Trauma (PTSD) and its effects on life: a journey to recovery and emotional freedom

D., a 35-year old Australian man, lived for many years a life of self-destruction. Addicted to several substances, he wasn’t able to keep up a normal job and family life. He had a wife, but he wasn’t there for her as a husband and a father to their 2 little kids. He was busy getting hammered or getting himself into trouble and she tried to get him out of it. And trying to protect their kids from witnessing too much of the chaos he created.

He was a nice guy, you could see that he had a good heart and would like to do good things- but that was only the short moments when he was sober and regretful. The pain and shame made him forget all his promises to his wife and get wasted again.

When intoxicated ( which was most of the time), he would get himself into fights. Later on in his recovery he told me that it wasn’t about beating up the other, it was more about feeling the bodily pain. Maybe a form of self-punishment and stress-relief. Back then he himself couldn’t understand or explain his behavior.

Because the drugs were expensive, he started selling drugs. He got himself into trouble with the police and dealers because he used more than he sold. He was incarcerated 2 times.

His wife was about to get divorced, when he finally admitted himself into rehab. The detox was hard but he was disciplined and devoted to his recovery out of fear he would lose his wife and his kids. That was the only thing that kept him alive, he said.

The treatment process: Trauma as a gateway to Addiction

But it is hard if you go into recovery for somebody else and not yourself. Obviously it is often the factor that forces you to work on yourself, but family and the stress it can give, can easily be the trigger that pushes you right back into addictive behaviour if you don’t feel the inner need and strength to do it for yourself.

You could see he was struggling during the addiction-treatment. Something was holding him back to surrender fully to his recovery.

When he finally came to the psychologist, he talked about nightmares, about intense anger that pops up out of nowhere, about a deep mistrust towards everyone around him, about sudden intrusive thoughts and memories and about being always on the edge, hyper-alert and jumpy. He was diagnosed with ADHD before, but that didn’t seem to cover or explain the intense negative emotions he felt.

Talking more about the situation when he feels triggered and his nightmares, slowly on he started revealing that they all seem to be connected to real events, real memories, real situation and experiences- to a childhood with severe physical and sexual abuse by a family member.

D. has never told anyone about this before. Not even his wife who knows so much about him and his current problems and who always tried to help him out of trouble. But his past experience as a child seemed too painful, too confusing and too shameful to even admit to himself. He was terribly wounded as a child but moreover the shame and guilt pressed maybe even harder on him. As a boy being molested by a man , being overpowered and being forced to do terrible things made him feel worthless, weak and full of shame.

But he started talking about it and he started crying and he started to slowly let go of the shame and guilt when he realized that the other (the psychologist) isn’t judging him and by this there came space to process all the hidden feelings.

His self-image started to change. He became more acceptant to his emotions and he started to understand his nightmares, backflashes and intrusions- through which they became less scary.

Through EMDR ( Eye Movement Desensitization and Reprocessing, for more information see www.emdr.com ) his memories turned from scary, threatening intrusions, nightmares and flashbacks into relatively neutral and non-threatening memories, that he could accept as part of his former life.

He wasn’t afraid anymore to go to sleep, his sleep-pattern normalized and he didn’t have nightmares anymore. Also during the day he felt more relaxed and less “on edge”. He could handle social conflicts better and wouldn’t burst out anymore.

For the first time he could really think about a new future and a new, healthy life, because now the big secret was neutralized and the main reason to medicate and sedate himself with drugs was gone.

And now he felt ready to be the man he always wanted to be: the reliable husband and father his wife and kids were waiting for.

Couples-counselling as a complementary aspect in the Individual recovery 

Obviously his wife needed some time to get used to this new version of him. Husband and wife and father and kids actually had to get to know each other within this new situation.

