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Creative Hopelessness and Trauma: Difficulties with Unworkable Control

By Sonja Batten, Ph.D.

This video is part of our upcoming online course about ACT for PTSD.

Highlights

  • The work of creative hopelessness doesn’t always proceed in a linear fashion.
  • The therapist should approach this work with curiosity and openness.
  • Some clients may feel frustrated while others may feel validated. 
  • The important thing isn’t convincing the client that control is the problem but instead, introducing the topic to be referred to in future sessions.

 

Transcript

In this video, I’m going to talk about some common difficulties that therapists can encounter when working with creative hopelessness and addressing workable vs unworkable control in PTSD.

So, here’s one thing that can happen. What if when you’re generating that list that I just talked about, the client suggests that they’ve tried mindfulness or meditation or they’ve tried acceptance already as ways of dealing with the trauma? What do you do then? Aren’t we trying to, you know, get them toward mindfulness or acceptance?

Well, the therapist should always remain open to the possibility that acceptance may not work. But oftentimes, when you explore further with the client what it is that they’re saying, it turns out that they’ve been using mindfulness or acceptance as control strategies.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

So, an example is somebody says like, “Well, I already tried meditation. I did it and the first few times I did it I actually felt relieved and afterward, I fell right asleep. But after that, like every time I would start doing mindfulness, I would just notice all the things I felt anxious about and I never felt relaxed again.”

So, what you hear when you listen to that story is that the person had sort of an initial response where mindfulness was maybe relaxing or helped reduce anxiety, but that then they started trying to apply it as a way of reducing anxiety, which, as we’re suggesting, is part of the problem.

So, you have to listen closely to what people are talking about. Often, if they talk about meditation, mindfulness, acceptance not having worked, it’s because they were using those things as another method of control. So again, what we’re suggesting is that when you’re trying that control agenda, that’s what leads to problems.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

If the client, in another way, starts to feel frustrated during this stage of therapy, it’s important to help the person channel their sense of hopelessness in a productive direction.

So, what we’re not saying is that it’s a hopeless endeavor to try to recover from a traumatic past. We’re not saying that the person themselves is a hopeless case.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

The issue is that the situation is hopeless if the client continues to try to make the negative content related to the trauma go away. We can’t solve those negative thoughts, feelings, and memories. We can’t make them go away.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

But if we can notice that sense of being unsure of what to do next, that’s actually a really positive and generative place to be because it can mean that the person may be ready to open up to an entirely new approach.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

And although some clients will feel frustrated or confused as we point out that their regular strategies are part of the problem, you know, other clients will actually feel validated.

They’ve thought that there was something wrong with them for a long time, that they weren’t able to just get over what they’ve been through, that they just weren’t trying hard enough to move on.

But as we start to point out that this is a culturally-driven process that we’re taught by many forces to do, it can begin to make sense why we try and try to use strategies that not only haven’t worked but likely will never work. And the reason that they haven’t worked isn’t because there’s something wrong or broken about the client.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

And although it doesn’t happen very frequently in my experience, it’s important to note that some clients will respond very strongly to the points raised in this session and may even argue with the therapist that control works.

If that’s happening, you may want to gently explore what it is the client means by that.

But it’s important not to get into a push-pull or an argument about semantics. The client is the expert in what his or her experience is, not you.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

So, in that situation, I might just ask, in a non-defensive way, if we can return to this topic from time to time and continue to explore the situations where internal control does and doesn’t seem to work.

So, by approaching the situation with curiosity rather than from a need to be right, the therapist can help to defuse the conversation rather than getting into an unnecessary intellectual argument.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

Introducing concepts of creative hopelessness can lean toward the intellectual or conceptual at times, and especially with highly verbal clients. Therapists should make sure that they are themselves mindful and on the lookout for times when they may be getting hooked on content or on being right, and catch themselves in those moments to bring the conversations back to the client’s direct experience.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

And finally, some trauma survivors may have a strong reaction to your words when you suggest that control may be part of the problem.

For many individuals, the experience of a trauma was itself a literal loss of control. And so the suggestion that they should let go of control may feel dangerous and terrifying.

If this comes up, the therapist can clarify we’re not talking about letting go of control in the external world. If there are things you can effectively control and manage, then there’s no reason not to do that.

What we’re suggesting here is that trying to control things in the internal world—your thoughts, your feelings, your memories—that that’s probably not very effective and may even be harmful to recovery in the long term.

References

Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. New Harbinger Publications.

So, to summarize the key points.
The work of creative hopelessness doesn’t always proceed in an entirely linear fashion.
The therapist should approach this work with curiosity and openness to whatever the client’s experience has been.

Some clients may feel frustrated by this part of therapy while others may feel validated that someone finally understands just how hard they actually have been working to try to deal with their trauma history.
Any client response is okay at this point.
The important thing is not convincing the client that control is the problem but instead, introducing the topic so that it can be referred to as it comes up in future sessions.

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