A Love Letter to Neurodivergence

Dear Reader,

This is for all the people who identify as neurodivergent; I hope you feel seen and validated reading this. This is for anyone questioning whether neurodivergence might be a part of their experience, I hope this answers some of your questions, or at least leads you in a direction that will. This is also for anyone who loves, is friends with, or works with someone who is neurodivergent. In a sense, this post is really for everyone. If you’re reading this and think you don’t know anyone who is neurodivergent, guess again. Neurodivergence is mostly an invisible experience. There’s a fair chance you’re in community with neurodivergent people and don’t know due to stigma, masking, and the simple fact that it’s often just not that obvious. 

Each person has the fundamental right to be loved and accepted for who they are without needing to change or conform to societal expectations. This is essential for neurodivergent individuals who often face significant mental health challenges largely due to societal pressures and stigma. When people are accepted as their true selves, it fosters a sense of belonging and reduces the isolation that exacerbates these mental health challenges. Supporting neurodivergent people means recognizing their unique strengths and needs and allowing them to navigate the world on their own terms. This contributes to an inclusive society where all people are valued and understood. 

What is Neurodivergence?

Neurodivergence is a term that is increasingly being recognized in mainstream culture. You may have seen this term circulating on TikTok or depicted more frequently in television and film. That’s because more people have identified with this experience in recent years. According to the Centers for Disease Control and Prevention (CDC), roughly 15-20% of the population identifies as neurodivergent, and that percentage is expected to keep increasing as awareness and research continue to expand. But, what does it mean to be neurodivergent?

The word neuro refers to the brain. Its Latin roots mean nerves or nervous system. Neurotypes simply refer to different types of brains. Neurodiversity broadly describes differences in cognitive processes and sensory experiences. Neurotypical is the way that most brains function. Our brains are all wired somewhat differently, so neurodiversity exists regardless of whether you have a neurotypical or neurodivergent brain. Again, you will likely encounter many neurodivergent people in life and never know. All of that is to say that neurodivergence is a term used to describe brains that diverge from the norm. It’s important to understand that there’s no “right” way for your brain to work. Diversity is always worth celebrating.

Neurodivergence is an umbrella term for many different kinds of neurotypes, such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, and more. Synesthesia, Tourette's Syndrome, Dyslexia, Dyscalculia, Dyspraxia, and Obsessive-Compulsive Disorder (OCD), all fall under this umbrella. Anxiety and panic disorders are more frequently considered a form of neurodivergence as well. The neurodivergent umbrella is constantly evolving as it is still a relatively new way of conceptualizing brain differences. 

ADHD and ASD are most typically associated with the term neurodivergent. ADHD is a neurodivergence (disorder) that affects someone's ability to focus and pay attention, sit still, and/or control their impulses. There are 3 types of ADHD, predominantly hyperactive, predominantly inattentive, or both. ADD is an outdated term because the predominantly inattentive type captures it. People with ADHD tend to need a lot of stimulation in their environment.

Autism Spectrum Disorder is a neurodivergence that affects a person’s ability to interact socially and increases sensitivity to senses. Autistic brains take in way more information because they have more neural connections. All brains go through a pruning system in early development where unnecessary connections between neurons are removed. Autistic brains do go through pruning, but not as much as a neurotypical brain. This is why folks with autism often need less stimulation in their environment. This contributes to what is called “autistic burnout.”  Stimming refers to repetitive or self-stimulating behaviors, such as making movements, and sounds, or saying words that people repeat. Stimming might occur at any time but is often used to calm or self-regulate when someone is overwhelmed. Among other behaviors, stimming might look like someone clapping their hands, tapping their feet, or rubbing or picking their skin. Echolalia is common in autism and involves an involuntary repeating of words or phrases.

AuDHD is a combination of both Autism and ADHD. This probably isn’t a term you have heard of unless you participate in neurodivergent communities. This can be confusing because Autism and ADHD may seem like totally different experiences. There is some overlap though. Both ADHD and Autism are interest-driven. Hyperfocus, the tendency to become completely absorbed in a task, is common in both ADHD and ASD. People with ADHD and ASD tend to experience rejection sensitivity (experiencing rejection more intensely than others) and time blindness (difficulty managing and perceiving time). Before the release of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was thought that the two conditions could not co-exist. This highlights how this area of understanding is continuously expanding with new research.