That wasn’t always easy. Because when you gain something new, you also lose something old that you were used to. The couple got relationship-counseling because they needed support in finding new trust but also new ways of communicating and interacting. While D’s wife was so used to doing everything at home and to be “the helper and savior” , she also had to find a new role. For a while this was really hard for her. She was so used to the stress and chaos of the past, that it was difficult to deal with the new stability. Maybe it was also a lot of old stress that came up in her since now she didn’t have to fight for him anymore. There are often patterns of codependency between a (former) addict and his/ her partner. Old patterns that formed their relationship but are in fact unhealthy for both partners. (For more information check out: www.coda.org )

After feeling depressed for a while – which came as a huge surprise to D since he expected her to be overly joyful with his amazing recovery- D’s wife realized that it was also unhealthy behavior patterns that kept her so long in a destructive relationship during the active addiction and maybe she even facilitated and enabled a lot of his old behavior unconsciously.

D’s wife had all of a sudden more time to give attention to herself and her own needs. For a while they split up in order to work on themselves and on their relationship. By seeing the couple-counselor weekly, they could work out good agreements on how to co-raise the kids. And through this process of learning to communicate, they worked on creating a strong base for a new relationship based on reciprocity and honesty.

D and his wife are living together again. Sometimes it is challenging and both have to be careful with their own triggers. Once every 2 months they check in with their couple-counselor and D is still seeing his psychologist once a month. But they both are still feeling stronger and more connected to each other than ever. The pain they went through in therapy was definitely worth the newly gained freedom and strength.

Autism and its effect on a young boy and his family: from diagnosis to stabilization

The boy who barks 

A young couple asked for advice about their 6 year old son. The mother sounded desperate on the phone, saying she really can’t handle the situation anymore.

In the waiting room the psychologist saw a tired and exhausting looking couple, but the son was nowhere to be seen. Until there was noise coming from under a chair: the 5 year old boy was sitting under the chair and barking towards the psychologist. When the psychologist greeted him, he made biting gestures into her direction, so she redirected her attention to the parents.

Under tears the mother told how her son was always a bit difficult and that throughout the years the parents encountered many problems in regards to his upbringing. In every developmental area he seemed to be more slow than others even though the parents didn’t have a lot of comparison because he was the only child and he never went to kindergarten. But to raise him was difficult for the parents. While the father was often away due to his work, the mother was alone with the child. From a young age on there were troubles regarding eating, sleeping, playing, talking etc. What was actually the worst for the mother is that she felt like she didn’t understand why her child would get upset all of a sudden and that it seems impossible to comfort him when he was upset. Throughout the years she found different ways that seem to work for him in regards to eating, sleeping and playing and the essential hygiene practices. But it all seemed very complicated because there were only a few things that he would eat and very few things and activities he liked. But once he liked something he wouldn’t want to stop. And he would cry and scream if – after hours of doing the same little routine- his mother would try to stop him in order to let him eat. Also changes to his routines would trigger escalations. He seemed to be the happiest when everyday went exactly like the day before. The same meals, the same activities and the same people- and this means: only his mom was allowed to be around him in the house. His father, who was working and staying in another city during the week, was not allowed back into the house on the weekends. His tantrums were so extreme that the father decided to sleep in the garden shed.

The parents were clearly afraid of their own son and -while he was a sweet looking young boy- his aggressive outbursts were quite extreme. According to his parents he was very quiet and shy most of the time, but if things happened that he didn’t like he would react with extreme behavior. And this behavior got more extreme over the years.

From Diagnostics to Treatment

Obviously this case needed a multidisciplinary team to look at the situation from different angles. The situation was judged as urgent since the parents seemed very overwhelmed and the behavior of the boy quite extreme.

The psychologist and the psychiatrist had to assess the condition of the boy first, which seemed difficult in the beginning. But after visiting the counseling center a few times, the boy got used to the psychologist who paid attention to using a certain structure in their activities every time they met and who explained and announced everything that would happen in order to make the boy feel safe.

