Latest / The Trauma Therapist / Episode 746: Complex PTSD Coping Skills with Tamara McClintock Greenberg, PsyD

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Episode 746: Complex PTSD Coping Skills with Tamara McClintock Greenberg, PsyD · The Trauma Therapist

0:10
Or welcome back to the Trauma Therapist Podcast. My name is Gaming Person.
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My mission is to help trauma therapist be their incredible cells, to be human,
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to be real, not just a clinician. I'm a big believer in
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who we are is more important than what we know, and this requires cultivating
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authenticity, genuineness, and vulnerability, and that requires intention. Can learn more
0:33
about my courses and workshops by going to the Trauma Therapist project dot com.
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That's the Trauma Therapist Project dot com. Let's get started. So five four,
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three, two and one, our folks, welcome back to the podcast.
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I am very excited to have as my guest today, Doctor Tamra mclintic
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Greenberg. Tamera, welcome to the podcast. Thank you for having me.
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You're welcome. So. Doctor Greenberg is a clinical psychologist in private practice in
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San Francisco, where she specializes in treating adults with depression, anxiety, relationship
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issues, trauma, and those who are coping with medical illness, either as
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a patient or affected family member. She also has extensive experience with older adults
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and their children regarding coping with dementia or other medical illnesses. In addition,
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Tomorrow treats couples as well as families with adult children. Her therapeutic approach is
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active and engaging, and she uses a variety of evidence based techniques that focus
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on reducing symptoms and feeling more connected to others. Termer has written a variety
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of books here, and we're gonna be talking about the Complex PTSD Coping Schools
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Workbook and evidence based approach to managing fear and anger, build confidence, and
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reclaim identity. Welcome to the podcast. Thanks for having me. You're welcome.
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So before we get going, please share the listeners where you're from originally
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and where you are currently. Gosh. I was born in Milwaukee, Wisconsin,
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and then raised actually in a small place north of Minneapolis in Minnesota,
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Okay, northern Anoka County for those who are familiar with Minnesota. That's where
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I was raised, and then moved out here for the second time after graduate
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school, and I've been here ever since. Okay. So I've got to
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say, I mean, the books you've written, and the amount of books
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is really impressive and inspiring. But and today we again we're gonna be talking
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about your workbook, the Complex PTSD Coping Schools Workbook. But let's kind of
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ease into that. How the heck did you get into this field? Uh?
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Yeah, that's a great question. I mean I think, I mean
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it's sort of cliche in a way, but I you know, in high
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school, I was always the kind of person that people came to with their
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problems, and I think in part because I wanted people to like me,
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you know, I kind of would visit to whatever people had to say.
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And I don't know if I was particularly good at giving advice back then,
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to be honest, But then when I went to when I went to well,
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I went to community college for a couple of years, and I really
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wasn't sure what I was going to do then, although I did take a
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lot of psychology courses. When I had the opportunity to finish college, I
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majored in psychology, and you know, again still wasn't really sure what I
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was going to do. I'd been working in the field though, since since
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I was in community college, believe it or not, in the eight yeah,
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I was. I was nineteen years old when I was hired by Child
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Protective Services. I had moved out here for a three year stint from the
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time that I was eighteen to twenty one and I lived up in Valet Home,
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so U in Salano County. I was nineteen years old. There was
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this pilot program to keep kids out of foster homes. And I had done
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some volunteer work in a group home when I was in high school, and
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they were looking for para professionals to work with families who were reuniting with their
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kids, families who are very high risk of losing their kids permanently because of
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neglect, abuse. And so I was like a I don't know, kind
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of a quasi babysitter in some ways for the kids, but also taught parenting
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skills and did coaching and that sort of thing. And I was really good
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at it. I really loved it. And that kind of made me think,
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like, boy, there's something to this, you know, that I
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could make a career out of doing this kind of a thing. So I
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worked with to put myself through college. I did more of that kind of
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work. Well, let me let me interrup you for one second. Family,
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Why did you like it? What about it did you like? Why
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were you so good at it? I mean, I think, like a
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lot of us, you know, I started the field by trying to,
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you know, take care of my own parents, trying to fix my parents,
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you know, like this unconscious fantasy that if people get the right treatment,
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they can treat their children better. But I think as I've matured,
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well, first of all, I've realized that's definitely not a good reason to
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feel or to say in the field, because it isn't very fruitless and never
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I really love I really love the work that I've done, and the writing
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that I've done has been really to kind of push the boundaries of people in
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the field where I feel like I don't feel like a lot of us have
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gotten really good training around a lot of things, to be honest, but
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particularly trauma. I started, as as you saw, I started writing about
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medical illness because one of my specialties was health psychology, and you know,
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some people in my field, our field, don't take medical illness seriously.
