Why It’s Essential for Medical Providers to Provide Trauma-Informed Care

I think most medical providers enter their profession because they have a desire to help people through providing the best in medical care. However, there is a largely ignored problem that is at the basis of a large number of medical issues, but also the way that medical care is utilized and approached by patients. To ignore this mammoth issue is to address the symptoms, but not the cause.

Trauma has been strongly correlated with a number of chronic conditions, including diabetes, obesity, chronic fatigue, asthma, heart disease, sleep apnea, etc. Trauma affects not just the mind, but also the body. To address trauma is also to address physical problems.

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Not only is it important to address trauma as one of the major root causes of physical issues, it’s also important to understand how trauma affects medical care. A patient’s trauma can affect their ability to feel comfortable seeking out and talking to a medical provider. Trauma can also affect a patient’s outlook on their treatment and prognosis.

Here are a few ways that trauma can interfere with patient care:

  • A patient might feel uncomfortable talking about certain symptoms or parts of the body due to trauma.
  • You might not get enough information from a patient due to body posture, words used, or inherent qualities about you as a medical provider that remind the patient of their trauma.
  • Certain medical procedures, even seemingly routine ones such as taking blood pressure or weighing a patient, might be triggering to the patient, resulting in a shutdown of communication.
  • How your office, waiting room, or examination area is set up can affect a patient on a visceral level and remind them of traumatic experiences. If they have experienced medical trauma, even just being in a medical setting can be extremely stressful. Even changing furniture can feel alarming to patients who have experienced severe trauma related to transitions.

Addressing trauma in a medical setting is not as difficult as it might seem. If you have a chance to take a course in trauma-informed care, that can be a great start to learn more about how to address a history of trauma in your patients. If you are unable to find training in trauma-informed care related to medical providers, you can seek out a consultant to help you develop ways to make your practice more trauma-informed. Seek out colleagues who have had success in making their practice more trauma-informed and consult with them about best practices.

Some of the benefits of making your medical practice more trauma-informed:

  • Better rapport with your patients.
  • Increased communication from your patients.
  • Decreased stress in your interaction with patients.
  • Better outcomes
  • More positive patient interactions with your patients
  • Growth in your practice as patients tell others about the positive benefits of working with a trauma-informed provider

What are the Effects of Childhood Physical Abuse on Adults?

The effects of childhood physical abuse are often overlooked by both therapists and medical providers. I think this is partly due to lack of knowledge and also that society as a whole can easily minimize physical abuse as an issue. Most people agree that really severe physical abuse of a child is wrong. We have all seen and heard tragic stories of children who suffered horrific physical abuse at the hands of biological parents, foster parents, etc. However, many other people’s stories of childhood physical abuse are buried below excuses and rationalizations that society or the victims or their perpetrators may make about why physical abuse is justified, how it’s normal, and it isn’t really worth complaining about. These kinds of messages keep victims of physical abuse from talking about it, and prevent providers from being able to address the problem. This post is written to share support for all those who have suffered childhood physical abuse in silence. You are not alone and your story is worth sharing.

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As a young child, I was often hit by my older brothers. When I sought help and protection from my biological mother, she took my brothers’ side, blamed me and encouraged my brothers to continue hitting me. I learned from an early age that I could not count on anyone to keep me safe and violence was the norm, rather than the exception. When I was adopted out of foster care, I lived in constant fear and vigilance of an adoptive sibling who would threaten to beat me and my siblings if we did not comply with his demands. My adoptive mom would also threaten that she would have this same boy beat us up if we did not do what she wanted. In other words, I had a pattern of two moms who used their sons as a henchman to abuse others. Much of the abuse happened in a group setting, with other bystanders around. It was a way to control the others and sent a clear message that if they dared to do anything, they too would have to endure physical assault as well. I was hit repeatedly by one mom in a fit of rage and had another mom dig her nails into my face, leaving scars. This was the story of my life until I ran away from home into the safety of college and true independence.

Only now, decades later, have I come to realize the effects of physical abuse in my adult life. I share my story in the hopes that others might also benefit from hearing it and find healing in their own lives. The following are a few of the symptoms of childhood physical abuse in adults.

