Trauma can be understood as any extraordinarily stressful experience in life that has a lasting negative impact on someone.
Our counselors have advanced training on how the brain and body respond to and hold onto the effects of trauma. Our team understands how trauma can have a lasting impact on people’s perspective, relationships, life story, daily functioning and how its effects can lead to feelings of extreme depression and anxiety as well as being misunderstood by people in your life, misdiagnosed by professionals, or even medically mismanaged.
Our goal is to help our clients understand how trauma affects them as a whole person and work with them to reunify their thoughts, emotions, and body. We have training on advanced techniques that can offer symptom relief and a path out of feeling hopeless. The good news is that with time and focus, most people can become symptom-free and learn to manage future difficulties from a place of inner peace and strength.
The Trauma-Informed Counseling Center of Grand Rapids is proud to be a wing of Health for Life Grand Rapids. The Trauma-Informed Counseling Center of Grand Rapids houses multiple counselors and therapists who specialize in the latest empirically-proven clinical therapies to help treat trauma and PTSD, as well as trauma-induced depression, anxiety, and relationship difficulties. We utilize scientifically validated techniques such as EMDR (Eye Movement Desensitization and Reprocessing Therapy), Somatic Experiencing Therapy, Trauma-Focused Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Trauma-Sensitive Mindfulness-Based Cognitive Therapy, the Neurosequential Model and more. All of our counselors have advanced training and education in the latest counseling interventions to help people who are suffering from trauma and trauma-related symptoms. It’s not just talk therapy anymore. For years, many people that had suffered from Post Traumatic Stress Disorder, Traumatic Events in their lives, Car Accidents, Assault, Relationship Devastation, Abuse, Neglect, a Sudden Job Loss, and/or loss of a loved one did not have faith in counseling because regular talk therapy may have helped somewhat, but they didn’t actually “feel” (physically) better. There were many symptoms and difficulties that still plagued a person, even if they were “thinking right” about a past incident and trying to “move on.”
Trauma-Informed Approach and
Thanks to brain and counseling research on advanced counseling techniques and the field of interpersonal neurobiology, we now understand that the effects of traumatic experiences often take hold in our muscle memory, nervous system, and the subconscious mind. Thus, people who have suffered from traumatic events in their lives would often continue to be troubled by physical symptoms, whether it be intense anxiety and panic attacks that seemed to originate out of nowhere, to irritation and anger that won’t cool down, to feeling constantly on edge, to having a crying spell that doesn’t seem to have ties to any current event, to nightmares, insomnia, upset stomach and more.
Thankfully, we now understand that using an integrated approach of Trauma-Informed techniques in Counseling that address both thoughts and the associated physical feelings that accompany memories and thoughts can have positive long-term and lasting effects that are much more consistent than talk therapy or physical therapy alone. At the Trauma-Informed Counseling Center of Grand Rapids (part of Health for Life Grand Rapids), we utilize mind-body techniques that are part of these new advanced therapies that address not only our thoughts and emotions but also the effects and feelings upon our nervous system and whole body. The good news is that with time and focus, most people can become symptom-free and learn to manage difficulties that they feel physically—thus often times avoiding many other costly physical treatments and multiple medications.
Learn more about Trauma-Specific Interventions:
The Trauma-Informed Counseling Center of Grand Rapids was established out of a need for high quality and empirically-proven Trauma-Specific Counseling Interventions and a concentration of Trauma-Sensitive Care in the Grand Rapids, MI and West Michigan community. We offer specialized counseling to those who have suffered through traumatic events in their lives and work with people to gain symptom relief that often does not come from traditional talk-therapy or CBT alone. Some of our Trauma-Specific Interventions and techniques that have been proven to help reduce symptoms dramatically in people that have suffered trauma, we combine with our holistic person-centered approach, are EMDR Therapy (Eye Movement Desensitization and Reprocessing Therapy), Somatic Experiencing Therapy, Trauma-Focused Cognitive Behavioral Therapy, Trauma-Sensitive Mindfulness Based Cognitive Therapy, Acceptance and Commitment Therapy, Trauma-Informed General Counseling, and the Neurosequential model. We have a heart for people and want for everyone to be free from suffering and not to despair that they “can’t” ever feel better–so we utilize science-based interventions inside a safe and therapeutic relationship and space.
We provide multiple types of Trauma-Specific Interventions EMDR (Eye Movement Desensitization and Reprocessing Therapy), Somatic Experiencing Therapy, Trauma-Focused Cognitive Behavioral Therapy, Trauma-Sensitive Mindfulness-Based Cognitive Therapy, Trauma-Informed Counseling (General), and Acceptance and Commitment Therapy, and the Neurosequential Model).
In each of these types of therapy we recognize many diverse needs of our clients:
- Our clients need to be respected, informed, connected, and hopeful regarding their own recovery
- We understand the interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety. We work to help our clients understand these correlations are based on research and that whatever shame or blame they have experienced is not theirs to carry.
- The need to work in a collaborative way with clients, family and friends of the clients (if appropriate and applicable), and other medical and therapeutic providers in a manner that will empower our clients to have a holistic and well-rounded recovery.
If you have ever experienced an extremely disturbing stressful or event that caused you to feel emotionally out of control and or helpless, you may have experienced trauma. After a traumatic event, Psychological trauma can cause you to struggle with intrusive thoughts, unbalanced emotions, unwelcome memories (or even flashbacks), and anxiety that doesn’t seem to stop. Other times, trauma can cause you to feel completely numb, disconnected from yourself and others, and with a feeling of mistrust of other people and organizations. After a traumatic event, it may be impossible to have a feeling of “safety” or even to fully relax. This may be a sign that you have experienced emotional and psychological trauma that may require professional trauma-informed counseling–so that you can feel like yourself again.
Emotional and psychological trauma is the result of extraordinarily stressful events that can shatter your sense of security, causing you to feel overwhelmed or helpless or even constantly angry at the world. Many traumatic experiences can involve a threat to life or safety (or a perceived threat to your life or safety), but the aftermath of any situation that causes you to feel completely overwhelmed and isolated can result in trauma, regardless if it involves a threat of physical harm or not. Traumatic experiences don’t follow a logical or linear structure; they affect your brain and entire nervous system and it has almost nothing to do with reason, but a biological response to a threat that is activated and begins to change your entire life experience. So, therefore, the objective circumstances that determine whether an event is traumatic are almost irrelevant, but your subjective emotional experience of the event is much more important. The more devastated, frightened and helpless you feel during it, the more likely you are to be traumatized. Some people go through horrific events and show little signs of trauma, while others go through something that they and people around them label as “minor” and eventually develop symptoms of Post Traumatic Stress Disorder. Our nervous system and biology are not logical entities in how they interpret threats–they are trying to keep us safe and alive at all costs–and act subconsciously; only later on can we make sense of it.