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You know, a lot of people are told that things are all in their
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heads and illnesses are minimized. But on the other side of that, there's
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also been a lack of appreciation for the mind body connection and how emotional issues
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can contribute to physical suffering, And certainly with trauma, we know that that's
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very true. But I think, you know, for me. I come
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from a lower class background, and being in the field I think has been
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really good in that I get to translate a lot of ideas that I think
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are hard to understand. You know. There's a way that a lot of
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the writing, you know, I think of this about psychoanalysis for sure.
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I always say, and it's true, I don't really understand ninety percent of
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the papers that I've read, you know, and so I've kind of taken
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it on as a way to this work to try to translate some of these
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complex ideas and make them applicable for all kinds of people. I do feel
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like a lot of psychology has alienated, you know, all kinds of people,
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but particularly people from lower class backgrounds, which is something I deeply relate
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to right right both on in terms of writing and also in terms of the
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practical aspect of actually getting therapy, receiving therapy, certainly, how you talk
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to people, um, you know, there's a way that I think,
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certainly myself as a patient, I've felt judged many times by people from upper
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class backgrounds who don't seem to understand my background. I think also there's a
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way that therapists can can really alienate clients by being you know, by by
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pathologizing them, you know. And so the way that I work is to
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I think most things people come to us with have normal aspects of them.
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They're developmentally appropriate or were at one time. And so I think we all
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need as therapists, we all need to take a stance that we're all in
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this together. Nobody's But just because you're in one side of the chair,
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on one side of the chair, right right, the right whatever, the
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therapist chair, doesn't mean that you necessarily know more or are better, you
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know. And so I you know, I mean, people do see me
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as somebody who has something to offer. But I always make it clear to
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people like, look, I've been through a lot of this, I've done
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my own work. I'm just going to give you some ideas of how I
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think, how I think I can help you. Yeah, I mean I
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agree with that. I think it's a really valid point. You know,
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Unfortunately or not, the whole system is set up such that from the get
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go there's an imbalance within the relationship. Right, But let me ask you
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something so really interesting you talked about from the get go you were working in
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this field at what point or How did you start. Did you say to
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yourself, trauma, this is interesting to me. I want to work more
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intentionally in this field. What was that like for you? Right? Well,
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it's been around me from the beginning, right, I mean, obviously
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working for Child Protected Services, But I think I started writing about trauma.
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I had been writing about trauma as it relates to medical illness and the impact
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of traumatic backgrounds on medical illness, or also how people deal with aging,
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or the impact of if you're a caretaker and you're taking care of a parent
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and there's been a traumatic history. I'd written about all that stuff, but
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really thinking about writing about complex PTSD. You're right, it's new, right.
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My twenty twenty book for Professionals, you know that was that was my
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first book on trauma, and then this most recent book that came out last
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year is my second book on trauma. So you're right, it's relatively new
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to write about it in such an intentional way. I think the thing that
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got me this won't surprise you, I guess given everything I've said so far.
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The thing I think there's a lot of things about the way I think
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about complex PTSD which I think are slightly different, but One of the things
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that I think that really motivated me to write about it is that a lot
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of people with complex PTSD get diagnosed with having personality disorders, and from its
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inception, personality disorder diagnoses have a very low interrate of reliability coefficient rate,
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and that rate is point three out. And what that means, without being
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too into the weeds in this, but what that means is that three out
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of ten clinicians are going to agree on what personality disorder diagnosis someone has.