Symptoms of Childhood Physical Abuse in Adults:

  • Depression
  • Anxiety
  • Eating Disorders
  • Sleep problems, including sleep apnea, excessive drowsiness, and insomnia
  • Weight issues
  • Difficulty forming and maintaining friendships
  • Social withdrawal
  • Poor impulse control
  • Difficulty focusing
  • Substance abuse
  • Delinquency
  • Post-traumatic stress
  • Aggression
  • Possibility of revictimization
  • Chronic pain
  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Irritable Bowel Syndrome
  • Risky sexual behavior
  • Higher likelihood of being in special ed classes or having to repeat a grade.
  • Hypervigilance
  • High incidence of divorce
  • Greater likelihood of becoming homeless or incarcerated
  • Over-compliance with authority figures
  • Heart disease
  • Headaches

I realize in looking at the symptoms of childhood physical abuse in adulthood, that I am fortunate in so many ways. I don’t have all of the symptoms, especially the more extreme ones, which I attribute to a lot of grace, the presence of other caring mentors in my life, and my Christian faith. While I was in foster care, I saw so many abused kids that suffered with many difficult symptoms of abuse, ranging from risky sexual behavior at a young age, aggression, school delinquency, and withdrawal. I will never know what happened to them, but I know the statistics for foster children are not good for a reason. Most of us don’t make it out of the system without becoming homeless, victims of human trafficking, or dying at a young age. I did become a victim of human trafficking, but that is another story for another time. I have definitely beat the odds in so many ways and feel very blessed to be able to help others with their own challenges, however big or small they may be.

What I have noticed in myself lately is that childhood physical abuse left me feeling disconnected from my body. At a young age, I took pride in being tough and not caring about being hurt. I would feel smug around other kids my age who came from much healthier families and would cry when hurt. I knew I couldn’t rely on anyone except myself, so that’s exactly how I lived my life. It also meant that I didn’t talk to people when I did need help. I avoided connecting with others. I didn’t ask questions or go out of my way to talk with others. I avoided vulnerability at all costs, because vulnerability would result in being hurt again, and that was a price I couldn’t afford to pay.

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Research has shown that victims of physical abuse tend to have a lower social status among their peers. This is due to a variety of factors, including social withdrawal, victims constantly scanning social situations for threats (perceived or real), victims not being able to form healthy social skills at home due to violent relationships, victims shutting down during social interactions and not able to name emotions or access the language and thinking part of the brain, victims acting out in a hostile manner to replay what they have learned to be normal social interactions at home, poor academic performance, teachers labeling victims as troublemakers or uncooperative, and peers seeing victims as weird or aggressive.

As an adult, the place where I have really begun to see the effects of childhood physical abuse has been at the gym. I noticed myself having a hard time paying attention to the class instructions, in spite of my best efforts. I would say that overall I have a pretty good attention span, so I was a bit baffled at how hard it was for me to follow even very simple instructions. I also noticed my heart rate going up and feeling a lot more fear and anxiety around following the instructions. My mind would sometimes blank out in the middle of an instruction, and I would have to watch others to figure out what to do. When I couldn’t remember what to do, I would feel embarrassed and hesitant to ask what to do. I noticed a lot of unusually negative thoughts that would flood my mind during exercise. I have also noticed that as I do my exercises, negative memories would resurface. I paid attention to the fact that I had a hard time with visceral memory, the ability to remember in the body a specific sequence of events without having to think about it. Doing the exercises felt kind of clunky and unnatural as I had to think over each step.

Being the therapist that I am, I took some time to ponder why all of this was happening. I realized that being told instructions in the past was a source of terror for me, because it would result in physical violence for me. The group setting in the gym was also a visceral reminder of how physical abuse had occurred in the past. This explained why my mind was shutting down, even though I logically knew that I was safe, in the present, and this would never happen to me now as an adult. That’s just the way the brain works when it is triggered.

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After one particularly difficult workout session, where I went into a fight-or-flight mode, I decided to talk to my coach I explained what was really going on behind the scenes for me, and I think that helped her understand where I was coming from. We came up with a plan for words that I could use that would help explain what was going on so she could better help me in the moment.

Because physical violence by its very nature is interpersonal, healing comes from developing positive connections with others. This can be tricky, as we survivors make a lot of mistakes in learning to form friendships. It’s important to practice self-compassion and also be open with others about your difficulties, as they might not understand what is going on in the inside.

It is also important to find ways to connect with your body in healthy ways. Find ways to nurture your body through food, rest, exercise, prayer, and meditation. As you try new and healthier ways of connecting with others and your body, don’t be surprised if difficult memories and emotions come up. This is part of the healing process and a sign of progress, as alarming as it might seem.

