PTSD

An In-Depth Conversation with Elizabeth Vermilyea

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   If you've worked in the field of trauma and dissociation for any amount of time, the name Elizabeth Vermilyea will likely be very familiar to you. For survivors new to their healing, you may not know her by name, but you've most certainly been using her tools and symptom management skills! In part due to her own humility and unassuming disposition, it's quite possible to be unaware of the impact of Elizabeth's work, despite having benefitted from it for years and years. If learning the detailed process of containment, modulation, healing pool/healing light imagery, or the more welcoming takes on internal communication, sounds familiar to you -- you have her to thank for that!

   Elizabeth's workbook, "Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress" truly revolutionized the way that trauma survivors could not only learn about their conditions, but explore a variety of tools to alleviate their suffering at the same time. An unintimidating and easy to understand look at complex trauma, it allowed survivors to really work at their own pace. Clinicians were also given a new language with which to explain coping skills to their clients, and most importantly, a chance to work on them together.  Elizabeth's message of educating with compassion and warmth, and always including survivors in the process, has remained steadfast throughout the years and is a lasting legacy on the community. Through her continued work in the field, she keeps the momentum of trauma education and care headed in the right direction -- always focused but empathic.

    It is our absolute honor and privilege to bring to you an in-depth interview with someone we admire and value so deeply. You'll get a chance to learn more about Elizabeth's personal journey, her experience weeding through the at-times tepid and contentious world of trauma, and also explore the past, present and future of trauma care! We sincerely hope you enjoy!


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Let’s start with some background for those who are being introduced to you for the first time.

・Where are you from/currently residing? Where did you attend school and what did you earn your degree in?
How long have you been practicing and in what capacity do you currently work with trauma survivors?

     I was born in Raleigh, NC, and I currently live in Napa, CA. I don’t like to focus on schools and degrees because I don’t think they tell us anything about who someone is. Suffice it to say, I’ve spent a great deal of time on my education, but I really learned the most from the people I’ve worked with over the years both as clients and colleagues. Currently I do not treat survivors, but I do train and consult with professionals and survivors alike. My consultation with survivors focuses on managing traumatic stress symptoms.

 

・What made you interested in pursuing trauma disorders? Did you always know you wanted to focus here, or was it something that found you?

     I like to say that I tripped and fell into this work, and then fell in love with it. I had intended to become an experimental psychologist. My first job out of college was at the Masters & Johnson Sexual Trauma program at River Oaks in Louisiana, and I got that job after sending out resumes everywhere I could. They were the ones who called back! It didn’t take long for me to realize that I wanted to make a career in the trauma field.

 

・When did you come to understand the full impact of complex childhood trauma vs. trauma as an adult? What was your introduction to dissociative disorders like?

     My work at River Oaks was my introduction to all of this. I remember going home one night in tears after having heard some horrific stories of abuse at the hands of a man’s parents. I found my mom and said, “Thank you for not abusing your power over me.” I realized how much that relationship means, how it can be twisted, how it can torment a child. Most of the clients in that program were diagnosed with a dissociative disorder, so I learned a great deal there. The program took a relational approach to the work, and I appreciated that. It wasn’t so hierarchical or tied to the strict medical model.

 

You began your work in this field over 25 years ago — a time where dissociative disorders were even more heavily stigmatized, disbelieved and could even be used to question the integrity of the very clinicians who supported their existence.

・What would you say the climate was like when you were first starting out? Did you face any particular challenges — clinically, interpersonally or even within yourself? 

     I started this work at the beginnings of what would become known as the recovered memory debate era, but I didn’t encounter much of that controversy until I moved to Baltimore and began working at Sheppard Pratt in their Trauma Disorders Program. Across town was Johns Hopkins and Paul McHugh who staunchly denied that recovered memories could be valid and that dissociation was real. The climate among those of us at Sheppard Pratt was one of dedication to the cause and to believing people. When I was starting out, the challenges I faced were related to understanding that horrible things are done to people, but that doesn’t mean the world is horrible. Holding those truths together is an important part of the work for all of us. More challenges came later when I began to chafe against the medical model and hierarchy in the treatment arena, and especially the “once a patient always a patient” mentality.

 

・When did you decide you wanted to write a book? And not just an informational or educational book but specifically a workbook for survivors?

     For several years I ran a PTSD Symptom Management group at Sheppard Pratt. I used to create worksheets because there weren’t any around that met the needs of the clients and my needs as a helper. Over time, I had a rather large portfolio of these worksheets. My colleagues and the clients started telling me I should write a book. So I began.

 

・Were there any unique obstacles to getting it published? Did you ever have any reluctance or hesitation, particularly given the atmosphere back then?

     Getting the book published was an incredibly serendipitous series of events. I was meeting with Esther Giller, the President and CEO of Sidran Institute, a publication company specializing in traumatic stress education and advocacy. Let me see if I can remember it the right way. She was looking for someone to come on board as a trainer for a Federal Grant project she was involved in. At the same time, she was looking for someone to produce a self-help symptom management book for a project being underwritten by the States of Maine and New York who were embarking on a massive training effort in their public mental health systems. This is a long story, but a good one.
     Survivors in the State of Maine had sued the state saying not only was the mental health treatment they received not helpful, but worse, it was hurtful. So the State handed down a consent decree that all state mental health personnel be trained in what is now called Trauma-Informed Care. This was the beginning! Esther had located professionals to create the material for training personnel (the good folks at TSI CAAP – Karen Saakvitne, Laurie Ann Pearlman, Beth Tabor-Lev, and Sarah Gamble – who wrote the Risking Connection Curriculum), and they also wanted material for the clients. That’s where I came in. I left Sheppard Pratt to take the training job at Sidran, and Sidran published the book, which was then distributed to survivors in the Maine and New York public health systems for free. I’m really proud of that.

