This is a fairly long post, because it includes an article by one of the authors of this non-fictional book, apart from my own review, but I felt it was so important it deserved the space.
Trauma Recovery – Sessions With Dr. Matt: Narratives of Hope and Resilience for Victims with PTSD by Matt E. Jaremko, Beth Fehlbaum. Recommended to readers and professionals interested in PTSD and to those considering therapy.
Trauma Recovery: Sessions with Dr. Matt conveys hope and resilience for trauma victims. Written by a psychologist with 35 years of clinical experience, and a survivor of childhood sexual abuse. Between compellingly-written scenes of group, individual and family therapy, the cognitive-behavioral science of PTSD and its treatment is explained. The book movingly describes the collaboration between therapist and clients as they strive to get unstuck from trauma-ravaged lives. Reluctant trauma victims who have avoided treatment or who are having trouble processing life’s catastrophes will find in these pages a “fly-on-the-wall” perspective of how therapy can help. Useful information about overcoming obstacles in treatment is provided while fears about facing trauma are allayed, motivating the reluctant victim to finally seek treatment. The book will also greatly inform motivated patients by providing a thorough, scientifically-sound understanding of PTSD’s nature and treatment. This book should be in every trauma therapist’s office and placed in the hand of each of their PTSD patients.
About the authors:
About Matt E. Jaremko
Matt E. Jaremko, Ph.D. Matt Jaremko has taught clinical psychology at the university level for almost 20 years. This academic activity has been balanced by the operation of an independent practice of clinical psychology for over 25 years. He estimates having taught over 2000 students through the years and delivered over 35,000 hours of psychological services to around 10,000 clients. During a career spanning 40 years, he also engaged in stress and trauma research activity, as shown by over 30 publications and nearly a hundred presentations at professional meetings. Matt retired from professional work in 2012 and lives in Dallas, Texas with his wife. In addition to writing, he spends time keeping up with his five grandchildren, teaching them to appreciate nature, science, self-sufficiency, and golf. His passion has become working with his hands, building/rehabilitating homes and making furniture. Check out Dr. Jaremko’s blog, Hope for Post-Traumatic Growth, at drmatt bookblog.com.
About Beth Fehlbaum
In addition to writing Young Adult Contemporary Fiction, Beth Fehlbaum is a high school English-Language Arts teacher who frequently draws on her experience as an educator to write her books. She has a B.A. in English, Minor in Secondary Education, and an M.Ed. in Reading.
Beth is a featured author on the 2015-2016 Spirit of Texas Reading List- High School for the Kirkus Starred Reviewed Big Fat Disaster (Merit Press/F+W Media, March 2014) and The Patience Trilogy: Courage (1), Hope (2), and Truth (3) (Steady On Books, April 2016).
Beth is a member of the RAINN (Rape, Abuse, Incest National Network) Speakers’ Bureau. She has a following in the young adult literature world and also among survivors of sexual abuse because of her work with victims’ advocacy groups.
She has been the keynote speaker at the National Crime Victims’ Week Commemoration Ceremony at the Hall of State in Dallas, Texas and a presenter for Greater Texas Community Partners, where she addressed a group of social workers and foster children on the subject of “Hope.”
Beth is a survivor of a traumatic childhood, like Ashley in The Patience Trilogy, and the day-to-day manager of an eating disorder much like Colby’s in Big Fat Disaster. These life experiences give her a unique perspective, and she writes her characters’ stories in a way meant to inspire hope. Trauma Recovery: Sessions With Dr. Matt is Beth’s first foray into creative non-fiction.
Beth lives with her family in the woods of East Texas.
One of the authors, Dr Matt Jaremko, contacted me about the launch of this book a few months before it was published, and he has kept me up-to-date with its progress. He was also kind enough to write a bit of a description/introduction for my readers, explaining how this book came to be and offering a bit more background on it. This is it:
Understanding How Post-Traumatic Stress Disorder Can Become Post-Traumatic Growth
A Brief Summary of Trauma Recovery: Sessions with Dr. Matt
In the early 1980s, my Monday evenings were spent as co-leader of an open-ended therapy and support group for Vietnam veterans at the Memphis Vet Center, a storefront clinic and service center housed in downtown Memphis, not far from Beale Street and its blues music. The Memphis Vet Center was the VA’s program to make services more intimate and available to veterans.