I am confident that as I keep moving siempre adelante, that things will improve and I will feel more comfortable with following instructions and have a better ability to pay attention and increase visceral memory capacity. As a narrative therapist, I teach my clients that there is a power in telling your story. I notice that as I begin to talk to others such as my coach, that I am better able to process and acknowledge what happened in the past, I feel more connected to others, which in turn will help me to better able to be connected to my body, my mind and my emotions. I am learning to be able to be more proactive in talking about difficult things, rather than resorting to my old negative coping skills that were unhealthy but helped me to survive a much more difficult time.

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There is a lot of research out there on the effects of abuse, but very few stories of people who were able to overcome the effects. I hope that by sharing my own story you too might be able to find inspiration and hope that change is possible.

How Trauma Can Get in the Way of Success

One of the assessment forms I always have my clients fill out in the beginning is a questionnaire to assess their level of Adverse Childhood Experiences. These questions will give me an insight into difficult, perhaps even traumatic events, they have experienced. Of course, the questionnaire does not cover everything and I think there are a lot of other questions that could be included, such as did you ever experience racism or discrimination as a child, did a household member including yourself end up in the foster care system, did you experience bullying outside of the home on a regular basis, etc. ? But it’s at least a good start for trying to understand how much trauma someone has gone through as a child and how much stress has built up into their system since then.

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Childhood trauma sets the stage for how we interact with the world, our beliefs about ourselves and others, and what is possible. The effects of trauma are not always visibly evident, they are invisible wounds that we carry around. Trauma does not come out until we are challenged or challenge ourselves in some way.

Success can be very triggering. One of the effects of trauma is anxiety. Anxiety tells us to avoid certain situations and play it safe. It’s a protective mechanism to help us avoid further damage. The problem with that is that anxiety keeps us from doing the things that will actually help us feel better in the long run, and reduce our sensitivity to threat.

Progress means change, and change can feel very scary to our autonomic nervous system. Many traumas are a result of some kind of transition – parents leaving a child, a robber entering a home, losing a beloved friend or family figure, being sent away, etc. It’s no wonder that even little transitions can seem huge in our minds and our bodies, even if we logically know that a transition now is normal and safe – like a change in furniture, change in plans, or a new person in our life. “Neurons that fire together, wire together” is a popular saying among somatic-based therapists. Transition, even positive ones, can feel dangerous to our minds because it has become linked with trauma.

So if you start to work on a goal, and you suddenly encounter that dreaded brick wall, take some time to assess the situation. Here are some questions to ask yourself:

  • Does this situation remind you of a situation you may have faced in the past?
  • Is there some immediate change or transition that may have affected your ability to see progress or feel safe?
  • Have there been any other stressors lately that may have compounded your ability to reach your goals and feel good about yourself?
  • Does your reaction to a challenge, or even positive signs of progress, seem out of proportion, or uncharacteristic of your normal way of reacting?

If you answered yes to any of these questions, you may be seeing the effects of hidden trauma. It is good to acknowledge what is really going on in order to be able to move past it. Even though symptoms of trauma can seem permanent, they don’t have to be. As we identify the problem and connect with others who understand, we are able to come up with our own solutions. In doing so, we strengthen our ability to feel safe, to pass through any challenges that come our way, and feel more connected to others and ourselves. And success seems a lot more possible after all.

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Why Is Progress So Difficult?

I think that most people want to improve their lives in some form. We would all like to feel better, look better, improve our financial situation, be better parents, be happier, have more fun, or some variant thereof. The desire for self-improvement is pretty universal to all peoples and all cultures.

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Come January 1st, we take a fresh look at our goals, old and new. What have we achieved, what would we like to achieve, what new strategies should we strive for given what we know about ourselves and the world we live in? Coming through (not yet out) of the pandemic, I think the desire for something new, something different, perhaps something untried will be stronger than ever.

When you first try something, progress can feel really great. You see the numbers dropping on the scale, you are going out and having new and exhilarating experiences, you feel pride in learning something new, etc.

Then at some point, you hit a roadblock. Someone tells you something that takes the wind out of your sails. Maybe you run across a financial hurdle that tells you, “You have bigger priorities now, whether you like it or not.” You get tired, exhausted, and you feel lonely, miserable, and discouraged. You wonder why you even started your goal in the first place. Is it really worth it – all this pain and disappointment? Life seems so much easier on the other side – the side of not trying and going with the flow.