 

Your workbook, whether you know it or not, truly revolutionized trauma care on the patient level. Worksheets were printed out on trauma units, weekly inpatient groups were held to teach your skills, your techniques and scripts became the go-to standard for coping with specific symptoms, and survivors in countries across the globe use your tools by name (sometimes not even knowing where they came from or having read your book)!

・Did you ever anticipate that your work would have such a profound impact or global reach, let alone become the foundational launchpad for which survivors worldwide would begin their trauma healing? 

     I am humbled beyond words by what you’re saying. I can tell you when I did the second edition I felt really good that there was still an interest in the book and that it was still useful thirteen years after the original publication. It’s mind boggling to think it has the impact you describe. I guess I have to take your word for it! I really felt I had arrived on the day a friend told me her book had been stolen! I replaced it for her, but for someone to steal it… it must be valuable!

 

・What has it meant to you seeing your work, and not just your book but your advocacy and education in all forms, fill such a massive void in the trauma community?

How does it feel knowing most has stood the test of time?

     Like most people dedicated to this work, I feel good about being able to educate, support, help, advocate, and hopefully change for the better the process of healing for trauma survivors. I know that every professional I am able to help will spread that exponentially outward, and that’s why I do it. I think it has stood the test of time because the material I focus on is universal and not subject to treatment trends. I want to offer something that can help everyone every time.

 

・What would you say is the biggest change you’ve noticed in the field of trauma since beginning your studies (ex. education, the approach to care, general attitudes toward trauma/dissociative disorders, etc)?

     The biggest change I’ve seen is the mainstreaming of trauma-informed care. There used to be a handful of treatment centers providing good treatment, and now, thanks to the Adverse Childhood Experiences (A.C.E.) study, there’s a deeper understanding of trauma as a public health issue. Even Oprah has got on board recently! I’ll be working with the Oregon Commission for the Blind next month because they want to better serve traumatized persons in their vocational rehabilitation programs. That’s huge! If you Google “Trauma Certificate Programs” you can find them all over the country. That’s amazing!

 

・What areas do you feel still need significant improvement? Is there anything you feel is almost missing entirely? What changes would you like to see be made in those areas?

     We need to improve the awareness, understanding, and addressing of the intersections of trauma with addiction and the criminal justice system. These intersections are at the heart of recidivism in both arenas. We have to keep showing agencies and organizations what’s in it for them and how trauma-informed practice can support and enhance their existing work. Essentially, we have to sell it.

 

・Do you have any colleagues or mentors that you really look up to or admire?

     Oh gosh, too many to name. I can tell you one person who had tremendous influence on me professionally. Her name was Andrea Karfgin, and she was a psychologist. She died several years ago, but she lives on in me. She taught me how to think about this work, how to understand really important dynamics in the work, and she guided me through tough lessons as a professional. I hesitate to mention other names for fear I’d forget someone. I worked with a number of survivors who were brave and trusting enough to let me into their inner worlds and allow me to walk with them into the wider world with more confidence, faith in themselves, and stronger boundaries toward life beyond survival. I’ve had many colleagues who were instrumental in shaping my professional development. I’ve had the privilege to work with some of the most respected people in the field and to have worked with the amazingly skillful lesser-known warriors for survivors. What I love is that I keep meeting people in the field who continue to inspire me and who keep me on track. I am so grateful that I get to do this work.

 

・What keeps you going after sitting face-to-face with some of the darkest, heaviest tragedies this world has had to know? What keeps you focused, rejuvenated or inspired?

     In the beginning I wrote a lot of songs to process what I was seeing, feeling, and understanding. I would play music for the clients in the evenings, sometimes songs about them and their struggles and strengths. That helped a lot. I keep a guitar in my office in case any of my staff need to sing the blues. Laughter is important and has always been a way for me to rejuvenate. We have to be able to laugh in the midst of awareness of such pain. I’m fortunate that people put up with my goofy humor. What helps most though is that with every workshop I do, I encounter people who believe, who want to help, and who are eager to learn how to be more effective in the work. It gives me such hope!

 

・·Do you have any advice to new, or even veteran, clinicians who are seeking to work with trauma patients?

     Do your own work. Get a good clinical supervisor. Make friends with countertransference. It will help you through so many confusing moments, and being able to notice it, understand it and use it to strengthen the relationship will be helpful and a huge protection when facing ethical dilemmas. Cultivate a good support system. Pay attention to and address signs of vicarious trauma, compassion fatigue and secondary traumatic stress. TAKE VACATIONS!

 

・What is the biggest thing you’ve learned from your patients, or other survivors, over the years? What have they taught you that books could not?

     I’ve learned that I can never give up on a person, never write them off, because people are more resilient that we imagine, and we never know when the moment of hope will come - the moment of immersive transformation that gives someone a reason and the will to continue. I’ve learned to trust people’s judgment about themselves. I’ve learned to be kinder. 

 

・If there was one thing you wish the world could understand about trauma survivors, or the clinicians that help them, what would it be?

   There is no “them.” There is only us.