The diagnostic assessment showed that his general cognitive abilities were about average (normal IQ) but his social-emotional skills, his executive skills (implementing his knowledge into practical actions) and the way he processed information were underdeveloped and his reaction to sensory stimulation was untypical. He was extremely sensitive to noises, lights, smells, tastes etc.

Further testing led to the diagnostic classification of MCDD (Multiple Complex Developmental Disorder), which is a form of Autism that can develop into a schizophrenic disorder.

(For more information on MCDD as a subgroup of Autism Spectrum Disorders see: www.researchgate.net or www.sciencedirect.com )

As frightening as it first sounded to the parents, this actually gave the team a clear direction on how to help the boy to cope better with his surroundings and how to help the parents to interact and support their son better.

The psychologist explained the special needs of a person with an Autism Spectrum Disorder to the parents (psycho-education) and explained them how to provide the safety and structure that the boy needs at home – but also healthy and clear boundaries so that the life of the parents would be less affected by the boy’s tantrums.

Rehabilitation at home: how to live together in a way that fits all family members 

First of all the psychologist created together with the parents a daily schedule that would provide a safe structure and predictability for the boy, but would also leave enough space for changes.

This schedule got worked out on a paperboard, together with different pictures of activities that the boy and the parents could choose from.

A parenting coach then introduced this schedule at the boys home and taught the parents and the boy how to work with it.

Besides making life more predictable, it was also essential how the parents communicated with the boy. Short, clear messages. Concrete information. Explain what you say. Predict what you are going to do. Give enough time to prepare before the changing of an activity..

Also, it was important to let the parents understand which triggers and stimulation he would react more extremely out of hypersensitivity to external stimulation and how to prevent overstimulation.

Like taking a shower, eating, sleeping, going outside- it all needed special attention in order to break through the very rigid patterns that the boy exposed.

The longer the parents- supported by the psychologist and the coach-  were working with the new system, the more they could introduce in order to extend normal behavior, activities and interests.

It showed clearly that the boy benefitted from the new system and he looked so much more at ease. Being more relaxed, he was also able to interact more with other people. He started to enjoy the playing therapy with the psychologist and exposed creativity and fantasy.

Social Rehabilitation: How to play together with other kids 

After a while the psychologist tried out to let the boy join in a small play therapy-group with 2 other kids with Autism. The boy adjusted surprisingly easily and enjoyed the weekly guided interaction with the other kids. After one of the play-sessions, when his mother came to pick him up, he all of a sudden went to the psychologist and hugged her. Both the mother and the psychologist were very surprised because normally he wouldn’t like hugging and touching and he doesn’t often express feelings towards other people. But it was as if he would express his gratitude. Even though maybe it was just the texture of the Psychologist’s trouser or the smell of her hair, that the boy felt comfortable with.

The final step: Going to school

Soon it was time for the boy to attend school- an event that the parents feared for because one year ago they thought he would never be able to go to any school.

But the psychologist found a school for special needs- kids that was accustomed to adjust to children with an Autism Spectrum Disorder. While the psychologist worked together with the special-needs-teacher to implement a suitable program for the boy, the coach accompanied the boy to school to get him adjusted to the new surroundings. The classes were very small and kids could work individually on tasks without a lot of distracting stimulation. While the first weeks were difficult for him and he had to go to the time-out room many times due to being overwhelmed, the boy felt more safe after 1 month and proved to be a good student.

After another month, the situation seemed stable at school and at home. So the Psychologist came to say Goodbye to the boy and his mother at his school. The boy had prepared a drawing for the psychologist as a gift and the mother said with tears in her eyes: Thank you for giving us our son and our life back.

Even though that the boy will probably need lifelong support in order to manage the future developmental tasks like going to high school, maybe studying, living on his own- he has a much better life now because the people who are close to him understand him now. They are not afraid of him anymore but they see his good nature and can care for him. And he can interact with them without being afraid.

For more information on Autism Spectrum Disorder in Children : www.helpguide.org , www.cdc.gov  , www.kidshealth.org , www.nimh.nih.gov , www.childmind.org

Coming Soon

Coming Soon

Autism at the workplace

The Autism Spectrum Disorder: What do we know?