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It’s at this brick wall that most people give up. We go with what’s easy, what takes little effort, what is simpler, what produces the least amount of pain. At my local gym, there is a saying on the wall that reads like this “Life begins at the end of your comfort zone.” I never thought I would be a gym person. I like being outdoors walking or running on trails, streets, anywhere outside. I experienced bullying on the playground and at physical education classes as a child. No way was I going to be around “those types of people” again! But when I hit a plateau in my weight loss goals, my integrative medicine specialist said I needed to work on resistance training. I thought I was the expert on resistance, I had been resisting going to the gym and exercising my whole life! So I stubbornly did the video training exercises at home in my condo. That would happen maybe once or twice a week when I could make the space for it in our small condo, modifying workouts that were done in a professional gym with professional gym equipment, using whatever I happened to have on hand. These exercise sessions were happening in between vying for space in our lovely open floor plan with two other wonderful beings that I share my condo with, along with having to balance the noise level with the upstairs neighbor. Needless to say, this didn’t last for long, and the effects of it were minimal.

I also had a lot of very good excuses for not going to the gym. I didn’t know who would be there, who the trainers were, what the trainers were like, how to use the equipment, how to act in a gym, or even what to do or say. Plus I had my traumatic memories trying their best to keep me “safe” in a way that was really impeding my progress. In my mind, I imagined worst-case scenarios, a typical anxiety response. I imagined what I had grown up with happening again. I would be made fun of for not knowing what to do, for being overweight, for not having the right clothes, etc. People would get mad at me for “not getting it, ” not being tough enough, for not being able to do or complete the exercises, for letting them know when I was in pain.

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I put off going to the gym for several weeks. On a whim, I suddenly had the inspiration to go. All of my anxiety thoughts were saying not to, but I knew in my heart I had to go now, ASAP, if it was to happen at all. My body was shaking, my heart was racing, and I felt like crying. These are all typical trauma responses and normal when you face a situation that reminds you of previous trauma.

The timing couldn’t have been better. It just happened that my integrative medicine specialist happened to be finishing a workout there, something I wasn’t expecting. Because he was someone who I knew and trusted, I felt a lot safer about going inside and “just taking a look.” He introduced me to the owner, who I chatted with for a bit and got a tour around the place. I was invited to a session that afternoon, but I wasn’t ready to take that big of a leap just yet! Just getting in the door was hard enough for me as is. But at least I was able to go home, process my emotions, and make a plan with the new information I had.

I decided I would try different classes and get a feel for each one. Some classes were harder than others, but I finally settled on a time that worked best for my busy schedule and caseload. Some days I come into the exercise classes with tears in my eyes as I work through the emotions of the day. I made and still continue to make a lot of mistakes. I battle with a lot of doubt about myself, my ability to progress, and fears about how I will be treated by others. It’s natural, given what I have previously experienced to have these doubts and negative thoughts. To this day, I am grateful for the training, education, and experience that helps me to see these obstacles for what they are – just my brain’s way of trying to protect me. But I can also acknowledge those thoughts, thank them for their efforts, but understand that in order to heal, grow, and make progress, I have to keep moving siempre adelante.

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As I have moved forward, I have discovered that by facing my own fears, I have gained so much in the process. My old negative beliefs about people who exercise have been replaced with more positive beliefs about people who exercise. I now see myself in a more positive light in regards to my ability to exercise. I am learning slowly to connect with my physical body, which has provided a lot of healing for the trauma related to exercise, and other various traumas. I have learned so much about myself, especially in relation to others. I have learned that even when I feel like I have failed, other people will not have the same beliefs about me, fortunately, and I can keep going, no matter what I happen to be feeling at the time. I have learned that I don’t have to hide my imperfections, but can just show up as I am and I will still be accepted. Some days will be harder and easier than others. Emotions and other old negative beliefs will show up as we keep challenging ourselves. I am also slowly, carefully, cautiously taking the next steps to connect with others – like so many other people coming out of the pandemic mindset. However, unlike so many other people, I know that my difficulties with connecting go much further and much deeper. And that’s okay because everyone is different and everyone has their own story to tell.

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When progress seems difficult, here are a few reasons you might be hitting that brick wall:

Why Progress Might Seem Impossible

  • You might be facing a previous trauma, and not be aware that you are experiencing a trauma response.
  • If you have experienced trauma or attachment issues as a child, transition can be really hard. Progress can seem dangerous when previous transitions have resulted in major loss or disruption of attachment figures.
  • You may have some emotions that are starting to rise to the surface, emotions you would rather not face. All emotions can be helpful, and can actually help you achieve your goals. Find a safe person you can talk to who can help you process your emotions, learn to get comfortable with feeling those emotions, and make good choices when those emotions arise.
  • You might be exhausted from stress or physical depletion. Remember that when you are challenging yourself, you are going to feel more tired than usual and emotions will be high before they go low. Be sure to balance your challenges with lots of self-care. And don’t be afraid to take a break.
  • You might have some false, negative beliefs about yourself that are not helping, but rather holding you back from achieving your full potential.