Psychological and emotional trauma may be caused by:
- One-time events, such as an accident, injury, or a violent attack, especially if it was unexpected or happened during childhood or during an important developmental milestone.
- Ongoing, relentless stress, such as childhood neglect and abuse, battling a life-threatening illness or experiencing traumatic events that occur repeatedly, such as domestic violence, bullying, living or working in a war-zone or living in a dangerous neighborhood.
- Often times, people suffer from trauma symptoms for years and did not realize they had experienced trauma. Some often overlooked causes of trauma can be the sudden death of someone close to you, the breakup of a significant relationship, a sudden job loss, a move to a different geographic region, or a deeply disappointing or humiliating experience, especially if someone was deliberately cruel. Another commonly overlooked trauma can be a surgery (especially in the first 3 years of life),
Recent findings have indicated that viewing many horrific images (from a manmade or natural disaster) through television, social media, and internet can overwhelm your nervous system and create traumatic stress, or “vicarious trauma.” At times, this traumatic stress may require trauma-specific interventions to help return a person to their normal state. While the odds are low that your average citizen would be the direct victim of a plane crash, mass shooting, terrorist attack, or natural disaster–thanks to access to modern technology we now have the ability to know about almost every terrible thing (on a large scale) that happens on planet earth, and viewing images or content about this over and over can cause similar symptoms to actually experiencing it first hand.
A traumatic event can be any event that has overwhelmed or deeply disturbed you emotionally, psychologically, or physically, or witnessing other people or animals experiencing a traumatic event. At times, even being inundated with images of disasters and war can have ‘traumatic-like’ effects on the nervous system.
Examples of traumatic events include (but are not limited to):
- Being a Victim of any type of Violence
- Witnessing Violence toward another person, or animals
- Witnessing an Accident or an event on this list (Vicarious Trauma)
- Sexual assault (includes rape, sexual harassment, stalking, relationship violence)
- Sudden Loss of a Job
- Being told you have a life-threatening illness
- Violent personal assault, such as a physical attack, robbery, or mugging
- Military combat
- Natural or man-made disasters
- Terrorist attack
- Losing a loved one/bereavement
The immediate impact of events like these (listed above) can be long lasting and can cause a variety of debilitating symptoms if the survivor does not receive effective support to regain stability and safety. The Trauma-Informed Counseling Center of Grand Rapids (at Health for Life Grand Rapids) can assist you by providing a safe space and support with the personal impact of these events, as well as providing trauma-specific interventions to help you regain a feeling of normalcy.
Some immediate effects of trauma may include:
- Recurring nightmares and/or memories of the event
- Sleep difficulties
- Difficulty concentrating
- Increase in anxiety or depressed mood
- Relationship or job/ academic difficulties
Whatever the source of the traumatic event, trauma can leave its imprint on the brain. For example, research studies consistently show that post-traumatic stress disorder (PTSD) is linked to greater activity in brain areas that process fear and less activation in parts of the prefrontal cortex. So even if the trauma you experienced does not meet criteria for PTSD, you may still be suffering from similar side effects. It is normal to suffer from traumatic stress after experiencing a traumatic incident (or witnessing one) and if, after some time, you are feeling worse and are not “returning to normal” you will want to consider getting into Trauma-Informed Counseling with Trauma-Specific Interventions.
Whether or not a traumatic event directly impacted you, it is normal to feel scared, unsafe, anxious, depressed and even uncertain about your current circumstances or the future. Following an event, your nervous system has become overwhelmed by what is called a “sympathetic response” which includes the following possible elements: Fight, Flight, or Freeze (which normally happen during the event), and then following the event there is a large sense of stress which can trigger a vast range of intense emotions and physical reactions. Reactions to traumatic events and stress often come and go in waves. For instance, there may be times when you feel on edge, anxious, or jumpy, and other times when you feel completely exhausted, numb, or disconnected.
Other normal emotional responses to traumatic stress and events include:
Shock and disbelief – What happened may not seem real or may take a while to “sink in”
Stuck on Replay– The events may play over and over in your mind even when you don’t want that to happen.
Intense Fear – There can be fears of a repeat of what happened or that you may completely break down.
Overwhelming Sadness – Your sadness may feel that it is “without end”
Helplessness and Loss of Control – You may feel out of control and that you are unable to do anything about your situation.
Inappropriate Guilt – Even when a traumatic event is not your fault, you may feel completely responsible and guilty to the point where it disturbs your thoughts.
Anger and Irritability – You may just feel angry and irritable most of the day.
Shame – You may feel shame over what happened, or even because of your reactions or thoughts about what happened.
Relief – At times you may feel relief and hope that your life will return to “normal.”
Some normal physical symptoms that can be triggered by a traumatic event or traumatic stress can include:
Common Reactions that happen to someone after experiencing a traumatic event:
The following summary is written for informational purposes only—if you believe you have suffered from a traumatic event(s), it is important to seek local treatment immediately with a practitioner who is trauma-informed. This article has compiled a list of common reactions that people have reported following a traumatic event in their lives. If someone suffers from multiple reactions concurrently, they may be suffering from trauma on their nervous system—and will want to seek professional help. If a person is experiencing a great deal of reactions (or symptoms) on this list, they may be suffering from Post-Traumatic Stress Disorder, or Anxiety or Depression (that has its origins in a traumatic event)—they will also want to seek professional help.
Changes in How You View the World and Yourself
- Difficulty Trusting People. If the traumatic event you suffered was at the hands of another person, you may find it difficult to trust people in general (post-event). For instance, especially if you formerly trusted the person who hurt you, this negative event may have you suspecting that other people could betray you—which can lead to anxiety and isolation.
- Believing that the World Is Extremely Dangerous. Immediately following a traumatic event, it is normal to view the environment around you as dangerous. However, as time goes on, if not addressed, this belief may start to generalize and cause a person to view non-threatening situations as extremely dangerous as well. For recovery, it is important to understand that while the world can be quite dangerous at times, and that at other times it’s relatively safe.