 

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     Thank you, Elizabeth for your sincerity, your thoughtfulness, and your humble dedication to survivors everywhere.

    You can find more information about Elizabeth here on her website. You can also order the "Growing Beyond Survival" workbook here (or here). [Note: While the blue cover edition is still available on Amazon, the Second Edition (green cover) is the most up-to-date and has the most current perspective on trauma, so we of course recommend that one. The first is also no longer in print, but Amazon has held onto some copies.]  We cannot recommend this workbook highly enough. It has been the first recommendation on our Resource page, since the day it was made, for a reason!
 

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Flashbacks 101: 4 Tools to Cope with Flashbacks
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

 

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Did You Know?: C-PTSD and DID Edition

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    No matter the topic, misinformation and lack of understanding is everywhere.  When errors are made or false ideas get perpetuated, they tend to go unchecked and unchallenged usually because most of us just plainly don't know enough to even realize it needed to be corrected or looked into.  And, this is completely understandable, right?  We can't be expected to be informed on nearly every subject and struggle of humanity.  We can try our best, but there will always be things we are still woefully ignorant on.  Access to education, reliable resources, and just knowing where to even look for more information on any given topic is so hard.  We're left to take our cues from those claiming to be knowledgable, go along with the basic understanding held by the general public and our loved ones, and/or just let it be and invest our attention elsewhere.  When it comes to mental health, no doubt, all of these issues collide head on - multiple times over.  We unconsciously acquire so much misinformation about psychological disorders by the time we're only kids - and just by casually picking things up in conversations, media, and comedy, we also tend to adopt some heftily stigmatizing ideas as well.  And, if this is true even for those expressing no real interest in mental health, imagine the damage when people who do try to learn from the professionals are met with uninformed practitioners or those grossly misleading the public, their colleagues, and even their patients.  This is how Complex PTSD, and most especially Dissociative Identity Disorder, have been treated for decades.  We would like to start changing that.

   Little by little, bit by bit, we want to undo some of that damage and raise more accurate awareness for both C-PTSD and DID.  You can read more about the conditions themselves here (individual DID page coming soon!), but we also think it important to touch on what survivors with these disorders are currently going through just to obtain treatment.  After all, they wouldn't be struggling to get care so badly if those in the field had more of a vested interest in them - becoming at the very least trauma-informed, or better-equipped themselves to treat a client with complex trauma.  This will be an ongoing series no doubt - with many myths to debunk and important notes to impress!  So, to start chipping away at that iceberg, here are 8 things we should all know about Complex PTSD and Dissociative Disorders, and the survivors who have them.  

 

  With as vast as the United States is, this is supremely disappointing.  You can find the current list of those facilities here on our website.  Even within those 9, many keep relocating or downsizing, some have a very small number of beds or are restricted to only certain age groups, others have had all their additional programs (like PHP/IOP) cut entirely or are so underfunded they don't run smoothly.  Overall, the standard of care for trauma patients nationwide is very low.
   Finding a trauma-informed unit at all is pretty scarce, but the greater drawback is that many who claim to be able to take Complex PTSD or DID patients offer them no therapeutic tools or classes designed to address their unique needs and have them intermingled with the rest of the mental health population. This might not sound like an issue, but due to the nature of a trauma patient in crisis and their high susceptibility for flashbacks, panic attacks, switching, and self-harm, being surrounded by unpredictable and sometimes volatile patients is unreasonable and unsafe.  Staff also need to be heavily trained in what is an acceptable and safe way to engage with a severely traumatized patient - particularly if they are in flashback, a dissociated self-state, or critically unsafe.  Units remain safest (from perpetrators and potential flight-risks) when they are locked, but an understanding that this can be also be extremely distressing for other patients is something staff need to be able to empathize with and negotiate.  In short, the nuance of care required for complex trauma patients is unlike that of any other mental health condition.  And yet we have less than 10 places we can safely send individuals, and many of those 10 even have their shortcomings.  A couple even continue to produce more negative reviews than positive, and some of the leading facilities have proven time and again they are fantastic with some patients but are not equipped to handle ritual abuse patients.  Greater education, as well as funding to produce more units in existing psychiatric hospitals is a MUST.

  As a side note, there are a handful of residential facilities cropping up in various places throughout the U.S.  Residential treatment centers, while valuable and a potentially great resource (especially when there's nowhere else to turn), are typically not equipped to handle clients who need stabilization or are struggling with safety.  They are also more unregulated, therapy modalities can be harder to discern, units are not locked, insurance rarely participates, and they tend to be extremely small in bed-availability.  While they are often very beautiful and relaxed, and nothing like an inpatient setting - they can be extremely expensive, with limited staffing, and tough to guarantee quality of treatment.  And again, while they may be able to facilitate a chronically traumatized patient through a rough patch in their healing, they are often not trained or equipped to aid in crisis stabilization, and are usually far from a hospital should the need arise.

   As it turns out, averages can be tough.  Research in this field is still limited, and even where it exists, trauma patients aren't typically the most eager to participate in a study.  However, despite research on treatment length being slightly dated, and the fact we are getting more practitioners better-able to facilitate a patient through their recovery, as well as those who can at least make an informed diagnosis more quickly -- we are still grossly behind.  So, while some may want to argue this estimate is too high based only on what they see in their well-trained offices, others who have patients working well into their 15-20th year of therapy would argue it's still much too low. Regardless of the exact specificity, this is a very reasonable estimate at the moment, and is witnessed to be valid by many, many clinicians, patients, and communities of survivors fighting this battle. Now, this does not always mean 10 years of consecutive therapy - though it absolutely can and does for many.  It's quite common for patients to have to stop and re-start therapy multiple times - for myriad reasons.  Finances, inadequate treatment, personal unreadiness, a geographic move, unavailability of clinicians, and/or feeling stable at one point but needing to return as more things surface later - these are all very common factors for a more drawn out therapeutic journey.