The mood of every session varied widely, but anger was a common theme. Group sizes ranged from 3 to 20 participants, homeless vets alongside retired officers. Most attendees came to only a couple of sessions, but there was a sizable block who were ‘regulars’—maybe 100—who attended dozens of sessions in the 3 years I was involved leading the group.
Most group participants had psychological and behavioral problems associated with Post-traumatic Stress Disorder. But as I listened to them talk about themselves and to each other, the most valuable lessons I learned had more to do with their strengths than their weaknesses. First, one of the biggest tragedies of military experience was not the nightmares, flashbacks, shame and/or horror of having witnessed or committed horrible acts, and not even the never-ending negative emotions of their lives. The worst outcome of serving in that war for many was being robbed of the value system they believed in prior to their service.
Most Vietnam veterans volunteered in order to contribute to a cause they thought noble and worth their sacrifice: to protect a democratic way of life by providing a check on Communism. Unfortunately, after serving, many vets came to the conclusion that their sacrifice had been wasted by politicized leadership agendas and military tactics that made little sense. The veterans were disillusioned because they began to see they were being used by their country, rather than serving their country.
Moreover, when those combatants returned home, their patriotism was attacked and shamed by those in a protest movement. Home was a place in which they no longer fit. They were hurting, alone and bitter about what they had seen and done. The ideals upon which they had decided to serve had been shattered. In the resulting “values vacuum,” only the unpleasantry of powerful PTSD symptoms was left. Additionally, they were rarely taught how to replace or renew the compromised values system.
A second thing I learned from those Vietnam Veterans was the importance of the “platoon”, usually a squad of 10 or 12 men. Even though together for only 13 months, the bond that quickly developed was very powerful and motivating. It was not uncommon in the sessions to hear men talk about how much they cared for the others in their basic small unit. In fact, often it was only other vets these men felt comfortable with and/or trusted.
I came to realize the healing power in those small groups. The Memphis Vet Center Monday Night Therapy and Support group became a “platoon” where vets could work with each other to rediscover or replace their lost values. Once they accomplished this values clarification, many found more strength to cope with the symptoms of PTSD, and they became more receptive to learning the cognitive and behavioral skills helpful in rebuilding life after trauma.
Since those days at the Vet Center, I have been involved in the treatment of many other folks who had traumatic events in their lives, including Childhood Sexual Abuse, motor vehicle accidents, crime victimization and sexual assault. A common feature of these trauma survivors is this loss of belief in previously-held values. Values can be defined as activities or outcomes considered important in life. Being clear about what is important is often missing for trauma victims. Like the combat veterans’ loss of guiding patriotic values, survivors of Childhood Sexual Abuse (CSA) spend the first 8–10 years of life learning trust, only to find that it was no more authentic than a politician’s promise. Many battered spouses go through life in fear for their physical safety, only to have such fears confirmed by violence eliminating a valuable sense of security. A vacuum is formed where once there was a strongly-held belief about an important feature of life. Without a sense of knowing what is important in life, trauma victims find little motivation to engage in the hard work of coping with unpleasant symptoms.
Addressing this values vacuum is important so victims can find increased strength to cope with the trauma encountered. Since the main method by which we learn values in the first place is through social interaction with important people in our lives, group process is a powerful mechanism by which victims can examine changed values systems and begin to renew and replace them.
Rates of Trauma and Overcoming It
A recent study (Kilpatrick, et al, 2013) reveals that over 80% of 3000 people surveyed report having experienced a major trauma. 80%! These traumas include physical or sexual abuse-53%; death of a family member due to violence-51%; natural disaster-50%; accident/fire-48%; witnessing physical or sexual assault-33%; and combat or warzone exposure-8%.