Autism gets more and more mainstream attention , people understand more about it and the stigma of “Rain man” ( American Comedy Drama about a guy and his Autistic brother, 1988) is getting corrected towards a more realistic idea about a person with Autism.

According to the CDC, in 2020 there are approximately 1 out of 54 children in the US diagnosed with an Autism Spectrum Disorder (for more information see:  https://www.autismspeaks.org/autism-statistics ).

And these are only the diagnosed cases- a lot of people with  so called “ High-functioning Autism” stay undiagnosed. These are the ones who can seemingly adapt to society and appear to function like the average person. Often they even excel at special tasks and have very specific talents in which they outshine the average – neurotypical- person. In certain area’s people with Autism seem to be specifically talented and are represented in high numbers like research and development and most commonly in the IT- sector.

Autism and the IT sector 

Eindhoven in The Netherlands is a city also called “The Silicon Valley of The Netherlands” due to its high number of IT businesses. Because it offers a lot of jobs in Information Technology, there is a higher than average number of people with Autism living and working in Eindhoven. (For more information on this topic and research see: https://www.livescience.com/14719-autism-information-technology-region.html ).

Many people with an Autism Spectrum Disorder exhibit strong skills in analyzing systems, creating new ones and finding faults on detail-level. This is a strong asset in IT-related fields, including engineering, physics, computing and mathematics.

On the other hand, they tend to be less skilled in the social, emotional and practical area of work. And even if you are good at WHAT you do, it is still important HOW you do it.

Communicative problems can lead to conflicts at the workplace, hypersensitivity to external stimulation can lead to being easily overwhelmed and exhausted and an inability to stop your activities can lead to a burn-out- syndrome.

How can a Psychologist help?

One of those IT-companies realized that they could benefit from psychological advice when one of their best employees was diagnosed with an Autism Spectrum Disorder after he experienced a major Burn-out Syndrome and was mentally and physically sick for many months.

They asked the Psychologist not only to help this specific employee with reintegrating into the job, but also to help the company to adjust their work environment to the needs of their suspected high number  of employees with an Autism Spectrum Disorder.

During a 3 months project, not only the physical environment was adjusted in order to provide a more clear, quieter and stimulus-reduced work- environment, but also the day structure and the communication between management and employees got supported and revised in order to create an Autism-friendly workspace.

In the end not only were the employees happy because they could focus stress-free on their work, but also the management saw major improvement since the all-over sick-leave got reduced but also productivity and efficiency increased significantly.

What is Burn-out Syndrome?

Burn-out as a work-related disease is on the rise. Not only in the Western world but increasingly in Asian countries as well.

But only a few years ago it was finally acknowledged as a real medical condition in the DSM 5 ( The handbook of Psychiatric symptoms).

Burn-out is defined in ICD-11 as follows: (ICD-11 is the handbook of medical conditions that is used primarily by physicians)

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

• feelings of energy depletion or exhaustion;
• increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
• reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

But this is actually only the finale state- and the energy depletion is not only mentally but also physically. A lot of people who suffer from Burn-out Syndrome experience severe physical problems besides the psychological aspects of this disorder.

The stages of  Burn-Out

As with any illness, symptoms of burnout change from person to person, however these five stages are commonly observed:

1: HONEY MOON PHASE:

High job satisfaction, energy, creativity and commitment to the job. The key issue is how you cope with the inevitable stress that comes with any job.

2: ONSET OF STRESS:

Stress kicks in, job dissatisfaction starts, concentration and efficiancy is decreasing but your head keeps busy at night what keeps you from sleeping. You might develop a general fatigue.

At work escapist activities are increasing (smoking, zoning out, etc..)