   Ultimately, treatment of complex trauma takes a very, very long time in even the best of circumstances.  It can be extremely daunting and feel outrageously unfair to the survivor.  The average of several misdiagnoses before arriving at a proper one alone, then coupled with misguided therapy, not only adds more years to the recovery but also risks turning clients away from therapy altogether.  It's even been a traumatic experience for far too many.  We need compassion and understanding for these survivors.  To support them through this long process, no matter how many years it may take or how many times they need to stop and try again. Recovery from trauma is scary.  They need our love and support, not added obstacles.

   As mentioned earlier, inpatient care for complex trauma is extremely scarce.  It requires a specialized unit and, for many, that will be out-of-state.  Insurances rarely cover beyond their state's borders and non-participating provider agreements can be very tough to come by - let alone something we should ever expect a survivor to have to fight for themselves while in a terrible, terrible place.  Because of this, many of them have to pay tens- to even hundreds-of-thousands of dollars out of pocket for care.  Many facilities will not let you pay once you get in and settled and can think clearly.  They often require a sizable sum up-front, before you even enter the unit.  And, again, coming up with thousands and thousands of dollars that most don't have to begin with, particularly while in crisis, is a feat many just cannot accomplish.  Needless to say, most go without.

    How many people in the world do you know with red hair?  There are at least that many people with DID in the world - though, more than likely a lot more than that.  Due to fear, stigma, high rates of suicide, misdiagnoses, lack of public education, and countless other reasons, most who have DID aren't even accounted for yet.  But, the bottom line is that this is NOT a rare disorder.  It's only rarely talked about.  And, when it is, it's very rarely talked about in a positive, empathic light.  Most refuse to confront the reality of its prevalence rate, because to do that would mean having to confront causality.  And, what causes DID?  It's most always man's inhumanity to one another and the cruel callousness of the world.  No one wants to acknowledge that or accept how rampant it is, so they sweep the survivors of such under the rug (while others go so far as to actively paint them as dangerous or truly insane, especially in media).  DID is not rare.  It's not a one-in-a-million case you'll never see.  It is everywhere.  And those suffering with it just want someone to help them after years and years of abuse, pain and neglect.

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   This is another fact that is just so very sad.  Complex trauma and dissociative disorders are hard enough on their own, but so are depression, anxiety, OCD, addiction, eating disorders, self-harm.  To have a collection of many of these at once just seems grossly unfair - yet that's the insidious nature of trauma.  The ever sadder part is how many of these aching, traumatized souls find themselves in eating disorder facilities or drug/alcohol rehabs (or even jail) for the more overt or destructive symptoms, but never receive trauma-informed care of any kind. Care that is specific to complex trauma or the uniqueness that DID can play in some of these more addictive or self-sabotaging behaviors is even more rare in places like these.  Additionally, when you try to "fix" an addiction or eating disorder through traditional means, without addressing the way its delicately woven and spun around the trauma, you can make them dramatically worse.  This, like all bad treatment, can turn them away from therapy (or help in general) forever - or more devastatingly, push them to lose their battle before they ever had a real fighting chance.

   It may be a broken record, but there is no place that the abundance of misinformation, redirection of resources, or ignorance of childhood trauma doesn't touch.  PTSD in any form is brutal and terrible and all-consuming.  But it's sad that in 2017, the first group of people that comes to mind for most whenever you mention trauma or PTSD, is still veterans.  If our "war flashbacks" and "triggered" memes online are any indication, people really do not understand the severity of the condition at all, nor do they even attribute it to the population struggling with it the most.  There is absolutely a way to keep the very real and VERY valid suffering of war veterans and those who've served in the military very present in our minds, hearts, and resource initiatives, while ALSO lifting up childhood trauma survivors and victims of sex crimes considerably higher than they currently are.  They need our attention and visibility.  And fast. 

    I bet if you call to mind any trauma survivor you know, they've also got at least one chronic (or "mystery") illness - maybe even several.  In fact, it's probably several if they've survived prolonged trauma.  Migraines, fibromyalgia, asthma, autoimmune disorders, rheumatoid arthritis, severe allergies, eczema, dysautonomia, POTS, EDS, neurologic disorders, chronic fatigue, or possibly even the highly insulting [and inaccurate] label of "conversion disorder".  These are all seen to coexist alongside trauma in abundance.  This list is by no means exhaustive, and - just like diagnoses for C-PTSD and dissociative disorders - many are still trying to just figure OUT what is wrong. They know they have a chronic illness, they just don't know which one, and every avenue they explore seems to point toward a dead end.
    We may have a helpful answer to you.  In reality, trauma affects absolutely every part of the body - especially the autonomic nervous system (which then affects everything else).  This can cause all sorts of havoc and in ways we are only just beginning to more fully understand.  It's been well-observed for awhile that trauma and physical illness go hand-in-hand, but it's only more recent that we've been able to see how, why, and where more specifically.  Because of this, and the fact it's a very lengthy topic, we cannot recommend the book The Body Keeps the Score by Bessel van der Kolk enough.  Or, at the very least, if you aren't interested in reading, maybe peruse some of his work online.  It'll be something you definitely won't regret, and supplies a well-studied introduction to all the ails, aches and pains, and mysterious illnesses you or a loved one have been suffering with for what seems like forever.