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The criteria for personality disorders are overlapping. They are inherently pathologizing. It implies
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that people can't get better. It implies that It also, I mean,
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the old teaching for personality disorders was people with personality disorders don't suffer, everyone
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else around them suffers. But obviously that's not true. People who have um,
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you know, severe issues related to developmental trauma are suffering a great deal.
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And so I think that, you know, one thing that led me
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to write about it was to really challenge this notion that personality disorders are a
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flawed way to understand complex human suffering and human behavior. I also think,
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you know, complex PTSD is frequently a euphemism for borderline personality disorder, you
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know, which is often applied to women and I think diagnosed in a way
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that is sexist. And so that's really what motivated me to start writing about
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complex trauma. And then from there it was realizing that there's very little good
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teaching on dissociation. Yet there's all these different models on dissociation and they are
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doing wildly different things in terms of how they're treating people, some of it
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without any empirical you know, support, and so I wanted to learn about
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that for myself actually and understand that as well as share some of my ideas
12:07
about dissociation. And then I think adding in some of the stuff that I
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have that that is incredible research coming out of England from Peter Fanighe and his
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colleagues about mentalization, applying that to complex PTSD, I think, you know
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also, I think a novel approach. And then the final thing is anger.
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You know, one of the things that doesn't get talked about in the
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trauma literature is anchor. And now anger is a very tricky thing, right.
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We have to be so careful in talking with clients about it because it's
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so easy for people to feel shamed and pathologized. But if you look at
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the if you look at all of the data on PTSD, there is less
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than two percent of papers that talk about anchor and PTSD. They talk about
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everything else, but nobody talks about anger. And so the other thing that
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I want to to contribute in my writing was to really focus on this fairly
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vexing problem that we have as therapists, that we have as as clients.
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How do we how do we deal with our angry feelings? How do we
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help our clients deal with angry feelings without feeling ashamed and being able to use
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anger as a signal that something's wrong, you know that they need to understand
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more about something that's going on, without making people feel shamed and pathologized.
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Wow, we remind everyone speaking with Temera mclinic doctor McClintic Greenberg, just take
13:37
a moment here to thank our sponsors. All Right, So a lot there
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exciting stuff there. I want to back up a little bit and you you
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said that, well, earlier on you said you felt a lot of people
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weren't getting the trauma training. Talk a little bit about that as we kind
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of move in here more to talk about this book. Yeah, I mean
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the old teaching what and it still is, is that people who are traumatized
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have to develop a narrative of their experience. That was what I was taught,
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and I think that's what a lot of people are still taught. Well.
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The thing is is with a lot of trauma, particularly complex PTSD,
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there may not be the narrative. Might be that there is no narrative.
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And so one of the things that I saw when I've been supervising, when
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I was training is there's this pressure often to have people who have trauma histories
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to talk about what has happened to them. It seems intuitively correct to do
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that, right, But I think the thing that I think some people in
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the field have missed is that pulleging people to talk about trauma can be very
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distatilizing. We see that with exposure treatments, right, they have very high
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drop out rates, as you know, and so we have to be really
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careful. And I'm suggesting that actually people don't necessarily need to be able to
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unearth everything that's happened to them in order to get better. In fact,
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with complex PTSD, that may never even really be possible. So you kind
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of have to. There's a way that you can deal with the past while
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working in the present, though, because if you believe in the psychoanalytic idea
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of a dynamic unconscious, right, then if you believe in that, which
15:35
is basically that we're always reliving the past, right, everything everything that goes
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on in our life is influenced by the past, including this interview, including
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how I treat my dogs, including how I talk to the mailman. Whatever
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it is it has to do with it has to do with the past.