- Blaming Yourself for the Traumatic Event Occurring. It is common to feel inappropriate guilt after something traumatic happens to you and unfortunately, this can lead to intrusive thoughts and negative feelings about the self.
- “If only I’d left home a few minutes earlier.”
- “I shouldn’t have worn that outfit.”
- “If only I had chosen a different day to go to the event.”
- “Why wasn’t I more cautious?”
It’s easy to use the advantage of hindsight to see the “mistakes” we made. In reality, we almost certainly overstate our own responsibility for the traumatic event, and as a result, feel unnecessary guilt. This is an unfortunate common effect of people who have suffered from a traumatic event.
- Thinking You Should Have Handled the Trauma Differently. Many trauma survivors get stuck in the “shoulds.” Many survivors keep repeating that they “should have” had a different response to the trauma. The “should have” statement actually flies in the face of the way the body and nervous system actually work and the research regarding the way and brain and body handle trauma backs this up. We may believe that we “should” or “could have” had a different reaction, but traumas actually overwhelm our system, and thus the usual fight, flight, freeze, or overall feeling of shock that comes over a person–thus they could not use their neo-cortex to bring reasoning and calm judgment into the traumatic situation.
- Viewing Oneself as Weak or Inadequate. Following a traumatic event, it is quite normal to begin viewing oneself as “less than.” Some people believe that it is their fault that the trauma happened in the first place or that they “attracted” the situation. As with most beliefs that have been distorted by a traumatic event, it is both untrue and debilitating to believe this. If one continues to believe this for long post-event, they should seek counseling.
- Self-Criticism About Your Reactions to the Trauma. In addition to suffering through the trauma, survivors sometimes find themselves upset and critical of themselves for being upset in the first place. It is emotionally normal and scientifically valid to experience a variety of seemingly uncontrollable emotions following a traumatic event.
Re-experiencing the Trauma
- Replaying the Traumatic Memory. Many people find that their mind seems to be on a loop–returning over and over to the intrusive and disturbing traumatic memory. It can be very disheartening and depressing to not be able to stop a memory from repeating. It can also be re-traumatizing. It is important to seek professional help if this is happening to you.
- Nightmares and “Night Terrors.” Post-Traumatic Event, your nervous system has taken a major shock, and so even in one’s sleep, the brain will continue to process the event–often in the form of awful nightmares and upsetting dreams. A nightmare may not be replaying the traumatic events, but it may be very stressful with a sense of “dread” and “terror” underlying it when the person wakes up. A series of nightmares can contribute to sleeping problems post-traumatic event.
- Traumatic Flashback. A flashback can occur when a trauma memory gets triggered and makes a person feel as if a traumatic event is occurring once again. Flashbacks are particularly upsetting and exhausting because they can bring with them back a powerful overflow of emotions and vivid recollections and memories of the traumatic event.
Avoiding People, Places, and Things Related to the Trauma
- Trying Not to Think About the Traumatic Event. It is logical and normal to want to avoid thinking of a traumatic event. Unfortunately, such avoidance of memory can lead to different types of symptoms–such as anxiety and physical tension. With proper therapy and exercises, it can actually become less painful to remember the traumatic event and thus, one can start to feel less hypervigilant.
- Avoiding People, Places, and Things Related to the Traumatic Event. In attempts to avoid a triggering memory, survivors often avoid people, places, and things related to the traumatic event (even if they were not directly related, but just remind them of the traumatic event). A common example would be a television show that has plot content similar to what happened to you. But sometimes, people avoid situations that they would normally enjoy, such as a concert, because the association with the trauma begins to generalize to other situations.
A Hypervigilant Nervous System
- Feeling Constantly On Guard or “ShutDown”. Following a traumatic event, most people find their nervous system is in a state of hyperarousal (while other’s find themselves in hypoarousal, or shut down). Whatever the case, a person may feel constantly anxious (hyperarousal) and may not be able to enjoy themselves even in normal activities. Another person in hypoarousal, may feel incredibly depressed or immobilized and find it difficult to do much of anything. Remember, the nervous system is causing this and it began as a way to keep you safe from further trauma. Please seek help if this is happening to you.
- It Seems Like Danger is Everywhere. Your brain and nervous system are naturally programmed and attuned to be aware of the danger to make sure you survive. However, after a major traumatic event, your nervous system is more prone to overreact at perceived threats and amp up your nervous system to account for many more “false alarms.” A series of false alarms can leave you feeling jittery and scared to the point where you find yourself suffering from major anxiety symptoms.
- Easy Startle Reflex. If your nervous system is temporarily stuck on the “high alert” you will find yourself becoming easily startled–sudden sounds or simply objects in your peripheral vision can set you off into a panic. It can take a lot of time in a safe space and utilizing stress reduction exercises before your nervous system can shift down to more of a medium or low alert.
- Difficulties with Sleep. Following a trauma, the nervous system can stay on high alert and this can cause difficulties falling asleep or even getting enough sleep. Nightmares can also cause difficulties in getting adequate sleep.
- Loss of Interest in Sexual Activity. Due to the stress of experiencing trauma, one may feel averse to sexual activity and notice a significant decrease in libido. Clearly, if the trauma was related to sexual activity it could easily reduce interest in sexual activity, but even if the trauma you experienced was not related to sex, experiencing post-traumatic stress symptoms can lower one’s libido.
- Fear and Anxiety. One of the most common emotional reactions to a traumatic event is feeling anxious or fearful. It is perfectly normal to feel afraid after something terrible has happened in your life. The fear you feel may be the result of normal nervous system functioning as your sympathetic system sprung into action during the traumatic event and has continued working post-event. You may find yourself feeling more anxiety than you normally do, even though the traumatic event is over. If this state continues, you should seek professional help.
- Anger and Irritability. Anger and irritability are common side effects of surviving a traumatic event. For some people, they may feel angry that this terrible event happened to them. For others, they actually blame themselves for the event and be irritated with themselves. It is quite normal to feel irritable and angry following a traumatic experience.
- Sadness. It is normal to feel sad and even depressed following a traumatic event. It is important to understand that sadness is a normal emotion and that crying and releasing emotions can actually help stimulate a parasympathetic response (though not if you are in the throes of PTSD), which can help one start to de-stress. It is normal to also have sadness and grief over what happened come and go in large waves. However, at times, the sadness following a traumatic event can manifest into a longer depressive episode–if this happens, you should seek professional help.