    Finally, in the same vein as so many of these facts but on a slightly different wavelength - traumatized children are seeing some of the most ludicrous misdiagnoses we've seen in quite some time.  The lack of understanding of what children who are being actively hurt (or just recently were) are "supposed to look like" in terms of their symptoms, is staggering.  Instead of traditional PTSD symptoms that we observe in adults, most kids are demonstrating all of the behavior one might expect from a child presently terrified, scared, shut down to numb, avoidant or afraid to attach, feeling under threat, trying to seek control and a voice, and who doesn't know what to do with all that adrenaline and nervous energy coursing through their tiny, terrorized little bodies. Sure, traumatized children can present in a variety of extremes, and that can be tough to distinguish at face value - but it's not too difficult to learn. And it's not acceptable to take the response of "No, no one's hurt me." as gospel in a child who's still in danger and never pursue it further - especially when all their symptoms are telling you otherwise.
   Jumping to the opposition-defiant, mood-dysregulated, ADHD, autistic, etc labels/misdiagnoses can be so harmful and even lead to more abuse at home.  Not to mention, they can follow them around forever, reshaping who they think they are or believe to be "wrong" with them.  It can make them feel broken or defective - particularly when the treatment for these suggested conditions can make them so much worse.  In reality, they are just traumatized children who did nothing wrong, but are being wronged by all the caregiving adults in their lives.  They're trying to communicate their suffering to you in any way they know how, but most of those "listening" are all too eager to villainize, label, or neglect them instead.  That is not helping them.  We need to do better.


  There are so many, many more things we all need to know and recognize about Complex PTSD, dissociative disorders, and the survivors who have them.  We will absolutely be continuing this list and adding more to the conversation.  What are some of YOUR greatest misconceptions about trauma disorders, or details you really wish people knew about the process of healing from them?  Please share them below!

 

MORE RESOURCE POSTS YOU MAY FIND HELPFUL:

  -  Grounding 101: 101 Grounding Techniques
  -  Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
  -  Imagery 101: Healing Pool and Healing Light
  -  Coping with Toxic/Abusive Families During the Holidays

 

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Imagery 101: Healing Pool and Healing Light

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Whether you are struggling with physical pain, body memories, illness, headaches, or any of the other distressing symptoms that can come with being a trauma survivor (or someone with a chronic illness) - there are imagery techniques out there that can help alleviate your suffering!  As I'm sure you're well aware, medications do little to nothing to relieve your body of pain it’s reliving from the past.  Conditions like fibromyalgia and other autonomic/nervous system disorders are also highly prevalent amongst trauma survivors, and they, too, show some of the greatest resistance to medications and other external approaches to treatment.  While there are several therapies that can help release your mind and nervous system of these specific types of pain, one solid tool you can use anywhere and anytime, no matter what shape your body is in, is imagery.  More specifically, Healing Pool or Healing Light imagery.

We'll walk you through both of these techniques, but to make sure you have the greatest chance at success, we want to be sure you understand the concept of imagery and how it's used first. (If you're already familiar, you can skip this part and head straight to the exercise!)

Imagery is a coping skill that allows you to picture things in your mind's eye - very vividly and in exquisite detail - to bring yourself and your body to a calmer state. It may be used to relieve pain, put away upsetting memories or intrusive thoughts, contain distressing emotions, retreat to a safer or quieter place, get some desperately needed rest, or just about anything your mind can create.  This is a skill that, like all tools for combatting trauma symptoms, does take practice and is one to experiment with when you don't "need" it. This way, when you're flustered, overwhelmed and unable to think clearly, it's second-nature instead of "some dumb thing that's probably useless anyway".  (Yes, we're very familiar with that rhetoric and guilty of it ourselves when distressed.)  Imagery is a technique constructed around being as detailed, descriptive, multi-sensory, and personalized as possible. Imagining yourself in a place or scenario that holds absolutely zero interest to you, that you have a hard time visualizing, or is even upsetting to you, is NOT going to be helpful.  Commanding the full use of your mind and its senses will engage so many more neurons and ask them to get off the upsetting or painful feedback loops they’re currently on - which is good not only mentally but for your physical health.  So, more detail, more customization toward my preferences and interest, got it!  What else?

Have patience with yourself.  Sometimes your mind is going to wander, that's okay. Sometimes the environment just isn’t going to work well, and you might feel frustrated, but that's also okay.  It's not your fault, or an inability to "do it right", or "never going to work".  Your body may be under a lot more distress than can be managed at that moment or it’s a visualization that just isn’t tailor-made for these symptoms. If for any reason it's making things worse, perhaps there's something triggering about the scene you chose that you hadn't even considered.  Or, particularly for those with DID, maybe there's a part of your mind who has misgivings about allowing you to feel comfort or make the pain "go away".  (Even if you don't have DID, some aspect of your mind may still feel this way.)  This happens sometimes.  It doesn't mean all is lost, that you'll never be able to use this skill, or that your mind is sabotaging you.  You just need to work with that stumbling block and either talk through it or at least find a compromise.