Masking is a term used to describe a process by which people may hide their neurodivergent traits and tendencies in attempts to appear normal. Masking can be intentional or an unconscious process learned and adapted over time. This is a term that has been historically used in the Autism community but has been increasingly used for other neurodivergent or mental health experiences. Masking is a strategy that helps people manage social situations, school, and work. It’s a tool people rely on to manage and achieve in those settings, however, it can result in psychological costs. For example, masking can be exhausting and often leads to burnout. It can also be invalidating and cause tension about one’s identity. Some people are high masking, meaning they can conceal their symptoms more, while others are low masking. High support needs and low support needs are also functional labels that are sometimes used within Autism communities. High functioning and low functioning are outdated terms because they are offensive and problematic, and don’t fully capture the complexity of experiences on the spectrum.  

What’s it like being neurodivergent?

There’s nothing wrong with being neurodivergent. Remember, different isn’t bad. It’s okay to have needs that are different from other people’s. Many qualities that neurodivergent people possess turn out to be gifts that can help them excel in their careers and lives, such as heightened empathy and compassion, unique perspectives, advanced problem-solving skills, attention to detail, the ability to hyper-focus, creativity and imagination, and a passion for social justice and fairness. One thing I want to be careful of though, is sounding too much like a cheerleader. For neurodivergent people, the struggles are so real.

Most challenges arise for neurodivergent individuals because the world is structured for neurotypical brains. It’s not just having this neurotype alone that causes dysregulation, but rather, certain environments that send the neurodivergent individual into sensory overload or burnout over time. Being neurodivergent is often traumatic for people. Quite literally, a neurodivergent experience involves some degree of nervous system dysregulation, especially in cases of ADHD, ASD, and sensory processing disorders. 

Nervous system dysregulation is a key component of trauma. Psychologist and founder of Somatic Experiencing, Peter Levine’s definition of trauma is anything “too much, too soon, or too little (i.e. in cases of neglect)” for our nervous system to handle. I appreciate this broad definition of trauma. This helps us understand that trauma is not only about the event itself but how our bodies interpret the experience. Peter Levine also defines trauma as experiencing fear in the face of helplessness. There’s a lot of overlap with how trauma and neurodivergence presents. 

Everybody has a nervous system. The nervous system runs throughout our entire body and has different states. The sympathetic nervous system state is known as the “Fight or Flight” response to a threat. This state also includes other responses such as Freeze, Fawn (to please someone to avoid conflict), and Flop (to become unresponsive and faint). These are all survival responses. They are all primal and adaptive because they can help you survive. The parasympathetic nervous system state, known as the “Rest and Digest” state, is reached when the body is relaxed and can focus on internal processes like digestion. 

Dysregulated is another term you’re probably hearing more of. This happens when the parasympathetic and sympathetic nervous system are out of balance. Psychiatrist Dan Siegel, M.D., introduced the concept of the “Window of Tolerance”. The window of tolerance describes the nervous system at its optimal level of arousal, where people can access their executive functioning skills (thanks to the brain's prefrontal cortex that allows for planning, organizing, and regulating emotions), be present, and respond effectively. It’s characterized by a sense of groundedness, openness, and ability to connect with other people. When you’re out of your window of tolerance, you’re either in a state of hyperarousal or hypoarousal. Hyperarousal looks like hypervigilance, heightened anxiety, and irritability. Hypoarousal is also a stress response but looks like shutdown, numbness, disconnection from reality, and dissociation. In the long run, hypoarousal looks like burnout or depression.

Everyone gets dysregulated. Everyone’s window of tolerance is also a little different, meaning every person has a personal capacity to handle distress and tolerate big emotions and challenging experiences. There is nothing to be cured. Your body is designed to be in these different states, but it is important to be able to move in and out of them. The goal is to be able to stay regulated for longer periods and to be able to move from one dysregulated state back into your window of tolerance without getting stuck. It’s common for people to get stuck in a trauma state, and not even realize it. Trauma can shrink your window of tolerance and make you more reactive to stress. Neurodivergent folks tend to be chronically dysregulated. You can work towards widening your window of tolerance though. When you learn how the nervous system works and about various ways to get your body back into its window of tolerance, you learn how to become less reactive to stress and increase your capacity to experience the full range of your emotions.