 3: CHRONIC STRESS:

Chronic exhaustion; physical illness (remember that stress is a risk factor in many diseases); anger, depression

4:BURNOUT:

Physical symptoms intensify and/or increase in number; obsessing about work frustrations; pessimism and self-doubt dominate thinking; you develop an “escapist mentality”

5: HABITUAL BURN-OUT:

The symtoms of burnout are so embedded in your life that you are more likely to be labeled as having some significant physical or emotional problem than you are to be called a burnout case.

For more information about the stages and research regarding these: https://www.winona.edu/stress/bntstages.htm

Is it only the work that cause a Burn-Out?

Burnout often stems from your job. But anyone who feels overworked and undervalued is at risk for burnout, from the hardworking office worker who hasn’t had a vacation in years, to the frazzled stay-at-home mom tending to kids, housework, and an aging parent.

But burnout is not caused solely by stressful work or too many responsibilities. Other factors contribute to burnout, including your lifestyle and personality traits. In fact, what you do in your downtime and how you look at the world can play just as big of a role in causing overwhelming stress as work or home demands.

Treatment for Burn-out

The form of treatment depends on the stage of Burn-out the client is in.

One of our clients was admitted for outpatient treatment on request of his employer because of anger problems at work. What looked like a form of depression in the beginning, clearly showed to be the 3d stage of a Burn-Out development , because it was overly work-related. Because the burn-out wasn’t fully developed, it was advised that the client would keep on going to work, but he had to make major changes in his style of working. Even though he worked a lot- he didn’t seem to work efficiently and moreover, he himself assumed that he never did good enough because in spite of his efforts, he could never witness any concrete result of his personal work. And this wasn’t about money or salary benefits- he just felt this way because he never got the feedback he needed. So he seemed to have developed unrealistic expectations. Part of this was influenced by the way management reported to the employees. They only gave general feedback of the company’s gains and for quite some time now they talked about decreasing numbers.

Fortunately the boss of this client was very willing to support his employee, so one day they came together to the counselling session. Backed-up by the psychologist, the client finally asked his boss about realistic feedback and could tell him all the things that bothered him at work. It was a very constructive talk, in which not only the client learned important information but also his boss gained more insights about how his employees experienced working at the company.

Following this session, the boss of the company asked for consultancy from the psychologist  about how to communicate better with his employees and implemented several burn-out-prevention- strategies suggested by the psychologist.

The client had 10 more sessions that were devoted to healthy self-care not only at work but also in regards to his private life in order to stay physically and mentally healthy in the future. Because in order to prevent a Burn-out at work, it is important to also have a healthy personal life.

Rehabilitation from a severe Burn-out

Some of our clients were not as lucky as the previous one and realized their problem when it already developed into a severe problem due to years of neglect.

A female Social Worker was admitted to outpatient treatment after months of medical tests and treatment didn’t present any concrete results and the doctors suggested a psycho-somatic problem. For more than 1.5 years she had chronic pain, severe migraines and significant gastric problems that caused her to lose 15 kg. She wasn’t able to work any longer and even needed help at home in order to cope with her daily tasks.

This made her feel extremely depressed as she was used to being the one that helps others and being useful was very important to her.

Due to the depression and physical exhaustion her cognitive abilities had even declined: she had severe problems to concentrate and her memory was very weak.

In this stage it would be too early to confront somebody with their personal features, that contributed to this state. She was even afraid of having a progressive neurological disease and her stress-level was chronically high.

So it was very important to first stabilize her and regain some basic physical energy. In order to achieve this, our life coach offered intensive support at home so she could regain basic physical stability. While the psychologist wrote a treatment regime for this client in the form of a week/ day program, the lifecoach supported her in exercising the daily tasks and reminding her of not setting her goals too high but to focus on these basic physical needs of healthy food, a healthy day structure and regular sleep besides physical exercise.

As simple as it sounds, for a highly driven and mind-strong woman, this was extremely difficult and she exposed the tendency of falling back into passive worrying.