And, finally?  The more you truly believe these skills are working for you - drawing out the pain from your physical body, sealing up those memories nice and tight, slowing not only the intense emotions but your heart rate and tense body too - the better it will work.  If you just go through the pictures in your mind and don't try to connect them to what your body and mind are truly experiencing (whether that’s because you were sure it couldn't possibly touch the level of pain you’re in, were just doing it to tell your therapist you did, think coping skills are worthless, yadda yadda), welp, then, you're right, it's not going to work.  The mind is sooo powerful, and highly susceptible to the input YOU give it.  If you tell your mind you're now feeling differently or that parts of your body are starting to feel numbed or relaxed, it's likely going to believe it at least a little (if not much more) and start to follow suit. (And not just in a hocus-pocus, frou frou kind of way, but instead a well-researched, biological way - based on the new neural connections you helped your body make.)  Trust in it; the more you do, the more success you'll have.  And truly, if you're in distress and just need the madness to pause, or the pain to stop, what do have to lose by committing your whole self to the exercise?  You've probably tried everything else, possibly even things with serious side effects.  This has zero, so why not give it your all?

Now for the fun part!

 

 

HEALING POOL

Healing pool is just what it sounds like.  It's imagery that relies on a body of water with personalized healing properties to target and alleviate your pain from head to tippy toe.

To start, choose a location that feels the most calming and soothing to you based on the type of pain you’re experiencing and the environment that appeals to your senses.  Nothing is off limits!  It can be a real place you’d like to visit or one you’ve already been and love. Or, you can create a magical, mystical wonderland that’s the perfect fantasy destination for healing. Try to paint the scene as vividly as you possibly can. Is it a tropical oasis?  ..on a beach with crystal clear waters, sand, and an ocean breeze?  Is it in a mythical forest?  ..with a hidden spring, ancient stone fountains, and tall woodland trees all around you?  Is it in a rainforest or Hawaiian escape?  ..with tall, cascading waterfalls emptying into a warm, quaint natural pool?  (Hey, it can be magic, remember? That pool doesn't need to empty out somewhere else just because there's a waterfall leading in!)  Or, do you prefer something in a colder climate? A northern, mountainous retreat with perhaps a hot spring bubbling up, or a cooler lake to calm the aching? If none of these known environments are pleasing to you, you can even leave this world behind and be on your own planet, in a futuristic world, or high atop the clouds in a land with its own prodigious body of water. Creativity in imagery knows no earthly bounds!

Once you've chosen a general landscape and water source that is perfect for you, go deeper still into that world.  What do you hear?  Are there birds or other animal/nature sounds? What kind? Are they quiet and sporadic or filling your ears like music? Does the water itself make a trickling sound, have crashing waves hitting the shore, or does it bubble as it waits for you to enter? What do you feel? Is the air warm? The hot and muggy kind? Sunny but breezy? That still and "just right" feeling? Or, is it instead cold, clear, crisp and refreshing? Now, what about the time of day? This may change each time you return, but is your healing hideaway in the invigorating daylight, amidst the beautiful colors of a sunset, or is this a moonlit dip in the water?  (You can try all the above in future visits!) Now, return your focus to the water.  This is your healing water - not just any old water. Does it have a special color? Does is glisten or sparkle? Does it have any billowing mist coming off of it? Perhaps it's not even earthly water, and instead a mystical, dry ice-like fog?  Or, maybe it's more like a warm liquid gold? Maybe crystal blue ocean water with iridescent ribbons of light eager to heal your pain speaks to you? The possibilities are endless!

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Now it's time to get in.  We know when you’re in terrible pain and agony, the urge to just jump right in and submerge yourself immediately can be so intense - anything to stop the pain immediately. But, this technique actually works much better, and for longer, if you can gradually go through each part of your body, one at a time - really feeling it take effect not only in your mind, but in your skin, muscles and bones. Some may even witness the coloring in their skin shift through different techniques as their body responds as though this were entirely real. So, go slow and commit yourself to experiencing the variety of sensations; relief will find you much more completely.