Growing up neurodivergent is also a traumatic experience in and of itself. Neurodivergent kids attempt to fit in socially and meet developmental milestones based on standardized criteria. This is where masking comes into play. Many people experience deep shame about their differences and confusion about why they are the way they are. When neurodivergence is overlooked and not diagnosed, kids are often considered shy, weird, unique, and/or misunderstood. Growing up neurodivergent is especially traumatic if you are undiagnosed. Especially because there is not an obvious physical difference, neurodivergent kids tend to internalize beliefs that they are somehow like everyone else, but worse or defective. They will likely feel stupid or not good enough as they struggle to understand and accept themselves. 

What’s next?   

For the most part, people are the experts in their own lives. I hold this sentiment very close to me and it has been a guiding principle in my work as a therapist. Receiving a mental health diagnosis is generally fraught with both pros and cons. It can be especially empowering, however, for neurodivergent people to receive a diagnosis. These labels can help people understand that their brains are not broken, but rather they just work differently. Finding a label can be very comforting.

While aligning with a diagnosis can be very affirming, the process of getting assessed can be challenging as it can be expensive and time-consuming. The mental health world is catching up in the realm of neurodivergence. It may or may not be worth it to pursue an official diagnosis. Even in the mental health field, there’s a lot of stigma and misunderstanding. It’s difficult to identify and diagnose neurodivergence and there’s a long history of misdiagnosis. Historically, girls and people of color were not diagnosed with ADHD or ASD. Things are changing in recent years, but historically all disorders in the DSM were normalized based on middle-class white men. These experiences are deeply personal. No two people with Autism or ADHD are alike. There is a vast range of traits and tendencies that a person may or may not experience. Two people may have the same diagnosis yet experience a different set of symptoms. There are plenty of neurodivergent-friendly providers out there. It’s all about researching and using discernment when pursuing mental health care. There is also validity to self-diagnosis if one has done a lot of research, self-exploration, and sought out the help of a professional like a therapist or other neurodivergent folks with lived experience. If you need accommodations, you have the right to ask for those, whether you have a formal diagnosis or not.

You might be reading this and wondering how you can help the neurodivergent people in your life. Even though our brains are all wired slightly differently, all human brains are wired for connection. This is a basic need that we all have. For connection to occur, we must experience a felt sense of safety. In the 1940s, psychologist Abraham Maslow published the Hierarchy of Needs, a pyramid depicting the order of human needs from the bottom up. Physiological needs are at the lowest level, which includes the most basic things we need to survive, like food, water, clothes, and housing. Next on this hierarchy is safety. Once safety is achieved, love and belonging can occur. Feeling safe entails a sense of security and protection both physically and emotionally. Emotional safety involves knowing you can be yourself and express your thoughts and feelings without fear of judgment, harm, or rejection. Safety allows for relaxation, authenticity, and trust that your vulnerabilities will be respected and supported. Feeling safe in relationships fosters the ability to grow, thrive, and be confident.

As mentioned before, it can feel embarrassing and shameful to be neurodivergent and to talk about it with others. It’s very vulnerable to share about neurodivergent experiences, but it’s also necessary. You can create safety for your loved ones by building a warm, loving, and compassionate environment based on nonjudgment and curiosity. Consistency is important too. Check in regularly, plan around people’s particular needs, establish routines, and talk openly about differences. It signals safety to let your loved ones know that struggling is normal. Sharing and talking about it helps when we feel validated and cared for.

There’s also sometimes space to work through things collaboratively. If it involves your relationship, communicate how you can figure out what works best for each of you and be willing to make accommodations. If it is something they are sharing with you but does not involve you, check in about what the person’s needs are in sharing. A simple rule of thumb in any relationship (neurodivergent or not) is to say something like, “Thank you for sharing. I am here for you and want to support you. I am listening. Would you like me to simply validate and empathize with your experience or are you hoping for problem solving and solutions?” Oftentimes, what we need most of all is to feel heard.

People deserve to be believed about who they are and what they say their experiences are. Even if someone else’s experiences seem confusing to you or you do not think they are neurodivergent, that does not mean that you have a better understanding of who someone is. As I’ve laid out here, these experiences are layered and complex. There is a ton of misunderstanding and misinformation about neurodivergence in the general public. Many people do not have an accurate understanding of neurodiversity, although this is starting to shift with increased awareness and dialogue. Take it upon yourself to do further reading, listen to podcasts, join a support group, or simply ask and allow people to tell you about their experiences. 