Why Being Tough is Not Enough

Being tough is great for survival, but it’s not great to just survive. It’s better to thrive. We live in a culture that celebrates stoicism. From a temporary standpoint, stoicism can help us to batter “the slings and arrows of misfortune”, but it does not help us to live the “abundant life” that we are all meant to live.

It’s hard to be vulnerable and there is a reason for that. Vulnerability means there is a possibility of being hurt. Even the thought of being hurt can be painful. Sometimes it can seem easier to just tough it out, not feel anything, not let other people know what is really going on inside of you. This is especially true if you have experienced previous trauma, shame, emotional abuse, etc that seems to legitimize avoiding and toughing it up.

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I get it, because I am just as guilty as the rest in being stoic. There are times when I’ve had to be tough in order to get through a difficult ordeal. I’ve also come to realize that being stoic can only take you so far in life and keep you from happiness. Stoics might win battles on a temporary basis, but they lose out on potential or current friendships, in other words, the bigger battles of life.

You see, vulnerability is also a superpower. Yes, sometimes people abuse it, but that doesn’t take away from the power of authentic vulnerability in a human relationship. When, instead of hiding and avoiding, you take up the bullfighter’s cloak and say “toro” to your fears of abandonment, rejection, being unaccepted, etc. you give yourself and other people a chance to get to know you and them for who you and they really are. You give people a chance to strengthen you, to affirm you in all of your weak points and point out your strengths.

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When you take these risks and expose yourself to all sorts of dangerous possibilities, you will naturally feel anxiety, fear, and think all sorts of negative thoughts. That’s okay, because that’s our body’s way of trying to prepare us to be brave. There are several possibilities that could happen when we allow ourselves to be vulnerable.

It could be that all of our worst fears could come true. Maybe we won’t be liked, we will be made fun of, no one will want to be around us, etc. However, it’s better to know the situation than pretend that everything is okay. Then we can move on, process our feelings, find better people to be around in our lives, and optimize our lives for better results in the future.

Or the results might not be great, but they might not also be so bad either. Maybe we will learn something from the outcome and make choices based on that new information we receive. Maybe we might find out that there is something we can improve on, or a new skill to learn. Maybe the great friendship we thought we had isn’t that great, but it isn’t so bad either. We can learn to adjust.

Or sometimes (as is often the case) we are surprised by how great things can really turn out when we let ourselves be vulnerable. We may form deep, lasting friendships. We could learn that we are worth loving after all, and that many people do care about us, but we didn’t know it because we were hiding in our turtle shell of avoidance and blaming others. We could find out that all of our fears are unfounded and we have been wrong all along. We could discover that we are much safer than we thought and little by little, we can slowly let our guard down and enjoy a life of not just surviving, but also living life to its fullest in the way that only you can.

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Why I Love Being a Rural Counselor

When I first moved here to the San Juan Islands, I was struggling with debilitating headaches accompanied by severe nausea. The sharp drops in barometric pressure that come with the weather on an island did not help matters any further. I wasn’t thinking about returning to counseling and had given up on that plan a long time ago. In fact, I wasn’t thinking about anything but surviving from one day to the next at the time. Faced with burnout from grad school, selling my house during the Great Recession, a surprise move to California, then burnout from homeschooling a child with a learning disorder while trying to keep her safe from gangsters in Southern California, I was exhausted and stressed out. I had absolutely no plans to go back into counseling, which had only brought me tears and heartache in grad school. However, God had other plans for me.

The headaches eased up just enough for me to be able to consider going back to work. I was still resistant to counseling, but decided to call the Washington Department of Health and they said I could be reinstated since all the rules had changed from long ago when anyone could hang up a sign and call themselves a counselor. I thought maybe enough time had passed to be able to try again, in a new location, where maybe things would be better than what I had experienced in grad school as an unpaid intern.

