Trauma and counselling – Recognizing trauma and choosing a suitable approach to therapy

Trauma counselling and therapy - suitable approaches
A client came to counselling bracing themselves for what they expected would be a terrifying and awful experience. I was the fourth counsellor she had seen over the period of a few months.

This client was a woman who had been suffering from depression and anxiety following an extended period of abuse. In my office she fidgeted, avoided eye contact and appeared anxious and distressed. She told me she was tormented by something that had happened a few years ago. She had finally sought help, but after one session with her first counsellor she couldn’t bear to go back for a second.

She’d tried other counsellors too but it always ended up more or less the same. They would ask her about the event that was troubling her, she would tell part of the story, the session would end, and she would go home feeling like a wreck. Now she found herself in an impossible bind; her symptoms were getting worse but she was increasingly afraid to get help.

Conventional psychotherapy may label a client who balks at telling their story “resistant”. In Hakomi (and in my practice) client resistance is acknowledged as a valid aspect of self. Hakomi therapists use methods that support and validate a person’s intuitive, natural, strategic defensiveness. Paradoxically, by supporting the defenses, the nervous system may relax and ultimately doors may be opened.

Being with this woman in my office, I could practically feel her nervous system reaching out and clawing at me in desperation. I focused on moderating my own nervous system as we began our first session. (Our human nervous systems, like those of other mammals, are constantly, silently communicating with each other.) I explained that I would not be pushing her for any details around painful life events. In fact, I assured her that I didn’t need to hear the story of her abuse to help her.

Everything I was sensing from this person, from her story to her body language, hinted at trauma. Here’s a useful definition of psychological trauma –

Psychological trauma is the unique individual experience of an event or enduring conditions, in which the individual’s ability to integrate his/her emotional experience is overwhelmed, or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity.
(source sidran.org)

My trauma counselling approach is in some ways different from my other treatment methods. Without a suitable map for working with trauma, it’s easy to inadvertently re-trigger a traumatic response in someone and cause harm. This is true for counsellors and therapists, but also for doctors and medical professionals, teachers and educators, even parents and spouses.

This woman in my office had been repeatedly re-traumatized by helping professionals who either didn’t recognize trauma, or didn’t have a sufficient map for working with it.

(Note – Post traumatic stress disorder, PTSD, is the current label used to describe a lingering state of shock that humans have experienced in various forms for a very long time. PTSD is a politically charged and problematic diagnostic term, and one that I use sparingly.)

Traumatic life events are generally experienced in one of two ways –

  1. The event is experienced and then integrated over time until it takes an appropriate place in our memories, or
  2. The event is experienced but then continues to haunt us with a variety of persistent mental, emotional and physiological symptoms.

In the first case, when we talk about a traumatic event from the past it feels like it happened in the past. It has taken its rightful place in the past and although it may trigger painful memories we do not feel our safety threatened in the present moment.

In the second case, talking about a traumatic event from the past may trigger extreme distress in the present moment. We may feel, against all rationality, that the event is happening again or may happen any moment. We may understand logically that this is not true but our nervous system is in fight or flight (or freeze) mode.

When past traumatic experiences get triggered, we might become panicked. We might perspire, tremble, clench. We might feel rage or despair. We might freeze, go numb or dissociate.

As you can see, trauma can trigger a lot of different symptoms. What they have in common is immediacy and a sense of disproportion. We might be confused to see someone get so triggered or so shut down by just a few words or a sound or some other small cue.

It’s important to understand that the post-traumatic response is much more visceral than it is logical. It’s a body experience more than a head experience. Feeling more than thinking. When someone is panicked or dissociated it is very hard to get through to them with reason. Trauma therapy that works directly with the body rather than entirely cognitively, or that engages reason in slow, small steps can be effective.

By instructing someone to tell the story of their traumatic event we may be setting them up for re-traumatization, as happened with the client mentioned above. If we understand something of the nature of trauma, and learn to recognize its signs, we can better support people who are struggling with its lingering effects.

Pacing is critically important when working with trauma. There is a window of tolerance that must be carefully observed. Go too fast, push too hard, and a traumatized person can quickly go into hyper-arousal or dissociative states. Nothing useful happens in these states.

Here are some signs that a trauma response may be activated in a person –

  • Trembling, clenching, flushing of skin
  • Darting or wide eyes
  • Swallowing, fidgeting
  • Shallow breathing, minimal movement, “freezing”
  • Far away sounding voice, avoidance, sense of not being present
  • Rage, aggression or terror

If you suspect that a trauma response is activated, it’s best to slow down whatever process you’re engaged in. Back off the hot topic. De-escalate any conflict or stress. Simplify your language. Show support and caring with words and body language. Attend directly to the nervous system activation that is happening in the moment. This is vitally important.

As my sessions with this particular client continued, she slowly revealed details of her ordeal. It isn’t that she didn’t want to tell her story – on some level she wanted desperately to talk about what happened. But every time she did it made matters worse. By parsing out the details at a pace that was manageable for her, and by attending to her nervous system directly at every step, and by working relationally and building trust, I was able to help this woman get some relief from her symptoms.

Telling her story – to me and to key people in her life – was actually an important step for regaining perspective, moderating nervous system arousal, and healing the sense of alienation she experienced. But she had to build up to it slowly. Only by understanding the effects of trauma and having a map to navigate it in therapy could I work with her in a truly helpful way.

Trauma is complex, and there are many approaches to working with it. Understanding and treating trauma requires training, study and practice. I use somatic processing rooted in mindfulness and Hakomi principles. This allows me to gently work with the trauma that is locked in the body, without forcing clients into potential overwhelm or retraumatization.

To learn more about trauma, PTSD and treatment I recommend Peter Levine’s books –
Waking the Tiger – Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

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4 thoughts on “Trauma and counselling – Recognizing trauma and choosing a suitable approach to therapy

  1. Marie

    This was a great article on PTSD and trauma especially in how therapist have the ability to make things worse for the client. In your example, thankfully your client kept on searching for help. All to often people do not for fear of being triggered without resolution from a therapy session. Triggers are not only unpleasant, they can be debilitating and interfere with functioning, even hours after the initial trigger occured.

    Reply
  2. sylvia jones

    Justice, is hypnosis ever a technique that you use in treating your patients. I have been reading about it recently and am interested in your thoughts. Sylvia Australia. Ps love reading your articles

    Reply
    1. Justice Schanfarber Post author

      Sylvia, hypnosis is not one of the techniques I use. I do sometimes use deep mindfulness with clients which can produce a slightly altered state of consciousness. Best, Justice. PS – Glad you enjoy my articles 🙂

      Reply
  3. Shad Morris

    A friend of mine has been through a pretty rough time, and they were thinking about having her go to therapy to help her. I really like that you find someone that has experience with trauma counseling. That way, they will know how to help the person if they are put back into that state of mind.

    Reply

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