- Guilt. No matter what has happened, many survivors of trauma feel inappropriate guilt. This guilt can occur if you were in an accident or situation where other people were injured or worse. But this inappropriate guilt can also occur regardless of what trauma has befallen you. In fact, many people feel responsible for being hurt or attacked–even when they had done nothing wrong.
- Feelings of Numbness. Some survivors of trauma do not experience strong emotions, but instead feel “shut down” and, at times, physically as if something is weighing them down. In fact, over time, they may experience anhedonia–or the loss of pleasure of nearly everything that they previously enjoyed. The numbness begins as the nervous system is attempting to keep the person safe by “shutting down” and “disconnecting.” If this is a long-term issue–it is important for one to seek professional counseling.
There are many different modalities of Trauma-Informed Counseling, in terms of approaches to counseling. The Trauma-Informed Counseling Center of Grand Rapids uphold the standards and abide by guidelines outlined by SAMSHA for being Trauma-Informed:
According to SAMSHA (United States Substance Abuse and Mental Health Services Administration), the definition of Trauma-Focused Therapy is a program, organization, or system that is trauma-informed and:
- Realizes the widespread impact of trauma and understands potential paths for recovery,
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system,
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
- Seeks to actively resist re-traumatization.
The emphasis on Trauma-Informed Counseling modalities was a niche part of the therapy world until the results of the Adverse Childhood Experience Study were published and its implications understood. In 1995, Kaiser Permanente and the Centers for Disease Control and Prevention began a breakthrough study on the overall health effects of people who had experienced adverse childhood experiences. For two years, researchers gathered comprehensive medical information from over 17,000 patients at Kaiser’s Health Clinic in San Diego, CA. In addition to personal and family medical histories, participants in the study were given extensive questionnaires’ regarding childhood experiences of neglect, abuse, and family dysfunction, such as physical and emotional neglect, physical and sexual abuse, exposure to household members who had substance abuse problems or had been in prison, and violence in the household.
ACE study researchers found that the presence of any of these harmful experiences in childhood was predictive of lifelong problems with health and well being (including negative physical symptoms and outcomes, more likely to suffer from an addiction, and severe mental health problems). In fact, the more negative experiences a participant reported, the more likely they were to have problems later in life, and the more health problems they were likely to report. A potentially culturally disruptive finding was that adverse childhood experiences were exceedingly common—much more than many researchers had anticipated. Approximately two-thirds of participants had undergone at least one adverse childhood experience, and more than 1 in 5 respondents had endured three or more.
The initial data of the ACE study began decades of study on the prevalence and damaging effects of trauma. In turn, the field of psychotherapy responded by working on the development of practices such as trauma-informed counseling (stressing the importance of recognizing and treating trauma and preventing additional trauma). Today, many new modalities have been incorporated into the field of counseling that includes a combination of trauma-informed counseling with trauma-specific interventions such as EMDR and Somatic Experience Therapy, which are tailored to address the effects of the precise traumatic events and situations that a person has endured.
A trauma-informed counselor helps clients understand where their symptoms and behaviors originate by explaining trauma’s effects on the whole person, including brain, body, and autonomic nervous system—and further, how this influences emotional regulation. In addition to utilizing trauma-specific interventions, trauma-informed counselors can help clients understand the real significance of physical activity (exercise and walking), basic self-care routines, deep breathing, mindfully eating, and that an intentional focus on wellness on a daily basis is one of the best ways to work on reversing the impact of trauma and nervous system arousal.
Counseling is not just talking anymore. Trauma affects us in our body and throughout the nervous system–not just in our minds:
When it comes to treating the effects of trauma, there are two very distinct camps:
- Counseling Techniques that were invented before trauma were more fully understood, and before the amazing proliferation of research on trauma, the nervous system, the mind-body connection, and neurobiology came to be the forefront of science (and influence new types of counseling). We can call these counseling techniques “old school” and while they have been proven to be highly effective for the average person who is not suffering the acute effects of trauma. Many people suffering from PTSD and trauma have reported that these “old school” don’t help very much or in some cases, make things worse.
- Counseling Techniques that were invented during and after the revolution of more fully understanding the vast effects of trauma through scientific research. These include EMDR, Somatic Experiencing Therapy, Trauma-Informed Counseling (in General), and Brainspotting. Other therapies were adapted to include the new revelations about trauma, these include Trauma-Focused Cognitive Behavioral Therapy, Different forms of Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Trauma-Focused Family Therapy (The Neurosequential Model).
So if you have met or worked with a healthcare professional, doctor, or counselor/therapist/social worker and they have said things to you like:
- “Just don’t think about it anymore.”
- “Well, I’ve done all I can do for you–you are probably going to have to keep repeating the coping skills you learned or stay on medications for the rest of your life.”
- “You aren’t working hard enough in therapy.”
- “Have you done your CBT worksheet? That is a cognitive distortion.”
Then, unfortunately, they are likely not a Trauma-Informed Healthcare Professional, which means that they may have not read the last 25-30 years of clinical research on the field of trauma and neurobiology. This is actually a common problem because many medical schools and graduate institutions have yet to fully integrate the trauma-based curriculum and understanding into their traditional medical or counseling curriculum.
Unfortunately, this is a widespread problem and is causing a great deal of misunderstandings and misinformation to continue–and thus people who are suffering from the effects of trauma might start to blame themselves or believe that “nothing can be done.”
In your personal life:
Have you ever been told when you’re stressed to stop worrying and just relax?
Has someone told you: It’s all in your head?
Has someone ever told you that all you had to do was to forgive the person who traumatized you and then you would feel normal again?
Has someone told you that it was “your fault” for continuing to feel anger and hurt at someone who harmed you in the past?
