I’m aware that there is no perfect way to write a short post on the topic of counseling trauma without evoking some big feelings. I also understand that as delicately as I might handle my words, not everyone will agree with my observations and reflections. The last thing I would want to do is make a person reading this feel small, de-valued, not seen or hurt. Trauma, and how it plays out in a person’s life, is very unique. Moreover, talking about the topic can be challenging and tender. As such, I approach my post today with love in my heart. I know that many of us are simply trying the very best that we can. If you are a victim or survivor of trauma, and you’re reading this, thank you. Thank you for continuing to fight in the face of immense adversity.
The Body Keeps the Score
So much has been written about Trauma. The landmark book in my mind is “The Body Keeps the Score” by Bessel Van Der Kolk; though, there are many great pieces of literature on the topic. In his book, Van Der Kolk shares his experiences of being a young psychiatrist working at the University of Harvard and realizing that so many people that he was working with were dealing with Post Traumatic Stress Disorder (PTSD), yet were diagnosed with other things.
The book thoughtfully meanders from personal stories, to realizations about what happened to Ivan Pavlov’s dogs when Pavlov’s basement flooded. Then, all the way into intense research Dr. Van Der Kolk was a part of. He provides a plethora of mind blowing statistics. We now know that experiencing Trauma has profound impact on our brains. While the book can be dense in spots, I believe it’s an important read for those struggling with trauma and perhaps more important for therapists trying to help clients with trauma.
With that, we are still exploring how to best treat trauma. I think convincing ourselves that we know exactly how to treat it is a mistake. We need different therapists with different personalities, with different ideas, trying different things. Eye Movement Desensitization Reprocessing (EMDR) has burst onto the scene as a hopeful modality. Cognitive Behavioral Therapy (CBT), yoga, art, Internal Family Systems (IFS) and sensory therapy have all been leveraged in the fight. Certainly, one size does not fit all and I truly want my clients to get what they need. Some have left my practice to try EMDR, while others have come to me after trying EMDR. You have to find the right fit for you. My point is that we know how sinister trauma is. We are still trying to figure out how to best help people dealing with it.
A Story about Counseling Trauma
Before I get into how I go about helping my clients with trauma, consider this story:
A woman was in a relationship for about 8 years with a man. Soon into the relationship, her boyfriend began to suggest how he wanted her to dress. Shortly thereafter, he became controlling about what friends she is allowed to see. Consistent criticism came shortly after. All the while, he drinks… a lot. And when he drinks, the lash of his tongue quickly turns into the fury of his fists. And for years, she takes an emotional and physical beating. He intimidates her and tells her that if she tells anyone he’ll “ruin her life”. In more insecure moments, he says, “If you leave, I will kill myself… and maybe you too.” His drinking progresses.
One day, she decides she can’t do it anymore. She plans an escape and 8 months after her original thought of leaving, she escapes while he’s on a buddies trip. A year later, she finds a therapist to begin working on things. She feels anxious all the time, is angry at herself for staying so long, is having nightmares, startles easy, is grieving how her 20s should have gone, and feels like she will never find love. On session 3 with her hopeful therapist, she explains that she will always be alone and that no one will accept her with this damage. She goes on to explain that she worked up the courage to go on a blind double date at her friend’s insistence.
The date starts well and they head to dinner when the man she is setup with orders a bottle of Coors light. The physiological symptoms set in—her heart pounds, her speech shakes and practically shuts down altogether. She excuses herself to the bathroom. The feelings and symptoms become so severe that when she returns to the table, she says she has an emergency and she has to go.
She tells the therapist that she wants to work on her anxiety. In her mind, she wonders: Who will ever want me with all of this? She copes by isolating herself, not going out, drinking wine, yoga, and sometimes cutting her arm to make sure she can still feel. Is this person crazy or are they immensely hurt? We focus too much on behavior/symptoms and not enough time on feeling and understanding (but that’s a whole other blog post).