Go ahead and stick your toes in. What happens? Does the water change color? Make a sound? Begin to draw the pain out of your body, dissolving it as it hits the water? Is it cold on your toes - almost making you shiver or giving you goosebumps? Or is it so warm and inviting - everything you ever hoped to be - stirring an audible sigh of relief at first touch?
Now, go ahead and let it cover your ankles.  Wiggle your toes around and paddle your feet, remembering that this is YOUR healing water, no one else's. It knows just what you need.
Move further still, putting your calves in. Notice them relax, surprising you at just how much tension they were holding while you were totally unawares. Give your legs another kick, pushing and pulling against the weight of the water, feeling it whisk between your legs as they pass each other. 
Scoot further in now and let it cover your knees.  Spend some extra time here and let it fully soothe your tired legs and aching joints. Notice how incredibly weightless they feel. It's quite possibly the best feeling you've ever had.
Slide in now and feel the water come up over your thighs and up to your hips. It's not too hot or too cool, it's exactly what your body craves, almost as if it was pulling you in. Notice your legs just completely melt, almost wishing to release a sigh of their own. It's as if not only the healing properties but the water itself goes straight through your skin into every tissue, cell and fiber of your body, drawing out every ounce of hurt or exhaustion in your poor, tired legs. They feel almost euphoric in the release.
Go in up over your tummy and up to your ribs now.  As a wave of relief washes over you, even the coloring in your face changes and the tension held in your pained expression relaxes. All the nausea and cramping and pain - any body memories or low back pain - it's all just drawn out of you and replenished with a level of comfort you didn't even know was possible. Cooling, numbing, calming every inch, while warming and softening other aching muscles.
Go ahead and let your arms start to fall in now.  After your fingers dip in, it's only natural to want to play with the water. You've never been in anything like it! What does it feel like? Does it swirl? Can you pick it up, does it change when you hold it in your hands?
Now sway your wrists and hands through the water, pushing and spreading it out. See how cramped and pained your hands were? You maybe didn't even notice in all the rest of your body's aching. Or, maybe they were swollen and rigid and tense and this was exactly what you wanted. Spend extra time on them. Now you can open and close a fist without pain, wiggle your fingers loosely, and dance in the water without pressure or restriction. They feel FREE!
Drop your arms until the water covers your elbows - now able to stand completely comfortably, your shoulders more relaxed. Take a nice deep breath. Do you want to keep walking around in it now - free to twirl in a circle - or, would you rather sit on an underwater stone or rocky ledge and just take it easy?
Either way, dip yourself slowly lower until the water is up to your collarbone.  Feel your chest cavity expand and the fresh oxygen rush into your lungs.  You'd been holding your breath for so long in the pain and you're now invigorated with such clean, healing air. You didn't know your lungs could open so far! Notice your heart rate slow and steady. And the PAIN held in your heart and chest, the spaces between your ribs - all of that weight from such emotional anguish and hurt - it just dissolves.  ...almost as if the healing water swirled around inside of you and gave your heart a warm, loving hug. Stay here as long as you need. This is so important.
When you're ready, cover your shoulders - possibly relaxing back against a cozy ledge.  Goodness, it's like your whole body has become jello now. Some of those last bits of tension are melting away and releasing the hold on you they'd had for so long. Take another deep, deep breath. Close your eyes if you want to.  And, now it's up to you if you want to take your head under or just splash some on your face instead. If you have a headache or migraine, I'm sure you almost can't wait. If you don't want to go under, that's okay, too. Just being close, or rinsing your face can be more than helpful.
If you decided to dip yourself under, go ahead.  Good news is that in this healing pool, you don't have to worry about holding your breath. Just let the water relax your jaw, smooth away the creases from your brows and forehead once contorted from pain. Feel it draw out all of the throbbing, aching, pounding, or sharp pains in any and every part of your head. Your thoughts calm and slow, and the worries, memories or awareness of pain just disappear. Everything goes quiet, and feels still. You could almost sleep in the absolute serenity. You're only right here, right now, and it's all you could ever hope to feel. Breathe deep. Spend all the time on you and your body that you need before lifting your head out of the water.

You can decide if you want to stay here and swim, take a nap in this place, or just relax for a few more moments - making sure you truly experience deep, deep healing in even the most stubborn parts of your body. When you're ready to leave you can slowly bring your awareness back into the present, but don't worry, the healing doesn't just disappear. You take at LEAST a piece of it with you for the most sore parts of you, and even more elsewhere. It wants to gift it to you and you’ve already changed a great deal of how your neurology while you were here. It won’t just undo. Over time, if it wears off or symptoms return, you can return. You can come back to this at any time and change any part of it that you need - customizing it for any future aches and pains, headaches, overstress or body memories.  

 

You may need to take a couple extra moments for grounding after coming out of such a calming oasis. If you're heading to bed or doing this before sleep, you're a-okay.  But if you need to return to the regular world, you may need to shake the fog from your eyes and fully connect with your surroundings before re-engaging with life again. So, be sure to orient yourself fully. (If you aren't sure what to do for grounding, good thing we've got 101 Techniques for that!)  But, even though reconnecting with the real world can be undesirable, that doesn't mean the calm, peace, and pain relief found there just goes away! You're more refreshed than you've been in...maybe ever.  Just be sure to fully re-orient, even if that haze seems more inviting.  ;)

 

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Healing Light

Healing Light works in a very similar way to Healing Pool, but it's especially great for anyone who has any kind of uneasiness around water, needs more of a localized "spot treatment", or has a harder time creating more scenic imagery in their mind.  

Just like Healing Pool, this skill is much more effective when you make it as descriptive and detailed as possible - only this time you will mostly need to focus on detailing the light and less so your surroundings. The light can even reach you right where you are sitting or laying right now if you'd like. But, if you want to visit a more soothing environment as you practice this, you are more than welcome to include one and detail it just as we did earlier! It’s all about your comfort and what will maximize the benefits you’ll receive.

So! When it comes to light, the possibilities here are endless. Is it a sun ray that bursts through the clouds and finds you? Is it more like a secret weapon, a thin, pain-zapping laser? Is it more like a glowing orb of light, personalized just for you? Or, perhaps it’s more conical like a flashlight, being emitted from some other precious source that you can turn on and off? Maybe it's no beam of light at all, but more like a dancing, ribbon-y, spritely kind of light flitting through the air. Is there a trail of shimmer or glistening particles that follow it in its magical nature? Is it warming and softening, or cold and tightening? Possibly something more gaseous, or like pressurized ice that can flash-freeze and numb ANY type of pain, seems more satisfying for your needs?
Does it make a twinkling sound, the whirring of a pulsating orb of light, or is it more of a buzzing or zap of a machine as it obliterates the pain? Does the light come in one color or many? Maybe you have different colors for different areas of the body, or a variety of colors and styles dependent on the type of remedy you need for it to give.  Perhaps you have one light that heats and relaxes the skin, another that freezes your pain dead in its tracks, a third that envelopes and "holds" the pain until the throbbing stops, a more aggressive light that shatters the pain into a million pieces and then individually dissolves each one, another that injects coolness through the area like a gel and feels like an internal ice pack, a highly unique one that simply erases the aching entirely as if it were never there, and a super satisfying light that draws the pain out from your body like a magnet or vacuum. You can even have one that incorporates more of a spiritual element, or the energy and care of someone you love, who can offer a special kind of comfort that no one else can. So many options!