After experiencing a significant stressful event, many people find that, even with time, it is not possible to stop worrying or stop feeling “stressed” when they “want to” or when another person suggests it. Example: Has someone ever said to you: “Why don’t you just relax?” Have you ever told yourself “Calm down!” What happened? Simple suggestive thoughts changing your physiologically is actually not the norm, and there is ample scientific evidence as to why. Post-event, the response one has can be subconsciously stored within the nervous system to guard against future threats. If you have ever experienced a stressful event where you felt out of control and utterly powerless, your autonomic nervous system (ANS) became significantly engaged. The ANS is responsible for many unconscious actions that happen within your body such as breathing or blinking. More specifically, the parasympathetic responses (rest and digest, emotional regulation), and the sympathetic responses (fight, flight, freeze, and avoid for safety) of the ANS are frequently becoming activated depending on the situation you are in. If you were experiencing a stressful event or a trauma, the sympathetic responses of the ANS were likely engaged. Additionally, the hypothalamic-pituitary-adrenal axis (located in the midbrain) most likely was activated and began sending signals to the hypothalamus through hormonal messages to the pituitary gland—which in turn triggers one’s adrenal glands.
When the sympathetic nervous system is activated (fight or flight responses) stress hormones such as cortisol and adrenaline are released from the adrenal glands. These glands enable the body to instinctually prepare to face danger. Peter A. Levine, a trauma expert in the field of psychotherapy, stated that trauma occurs when the natural biological process to fight, flight or freeze is overwhelmed during an incident, and later an individual is not capable of physically releasing and psychologically processing the stressful event that occurred. A stressful event may not become a traumatic event stored in the nervous system if a person is able to fully process what has occurred psychologically and also release the energy physically. A brief example of a physical release would be crying, screaming, and shaking –just as a dog may “shake off” a stressful event. However, for most people, it is not this easy as there may be complex psychological and historical factors that cause the memory of this event to become a trauma. There is no “one size fits all” to determine if a stressful event will become a traumatic event stored in the ANS—it is all situational and depends on multiple factors.
Nonetheless, if the stress response is not processed post-event, the effects will likely remain in the autonomic nervous system—causing both physical and psychological symptoms. Typically, post-stressful event, a person may come across a situation that does not present a significant threat, however, the ANS subconsciously or consciously recalls a traumatic incident—causing an automatic release of stress hormones and subsequently, the person may experience a whole host of negative symptoms (one example would be Post Traumatic Stress Disorder). A frequent “stress trigger post-event” may result in blood rushing to extremities, the pupil dilatation, muscle tension, increased breathing rate, rapid heartbeat, and sweating. Therefore, the autonomic nervous system responds in a sympathetic manner to both significant life-threatening events and insignificant non-life-threatening events (that appear to the subconscious ANS as a threat). In similar ways—which is problematic to a person who is attempting to go about their day, but continually feels (physically) “triggered” by non-threatening situations and then finds it difficult to reach a parasympathetic state where they may feel emotionally and physically regulated, relaxed, and connected with an ability to focus.
For most people, “rational thinking or logical analysis” does not easily control the biological responses of the ANS. When you are caught up in a sympathetic response cycle—you will not be able to “think your way out of it.” If you then experience chronic stress post-event, it may cause a vicious pattern of emotional dissociation, immobility (freeze), or an ongoing release of stress hormones, which can lead to high blood pressure (among other symptoms), and cause damage to one’s overall health. The brainstem (the most primitive part of the brain) evolved to keep us alive and safe and, as a result, can easily override “higher order concerns” of the prefrontal cortex and long and short-term memory retrieval of the midbrain. When the brainstem is triggered into action by a real or perceived threat—it causes the ANS to jump into a “fight, flight, freeze” response and will override the more evolved “human” part of the brain—the prefrontal cortex. This is likely why it is difficult to utilize reason and rationality to “calm down” when a sympathetic response is occurring and why a more physically oriented therapeutic reaction would be more useful. Thus, when one is suffering the effects of trauma in one’s life–they should not feel ashamed if they cannot “calm down” when someone suggests that they do so.
Peter Levine elaborates:
The question is: how can humans become unstuck from immobility? Moving out of this frozen state can be a fiercely energetic experience. Without a rational brain, animals don’t give it a second thought, they just do it. When humans begin to move out of the immobility response, however, we are often frightened by the intensity of our own energy and latent aggression [fear of emotions], and we brace ourselves against the power of the sensations [energy mixed with emotions]. This bracing prevents complete discharge of energy necessary to restore normal functioning.
Raw and unprocessed stress stored in the ANS may be tied to a traumatic memory that remains dormant “just below the surface.” A current situation or sensation (touch, taste, smell, visualization, sound, etc.) may prompt an unprocessed memory or physical response to “surface.” If one can understand what is happening with one’s own brain, ANS, and body, it is easier to have empathy and compassion for biologically programmed responses. Learning about why one’s body responds (via the brain and ANS) the way it does, can lead to further awareness and empowerment. It can move one from feeling like an isolated, fearful, and defeated person toward an experience of understanding and empathy for one’s self. In fact, a person may then seek treatment for past traumatic experiences, which are causing unwanted symptoms in their current life, and be inspired to work on body-based exercises such as yoga or mindfulness to preventatively work on regaining emotional regulation. If one learns about the power of the brain and ANS and that most unconscious behaviors are for the purpose of “staying safe” or alive, one can move past the unnecessary shame and guilt that many experience post-traumatic event.
When we understand the physiological and psychological processes that are attempting to protect us from future harm (but may have become exaggerated due to unprocessed stress or trauma), we can learn to turn down the volume on our “inner judge” and begin to approach ourselves with kindness. The post-traumatic stress symptoms that plague people are reversible over time with the right doses of treatment, preventative activities, and non-judgmental self-care and reflection. After personal safety is established, post-event, one must understand that their overblown physiological, psychological, and emotional responses that they may be avoiding are no longer a threat to them.
Eventually, there is work to do both psychologically and physically—especially in retraining the body through “mind-body” oriented therapies and activities. Some positive practices that people often utilize are yoga, spontaneous movement and dance, swimming, listening to soothing music, deep breathing, organized music or dance groups, felt sense oriented meditation, vocal toning, hiking, running, spending time with pets and safe animals, professional massage, tai chi, martial arts, or spending time in nature. A simple act that you could practice is simply hugging a trusted person—which can enhance secretion of the hormone oxytocin, which is produced by the pituitary gland and can boost a sense of relaxation, bonding and connection.