Treating Trauma in Counseling
So how do I treat Trauma? Short answer… carefully. Longer answer: it’s nuanced but I’ll give you the basics in a somewhat bullet pointed list. Let me preface this by saying that clients fighting trauma are often with me for a good while. Moreover, these clients come to know that progress is messy and victories, both big and small, aren’t always pretty. What I’m about the explain is mainly rooted in Inter Family Systems Theory. I also want to add that I use a lot of role-playing, soft confrontations, here-and-now techniques along the journey. But here it is in a nutshell:
- After spending time with the client, listening to them, attempting to grasp their human experience, I invite them to the possibility that their depression, anxiety, and other symptoms are manifestations of this trauma. I tell them that when they experienced trauma (often in childhood but not always) there is a part of them that is still there. They feel like they have to face their trauma or abuser the moment they become triggered (the brain plays a clever trick). There is another part of them that is trying to protect the part that still feels like they are in the midst of trauma. And I ask them how these two parts are doing in their relationship with one another. Often, this inner relationship has not been good for a long time. The part that is hurting hates the other part for how they are coping. And the coping part feels like if they stop coping, the other part will crumble and they’ll both die. So they are in a profound power struggle.
- I then invite my client to wonder what it would look like for these two parts of themselves to work together—to treat one another with compassion, love and respect. I use all sorts of role-plays and techniques to facilitate dialogue between these two parts. The part of them that doesn’t know how to stop working or drinking because if they stopped, they would feel scared… well this is the same part of them that got them through a lot of adversity. Perhaps that part of them got them through medical school or a really horrible divorce. This part of the process is ongoing and takes a long time. Is it possible for these two parts to acknowledge that they’ve been trying to protect and help each other all along but it went haywire at some point? By the way, this part comes after a lot of talking, reflection and me sitting with their pain.
- I encourage people to really explore their “why” questions and come up with their best theories. Socrates believed that the first step towards true wisdom was to “know thyself,” and I invite my clients to get to know every little part of themselves rather than judging themselves. So if my client wonders, “why can’t I just take a compliment?” Or “Why can’t I show myself love?” Or “Why can’t I get out of bed?” I ask them to dig in and answer it. There might be very good reason they are struggling. Maybe they never got praised as a child or maybe their bed is a safer place that having to face their co-workers. Ultimately, I want the client to be able to explain any “why” question that they wonder. This gives them a roadmap to navigate difficult feelings rather than fall into the trap of self-punishment.
- I encourage my clients to hug the part of themselves that need it the most. To protect this part with love. To treat this part the way they deserve to be treated. Rather than going to the gym because they feel like they look ugly and need to “whip themselves into shape”, to go to the gym from a place of, “I don’t want to neglect this part of me anymore. I’ll take myself to the gym and show this part of myself that they have nothing to be ashamed of. That if they feel uncomfortable, I won’t call them weak, but offer them support and even leave with them if the discomfort becomes too much.” I call this “Radical self-kindness”. I’m not the inventor of this and one buzz term that I’ve often heard that fits here is “re-parenting”. This is a very nuanced process that takes immense commitment. In this phase, the client is doing most of the talking in our sessions.
- I teach and encourage my clients to exercise and pay attention to this relationship with themselves everyday. All great relationships require persistence and reciprocation.
- I consistently remind my client that they have nothing to be ashamed of.
- I continue to reflect how I’m seeing the relationship between them and them.
So, how is the relationship going with yourself? Do you ask yourself the “why” questions and feel bad about how you cope? Are you taking the time to really listen to yourself with a loving ear? Find someone who will listen and hold you accountable when you are sharp with yourself. Someone who will call you out for being down right nasty to yourself. Therapists should know how to do this in the most empathic and loving way.
TLDR: You don’t have to hate yourself anymore and you have nothing to be ashamed of. I hope one day you can believe that as much as I believe it for you.