Working on an island was not easy. The only place to earn hours was a community mental health center which did little to help and did much to hurt our island community. I walked away from that place twice, and am still amazed that I survived to tell the tale. I often attribute my survival to the grace of God and a strong sense of ethics instilled in me by my Catholic education of long ago. I also found myself blacklisted by the social work community due to my Christian faith. When I quit my last job, it was in the middle of COVID pandemic, spring of 2020. I had become so severely sick that had I not quit, I most likely would have died. What had started out with a dust allergy from a coworker moving around furniture that probably hadn’t been moved in 20 years morphed into a cough which developed into severe asthmatic attacks and extreme bronchitis. By the end of it, I was coughing up blood and could barely breathe other than short, shallow breaths that caused great pain to my lungs. I tried to get tested for COVID in several places, but was denied testing due to my age. I could not receive regular medical treatment in person because it was the middle of the pandemic, and therefore could not receive testing to see what was wrong with my lungs, throat, etc. Three different virtual doctors told me that they didn’t believe it was COVID, but was in fact caused by workplace stress from the toxic work conditions I was in. I had seen so many ethical abuses in my workplace, tried my best to address them, only to be harassed by my coworkers and boss, who became increasingly more abusive towards me. So I walked away, believing that my career was most likely over with nowhere to gain hours for licensure and not even knowing if I would be alive within the next few days or months. I prepared for the worst.

It took me a few months to recover. I saw a counselor who gave me permission to cry it out. Tears were the best medicine, and that’s how I really began to heal, both physically and mentally. The headaches, which had become a daily problem at my last workplace, continued.

At this point, I didn’t know what to do. Fortunately, I didn’t have to work since my husband was already employed. However, I knew that I only had so many times I could renew my associate license before I would lose the possibility of ever becoming fully licensed in my state. A friend recommended I apply to a place. I heard back right away and began contract work with them. I worked out of my house in a spare office, providing telehealth to mainlanders. This was in the middle of one of the most severe lockdowns our state has ever experienced, a very contentious presidential election, and race riots. I saw and heard it all. People were suffering greatly, and it was almost impossible to find a counselor, since we were all going through one of the greatest mental health crises the state of Washington has ever known. I was really glad at the time to be able to help out and often felt like a medic on a battle field, sometimes just doing triage to see who needed help the most and attending to as many people as I possibly could. My clients came from all political parties, social classes, races, religions, etc. I love working with diversity, especially at a time where there was so much division. At the end of my contract with the mainland agency, I said goodbye, as I was now fully licensed and confident that I could practice on my own.

I found a wonderful integrative medicine practitioner and was able to discover the root cause of my headaches and other health issues. Since then my headaches have completely disappeared and I have really enjoyed the process of becoming healthy and strong again. Along the way, I went from being a skeptic to a complete convert of the functional/integrative medicine approach.

To this day, it is still hard to earn the trust of locals, but I have been honored by the clients who take that first brave step to seek help. Despite being blacklisted by the social work community for my religion, I have found that there are many local clients who truly respect diversity and enjoy working with me. I am open about my background and that allows clients to feel comfortable talking about their own life history and values. I do work with many people from the mainland as well via telehealth and I enjoy hearing about mainland life and culture.

I really enjoy the long-term aspects of rural counseling. I get to see not just individuals, but also families. I see children, adolescents, and adults. I get to see the complete picture of what is going on with an individual by also getting to know their family. I know that when I help an individual, I build up the family, and in turn, the community. I get to see the long-term benefits of counseling in a way that most mainland counselors never get to see. It always makes me happy when a former client stops me somewhere and thanks me for all the ways I helped him or her. Or sometimes I see a client doing something that used to be difficult, but is now easy now that they have overcome their anxiety. Most mainland counselors don’t get to see the after story.

I don’t really mind bumping into clients at the grocery store, at church, school, sports games, at local events, on the ferry, and sometimes even out on the trail. Sometimes I see them at baptisms, quinceaneras, weddings, and other important events of their lives. Clients get to see me for who I really am and I strive to be authentic with them. They know that I am a parent, a fellow Christian, and just another islander with hopes and dreams like anyone else. I get to donate to local causes and I have a soft-heart for lemonade stands and other entrepreneurial adventures of local kids, because it reminds me of my own early attempts at entrepreneurship.

The headaches have since disappeared from my life, and are replaced by a newfound peace in the small moments of rural life. I experience a lot less stress as a rural counselor. My office is within walking distance of my condo. I can take my time and the commute is minimal. Here on the island, there is no need to rush. If a client cancels, it means I have more time to take a walk, chat with someone, or grab a cup of tea. If I have to take a little longer to talk to a parent about a child, that’s okay because no one is in a rush here.