These important exercises can alter our physiology and influence our mood over time and with repetition. The next time a person proposes “it is all in your head”– you will know how to accurately educate them and do not need to shame yourself. Your newfound awareness may help you overcome past hurts, guilt, and shame. Through accepting the influence trauma and stressful events have had on your life and being aware of the mechanisms (the brain, and ANS) at work inside you, you may find yourself empowered to work on your own recovery from trauma. Further, understanding that there are scientifically proven therapies (EMDR, Somatic Experiencing Therapy, etc.) as well as preventative activities that you can engage with to help you on your journey, means that there is hope. With consistent repetition over time, we now know that the brain can “rewire” or increase the speed of synaptic connections that promote a feeling of health and well-being, instead of the “fight, flight, freeze” responses.
- We understand that a safe therapeutic environment is essential to aid in recovery. If you have not felt safe with past healthcare professionals, then you will understand why we believe this. Often times, someone who has experienced trauma can feel “dismissed” by their therapist or healthcare professional. Some people have reported that their therapist guided them away from certain topics because they feared “opening up” all of her pain. In contrast, a trauma-informed therapist recognized that learning to cope with pain is an essential part of recovery. A trauma-informed therapist should not shy away from certain topics.
- Trauma-related stress, symptoms, and behaviors originate from a person attempt to adapt following traumatic experiences. At times someone who has experienced trauma will withdraw or “shut down” when encountering emotional pain. A Trauma-Informed therapist will understand and accept this as a coping skill–not as “resistance.” Many “problem behaviors” such as cutting, overusing alcohol/drugs, or certain behaviors are an attempt to soothe emotions post-trauma, and so a trauma-informed therapist will understand this and not cast moral judgments. While these aforementioned behaviors are not ideal coping strategies, they did serve a purpose at the time. A trauma-informed therapist gives individuals an opportunity to realize how resourceful they were in managing a very difficult experience.
- Recovery from trauma and trauma-symptoms is identified as a goal in treatment. Many clients come in complaining of depression, anxiety, insomnia, and poor life satisfaction. Often times, they have not been shown that there is a major connection between their past trauma history and their current difficulties (or “symptoms”). A trauma-informed therapist understands that scientific evidence endorses brain plasticity and the ability to recover from trauma–the difficulty is not only helping the client with trauma-specific interventions to directly confront the traumatic past but also helping the client set up different ways of living and promoting brain-plasticity in their lives outside of therapy.
- Resiliency, strength-based techniques, and skills training should also be a part of treatment. There are many alternative coping strategies that can be learned to cope with past trauma. The Trauma-Informed Counselor should teach the client some of these that they can practice outside of therapy.
- A Trauma-Informed Therapist focuses on strengths rather than pathology. It is astounding that some people have even lived through the trauma. So it is important to acknowledge this fact and show them their own resilience. Further, a Trauma-Informed Therapist should help a client build up their strengths, while working on ways to reduce the symptoms or behaviors that are troublesome to them.
- Trauma recovery should be a collaborative effort. The Trauma-Informed Therapist should continually help a client define their personal goals for treatment, and what recovery would look like for them.
The Center for Disease Control (CDC) statistics on violence and abuse in the United States are eye-opening. Based on longitudinal studies, the CDC reports that, in the United States, one in four children will experience some sort of maltreatment (sexual, physical, or emotional abuse), while one in four women will experience domestic violence. Additionally, one in five women and one in 71 men have experienced rape at some point in their lives — 12% of these women and 30% of these men were younger than 10 years old when they were raped. This means that a large number of people in the United States have experienced serious traumatic events at some point in their lives. As a result of the CDC findings and other such reports, we believe it is of extreme importance that all healthcare professionals become trauma-informed so that they can better understand the influences of trauma on their patients and help them better diagnose and treat what they find.
However, broadly speaking, healthcare training and education have not kept up with the neurobiology research and scientific studies that have experienced groundbreaking and revolutionary revelations since the late 1990s. Because of this, many antiquated cultural attitudes and outright false ideas are still being uttered by doctors, social workers, and therapists alike during medical visits and counseling sessions. These clichés, based on older science and cultural stereotypes, and complete ignorance of the latest research have had many negative effects on patients. For instance, some patients, who are struggling from the effects of trauma, may have been labeled with an extreme diagnosis—which may identify a “cluster of symptoms” but does not explain the etiology of their situation, nor the cure. As a result, many patients have accepted that they are just “mentally ill” instead of understanding that these diagnostic labels should not be treated as “the answer” to their problem, but rather are an oft-inaccurate way for healthcare professionals to understand the “chief complaint” or an idea of “symptomatology.” Mental Health Diagnoses give a “snapshot” of what is going on, but are not the “whole picture.” In fact, almost all mental health diagnoses cannot be validated by blood tests and other “hard scientific tests.” Therefore, if a healthcare professional does not understand the effects of trauma on a person’s mental state and their autonomic nervous system, they may slap a diagnosis on them, which (while a part of the picture), completely derails them from fully understanding what is happening to them and may avert them from receiving treatments that are designed to help people who have suffered from traumatic events.
Not only are healthcare professionals, as a whole, not receiving adequate education on trauma and its physical and psychological effects on the person—but, many graduate institutions currently training counselors and social workers have not fully incorporated the new science and paradigm-shift implications into their training. Lately, there has been a push to make graduate schools “trauma-informed,” but unfortunately, being “trauma-informed” is not yet the norm in most clinics and thus, the public suffers and healthcare professionals and even therapists are frustrated because they can’t understand why certain people are not improving, while at the same time, certain modalities and techniques are helping other people (who are not suffering from the acute or chronic effects post-traumatic event).
Thus, many counselors and therapists have taken it upon themselves to receive continuing education in the field to become trauma-informed. Even further, trauma-specific interventions require a long period of training to become certified. The Trauma-Informed Counseling Center of Grand Rapids ensures that all of their therapists who utilize trauma-specific interventions have taken the necessary extra-curricular course work to be certified in that modality (or proficient, depending on the intervention). In other words, we have significant training—we did not just go to a weekend seminar and state that we now practice “X” intervention without the appropriate training.
The therapists at the Trauma-Informed Counseling Center of Grand Rapids are highly influenced by the research and work of Dan Siegel, M.D., Francine Shapiro, Ph.D., Bessel Van Der Kolk, M.D., Bruce Perry, M.D., Peter Levine, Ph.D. to name a few.
The counselors at the Trauma-Informed Counseling Center of Grand Rapids have spent time becoming educated by the work of the Child Trauma Academy, The EMDR Institute, the ACES study, Interpersonal Neurobiology Series, The Trauma Research Foundation, Somatic Experiencing Trauma Institute, Mindsight Institute, and the Arizona Trauma Institute and other organizations utilizing research to help better the lives of people, through education, clinical practice, and policy, etc.