But the lifecoach always stimulated her to stay active and concentrate on the basic daily tasks. After one month her physical condition got slowly on better but she kept on worrying and being tense and anxious. That is when the psychologist and lifecoach implemented mindfulness-exercises to help her calm her mind.

Due to the newly developed discipline that was enforced by the lifecoach, her cognitive abilities improved. She could concentrate better, ruminate less and her memory improved.

That was when the Psychologist could start the counselling sessions. At the beginning the client showed a lot of self-doubt, disappointment and anger towards herself. Slowly this turned into grief and later on into a series of self-discovering events when she started to understand which personality traits lead her into overworking herself and how they were connected to her past.

By understanding which self-owned expectations lead her to the burn-out, she slowly let go of unrealistic ideas and expectations that she had towards herself and started to understand what she actually really needs and wants. She started creating a more realistic self-image and began to take better care of her real needs. While she first focussed on her social and leisure activities only later on she started re-orientating on her personal and occupational interests. And she decided to take a course in creative therapy, which actually fit better to her wish to contribute to clients in a positive way.

After 9 months she started an internship as a Creative Therapist and 3 years later she is still working at that facility.

She has a very different life now. She still cares for others and wants to help them, but now she can take care of herself first and is more satisfied with her personal and occupational life than ever before.

Prevention of Burn-out

All the above cases could probably have been avoided with the right care at the right time.

But how can you do that?

At the workplace prevention of Burn-out can be implemented on 3 different levels:

The individual, the team and the manager and the organization.

On an individual level you can ask yourself the following questions:

Do I like my job and do I want to pursue this career? Is my workload realistic and are my tasks well organized? Do I ask for help, feedback and support if needed? Do I put down clear boundaries and do I handle a good balance between work and private life? Do I have a healthy and relaxing private life? Can I manage stress in general and do I relax enough?

If not, this could be an important starting point to start developing your skills. Depending on the topic and your own resources you can talk about this with your manager or a jobcoach.

On a team and management level it is important to make sure that you are working within a functional team with a clear structure, clear goals and job expectations. Is the workload realistic? Are procedures, responsibilities and tasks clear to everyone?

Having regular talks (besides team meetings and performance evaluations)  helps a manager to stay in tune with all team members and to make sure that the mutual expectations and needs are clearly expressed. Make sure that these talks can be honest and open without any repercussions.

The manager has a key role in creating a healthy and positive work environment. Besides motivating performance and efficiency it is also important to stimulate positive self-care like taking breaks, eating healthy and going home on time.

As an organization there is a lot you can do to prevent burn-out among your employees. Every company wants to have happy and healthy workers because that benefits the productivity and the allover success of the business.

Many aspects contribute to a healthy work environment.

It starts with a compatible physical work environment, where lighting, seating, noise control etc fit the standards of stress-free working.

Obviously it is also important that the organizational structure, roles, tasks and goal-setting meets the expectations and needs of an efficient work-flow.

Roles and tasks have to be useful, helpful and realistic as well as team meetings and gatherings which need to be useful and well-balanced in order to serve their goals.

But most important are the communication style and the work-culture, that your company tries to promote.

Don’t only stimulate work- performance and goal-archievement but promote a healthy work- leisure balance as well.

Employees with a stable and healthy personal life are in the end more productive than the ones who burn themselves out for the company.

Encourage relax-time by emphasizing the importance of breaks, after-work life, weekends and holidays.

Expand wellness programs and benefits. Stimulate physical health and mental health programs, make mental health a topic people dare to talk about and take it serious.

Be cooperative in flexible work-options and family-friendly work solutions so employees don’t have to juggle constantly with the different and often clashing demands of work and home life.

High – stress functions could be supported with stress-management and coping trainings.

Regular fitness and cycling to work are options that should be encouraged.

Last but not least create a culture of recognition. This can be done with the little things like saying “ Thank you” or mentioning individual efforts during meetings. People who feel recognized tend to invest more at work. Positive recognition leads to a higher motivation, better performance and less turnover.

Only a healthy organization can create sustainable success