Most victims of trauma (including most veterans of military combat) “get over it” in 12-18 months. But 20% don’t. They develop PTSD. What is the difference between the 80% who adjust and the 20 % who can’t “get over it”?
An entire article can and should be devoted to the complicated concept of “getting over it.” For starters, even if they get past the trauma, their life narrative is forever changed. Plus, somewhere between 40-60% of folks who have a life trauma end up eventually saying that their life is better for it: an outcome called post-traumatic growth (Calhoun and Tedeschi, 2103).
In fact, if one thinks about it carefully, a good question to consider is WHY IS THERE NOT MORE PTSD, if over 80% of people report having had trauma in life? My experience with Vietnam veterans has led me to the conclusion that folks who “get over it” address the destruction of their values system in some kind of group interaction, formal or otherwise.
Internal Dialogue: The Role of Narrative in Recovery
Each of us spends most of our waking hours engaged in an “internal dialogue” where we describe, evaluate, and re-imagine the events happening around us. To a cognitive-behavioral psychologist, internal dialogue is behavior that can be examined in a technical manner. It is determined by past social experiences and it is changeable.
The incessant internal dialogue going on inside is the raw material of the life story or narrative we each are creating. After a trauma, that narrative naturally becomes negative, even tragic. But the good news is that the trauma-tinged internal dialogue can be modified by changing the patterns and content of interactions with others.
Verbal behavior, including self-talk, is strengthened or weakened by how those listening to it respond to it. When what we say is met with positive reactions from others, similar thoughts and statements in the future are more likely. But when the verbal behavior is met with bland or even negative reactions from those in our social community, such content tends to be weakened. This process of ‘shaping’ what we say and what we think goes on constantly and has been going on in our social interactions since birth.
Thus, the content of internal dialogue is infinitely changeable, depending on with whom one is interacting. However, once set, internal dialogue can and does get stuck if the social group with whom one interacts becomes stagnant where only one type of content (e.g., negative/hopeless) is encouraged over other types. In addition, many exposed to trauma greatly reduce the number and range of people with whom they interact, further reducing input to change internal dialogue.
The narrative of a life can be going along great, maybe even according to one’s life plan, and then WHAM!—a trauma happens, and the narrative changes. Before trauma, a glimpse of the internal dialogue might be summarized as “Everything is okay/I’m in charge/I like my life/ I have hope/this is fun, if not hard.” After trauma, however, it becomes “The hurt is unbearable/I can see no end to it/I can’t do anything to stop this pain/others don’t understand/nothing matters anyway/my life is awful/I’m awful/HELP/leave me alone.”
Specific content in the internal dialogue is important. Social communities encourage asking others for advice, input and even help. Also encouraged, even demanded, is the labeling of the causes of the events that happened and attributions of who caused them. Most of us spend significant time engaged in an internal dialogue musing about who did what and why it was done, influenced greatly by what those around us are saying on similar issues. Unfortunately, after trauma, when victims decrease interaction with others, less input can be provided from other people and internal dialogue can remain stagnant and usually negative.
When that happens the avoidance symptoms of PTSD take over, and the life gets stuck! But the internal dialogue does not stop. Constant negative self-talk, often on “automatic pilot,” goes on indefinitely. Social relations suffer (and stop), health suffers, job/family/marriage and other practical matters get dysfunctional. The narrative that accumulates turns into a pain-filled and hopeless modern tragedy. Mix in alcohol, drug abuse or poor life decisions, and the spiral swirls wildly.
Two Particularly Pernicious Patterns-Values Vacuum and Loss of Self-Efficacy
The unchecked internal dialogue results in an unrelenting and pervasive sense of pain and avoidance, which makes life bad enough. But when the victim stays stuck for too long in this spiral, life worsens.
