 Many people with trauma experience intense disregulated anger and other disregulated emotional states. During these moments, traumatized people often feel they have little control and feel shame after coming back to emotional homeostasis. Though I know next to nothing about comic books, I think Dr. Jacob Ham's metaphor using The Hulk is perfect for describing what a lot of trauma survivors experience.   
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 I recommend this podcast episode from Therapist Uncensored to my couples therapy clients all the time: Ping Pong Vs. Catch: Turning Communication from Competition to Connection.
    
*You keep talking about "attachment-based relationships." What do you mean by that?
By "attachment-based relationship" I mean an intentional relationship where you agree (or less ideally, it's implied) that you show up regularly for each other, prioritize the each other and the relationship, and are committed to the relationship. This can mean answering calls of distress during your work day, being an emergency contact, responding to emotions, building a domestic life together. Sue Johnson says it best: "Underneath all the distress, partners are asking each other: Can I count on you? Are you there for me? Will you respond to me when I need, when I call? Do I matter to you? Am I valued and accepted by you? Do you need me, rely on me?" Attachment-based partners should answer an enthusiastic yes to all these questions. If not, couples therapy can help!  Childhood trauma can result from a wide range of experiences, including but not limited to: 🌟Physical abuse 🌟Sexual abuse 🌟Emotional abuse 🌟Neglect 🌟Chronic Invalidation 🌟Witnessing violence 🌟Natural disasters 🌟Bullying 🌟Serious accidents, injury, health crisis 🌟Loss of, or fear of loss of, a loved one (death or separation) 🌟Poverty and severe lack of resources 🌟Fear of violence 🌟Racism, sexism, homophobia, transphobia, classism Childhood, developmental, or complex trauma can leave individuals suffering beyond the typical PTSD symptoms. The effects of childhood trauma can be long-lasting and can interfere with the development of healthy relationships, self-worth, and coping skills.  Due to a lack of healthy relationship models and low self-worth, trauma may impact an individual's ability to trust others and form healthy relationships, leading them to find themselves in and tolerate abusive partners. Childhood trauma can also lead to feelings of worthlessness and self-blame, causing a person to believe they deserve abusive treatment. Trauma may lead to the repetition of unconscious patterns of behavior and emotions from childhood in present relationships. These patterns can manifest as conflicts, power struggles, or communication issues in the current relationship and often serve as a reenactment of childhood traumas, unmet needs, and unresolved conflicts.  Self-criticism can result from internalizing negative messages and beliefs individuals receive during traumatic experiences. These experiences can lead to feelings of shame, guilt, and self-blame, causing the person to believe that they are responsible for their own mistreatment. The intense self-criticism can also stem from a belief that they could have done something to prevent the trauma, or that they are inherently flawed or deserving of abuse. This self-criticism can have a profound impact on a person's self-worth and can lead to negative thought patterns and behaviors that perpetuate the cycle of trauma.  Trauma can lead to feelings of insecurity and fear, causing an individual to perceive even minor conflicts or perceived rejections as threats to their well-being. This heightened sense of threat can cause them to react with defensively, which can further strain the relationship. Additionally, trauma can also impact a person's ability to form secure attachment bonds, making it difficult for them to trust others and leading to a persistent fear of abandonment. Trauma can have a profound impact on an individual's emotional regulation system, altering the way the brain processes emotions, and causing a person to experience intense and prolonged emotional reactions, even in response to triggers that may seem minor to others.  Trauma impacts one's sense of self and perception of the world. Childhood trauma can lead to feelings of self-doubt and a tendency to second-guess one's own thoughts and feelings and can also interfere with the development of healthy coping skills and increase anxiety, making it difficult for an individual to accurately interpret their internal experiences. Trauma impacts the brain's ability to process and store information, causing an individual to have difficulty discerning and trusting their own thoughts and feelings. Trauma can lead to feelings of self-doubt and low self-worth, causing an individual to question their own judgment and abilities.  Trauma often leads to feelings of shame, guilt, and self-blame which can cause a person to view themselves as inherently flawed or inadequate. The lack of healthy self-worth and self-esteem leads to a persistent sense of insecurity and self-doubt. The belief that one is not good enough can have a profound impact on an individual's relationships, career, and overall quality of life. Trauma can lead to feelings of insecurity and fear, causing an individual to believe that their survival and well-being depend on the approval and acceptance of others interfering with the development of healthy boundaries and a sense of self, leading to difficulties in asserting oneself and saying "no" to others. This can cause an individual to be overly accommodating and to avoid expressing their own opinions or needs and living authentically.