Self-care is a lot easier to do on island, because obligations are minimal. I take walks at local parks and all my stress and emotions melt away into the beauty of nature. I take time to chat with friends and neighbors wherever I am. On weekends, I go jogging or hiking. A hot bath after a long day at work does wonders. So does time with my husband and daughter. Or going out for a coffee with a friend.

I chose the motto “Siempre Adelante” for my business because it represents what I have had to do in order to survive a tough, rural experience here. I have managed to move forward in spite of health problems, illness, bigotry, and a harsh work environment. I hope that I can inspire my clients to move forward with whatever challenges they might be facing at the time. And maybe somewhere along the way, I might find that ranch that I call home.

Can Emotional Abuse Cause Complex Post-Traumatic Stress Disorder (CPTSD)?

When most people think of PTSD, they imagine someone who has gone through a natural disaster, a war, or physical or sexual violence. Very few people understand or are aware of how severe the effects of emotional abuse are.

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Emotional abuse is systematic, intentional, and repetitive controlling of a person, using the victim’s own emotions to shame, belittle, isolate, change their understanding of reality, and wear down their defenses.

The effects of emotional abuse can be far-reaching. Emotional abuse can lead to a host of chronic health problems, poor social skills, lack of social support, financial problems, depression, anxiety, poor self-esteem, concentration and memory problems, and sensory issues.

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When a person’s emotions are continually used against them to harm them, it can cause severe and complex trauma symptoms for the victim. Some of the symptoms of CPTSD in victims of emotional abuse include:

-hyperarousal of emotions

-hypoarousal of emotions

-feelings of numbness

-nightmares

-flashbacks

-poor sense of self-worth

-avoidance of triggers that remind victims of their abuse or abuser

-panic attacks

-physical symptoms related to reliving the trauma

-believing the world is a dangerous place

-overwhelming crying spells

-inability to register sensory input

-insomnia

-extreme fatigue

If you have suffered from emotional abuse, the best way to overcome it is to get help from a trusted, emotionally mature person. Seek out a counselor trained in treating the effects of CPTSD and emotional abuse so you can start to heal and grow stronger, becoming the person you were meant to be.

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When Is It Okay To Say “I Love You”?

Although dating has changed at a rapid, break neck speed our basic human needs have not. We are all made to be loved unconditionally and to give of ourselves to another human being without reserve, completely. Anyone who says otherwise has had the tragedy of never being loved completely or has had their heart broken in a terrible way.

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Love is a great risk, and yet we try and try again until we find that person who is just right for us. As I write this in 2021, many young people are choosing not to marry, are dating numerous people in rapid succession through the use of dating apps, are experimenting with so many flavors of relationships, and yet there is still a large loneliness and a longing for love that can’t quite go away.

This longing for a deep, intimate love is built into the core of our being. Yet with each rejection, each shallow relationship, hurt builds and builds until it explodes and is taken out on either ourselves or others. Is it any wonder that the biggest fear in a relationship is saying the words, “I love you?”

When people are hurt, it’s common to look for answers to our problems. We might see solutions in rejecting all men or women, monogamous relationships, people of a certain socioeconomic group, race, etc. None of these answers really satisfies the heart, however. As much as we are made for love, we are also not made for hate (the permanent, stick-around-forever kind of hate).

With so much instability in modern relationships, people will do anything in a relationship except say “I love you.” That’s because love means something permanent and a big risk. Being in love and declaring your love makes your relationship open to the possibility of rejection and solidifies it into something more than an ethereal passing moment of two lives joined together. It speaks the truth of the heart and of the relationship and how it’s meant to be.

Speaking truth to power in a relationship is always recommended, even if not well-received. It’s important to be honest not just with others, but with ourselves. Hiding who we are and our positive feelings towards others is not good for us or the people around us, especially those we are closest with. It’s better to take a stand in our closest relationships and identify our love for what it is, something beautiful and what is meant to be.

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Why It’s Good to Let Yourself Be Disappointed

As adults, we naturally tend towards hedonism as a way of life. We tend to avoid what hurts us and seek out what feels good. Pain, whether psychological or physical, causes stress to our bodies and our minds, which, when we endure it for too long, can cause mental health problems, chronic health issues, and burnout.

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However, staying too safe isn’t good for us either. Even as adults, our brains are constantly growing, developing new neural networks. Or at least that’s how we are designed. We are meant to be constantly evolving in new ways, learning new things, and achieving new insights and success along the way.