First, as outlined above, the trauma event often shatters long-held central beliefs and values. The victim loses sight of what is important in life. With the values vacuum often comes a lack of passion and enthusiasm for progress or renewal. The grieving parent loses the motivation to show love to others. An abuse victim dares not place trust in others, however well-meaning. A veteran finds it impossible to take orders or tolerate the petty details of life. Crime victims never allow themselves to assume safety. A rape victim can’t let intimacy happen because it only means more pain. Getting stuck in the negative internal dialogue only creates more being stuck because new interactions and ideas are avoided due to reduced interaction with others.
A second outcome of a life thus interrupted by trauma is a horrible case of the “I can’ts.” Psychologists identify Self Efficacy as the belief a person has that he/she can actually perform a specific behavior. For example, successful cooks have the belief they can prepare a tasty meal, whereas someone who has never done any cooking has very little belief (self-efficacy) in the ability to cook. An experienced driver might have a strong belief that she can drive in heavy traffic, but the new driver is not so certain.
Self-efficacy beliefs result from four types of life experiences: performance accomplishments, vicarious experiences of watching another conduct a task, verbal encouragement from others about learning and doing a new skill, and the experience of actual physical sensations/feedback when a task is attempted and completed.
Self-efficacy is important because if one has little of it in a particular category of behavior, that person will make very few, if any, attempts to perform that action. Trauma victims who are stuck are convinced they can do nothing about the unpleasantry of their lives. They can’t be honest about the trauma and their shame. They can’t let other people know how completely messed up they feel. They can’t take on new challenges added to the load of daily survival. They can’t, they can’t, they can’t. And sadly, they don’t.
PTSD is a disorder of “being stuck” in a never-ending cycle of avoiding the unpleasantry, believing and/or trusting in nothing once-valued and a lack of belief that something can be done to change this cycle (self-efficacy).
A crucial component in trauma recovery is becoming educated and aware of this process of getting stuck so that plans can be devised to reverse it. Cognitive behavior therapy typically consists of three phases: education about the problems-their causes and effects; identification and practice of skills that reduce the problems; real-time application of the newly learned coping skills in day to day life situations to reduce the problems. The first step in the education phase for trauma victims is to understand why they are stuck. Such an educational rationale then provides the framework on which new skills and behaviors are gradually tried and eventually perfected.
Engineering Post-traumatic Growth-What Must Be Done to Become Unstuck
The good news is that there is much that can be done to change the dynamics described above. In fact, the difference between trauma victims who eventually come to have post-trauma growth and those who go on to get stuck in PTSD is the arrangement of a social community in which self-efficacy is “manufactured” by arranging the four life experiences mentioned above.
Engineering can be defined as the process of combining smaller parts to construct a larger and useful entity. A thousand 2×4 sticks can be made (engineered) into the frame of a 3000 square foot house. Behavioral engineering happens when we combine smaller acts into a longer chain of acts that can produce beneficial outcomes. Attending 120 hours of college classes can result in learning a profession or trade useful for the rest of one’s life.
For the trauma victim, the narrative of “I can’t” must change to “I can.” Behavioral science suggests a technology of behavioral engineering through social interaction, i.e., the power of the group. Trauma victims who survive and learn to thrive make social interaction changes by taking small steps toward being more real and “authentic” with themselves and others. They begin to make gradual progress toward improved coping by learning new stress management skills. And they redefine what is important in their lives by finding passion and meaning in pursuing those values. All of these outcomes happen by changed social interaction patterns, sometimes in therapeutic situations and sometimes in self-help groups or other groups occurring naturally in a person’s life, like family or a work environment.
While it might at first seem difficult if not impossible to find or become a part of such a healing community, changes are more possible than ever in the age of social media. Many opportunities exist in which trauma victims can reach out to others and begin the step by step process of rehabilitation. The necessary conditions for the above changes taking place include finding someone to guide such a journey (therapist, mentor, coach or sponsor), taking small steps toward being more truthful and open about the trauma and its impact (writing or sharing an account of what actually happened), learning new skills to think about and manage stress or modify behavior (stress management training and behavior contracting) , participating in group involvement with others on similar journeys (regular meetups devoted to supporting and challenging oneself and others) and finally, finding meaningful life pursuits that generate passion (values clarification).