So, it’s important to stay open-minded. Above all else, people deserve to be loved and accepted as they are, without pressure to change or fit into a box that was not made for them. This is especially important considering neurodivergent people are at much more risk for depression, anxiety, thinking about and dying by suicide, and substance abuse. This goes back to that deep-seated belief that “something is wrong with me.” But, nothing is wrong and nothing needs to be fixed. You can remind yourself and your loved ones that your brain works beautifully and is needed. Whether you’re on your journey of self-discovery as a neurodivergent person or you want to learn more about the neurodivergent people in your life, go slow and be gentle with yourself. It takes a lot of time and effort to change your patterns of thinking, learn how to regulate yourself, and have vulnerable conversations.

With warmth and gratitude, 

Kaitlyn Folkes, M.A.

References: 

CDC Data and Statistics (2024) 

https://www.cdc.gov/adhd/data/index.html

https://www.cdc.gov/autism/data-research/index.html

The Developing Mind Daniel J. Siegel (1999) 

The Myth of Normal by Gabor Matė (2023) 

Unmasking Autism: Discovering the New Faces of Neurodiversity by Devon Price, PhD (2022) 

Waking the Tiger: Healing Trauma by Peter A. Levine, PhD (1997) 

Your Brain’s Not Broken by Tamara Rosier, PhD (2021) 

Where's My Coconut Radio?

By Concentric Counselor Christian Younginer, LPC, NCC

When reaching into my therapeutic bag of tools, seldom do 1960’s TV shows come out. But as I sit in the world that is my apartment these days, I found a kinship with those fateful souls marooned on Gilligan’s Island. 

I ran with this idea, not wondering where it would lead, but I had nothing else to do- as is often the case in this shelter-in-place. For those not familiar with the premise of the TV show: a merry group of vacationers, under the impression that they would be taking a 3-hour tour (a three-hour tourrrr), are tossed about in the seas and left stranded on an island, with only the clothes on their backs, their wits, and the several large steamer trunks of clothes packed by an ostentatiously wealthy couple. 

While not anywhere close to being alive in the 1960s, I am well aware that the decade as a whole requires a suspension of disbelief to make sense of it, and Gilligan’s Island is no different. Throughout the series, the Professor constructs various and outlandish gizmos and contraptions with nothing more than coconuts and acceptance by the viewer. And this is the crux of why this show came to me while pacing my apartment. The Professor, the eponymous inventor who was on this tour for some reason, built a coconut radio… A radio, made of coconuts. Not like a transmitter to call for help, just a radio. And it’s this level of acceptance that I think can be therapeutically useful during our new reality in this pandemic. 

A person who makes a coconut radio is not a person who is waiting to be rescued. This invention speaks to these ill-prepared islanders’ acceptance and presentness of their situation. Hell, they never even tried to fix the boat. 

This got me wondering: what is my coconut radio? What is something that can help me accept that I am not in control right now, but find a way to live within the situation handed to me? I am not in control of when this shelter-in-place will be lifted. I am not in control of what the world will look like in 1 month, 6 months, a year after this pandemic. But just in the same way the folks on Gilligan’s Island arrived (surprisingly quickly too) at a place of peace with their circumstances, maybe I can find a way to sit back, make a coconut radio, and find control where I can. 

Planning for the future, for when quarantine and the pandemic are over, keeps me from living inside the quarantine and the pandemic. And if I’m unable to live in it, then I’m nervously ticking off the days, festering in the anxiety of my apartment. So this is my challenge to myself, find my coconut radio. Find something that helps me stay present and accepting of my surroundings, rather than dreaming of a time when I can get off this island.

Essential Workers & COVID: Time and Space for You

By Concentric Psychotherapist Kylie Cherpes, LCSW, MFT-IT, CYT

In times of great stress, such as now with the COVID-19 pandemic, we each find that we have our own unique way of getting through. Some people find comfort by burrowing in at home and disconnecting from constant reminders of their fears. Others juggle between caring for their vulnerable loved ones and carving out time to connect with the support that they themselves need. Some turn their stress into energy towards solving problems or creating something new. While others hit the ground running, called to serve their community. Though we are all under cumulative stress and doing our best to face changes in our day-to-day norms, some, such as Essential Workers, are being impacted exponentially. Essential Workers are being asked to do more and risk more, all while having less access to what would normally help them respond to and recover from their stress.  