Here is just one of many studies discussing the enormous treatment effect of EMDR:
- “Of particular note with respect to general clinical practice is a study conducted at Kaiser Permanente 21,22 that reported that 100% of single-trauma victims and 77% of multiple-trauma victims no longer had PTSD after a mean of six 50-minute EMDR therapy sessions, demonstrating a large and significant pretreatment versus post-treatment effect size (Cohen’s δ = 1.74). This is consistent with 2 other RCTs that found that 84% to 90% of single-trauma victims no longer had PTSD after three 90-minute EMDR sessions.23–25 Most recently, a study funded by the National Institute of Mental Health evaluated the effects of 8 sessions of EMDR therapy compared to 8 weeks of treatment with fluoxetine.26 EMDR was superior for the amelioration of both PTSD symptoms and depression. Upon termination of therapy, the EMDR group continued to improve, whereas the fluoxetine participants who had reported as asymptomatic at posttest again became symptomatic. At follow-up, 91% of the EMDR group no longer had PTSD, compared with 72% in the fluoxetine group.”
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/
You don’t have to just talk about it anymore! That is the beauty of EMDR and Somatic Experience Therapy is that they are scientifically validated “mind-body” techniques. With these therapies, the focus is not just on talking and processing current problems and issues, or even past events. It is normal to “not want to talk about it!” It is also ok. The great thing about mind-body therapies is that you receive all the benefits of counseling (talk-therapy) (which is already an extremely effective form of treatment for all kinds of symptoms and situations and you can work in different ways to address the underlying somatic feelings and emotions that are not easily accessed with “talk only” techniques. EMDR and Somatic Experience Therapy work to incorporate physical sensations (the body) in a therapeutic way with cognitive techniques (that targets the mind). Both therapies are now offered at The Trauma Informed Counseling Center of Grand Rapids (inside Health for Life Grand Rapids).
Of course, you can. While we have focused our practice on helping those who have experienced traumatic events, we all have training in traditional counseling and talk-therapy techniques. And we all utilize those modalities when appropriate.
While we have advanced training in treating the effects of trauma, we can most likely help you with whatever you are going through in your life. Visit our “Contact” page to schedule your free 15-minute consultation with one of our counselors today.
With enough work both in therapy, in your personal life, and other appropriate modalities (medical interventions, other therapies, preventative activities, etc.) most symptoms that are focused on will eventually either be eliminated, reduce greatly, or transform and stop being so bothersome.
Related to focusing on a symptom, we have to realize that there is a difference between relief and having control of a situation that is triggering. Even with intensive therapy, you may still experience triggers—depending on your traumatic background. However, the aim of trauma-focused therapies, is that your “triggers” have a significantly reduced stress-response, and therefore you are able to maintain meta-awareness (also called “dual awareness”). Eventually, when faced with a trigger, you should be able to maintain an awareness that you are “triggered” and that you are not being faced with imminent danger—which can cause the symptoms to be much less than before treatment.
While results vary, it is safe to say that a counselor that is trauma-informed is going to have a much better understanding of your situation than a counselor who is not. Part of getting results is making sure you have the “right fit” in terms of a therapist. And also, make sure you are getting educated about your symptoms and what you can do about them outside of therapy.
For instance, a person who has experienced “single-incident trauma” (such as a car accident, or sudden job loss, etc.) that happened while they were in adulthood often sees results much more quickly than someone who has experienced multiple, intense, and complex traumas over a long period time.
Another example is that a person who has been diagnosed with Post-Traumatic Stress Disorder may have a lot more work to do in therapy than someone who identifies as having basic trauma in his or her life from a traumatic experience.
Someone who has experienced Childhood Developmental Trauma will likely need more long-term care in multiple modalities to help them manage their symptoms and have a better quality of life. However, there is hope for them and everyone discussed above if they work on it. Just like if you are in physical therapy for a problem with your ankle—if you strengthen the muscles in the appropriate places, eventually you should be able to walk with much less pain than before. Just like therapy, trauma-informed counseling should have a comprehensive approach to not only focus on symptom-relief, but to empower people to move into further into their recovery.
Yes, there is ample evidence to suggest that current symptomatology of anxiety, depression, anger, and even relationship issues can be rooted in the autonomic nervous system responses and subsequent changes in perspective and personality originating with experiencing one or more traumatic events. While this is not the case for everyone, it is worth investigating if your symptoms are the result of unprocessed traumatic events resulting in psychological and physical symptoms in the present. For certain people, they may find that working on processing their past-traumatic experiences first may help them gain symptom relief. For others, they may need to work on reducing current symptoms and resolving or changing current situations before working on anything from the past that may be influencing them. For most people, they will notice that there is a combination of factors at play, including current stressors, difficulties, and symptoms which can all have independent effects, but also can and will interact with stored unprocessed or unresolved memories and old patterns in the autonomic nervous system—which makes it important for them both to develop coping skills in the present, work on the existential meaning of all that has occurred, and work to resolve unresolved memories and physical patterns so that they can better function in the present. In a sense, the prefrontal cortex is able to function without unnecessary interference from brain stem (which may perceive neutral objects and situations as a threat, post-traumatic experience), and in this case, cause the individual to regain higher functioning, experience less perceived stress, and even feel joy and happiness once again. It is important to understand that there is not a “one size fits all” for any type of counseling or psychotherapy. Whether a trauma-specific intervention or not—any therapist that tells you that there is “one way” to recovery should be suspect. The more education you seek about your mind and body, the more powerful advocate you will be in your own recovery and thus, can find a clinician that best fits your personality and situation to aid you on your journey.
The basic definition of trauma is “A deeply disturbing or stressful event.” Traditionally we believed this to solely focus around survivors of war, violent crimes, or sexual abuse. In the last several decades of research into trauma, we’ve come to expand that definition to include any event where an individual perceived their or another person’s life to be at immediate risk, a series of events where intense psychological or emotional stress was present, or, a prolonged period of psychological or emotional stress. In short, trauma in any event or group of events that overwhelm our bodies normal capacity to process information coming in, and instead, pushes you into a survival mode.