Cognitive and behavioral therapies, preferably in group contexts, are available to create the new social communities that will help one re-write the narrative of damaged lives. Many published or online sources exist that show how to create these essential changes. An excellent place to start is this website: cptforptsd.com. Another helpful webpage details the narratives of trauma survivors who achieved post-traumatic growth by clarifying values and finding life pursuits about which they became passionate.
And when recovery from trauma happens, a glimpse of the repeating loop of internal dialogue might become: “That hurt was the most difficult experience in my life/But I have managed to survive/If I can survive that, I can do anything/Thank goodness for my real friends/I’ve learned what is truly important in life/I’m pumped about passing on what I’ve learned.”
We hope you begin to investigate this approach to trauma recovery through rearranging social interaction in healthy and progressive ways. Our new book, Trauma Recovery: Sessions with Dr. Matt is one way to visualize such a journey in that it describes in detail the narratives of seven trauma victims whose interactions with a therapist and each other achieved the needed changes to recover from trauma. While the book is on sale at Amazon and other booksellers, both Matt and Beth are committed to making a copy of the book available to anyone who is not able to afford its purchase. We can be contacted through our website, drmattbook.com.
You can also access his interview with Dr. Michael Britt on The Psych Files here: http://www.thepsychfiles.com/2018/10/ep-314-trauma-recovery-with-dr-matt-jaremko/
I thank the authors and the publisher for providing me an ARC copy of this non-fiction book that I freely chose to review.
As some of you might know, I’m a psychiatrist, and although I am not working as a psychiatrist at the moment and have mostly worked in Forensic Psychiatry, there is no specialty of psychiatry where we don’t come across Post-Traumatic Stress Disorder, unfortunately. As researchers and practitioners have discovered in recent years, trauma is more widespread than people think, and it can have a bearing even in some of the classic psychiatric diagnosis, like schizophrenia and bipolar disorder.
You have probably come across many books written by survivors of a variety of traumatic experiences, and this is a very useful trend, as one of the things that people who have experienced trauma share in common is the feeling that they are alone and nobody understands or shares the way they feel. Reading other people’s accounts and sharing in their hope can be a very useful first-step towards seeking specialised help and starting the journey towards recovery.
This book manages to combine two aspects contained in books on the topic that are difficult to get right. On the one hand, there is a solid and clear explanation of the main therapeutic technique he uses and some adjunctive therapies, and the background to the approaches that Dr Jaremko has used in his everyday clinical practice for many years. On the other, and to illustrate the theory, there is a fictionalised account of a series of sessions of group therapy that seven patients engage in throughout the book. These patients, males and females, from different backgrounds, ethnic and social origins, and who had suffered a variety of traumas, meet regularly for a whole year and learn together, through their interactions within the group, how to apply the lessons learned through the therapy, while supporting each other and modelling their behaviours upon those of the others in the group who might be further away in their journey. Some of the patients, like Ashley and Darren, had been attending the group for a long time, while others, like Patty and Felicia, are newcomers. Beth Fehlbaum, the co-author of the book, has her personal experience as a trauma survivor to bring to the book and her years as an author too, and the fictionalised part of the book works very well. The characters are individualised, fully-fledged, and we get to know them, not only through their group sessions, but through some fragments of chapters when we share in what they think and how they feel from their own perspective. There are highs and lows for all the characters, and not a single one of them is always right and well (life is not without its bumps), even those who have come the farthest through the process. Because it is a process and there are no magic bullets, but there is help out there, and that is what the book excels at: giving hope to those who experience PTSD but have never tried therapy, or have tried therapy but it has not worked for them.