Essential Workers continue their work in environments physically underprepared for a pandemic. In a time that feels precarious, Essential Workers are asked both to stay calm and to stay flexible while managing ever-changing recommendations on how to keep their workplace, selves, and families safe. They spend hours reading, learning, and preparing protocols and responses to “what-if” scenarios that breed uncertainty and anxiety. Even after all of the precautions they take, they wonder if it will be enough to keep their work-family safe. When they leave work to go home they find it hard to relax as guilt, worry, and fear about possibly carrying the virus home to their loved ones enters their mind. Though they may have reached for their family and friends for help, love, and reassurance before, it now seems too risky. Where they would go for support and stress relief before, like churches, gyms, bars, and social outings, are no longer options. And even when there is time for it, it is hard to get restful sleep. 

When unable to respond to stress, especially on-going (chronic) or traumatic stress, the body, mind, emotions, and spirit start to show wear and tear. Those under chronic stress may notice that raw feelings such as fear, anger, helplessness, and sadness seem to be lingering, or other common changes such as an increase in irritability, numbness, bitterness, or detachment (that “spaced-out” or “distant” feeling). Chronic stress can also show up as headaches, stomach aches, and muscle pain, or changes in appetite and sleep. Sometimes those under chronic stress may not even be the first to notice the impact it is having, but instead, those closest to them do. For instance, slips in memory or ability to recall information, mistakes at work that used to be uncommon, or shifts in hygiene and self-care regime may be noticed by work colleagues. Family and friends of those under chronic stress may see their loved one’s constant exhaustion, zoning out, adopting an abnormally cynical outlook on life, or lacking the ability to find pleasure in things they had once experienced as enjoyable. 

As therapists, we can close gaps in the care being offered to Essential Workers by providing access to the mental and emotional support they deserve. To support Essential Workers’ day-to-day functioning and healing, we hold space for them to process and release stress and trauma. Just as each Essential Worker has their own unique way of responding to their stress and trauma, each therapist has their own unique approach and is able to tailor care to each individual they work with. Whether it be brief or long-term, therapy is a safe place for self-expression and a secure place to find relief from fears, anxieties, anger, and sadness. Further, therapy is a place of creativity and strategy, used for building coping skills to reduce distress and restore feelings of stability and hope. 

At this time, we know that the Coronavirus is not going away anytime soon and that things may indeed get worse before they get better. We also know Essential Workers will continue to be asked to bear the brunt of this pandemic with limited space (time, resources, and support) to respond to their stress in their own unique ways. It is not an option to wait to address the physical, mental, emotional, and spiritual needs resulting from the chronic and traumatic stress being endured by our Essential Workers. Unaddressed chronic and traumatic stress does not just go away, it accumulates. As therapists, we see the effects of these stressful days mounting on our Essential Workers, and we respond to say, “We are your Allies.”

Special Announcement: During April through May 2020, Concentric Counseling & Consulting is offering short-term telehealth and virtual video counseling to Essential Workers during these challenging times due to Coronavirus (COVID-19). We are all incredibly grateful for all that you do and we want to give back! You can use your health insurance for teletherapy. Also, for those who do not have insurance coverage or have certain insurance plans and have endured financial hardship due to the impact of COVID, we are offering sliding fee and pro bono to a limited number of Essential Workers.

How to Open a Door When Coronavirus is Closing our Doors

By Concentric Owner Jennifer Larson, LCPC, NCC

Originally posted in The Sounds newspaper, Volume 43, Number 15 on April 4, 2020 and later in published in the Illinois Mental Health Counselors Association (IMHCA), a division of Illinois Counseling Association (ICA), News Update. Click here.

You know the saying “When One Door Closes, Another Door Opens”? During this time, we can’t help to notice closed doors everywhere, from schools to restaurants to places of worship to retailers. Even our home doors are closed, keeping others away and containing us inside.  It may seem overly optimistic to think this quote holds true during this extraordinary and challenging time with COVID-19 knocking on everyone’s door.  Alarm bells are sounded within us daily, the threats are real and experienced by so many, and some of us feel our life has been hijacked.  So how can we during this time envision doors opening up or experience something positive from all of this? 