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It's always present. So we can focus on understanding relationship patterns, attachment,
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how people will respond to stress, help people respond to relationship, the threat
16:03
of loss, that sort of thing. We can do all of that without
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having to necessarily unearth things from the past. If people come in and they
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want to talk about the past, that's fine, and that's great. But
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I think that there's been too much of an emphasis on you have to talk
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about A, B and C and then you'll be better. And as we
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know from people who you know, just studies, the people who've been an
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analysis for thirty forty years, you can talk about the past, you know,
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till the cows come home and they you know it can be all intellectual
16:34
and people don't get any better that way either. So I think, you
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know, there's a way to really focus on helping people without retraumatizing them.
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And that's my emphasis. So again the book The Complex PTSD Coping Skills Workbook.
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Let's start with a definition of complex PTSD. Complex PTSD is very different
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from primary PTSD. Primary PTSD involves you know, one to two severe events
17:04
that causes significant impairment, like psychic numbing and intrusive thoughts, flashbacks, nightmares.
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Complex PTSD includes all of those, but has more um disturbances in terms
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of UH like it's disturbances of like like what do they call it? Like
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self functioning. You can have dissociation, You can have h like dissociation including
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losing track of time, amnesia, difficulty with memories, but also difficulties and
17:37
relationships, not feeling safe in relationships, disorganized attachment for people who know that,
17:42
who know that, lingo um and UH difficulty feeling satisfied in one's life
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choices. Even people who are ostensibly successful who have complex PTSD, they can
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feel very lost. And I think for me, I think of identity theft
18:00
as a primary as a primary symptom of complex PTSD. People can seem to
18:07
be doing fun in their lives, but they really don't know who they are.
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They don't have a relationship with their own minds. One of the things
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that and I think of this as a consequence of kind of built in,
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baked in hypervigilance if you think of hypervigilance as a cognitive style. And this
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is for those who are into old psychometric testing stuff. This was an idea
18:30
from Exner. It's not original, but if you think of hypervigilance as a
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cognitive style, you are always focused on the outside, not just to assess
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threats. I mean, that's obviously part of it, but the other part
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of it is you're always in someone else's minds because you need to know what
18:48
they might do to you. You're always trying to size up everyone in your
18:52
environment. So think about how that can be adaptive, really adaptive. Right.
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You can make a great career, is that the arapist or a layer
19:00
or a doctor out of doing that right? But if you do it too
19:03
much, you forget to pay attention to what's going on inside of you.
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You're constantly outsourcing every thought and feeling into everybody else. You're constantly letting other
19:14
people define who you should be and how you should be, and so therefore
19:17
you don't really know how to protect yourself when you're in dangerous situations. And
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so this kind of circles back to well, complex PTSD what is it.
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It's developmental trauma, it's early trauma, but then it leads it to adult
19:30
trauma. And part of the reason for that is being scientifically, being a
19:33
victim makes you statistically more likely to be a victim. Again, however,
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if you are constantly in the minds of others, you can't learn from experience.
19:45
So it's really hard to take care of yourself and to learn. Okay,
19:48
when a guy does this, for example, you know, when a
19:51
guy does this, or when a friend does this, I need to realize
19:56
that they might be taking advantage of me and I need to back off,
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or I need to set some boundaries, or I need to get away.
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But if you're constantly in other people's minds, you can't do that because you're
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you're not in your own mind and you don't know how to take care of
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yourself. That's kind of a beyond the criteria wave of how I think of
20:14
complex PTSD so is the book for therapists for survivors both exactly, Yes,
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it's it's for both. It's a workbook for it's a workbook for survivors clients,
20:27
UM, that you can do on your own or with a therapist.
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Um. Many many therapists use the book with their clients. I've been hearing
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um and UM. A lot of people just get it on their own and
20:40
try to go through it, you know, different. I mean, the
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great thing about a workbook is you can just pick pieces of it that applied
20:45
to you. Um. So, but it is, it is for both.
20:48
Yeah, So if we can, can we talk about particular exercise that
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is in that Can you break one out for us? Um? Sure?