A superbill is a detailed receipt you can submit to your insurance provider to seek reimbursement. You pay your therapist directly and are reimbursed a portion by your insurance later. More about my process with superbills here.
Use This Free Tool To Estimate Your Reimbursement Rate:Questions to Ask Your Insurance:
Call the number on the back of your health insurance card and ask for “member services." Ask these questions to verify out-of-network coverage:
 Sliding-scale clinics and therapists offering services in the East Bay and San Francisco:
OpenPath Collective (You can choose you own therapist. Clinicians charge a max of $70 for individuals and $80 for couples) Pacific Center (serving the LGBTQQIA community) Queer Life Space (serving the LGBTQQIA community) The Liberation Institute (fees starts at $1) The Wright Institute Clinic JFK Counseling Center Church Street Integral Counseling Center The Psychotherapy Institute Alchemy Therapy Cal State East Bay Clinic Family Paths Heart In Balance Roots Community Clinic  Ever wonder why you have a hard time trusting yourself? Why you you have a hard time making a decision? Why you have such a harsh inner voice? Perhaps you grew up in an invalidating environment.  According to Marsha Linehan, the creator of Dialectical Behavioral Therapy, "an invalidating environment is one in which communication of private experiences is met by erratic, inappropriate, and extreme responses", such as punishment or ignoring.  Chronic invalidation during childhood can have a significant impact on an individual's mental health and well-being as an adult. When a person's thoughts, feelings, and experiences are dismissed, ignored, or judged repeatedly it can lead to the development of negative beliefs about oneself and one's experiences, as well as difficulties with trust, self-esteem, and emotional regulation. It can also increase the risk of developing mental health conditions such as depression and anxiety.  Ooooh, easier said than done, for sure, but quite worth it!
 Self compassion helps individuals to be kind and understanding towards themselves when they are experiencing difficult thoughts, emotions, and experience. This can lead to a reduction in negative self-criticism and an increase in positive self-regard. Research has shown that self-compassion is associated with lower levels of depression, anxiety, and stress, as well as increased well-being, happiness and life satisfaction. Here's a Stanford study. Self-compassion can INCREASE accountability by helping people recognize and acknowledge their mistakes and shortcomings without becoming overwhelmed by feelings of self-criticism and shame. When individuals are self-compassionate, they are able to view their mistakes and failures as part of the human experience, rather than as a reflection of their personal worth. This allows them to take responsibility for their actions without becoming overly self-critical. Self-compassion can also help individuals to learn from their mistakes by encouraging them to be honest with themselves about what went wrong, without becoming paralyzed by self-doubt or fear of failure. By taking this approach, self-compassion can help individuals to develop a more resilient and growth-oriented mindset, which can lead to better problem-solving skills and improved decision-making. More on that. Self-compassion will not make someone less productive because it actually promotes a sense of motivation and engagement. Self-compassion allows individuals to understand their mistakes and shortcomings without feeling overwhelmed by self-criticism and shame, which can lead to feelings of hopelessness and demotivation. Instead, self-compassion provides a sense of emotional support, which helps individuals to be more resilient and persistent in their efforts to achieve their goals. Additionally, self-compassion promotes a growth mindset, which encourages individuals to focus on the process of learning and self-improvement, rather than the outcome. This can lead to a more positive and proactive approach to problem-solving, which can ultimately increase productivity. Self-compassion also allows individuals to take a balanced view of their performance, which can help them to maintain a healthy work-life balance and avoid burnout. By being kinder to oneself, individuals are less likely to experience feelings of stress, anxiety and depression, which can negatively impact productivity. Instead, self-compassion can lead to better mental and physical well-being, which can enhance overall productivity and effectiveness. An exercise to start thinking more compassionately.