Like the slow entry into the water in Healing Pool, it is oftentimes more effective to start with an area of the body that's unaffected - gradually approaching your "target" area so that your mind and body have an opportunity to fully connect this imagery exercise with your actual pain. If you're a fan of those that obliterate and destroy the pain with like dry ice blocks, etc, you miiiight want to give the light a "seeking" function that just cools and nurtures the healthy areas as you begin the process, then let it 'scan for' the most painful section you want it to destroy.  We don't need you feeling like your forearm just got pulverized or flash frozen when it was your shoulder that was waiting for the relief, ya dig? ;)

Okay, so, first!

Visualize in your mind's eye where the light source is coming from. You might even start to feel building anticipation of the relief you’re about to receive. Picture this light source, notice its glow, feel the warmth or coolness it’s emitting, listen to its unique sound.
If it's your head that is throbbing, perhaps allow the light to first hit your spine - releasing and soothing each individual vertebrae as it climbs your back to your neck and head. Allow the healing particles to weave throughout your jaw and mouth, completely relaxing them along with your brows, forehead, and eyes. Then send it to your pounding skull. Let it do there what you’ve desperately been needing it to. Let your mind subconsciously direct it. If your abdomen or low back are aching, maybe show some love to your toes, feet and legs before reaching the pain of your midsection. If it's your shoulders or neck, let the light graze your fingertips and creep up your forearms, triceps and deltoids before tackling your upper body pain and releasing that suffering.

This light is so detailed and meticulous, so specified to you and your needs. It reaches through every capillary, tissue, cell wall, vein and nerve fibre. It knows what you need without your instruction.

Visualize what's happening beneath the surface as it finds your pain. The way it coats, cools, and soothes your pulsating nerves. See the light pierce through all parts of you to find your toughest tissues and muscles, melting them into the greatest relaxation you've ever felt. Imagine how your light sprinkles your skull with tingling, healing properties - how they then trickle through all the wrinkles and spaces and curves of your brain, quieting and soothing not only the aching but all your frenetic thoughts, too. Picture its warming, swirling path to all the cramping and twitching muscles that are remembering something from the past. See it drawing out the inflammation and "darkness" that can feel so heavy when it gathers in your joints, or even in your lungs or heart. It's gone now. You can breathe. You can feel that relief. It may have even felt so good that now you need that light to go everywhere else. That's perfectly okay! Practice that self-care and bathe in that light if that feels right to you. This is your light. No one else's. It's made just for you, for your pain. No one can change it, tamper with it, or even know about it if you don't want them to! This is YOUR healing light.

When you've decided that you are finished, you can watch the light slowly leave your body - taking any last stubborn remnants of pain with it. Take a deep breath knowing that as it leaves, the pain will not just immediately return; it's been healed. Your mind and nervous system have chosen a different path and sent wellness to that area. You aren't just "imagining" relief, you've neurologically and chemically given your body some different instructions. And when life is being a jerk again, you can call on your healing light any time to give your body that relief once more. It is so precious.
 

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These techniques are but a few in a sea of treating ailments and managing distressing trauma symptoms through imagery. There are countless others, like those involving the use of colored “pain water” that fills up the body but is slowly drained out from the heels. Another semi-silly one that is taught in some trauma units is called "flick the pea". In this one, you imagine your pain as a very large sphere (like a basketball or even larger if it feels more massive). You then move that ball away from that area causing you so much distress, toward your arms, shrinking it down in size as it travels, until it's so small (the size of a pea) that once it reaches your fingertips, you can flick it away with a very, very satisfying flick. There's another that is specific for numbing that just involves sticking your finger in an ice cold water and mentally carrying that frozen feeling up your arm and through your body until it meets the pain you’re suffering with. This is one you can often see the color change occur in the skin as your mind registers the chill taking over you.

We have also made a post on Color Breathing, which not only helps with emotions and panic, but pain as well. There is also an introduction to imagery techniques that use dials to help modulate pain, intense feelings, and memories which you can find here.  If you would like us to share any of these in more detail, we can certainly do that. We are planning to make many more articles on imagery - particularly containment skills (for memories, emotions, intrusive thoughts, self-harm urges, etc), but we wanted to be certain to tackle those that help with physical pain first!

We truly hope these skills help! Feel free to expound upon any of them, make them your own, or - if you're just learning - even let your phone or computer read them out to you so that you can just close your eyes and follow along, visualizing as it guides you through! These can also work for anyone, not just trauma survivors! So don't hesitate to share them with friends and loved ones, particularly if they have chronic pain or any chronic illness!  Good luck, and if you have any questions, please ask below or message us!

 

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More Resource Posts You May Find Helpful:

✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
  ✧  Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
   Coping with Toxic/Abusive Families During the Holidays

  ❖  Article Index  ❖

 

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