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Related to anything? Yeah? Anything. I want our listeners just to get
21:07
a glimpse a taste of what the book is about. Sure. I mean,
21:11
how about dissociation? Since that's relatively and frequently talked about, it very
21:15
hard to understand. So there's a there's a checklist that a lot of people
21:22
have commented on that they find really useful in terms of thinking about dissociation.
21:27
Dissociation can be adaptive or maladaptive. Right. Dissociation is when we leave a
21:33
situation because we're stressed. The old example of this is when you're driving down
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the highway and you miss your exit and you aren't aware of it until a
21:41
couple exits later and you're like, wait, how did I pass my exit?
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That's like normal dissociation. Extreme dissociation is when you're so stressed. Um.
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I think of it as anxiety that then leads to a fracture that then
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leads for people to kind of leave their minds and their bodies, and at
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which point, you know, people can feel that they aren't even in their
22:03
own bodies. They can feel like they're not alive, they can feel like
22:07
robots. I've had a couple of clients tell me recently, in severe dissociative
22:12
episodes, they woke up and they didn't even recognize their partners or their surroundings.
22:18
It's a horrible it's a horrible symptom when it's severe, and so one
22:22
of the so there's a checklist for identifying kind of different ways that people dissociate
22:29
from different models. By the way, there's a number of different models of
22:32
dissociation. I glove them all together, take the best parts of all the
22:36
models and help people think about what it might be to them, but to
22:40
the point of exercises. The most simple, eloquent, best exercises for dissociation
22:45
actually come from DBT and Marshall Lenahan, you know who who developed that theory,
22:52
and they're grounding techniques. So grounding techniques are just perfect from when we're
22:56
stressed, especially if you're at it could becoming dissociative, and so grounding techniques
23:02
or something like look out a window, pick one thing and describe it to
23:07
yourself. So you know, I'm looking out my window and I see these
23:10
pink flowers and they have a yellow yellow thing in the middle and the leaves
23:15
are green, but one of them is browning at the edges. Like that
23:18
kind of thing you go into like massive detail to describe something tactile sensations.
23:23
In my office, I have lavender oil. I have different oils that people
23:29
can put on to ground themselves. I also love, like, you know,
23:33
rocks with jagged edges that people can touch, sucking on sour candy,
23:38
biting into an orange or a lemon. Anything that will ground you is really
23:44
good under periods of stress, particularly if you're going to become dissociative. Things,
23:48
so you just kind of think of all the senses, like, how
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do you engage the senses in a detailed way. It's getting yourself, it's
23:56
getting yourself grounded into something in the physical world that can quiet you know,
24:03
some of the anxiety that can lead to dissociation. Would you categorize dissociation on
24:11
a continuum of severity you mentioned anxiety in a sense, Yeah, I would,
24:17
I absolutely would, because I think, I mean the people there's there's
24:22
a bunch of people who talk about normal dissociation and describe that normal dissociation can
24:26
even be daydreaming, you know. So, But for me, when I
24:30
think about dissociation, I think, I think generally dissociation occurs in response to
24:37
stressful external or internal stimuli, and so I do absolutely think of it on
24:42
a continuum. And you know, normal dissociation is healthy and it allows people
24:49
to get away. I always joke like, the best kind of normal dissociation
24:55
is when you can be in a meeting with a really aggressive boss and they're
24:59
just going on a on and you can look at them and you can pretend
25:02
like you're listening, but you're somewhere else completely Like that's amazing, right,
25:04
That's great dissociation because you're protecting yourself from somebody who feels, you know,
25:11
intrusive and hostile. But dissociation usually has a shelf life it stops working over
25:18
time because it can get more severe, and so eventually dissociation can feel like
25:25
it can start off like and I've seen clients like this. They're just kind
25:27
of spacing and out of it, and you know, they aren't really terribly
25:32
uncomfortable. But as dissociation gets worse, if it does, then people start
25:37
to feel really uncomfortable. They feel anxious about not being grounded in themselves.
25:44
I think in part because people start to realize, oh, when I'm associative,
25:48
bad things can happen. If I'm not paying attention, bad things can
25:52
happen. I think that's part of it. But I also think it just
25:55
feels terrible to be to not be grounded in yourself and to know that you
26:00
aren't really sure what your thoughts and feelings are. I think that's what happens.