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Part of that growth naturally involves disappointment. No one, male or female, is successful at everything we attempt for the first, second, or third time. As we try things, and as we fail, we learn what works and what doesn’t. We become more creative, stronger, and more resilient. When one path leads to a dead end, we find a wonderful new trail we didn’t know existed and end up in destinations unheard of. Trying to be competent, safe, and sure of everything ahead of time is simply trying to avoid shame and disappointment. You go down the path everyone else has already trod on a million times that leads to the same place that you already knew about ahead of time. Your mind, your body, and your life remain stagnant, not really going anywhere.

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Sometimes people have an idea that they should wait until the unpleasant feelings go away before they try something new, before going on an adventure, before charting unknown territory. What happens is that they never go anywhere as those negative feelings hold reign over their lives and become their own prison. Rather, it’s better to take risks, experience disappointment, and grow from it all first. In other words, become really good at being a beginner. Over time, the unpleasant feelings will give way to the more positive feelings that naturally come with mastery and overcoming challenges. A good struggle, whatever the outcome, can make life more interesting and a tool for growth.

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There is no better time than now to reach out and try something new, scary, and challenging. Test your limits, and see how far you can go, and what you can learn from your experience. If nothing else, you will have some great stories to tell later.

Emotional abuse and the Independent Woman

Modern American culture celebrates and honors the independent woman. And that’s not a bad thing either – for a woman who is free to make her own decisions, truly liberated from the tyranny of being forced to behave or do something without respect for her free will – is a woman who can go on to achieve her full potential. However, beneath this lovely veneer of female American independence lies an unnoticed class of women who might appear capable, fierce, and successful – everything American culture glorifies. Yet on the inside, all of this independence is not a result of true freedom, but instead stems from having to do everything themselves from a young age, knowing they could not rely upon other people when they most needed help. Or if they did go for help, they were criticized, shamed, and rejected. Girls were not protected, fought for, or given evidence that they were worth spending time with.

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Dads play a big part in building up their daughter’s confidence. This isn’t to downplay the role of mothers either, but we need to look at how important dads can be in their daughter’s lives. I have had the honor of seeing so many wonderful dads who really encourage their daughters to try new things even if they are afraid of them, encourage them, and teach their daughters that they are valuable and worth protecting and cherishing.

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On the other hand when a dad makes himself too busy to spend time with his daughter, when he tries to force rather than encourage her to do something, when he criticizes his daughter being not _____ enough, when he compares her to other people, or calls her names, a daughter learns that it isn’t okay to be herself, that she isn’t good enough, and there is nothing she can do about it, because there is nothing her dad will do about his own behavior. Or the father may be passive and withdrawn, leaving the daughter to fend for herself and expecting that no one will help her out when she needs it the most. If her own dad won’t stand up for her or interact with her in a healthy way, who will?

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In other words, the daughter sees the truth about her dad’s behavior and unfortunately applies it to every relationship to her life, making it the blueprint of her actions and her destiny. She stops asking for things, she avoids relationships, or only enters into relationships that feel “safe”, and she withholds and withdraws from opportunity, growth, intimacy, and the potential for rejection. On the outside, the woman can appear capable, confident, and successful, but on the inside the woman is lonely, hurting, and suffering from anxiety and depression. Her own negative beliefs about men and her self-worth become self-fulfilling prophecies as she either numbs herself to the pain of her self-imposed isolation or repeats the same cycle of dysfunctional relationships with her partners. Her house is built on sand and it only takes a few things to trigger an avalanche of self-doubt, self-hatred, and tears that possibly no one will ever see. This is the hidden face of emotional abuse and it is unfortunately all too common.

How to Break Free From The Effects of Emotional Abuse in Your Life:

  • Find good people in your life who affirm your true value and spend time with them.
  • Don’t accept untruths about yourself from others.
  • Practice asking for and receiving help from the right people.
  • Work on changing those negative thoughts about yourself.
  • Either take a break from or cut out people in your life who tear you down.
  • Or alternatively, learn to set boundaries, including emotional boundaries with people who tear you down.
  • Celebrate your mistakes and shortcomings, rather than fear them. We all have them and it’s what makes us unique.
  • Celebrate what you have accomplished.
  • Practice self-care on a regular basis.
  • Overcome your shame by being honest about your thoughts and feelings with those who care.
  • Tell your story, and don’t hide it.
  • Find meaning and value in your community and your friendships.
  • Follow your dreams, even if they don’t match what other people want for you.
  • Know that your past does not determine your future.
  • Know that it is okay to have your needs met.
  • Know that you don’t have to be perfect.
  • Don’t ever give up on love and healthy relationships.
  • Learn to be okay with being yourself.
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