I am by no means suggesting doors are flying wide-open given the sheer number of doors that are literally closed and even locked. But, if you can take a moment to pause, focus and be intentional, you may find that you can open doors to otherwise missed opportunities. 

Psychotherapist and author Esther Perel states when faced with our own existential anxieties it can open the door to fully living.  Some of us may have been living life on auto-pilot depriving ourselves of certain reflections, experiences or opportunities. So, what does living fully exactly mean?

It can mean a lot of things, but to start, it can mean experiencing each moment and each day in the here-and-now noticing and appreciating all of life’s offerings. Perhaps you had been more disconnected from yourself, no longer appreciating your talents, thoughts, feelings and your body’s capabilities -- which you can now fully appreciate.  Or taking a moment to get out of your head to be fully present and connected with another person can offer you an opportunity to be transported, experiencing life through a different lens other than your own.  Also, fully activating your senses can bring about a subtle, yet powerful sense of fully living.  Consider next time you take a walk outside, notice all of your surroundings paying attention to each of your senses. Notice your positive feelings as you attune to your senses.  

Shawn Achor, an educator, researcher, and author, offers a number of research-based ways to live a happier life. One of them is to take a few minutes each day to write down 1 positive experience within the last 24 hours and provide 3 rich details about that experience. Also, write down your gratitudes, giving specific details.  And reach out to someone to fully express why you appreciate them.  We know giving to others not only makes us feel better, but helps the person on the receiving end feel happier too.

And last, what is something you can look forward to when the shelter-at-home Executive Order is lifted and you can bust out the sheltered seams?  Will it be something specific such as dining at your favorite restaurant?  A ritual or practice you will reacquaint with again?  For me, it will be telling myself “I get to go here or I get do this” which represents a door opening into seeing how choice and freedom are true gifts.

Remember The Weatherperson?

By Concentric Counselor Christian Younginer, LPC, NCC

What We Wish Life Were Like

The Curiosity rover landed on Mars August 6th, 2012, the end of a flight that began November 26th, 2011-- 9 months prior. At its traveling speeds, all predetermined by NASA’s Jet Propulsion Laboratory (JPL), scientists had to calculate where an orbiting planet would be 9 months from the moment of launch. In fact, they needed to know where Mars would be years in advance as they began building and programming the rover. They were able to plan for, predict, and pinpoint the location of a planet hurtling through space at 53,600 mph, rotating at 532 mph down to the meter to land a rover on its surface.

This is possible due to the predictability of the celestial bodies. Astronomers from thousands of years ago plotted out eclipses for hundreds of generations into the future, with impressive accuracy. It’s that there just aren’t very many variables in space; bodies in motion stay in motion, unless a force acts on them. And if no force does, they keep on trucking. Thus, their location is predictable. This does not mean that any part of landing a rover on another planet is easy--it’s just possible.

What Life Is Actually Like

Conversely, it is a common occurrence that shuttle launches are cancelled, last minute, tanks fueled, on the pad- due to weather… Earth weather. A shuttle, bound for space, to another planet, is grounded because humans cannot accurately predict the weather more than a couple of days out. And even then it can be a crapshoot. 

The reason for this comes down to something much more akin to living life: variables and information. There are simply too many variables to predict and too much information we’re not able to know. For example, if I knew the direction and velocity of every air particle on Earth, I could give you an accurate weather model. Obviously, this is not possible. So we’re left making educated guesses, working with what we have, and most importantly a social understanding that forecasts are guesses, not gospel. With this understanding comes a grace--sometimes annoyance--but a grace for being wrong. An ‘it’s out of our hands’ amenableness that wonderfully conflicts with the modern American desire for planning, preparation, and predictability. 

What Can We Do?

So often we try to plan for every eventuality, scrutinizing the details, languishing in an anxious mire of a desire for control, only to see our plans crash into a Martian hillside, due to an unforeseen variable. 

Often, the anxious try to view life with such a level of predictability. Hopes that the world will fit into plans and preparations, only to be disappointed when something unaccounted for goes awry. Often times this desire for control flows into our lives as a nagging generalized anxiety, a worry for all things in an effort to be prepared for every outcome. We wish life were as predictable as space travel. As oxymoronic as it sounds, going about our day may be more complicated than rocket science. And we tell ourselves that the stakes are just as high. 

