much unanimous.  In fact more than unanimous—there was noise and emphatic head nodding when this question was asked.  In a relationship with a narcissist, the target is conditioned to learn how to not say “no”.  Saying no may mean incurring wrath, so the target learns quickly that to preserve their safety it’s best to always agree or never challenge the narcissist.  This agreement can then possibly spill over into other relationships in our lives.  Romantic relationships or even work/boss relationships can be affected.  We may work well past our eight-hour days or continue to take on project after project because we can’t say no.  Conditioned targets can also be real people-pleasers.  That might be part of why we can’t say no—we fear disappointing or losing our place as the “golden child” or “star employee”.  The narcissist has made us believe that if we ever say no, we are less than or not good enough in their eyes. 
 
Someone recently shared with me the idea that boundaries can include both a door and a window.  This idea was a game changer for me.  I feel that when we are used to interacting with narcissists, because of their behaviors of idealization and devaluation, we are so used to things being black and white that the thought of considering some grey areas is foreign to us.  JH Simon’s book, “How to Kill a Narcissist” states otherwise.  It suggests that we can:
 
“utilize the ability to say enough.  We can remain in a situation but change the terms of engagement.  We can go shopping with somebody but use some of that time to seek out our own stuff that we want.  We can speak with a person then politely end the conversation when it gets too much.  If the people in our lives love us, they will be flexible and open to negotiating each situation so that everyone is comfortable.  We have the right to change the situation to suit our internal state better.  When we do it in service of our true self, we never have to feel guilty”.  (p. 157-158). 
 
See?  Doors and windows. 
 
This takes practice.  This is hard.  Especially when we have not done much boundary setting before.  But boundaries are scorched earth to a narcissist—they cannot continue their assault if their blood-source has been cut off, if the target is refusing to play the game.  Start small with boundaries that don’t involve the narcissist yet by maybe not staying that extra hour at work, or not over-scheduling yourself during the weekend and see what that feels like.  Pretty soon you will fall in love with “saying no” and hopefully also yourself along the way.
 
Simon, J. H. (2016). How to kill a narcissist: debunking the myth of narcissism and recovering from narcissistic abuse. United States?: JH Simon.

Have you ever been in a situation where you just can’t seem to remember exactly how the events played out?  Maybe you went out to eat with your partner and you remember having the fish, but your partner insists you had the chicken?  And your partner does everything they can to convince you that you are not remembering things—what YOU ate--correctly? Sounds pretty harmless, right?  Well, not when you involve a narcissist…
 
The Oxford Dictionary defines gaslighting as a “form of psychological manipulation where a person seeks to sow seeds of doubt in a targeted individual” (Oxford Dictionary).  This is done to make that individual question their own perception, memory, and sanity in order to destabilize the target and delegitimize the target’s beliefs, using such methods as denial, contradiction, lying, and misdirection.  The term originates from the 1938 play entitled Gaslight, in which a “husband attempts to convince his wife that she is insane by manipulating small elements of their home environment, including slowly dimming the gaslights in their house while pretending nothing has changed, thus making his wife doubt her own perceptions” (Angel Street).  
 
How does a narcissist utilize this skill to their target’s detriment?  And how does this circle back to questions raised in my previous blog posts?   Remember in my first blog when I asked who you see when you look in the mirror?  Through gaslighting a narcissist is making sure that you see them—their thoughts, their perceptions, their beliefs.  The trick is the make their targets think they are not capable of functioning without the narcissist, and thus the target will rely on the narcissist to give the “correct” version of reality.  If we are “taught” that we can’t trust ourselves then we will inevitably be drawn to the person that has ensured their version of truth is the only option. 
 
Another tactic of gaslighting is known as “splitting” and one that the narcissist may use frequently.  Splitting is when you are pitted against others by the narcissist, the purpose of which is to isolate you from the important people in your life.  This can even happen in a clinical setting.  In my previous job working as a therapist in an inpatient drug and alcohol facility, I would often have a patient that would tell me one thing and then go to another therapist to tell them something completely different or only a small version of the truth.  In these instances, I would usually have to tell staff members to direct this patient back to me in order to put an end to the splitting.  When the narcissist is challenged in this way and the splitting is disrupted, this tactic can usually be stopped or at least lessened.  This type of behavioral monitoring is definitely not fun, but can be, if they are open and willing to take it in, a beneficial learning experience for the narcissist. 
 
But now back to the target.  What can we do to help ourselves when gaslighting is present?  Most importantly, make sure that you seek out your own support system: a therapist, a trusted friend or family member, a support group, etc.  Second, hold on to what you know to be the truth.  Try and stay grounded in your authentic self, and understand what it is that the narcissist is trying to do to you.  Lastly, don’t be afraid to stop and pause before reacting.  One of the best pieces of advice I heard early on in my career is that just because you were invited to the crisis does not mean that you have to go.  Not reacting is a reaction and probably not one that the narcissist is used dealing with.  Remember the shame/grandiosity continuum chart from my last blog post?  Gaslighting is a tactic to inflict shame on the target and if we don’t bite, the narcissist can’t be successful. 
 
I thought it might be interesting to research TV or movie characters who have been crafted to use a gaslighting technique.  One that was surprising to me, though I can totally see it now, was Ross Geller from Friends.  Ross lies to Rachel about still being married after their ceremony in Vegas and convinces her that they are no longer married when in fact they are; he puts ideas in her head that just because he is the father of their baby she should be with him; and of course who could forget about the whole “We were on a break!” thing?  Gaslighting at its finest. 
 
Until next time my friends (no pun intended), be like a tree and remain grounded.  And please check out posted information for our new outpatient group “Shattering the Mirror:  Support and Recovery for Adult Children of Narcissists” starting this next week. 

"Oxford Dictionary definition of 'gaslighting'". Oxford Dictionaries. Oxford University Press. Retrieved 23 September 2019.
​ 
"Angel Street". Internet Broadway Database. Retrieved 23 September 2019.

Howard Stern shares why he avoided and then embraced therapy
​A LOT of people have reservations about going to therapy.
​What really happens when you sit and talk with someone, anyway?  Does it work?  Do they just want to take your money?  It is not uncommon to have fears and reservations about starting or continuing with therapy, ESPECIALLY if you have seen a crappy therapist in the past.  If you have---I’m so sorry.  Like all professions, some of the practitioners are not as competent as others. BUT-- when you find that right person and you get that *click*, it is worth it!

​Have you been thinking about therapy for a few years?  Perhaps you want to make some changes in your life, but are unsure if therapy is the right step?  Your fears and hesitations are normal! If you have been thinking about therapy for a few years, perhaps you want to make some changes in your life but are not sure if therapy is the right step--your fears and hesitations are normal.  Many people have hesitations and reservations about going to therapy.   Here, Howard Stern shares what kept him from therapy, why he finally started it, and what he got out of it.  Hint—He’s a fan.

​​


I’ve listed TWO podcasts below. If you are generally offended by Howard Stern, I recommend his interview with Teri Gross in Fresh Air.  You are least likely to be offended listening to that one.  If you don’t find Howard Stern offensive, I recommend his interview with Conan O’Brien on the podcast Conan Needs a Friend. It is 3 hours long, but in between penis jokes, he talks about his experience in therapy.  They discuss a number of themes, including depression, but if you want to skip to where they discuss therapy, it is around the 50:00 min mark.

See the links to the podcasts below:

​Fresh Air with Teri Gross Interview with Howard:
https://www.npr.org/2019/05/18/724044452/fresh-air-weekend-howard-stern-phoebe-waller-bridge

Conan interview with Howard: 
https://www.earwolf.com/episode/howard-stern/