As I read the book, I kept wondering about its format. At first, especially as somebody who has read a bit about the subject (although I have never worked exclusively as a therapist, run group therapy, or used Cognitive Processing Therapy, the approach recommended by the book and also by many experts working in PTSD), I found that there was a fair amount of repetition of some of the key elements and theoretical concepts, that would make sense if the book was read more slowly by people interested in becoming familiar with many of the basic therapeutic aspects, perhaps chapter by chapter. Although I felt readers would probably connect more easily with the fictionalized characters and their difficulties and experiences, than with the purely theoretical parts, I realised that the process is somewhat similar to that the characters go through. They have much to learn and to become familiar with at first (you cannot enjoy stories if you don’t know the alphabet and understand the mechanics of reading), but slowly they gain in confidence, start applying what they have learned and can offer insights to others that they might have missed. The book, towards the end, becomes more dynamic and we can follow more directly the group sessions and the events in the characters’ lives, with the therapeutic aspects more seamlessly incorporated.
Dr Matt, the fictionalised version of Dr Jaremko, also shines through the book, and we get to know him, not only as a professional, but also, although less, as a person with his own plans and interests outside of his practice. Although he is well-liked by the patients, there is no hero-worship at play, and the book clearly explains that finding a therapist with whom one can work is not easy, no matter how good a professional the therapist is or how highly recommended s/he comes. The book emphasises the importance of finding a therapist or a mentor expert in the condition and there is never any suggestion that the book itself can cure anybody, but it is meant as a way to explain and exemplify what the therapeutic process might look like, and to offer hope and encouragement to those who have been stuck suffering, unable to decide what to do, or firmly believing there is no solution.
The book also offers great resources, to both professionals and patients. There is a bibliography at the end that includes books, articles that can be downloaded, and websites to check for more information. The appendixes include relaxation techniques, worksheets, advice on how to choose a therapist (and although some aspects of this are very USA based, the general principles would apply anywhere), and one of my favourite aspects of the book was that each chapter contains a playlist including songs and movies relevant to the aspects of trauma and therapy discussed there, and there is much emphasis placed on the importance of reading and of books that inspire the journey to recovery. In the same way that no patient would be cured just by reading this book, but they might feel inspired to seek help, no psychologist or therapist would become an expert on how to treat PTSD just by reading this book, but they might discover new approaches that they might want to explore further and learn more about. Although the book talks about PTSD, as I read it I could not help but think that many of its lessons and the examples of behaviours and erroneous beliefs highlighted through the theory and especially the sessions (there are some individual sessions also illustrated in the book, although they always result from questions or aspects of a patient’s experience that has been discussed in one of the group sessions) would have practical application in many other conditions. Cognitive errors (or “stinking thinking”, as it is known in the sessions) are common in many psychiatric conditions, and we all get stuck with them at some point or other. Much of the advice about how to change behaviour (CPT has its roots in CBT, cognitive behavioural therapy) could be applied to aspects of our lives that we wish to change, and that is one of the beauties of this method and the book, that it feels common-sensical once we get used to analysing the way we think in those terms.
As a writer, I also thought this book would be a great resource to other writers who are interested in understanding their characters’ motivations better, in particular to those who write about characters with a diagnosis of PTSD or severe trauma.
This is not a book for everybody, but it is a book that I am sure will provide useful information to people interested in the subject, and you do not need to be an expert to follow the theoretical basis behind the therapy. It is also very well written, and you will get to care and feel for all the characters in the group, and that is something that as an avid reader I know is not always easy to find, even in fiction. As you can imagine, the book contains descriptions of the traumas that the characters have suffered, as that is necessary to understand the therapy and the way the patients react to it. Those go from sexual and physical abuse to war trauma, natural disasters, hate crimes, and road traffic accidents. So, plenty of trigger warnings. On the other hand, if the book can inspire readers suffering from the condition to seek a therapist and start in the way to recovery, it is well worth a read.
Note that both authors are happy to provide copies of the book to people who cannot afford it but feel might benefit from it.
A great resource for professionals and others interested in the topic, with characters that feel real and we get to understand and care about. Highly recommended.
Thanks to both authors and to the publishers for this opportunity to read this important book, thanks to all of you for reading and remember to like, share, comment, click, review, and if you know anybody who might be interested, please, let them know. And keep smiling!