As mentioned in regards to weather, the secret lies in the ability to tolerate the ambiguity of an uncertain system. We can be disappointed with an inaccurate weather report, but continue on to the next day. Yes it can suck when it rains when the news said it wouldn’t, but we don’t hold ourselves responsible for the outcome. In our own lives, we can place an enormous amount of responsibility on ourselves, often for things not in our control. We can assault ourselves with a barrage of ‘should have planned for it’ , ‘should have seen it coming’, or ‘should have done it differently’. All of which are the equivalent of looking at Tuesday’s weather and telling yourself you should’ve known that on Monday. 

Maybe we can have the same grace for the weatherperson, AND with ourselves. If we get it wrong, be disappointed for a bit, be annoyed, but let it go. Tomorrow is another day to try again. If we find ourselves feeling anxious about the ambiguity of life, rather than try to think out the outcomes, what if we gave ourselves permission to feel anxious for a bit? Feeling anxious about the ambiguity of every day is not a failing, but rather an admission to one’s self that we don’t have enough information. And instead of punishing ourselves for trying to know something we can’t, maybe we can have a little grace with ourselves, and remember the weatherperson. 

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Better Understanding Grief & Loss→

By Concentric Counselor Jennifer Larson, LCPC, NCC

During the Spring of this year, I popped onto the Dear Abel and Sofi advice column for the first time and came across a story about a Firefighter’s struggle with grief & loss after he needed to leave the workforce due to injuries he sustained on the job. He was in the rebuilding stage and had recently turned his passion for woodworking into a small business that had been met with tireless effort and financial struggles. While this former firefighter shared his story and posed questions on the advice column, I could not help but see his intrinsic desire to connect with other people as he grieved and was rebuilding his life. Seeking connection, feedback, validation, and ideas from others was a part of this man’s grieving and recovery process.

Reading this story jogged my memory about a blog post I started in August 2018 (and didn’t finish) about grief & loss. At that time, I became re-enlightened about the additional types of grief & loss that exist, namely the loss of thoughtfully designed objects and structures in our country, and the unfortunate outcome this can have on social and human connectivity. I’ll touch upon that later in this blog post.

For many, grief & loss cannot exist without experiencing some form of connection with oneself or others, and rebuilding in the wake of grief & loss cannot exist without human connection. The firefighter's story made me think about my own grief & loss experiences felt during the earlier part of the year.  The flood of feelings and experiences that emerged from within me were great, and subsequently, I decided to really reach out to others.      

During my grief & loss earlier this year, I allowed myself to feel and accept my grief by intentionally creating space and capacity to feel a myriad of feelings.  I also reached deep within to try to understand the messages, gifts, and lessons in my losses. Reaching out to family, friends, my therapist, and colleagues granted me the opportunity to take care of myself and to feel their heartfelt and unwavering support. The swell of feeling cared for, respected and supported by others was truly one of the best gifts I ever experienced.  Eventually, I felt myself naturally propelling forward by carrying my values with me and, yet, creating a semi-new reality ahead. My grieving process, particularly connecting with others, reminded me of the firefighter’s desire to connect with others through the advice column as he grieved and re-built his life.  

For some, grief & loss can be experienced as a harrowing crisis and this crisis can truly be fodder for future opportunities and growth. And, through my own experiences as well as listening to others’ experiences, I have come to truly appreciate that grief & loss comes in many forms and shapes.

Long gone are the days when we thought of grief & loss solely as one facing their own mortality due to a terminal illness or losing a loved one to death. These are most certainly some of the most difficult types of grief & loss people can face in a lifetime as it can bring about great pain and suffering. The loss of a loved one can stir up a deep emotional response, physical and behavioral changes. Other forms of losses can bring about up deep emotional, physical, and behavioral responses and changes as well.

Experiencing a significant life transition (such as entering into college or parenthood), a childhood robbed of important attachment figures or childhood experiences, the demise of an intimate relationship through betrayal & infidelity, and the loss of being connected with one’s feelings or reality by route of escaping into addiction, perpetual distraction or fantasy -- all of these examples fall under the umbrella of grief & loss. 