26:03
Yeah, so I appreciate that. So that's just one example of an
26:07
exercise in the book. In terms of trauma treatment modalities, maybe those geared
26:18
more towards complex BTSD. I mean, there are innumerable modalities out there.
26:25
How do you conceptualize or put a framework on all these different modalities? How
26:33
do you mean, like conceptually, Well, in terms of let's say you
26:38
have a student who's interested in learning about trauma, Yeah, where do you
26:44
start to encourage them to learn more about it in terms of treatment? Yeah?
26:52
Well, it's a really good question, and it's a really complicated question.
26:56
I mean, the way I was trained, we learned all of the
27:00
techniques and tools that there were to help people, and then we applied what
27:04
we learned to who came in the door based on what their needs were.
27:08
The problem with training today is, in my opinion, not to sound like
27:12
a cranky old person, but the problem with training today and with the field
27:18
today is that there are these factions and if you're a CBT clinician, you
27:22
can't really learn about psychoanalysis. If you're DBT, you do just that.
27:27
And what makes me anxious is that people learn one to two techniques and then
27:33
they apply them to everybody who comes in the door. And I and so
27:37
I would say to somebody who's learning to do trauma treatment, you have to
27:41
learn all the things there are to learn and be careful for things that are
27:45
really fattish, you know. I think that would be the other thing.
27:48
I would say, like, you know, the current reliance on ketamine and
27:53
psychedelics as being you know, the panacea to treat all ills worries me as
28:02
does theories that have basically been around in other forms, like internal family systems
28:07
is really big now, but that's recycled work from you know, the AES
28:12
and you know, like people in Europe do that use that they when they
28:17
do you know, quote part work for dissociative patients and stuff. So I'd
28:21
say, learn the stuff that's been around for a long time that has empirical
28:26
data supporting it. And there's a lot of different schools, very different schools
28:30
of thought. Psychodynamic therapy is very well validated for complex clients. CBT has
28:37
a tremendous value in helping people in terms of providing tools you know, act
28:45
DBT, all of the different theories that have been around a long time that
28:48
have data to support them. I think we owe it to our clients to
28:52
learn all of them. We're doing everybody a disservice if we're learning just one
28:57
or two things, because our clients sometimes they don't know they come to us
29:02
and they're like, will help me? And if you're just doing one thing,
29:07
um boy, I really worry about that. I really worry about.
29:11
MDR would be a great example of that. I think that EMDR can be
29:14
very helpful. The data shows it's helpful for primary PTSD for some people.
29:19
The data is not as strong for complex PTSD. I will add, but
29:23
but I feel sorry for clients who might go to an MDR provider and if
29:27
that's all they get, not knowing that there's other options, that's what really
29:33
worries me. So I think we learn all the things you know right right
29:37
right? I mean I would agree with that. The other side to that,
29:41
and I think it's it's obvious. I mean, there's a reason why
29:45
people only study a few buy because it's time consuming and it's expensive. But
29:51
additionally, there are a lot of modalities out there that are very popular for
29:56
which there isn't any empirical I know evident. What are your thoughts on that.
30:03
I try to just be I try to educate people, you know,
30:07
I try to educate clients about the data I am. Look, I'm not
30:11
in the business of telling people what to do, but I tried to just
30:15
let people know what the data says, if somebody really wants to try something,
30:21
you know, and that's what they want to do. Again, I'm
30:25
not wanting to stop them, but I think people are entitled to know what
30:29
the data says. And again, there's a lot of confusing messages out there,
30:34
and it's really confusing for people. And you're right about it being expensive
30:40
and time consuming. But I learned, I mean I learned in graduate school.