 When clients are working on feeling, understanding, processing, and soothing their feels I often recommend, Tara Brach's RAIN practice, a mindfulness technique that helps individuals recognize, allow, investigate, and nurture their inner experiences. The acronym RAIN stands for: R - Recognize what is happening A - Allow the experience to be there, without trying to change it I - Investigate with curiosity and openness N - Nurture with self-compassion The practice encourages individuals to become more aware of their thoughts, emotions, and bodily sensations, and to approach them with a non-judgmental attitude. By investigating these experiences with curiosity and openness, individuals can gain insight into their patterns of thinking and feeling, and cultivate self-compassion and self-acceptance. She has a free recording of this practice on her website. 
 Dialectical Behavior Therapy (DBT) is an evidence-based treatment that has been found to be effective for individuals who have difficulty regulating their emotions. There are several reasons why DBT is effective for emotional regulation:
A wildly oversimplified example of how one might apply their DBT skills IRL.Below is a hypothetical example of how one might use the DBT Skills Stop, TIPP, WiseMind, and DearMan.  Stop stands for Stop, Take a breath, Observe, and Proceed mindfully. It's a skill that helps individuals to manage intense emotional experiences, by allowing them to take a moment to pause and gain a new perspective before reacting impulsively. Here's a video.   TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Progressive muscle relaxation. It is a skill that helps individuals to regulate their physiological state and emotional arousal in order to manage intense emotional experiences, such as anger, anxiety, or panic. Temperature: It's a technique to change your internal temperature, by drinking cold or hot water, or put a cold pack or a hot pack on the part of the body where you feel the sensation of the emotion. Intense Exercise: Physical activity is a powerful way to release pent-up energy, reduce stress, and improve mood. Engaging in intense exercise can help to reduce feelings of anxiety, anger, or depression. Paced Breathing: When you're feeling anxious, angry or stressed, your breathing can become shallow and rapid, which can make you feel more anxious. Paced breathing is a way to slow and deepen your breath, which can help to calm your body and mind. Progressive muscle relaxation: This technique involves tensing and relaxing different muscle groups in the body, which can help to release tension and relax the body. By using TIPP skill, individuals can learn to regulate their physiological state in order to manage intense emotions and improve their ability to cope with stress. It's a powerful tool for managing intense emotions and reducing stress. Here's a video.   In DBT, it is said that people have different states of mind, such as emotional mind, rational mind and wise mind. Emotional mind is a state of mind where emotions are the main driver for the behavior and decisions. Rational mind is where logical thinking is the main driver. Wise mind, on the other hand, is the state where rational thinking and emotions are balanced and integrated, allowing the individual to make decisions that are grounded in both logic and emotional understanding. It's the state of mind where the person is able to make the best decisions in their life. Here's a video.   The DEARMAN technique is a way for individuals to build assertiveness skills and to communicate in an effective way. It can be used in situations where one feels uncomfortable or unsupported in expressing themselves. Here's a video.  The goal of DBT is to help individuals by teaching them skills to regulate their emotions, increase nervous system regulation, improve their cognitive flexibility and increase their mindfulness. This can help them to make better decisions, solve problems more effectively, and improve their overall well-being.
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AuthorStephanie Bain, LMFT Archives
March 2023
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***Resources are not a substitute for therapy and are not intended for making diagnoses or providing treatment. Not all practices and tools are suitable for every person. Please discuss exercises, practices, and tools with your individual therapist or health care provider.
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