People who experience grief & loss can go through a number of stages, sometimes in sequential order, other times bouncing back-and-forth among the stages, and for some, remaining stuck in a stage or bypassing certain stages all together. There are a number of identifiable stages of grief listed, one of the more common models is Dr. Kubler-Ross’ modified 7 Stages of Grief & Loss. For brevity, here are those 7 Stages:

1. Shock (Initial paralysis hearing the news)

2. Denial (Trying to avoid the inevitable)

3. Anger (Frustrated outpouring of bottled-up emotion)

4. Bargaining (seeking in vain to find a way out)

5. Depression (Final realizations of the inevitable)

6. Testing (seeking realistic solutions)

7. Acceptance (Finally finding the way forward)

Having the understanding and knowledge of The 7 Stages of Grief & Loss can be instrumental in cultivating understanding which can eventually contribute towards facilitating growth and change. As I highlighted earlier, I believe interpersonal relationships -- connecting with others -- is also important to incorporate during the grief & loss process and survival.  Whether it’s with a trusted family member or friend, therapist, or your community can be healing as your experience and move through your grieving process and recovery. 

Being there for people by exercising empathy, attunement, and being fully present is critical as one heals.  Also, giving yourself permission to be vulnerable to express yourself with people you feel safe with creates a holding space for you and your experiences. Emotional and relational connection like these brings about a deeper understanding of one’s experiences which can then help promote compassion, transformation, healing, and recovery. The emotional-felt experience within a relational context is vital for healing and survival during grief & loss.

I am going to revisit something I referenced earlier in the blog, and I know it may seem like I am veering off (which I am) and going on a tangent, but this is an area I want to weave into the area on grief & loss.   

Around last summer, my mother-in-law remarked how the United States tends to tear down old buildings to make space for newer buildings to be built.  She conveyed her concern about our country undermining the inherent value, respect of others, its history and imprint, and ultimately the loss of felt social and human connection by tearing down old buildings. The decimation of older structures and the lack of integrating new and old buildings together equates with grief & loss for the people of this country.  This was the message I heard, and it struck me.   

The following day after my mother-in-law shared her perspective, I had read "He Knows What You Really Need" article in Psychology Today which highlights Glenn Adamson's perspective on the value of knowing how objects or things are made or cultivated. The article revealed Adamson's book, "Fewer, Better Things"  which highlights the act of purchasing or collecting mass-produced items can water-down the value and connection between consumers (people) and goods. Glenn believes diving deeper into learning more about the maker and the making process promotes greater understanding and respect for the maker and object, and overall promotes social and emotional connectivity.  Mass produced items create a lack of human connection - loss, in other words. Experiencing an artisan’s creative piece awakens our senses and taps into an emotional and human connection with its maker.

And then the following night back in August 2018 (yes, I’m serious about these sequential events), I found myself seeing these same themes emerge in the then new show, "Making It" hosted by Amy Poehler and Nick Offerman. The show is about bringing master craftspeople and artisans together to compete in a friendly and fun environment.  During the crafters' introductions, one of the makers remarked that crafting in today's culture has dwindled down as people expend more time and energy on their phones. Crafting with others creates memories, she added.  Memories filled with emotional and social connections. 

The idea is that thoughtfully-designed, emotionally and physically labored crafts, objects, and buildings promote greater human connectivity. Eliminating them only promotes greater relational loss. I really started to sit with the idea of how the loss of certain physical objects or structures impact us psychologically, relationally, and culturally, and what this could mean for us and perhaps, for human evolution.

Of course, facing a terminal illness or experiencing the loss of a loved one pales in comparison to the loss of not knowing the maker of a vase on your dining room table. I am not making the comparison that both are similar in terms of its impact when it comes to grieving.  But, I do think it’s worth acknowledging that grief & loss comes in many different shapes and forms. It’s not black-and-white.

So, here are my hopes. My hope is we can continue to acknowledge, better understand and define the various forms of grief & loss that touch people in various ways both intimately and globally. That we can all take a leap by vulnerably reaching out to others for support during our own grieving journey. We can be truly available and present to those who are grieving. We can take a moment to think about preventing unnecessary losses. And, we can appreciate the preservation of human connection, particularly in the wake of grief & loss. Because human connection is truly a powerful thing, take it from me.