MRI’s of individuals who have suffered from trauma have shown reduced brain activity in the areas surrounding concentration, emotional regulation, and the areas traditionally associated with learning and long-term memory. Scans also show heightened levels of activity in the parts of the brain that regulate our survival instincts, such as increased levels of the stress hormone known as cortisol.
Finally, individuals who suffer from trauma have higher activation of the area of their brain that controls our “fight-flight-or freeze response.” For those of you who may not know what that is, our fight-flight-freeze response is effectively our gut response to danger, which is either to attack the source of the danger, run or distance ourselves from the source of danger, or, to freeze up and not move in order to avoid drawing the danger’s attention.
Children who have suffered trauma experience show reduced levels of development in the areas of learning, social, and emotional development. They have reduced levels of concentration, heightened startle responses, inability to self-soothe or calm themselves down, and increased transition rates between their emotions (or put more simply, they change their mood rapidly and sometimes without warning).
The ACE study, or Adverse Child Experiences, was conducted by Kaiser Permanente and the Centers for Disease Control and Prevention in 1995. There were approximately 17,000 individuals who were part of this study which lasted over 2 years. About half of the people in the study were male and half female, 75% of them were white, the average age was 57, 75% had a college degree, and all of them had good working jobs and health care. The study showed that there is a correlation between traumatic events experienced in childhood and adulthood high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity, and severe obesity. In addition, there was also a correlation with almost all forms of poor health, such as depression, heart disease, cancer, chronic lung disease, and a shortened lifespan.
Of the participants, 28% had reported physical abuse and 21% sexual abuse. 40% of the participants reported two or more ACEs, while 12.5 % reported 4 or more ACEs, so effectively half of the participants reported multiple ACEs. So to put simply, as they continued to check in on the participants over the next two years, they found that the more ACEs someone had, the more they would be suffering from every negative life experience I talked about earlier.
There’s good news about children, children are resilient. Basically, kids can recover quicker than adults, and the younger they are, the faster they can recover. If an individual has recovered from traumatic experiences, they are less likely to suffer all those negative things we talked about earlier
On that note, we will be talking now about Mindfulness, what is it, and how can it help. Social workers and therapists would say “mindfulness is the self-regulation of attention with an attitude of curiosity, openness, and acceptance.” I find the standard definition for mindfulness to be easier to understand and that is “mindfulness is focusing one’s awareness on the present moment.”
What studies have found is that being aware of your present, which means being aware of what you are feeling, your body sensations, your thoughts, and just the world around you, you increase your ability to self-regulate or soothe yourself, build increased nerve connections in your brain for clearer thoughts and better short and long term memory, decrease stress levels, increase your emotional intelligence, and you increase your resiliency or how long it takes you to calm down after something stressful. By noticing the world around us and what we are experiencing, without trying to judge or analyze it, we are effectively telling our brains that it is ok to process the experience and move on from it.
Children primarily learn by watching adults, if your child is able to see you maintain yourself, remain calm with them, and to just be happy here in the present, your child will be interested in how you do that. If your child is interested in how you treat them differently from others, or how you stay so calm, show them these techniques and help them figure out how to make it work for them. It will probably take a lot of time and trust before some of these kids will ever ask that, though I hope I’m wrong.
Last points are this, anyone can benefit from mindfulness and there are plenty of activities you can find online, on your phone, or in books to do mindfulness. I just want you to remember, mindfulness is a life-enhancing skill, it does not make the healing happen in a traumatized person’s life. Think of mindfulness as a tool for people to live a better life and to manage their pain. If someone is interested in long term healing, or no more pains, please send them to a licensed professional counselor or social worker who specializes in trauma therapy.
If you feel that you know someone who is suffering from trauma and want them to find long term healing from it, please feel free to contact the Trauma-Informed Counseling Center of Grand Rapids. We have many therapists at our clinic who specialize in trauma therapies, as well as people who focus in specific age groups, genders, and spiritual or cultural beliefs.
Trauma-Informed Counseling Center
Health for Life Grand Rapids is a multi-faceted clinic that aims to treat the whole person. Health for Life Grand Rapids houses the Trauma-Informed Counseling Center of Grand Rapids, two Naturopathic Doctors, a Medical Support Clinical Hypnotherapist, and a Health Coach. We’re your one-stop shop for getting to the root of what is troubling you in mind and body, and helping you heal.
Name - Nicole Vega
Client quote: “Nicole has been my health coach for almost one year. I am so grateful for her participation and encouragement in my journey as I continue to work towards my personal goals. Nicole has inspired me to be a better version of who I am through her passion and commitment in helping others. She has provided me with [...]
Name - Nicole Vega
Client quote: “I met Nicole in grad school. Her warm energy and compassionate soul made her very approachable. She’s always been health conscious, from clean nutrition to mental health stability. When Nicole reached out to me after I’d had my daughter, I was so relieved. I was looking for a way to take charge of my health and nutrition [...]
Name - Dr. Cain
Dr. Cain was awarded the Doctors Choice Awards top 100 Doctors of the Year in 2016. She was also the winner of the Doctors Choice Awards Family & General Practitioner of the Year in Scottsdale, Arizona in 2016. She was awarded physician of the month in both August and September of 2016. http://www.doctorschoiceawards.org/nominees/dr-nicole-cain/
Name - Dr. Matthias
Professional quote: “Dr. Ronald Matthias has given a 5 out of 5 star rating on November 29, 2016 on Doctors Choice Awards: ‘Dr. Nicole Cain is an amazing physician. I had the good fortune of studying under her while in medical school. I am the doctor I am today in large part because of her. There is no better [...]
Name - Actual Patient
Patient quote: “Dr. Cain is different than any other clinician I have worked with. I know she really cares about me and she spent a lot of time with me working to understand my experience. When I started working with Dr. Cain I was taking 5 different medications and I have been able to discontinue all of them. I [...]
Name - Paul Krauss
Professional quote: "I'm pleased to recommend Paul as a talented and diligent therapist. During our time together as clinicians at Jewish Family and Children's Service, we facilitated adolescent therapy groups and staffed with each other regarding the clients and families we were both involved in providing services for. During these and other interactions, Paul consistently demonstrated professionalism, genuine care, [...]
Name - Actual Patient
Patient quote: “Paul, I think I know why I can be open with you and not all of the other counselors I have seen. Because I deep down truly and fully and in my heart BELIEVE that you CARE, about me, and about everyone. That is how you made yourself SO good at what you do. And that makes [...]