30:45
Now, granted there wasn't as many things around when I was in graduate
30:48
school in the early nineties, but still I learned all of the foundational approaches
30:52
in graduate school. And so I do think if we could go back to
30:56
training people, you know, in a more in a way where we teach
31:00
integrative using integrative approaches, I do think that would help. And I think
31:07
the stuff that's not empirically dated, you know, not empirically validated, we
31:11
have to warn people about. Um. Okay, So as we wind down
31:17
here, what's the take home for this book? Who do you want to
31:22
get this book? I mean, I think it's really good for therapists who
31:27
want to work with clients using multiple approaches, particularly for dealing with some of
31:33
the really more complex things that a lot of us didn't have training in so
31:37
anger and dissociation I think are are really well covered in the book, as
31:42
well as um you know, there's a chapter on substance abuse and dealing with
31:47
that, as well as suicidality, which isn't really written about a lot.
31:51
So I think for people who have you know, complex clients who need a
31:56
lot of support, I think the workbook can be a great adjunct. But
31:59
a lot of you know people have written me and said that they've bought the
32:02
book to use on themselves and they find it really validating and useful. So
32:08
before we go, I did want to ask you to pull out that a
32:13
little more information on anger. Why did you feel it was important to include
32:16
that well, because, like I said, it's so not covered in the
32:22
literature. And then where anger has been addressed, So within the psychoanalysis there's
32:29
a group of folks called Clientians. They follow Melanie Client's work. They deal
32:36
with anger, but they deal with anger in a very specific way where they
32:39
are very pathologizing about talking to clients about their anger, and so I wanted
32:45
to get away from that, but I did want to figure out, well,
32:47
how can we talk about this really difficult thing without making people feel pathologized
32:53
and shamed and crazy. It's just anger is not really discussed in our culture.
33:00
Sure, I mean it's lived right on social media, you have,
33:04
right, I mean in politicians and stuff you have, you know, incredible
33:07
expressions of anger. But in terms of everyday life and us trying to figure
33:13
out how to manage ourselves and personally, there's not a good guideline for that.
33:16
Trauma survivors, including people who seem very angry by the way, often
33:22
they are terrified by aggressive feelings. Most people are terrified by aggressive feelings,
33:30
and so my goal is to help people develop a relationship. We all have
33:34
to develop a relationship with our anger. In order to be assertive. We
33:37
have to understand that anger is not going to kill us. It's not going
33:40
to kill anyone else most of the time. And we need to not worry,
33:46
right, I mean, think about an everyday interaction. You want to
33:49
tell your hairdresser that you're moving on people worry about that. You tell your
33:53
ride share driver to slow down. You tell your friends you can't talk right
33:58
now, Like little any things in life, these things can cause people to
34:02
feel very anxious and guilty because it's a little way of being assertive. And
34:07
so, you know, a lot of work I've done on myself as it
34:10
has been around this, and I had great help from a therapist I saw
34:15
a long time ago. But you know, just imagine where you can tell
34:19
someone know and not feel bad. That's kind of where I'm coming from,
34:23
because people who have trauma histories do not have that luxury. They feel terrible
34:30
whenever they sent any kind of limit, and in some cases it really severe
34:36
trauma. They worry that setting any kind of a limit is going to cause
34:38
someone to be destroyed. And so I, you know, I try to
34:43
help people deal with that when they're ready, because life is just a hell
34:46
of a lot easier when you can set limits. Well, the book sounds
34:51
amazing again, the Complex PTSD Coping School's Workbook. Where can people get it?
34:57
It's on It's in local books at least around here in San Francisco,
35:01
but it's online at Amazon. It's also on the New Harborger website, but
35:06
it's on It's on all um websites, online booksellers. Okay and Tamara.
35:13
What is the best way for people to get in contact with you? They
35:15
can go to my website which is Tamara hyphen Greenberg dot com. Okay,
35:21
and we'll have that as well as the book linked up here at the show
35:23
notes page at the Trauma podcast dot com. You are a wealth of information.
35:30
Love to have you back anytime. I mean, pick a book,
35:35
we'll talk about it. Thank you very sweet. You're welcome and I appreciate
35:38
you sharing your own experience. Uh, it's awesome talking to you. Thank
35:44
you so much. All right, thanks, take care.