Counselling West Bridgford
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Therapy for Trauma
The word ‘trauma’ is one that’s used frequently, often as a throw away label for difficult situations (“it was so traumatic!” about a relatively minor difficulty), as well in relation to serious, difficult events.
In this article I present a broad definition of trauma, the symptoms to look out for, a bit of relevant neurobiology and then how effective therapy for trauma works. I’ve also included, if you decide you might like to explore your experience in psychotherapy, what to look out for to ensure your therapist has competence in this area.
Definition of Trauma
The definition I use is the one presented by Dr Gabor Maté. He describes it as the disconnection from our true authentic selves, and the reason for that disconnection is that it’s too painful to be ourselves. So trauma isn’t the thing that happened, but rather what happens inside as a result.
Often trauma is thought of as being about a single, big adverse event such as an assault, consequence of war, or serious accident. Of course, they often result in trauma and are most definitely included within the list of adverse events, but the definition I’m using here is much broader. What is often missed out when we think of trauma, are those individually small adverse events that are repeated over an extended period. For example your parents having one bad day when they ignored you crying is unlikely to lead to trauma, whereas multiple years of that kind of treatment is highly likely to.
The types of adverse events that potentially lead to trauma are broad. If your parents were struggling during a divorce and they were unable to be present for you, if things were chaotic at home, perhaps a sibling had difficulties which distracted your parents or your parents themselves had mental health challenges. Maybe academic, career or performance expectations were directed at you that you couldn’t or didn’t want to fulfil, if feelings and emotions weren’t allowed to be expressed at home, or perhaps you were teased or bullied at school, work, or home.
And those adverse experiences don’t just have to have happened in childhood, it can be anything in our history up to this point.
As you read that, you may reasonably comment that many of those are common experiences, and you may even give examples where those things have happened but they have not led to a sense of trauma.
The difference for those that don’t seem to suffer internal consequences from adverse events, is usually that they are able to speak about what happened to them, be heard and understood (through their close relationships or by accessing therapy for trauma), and process it into the memory banks and move on.
And this is why, in a group of individuals who experienced the same adverse events, some will be negatively impacted in the long term and others not.
It can also be that the symptoms of trauma might not be what you expect, so it may appear someone is unaffected, but the consequences are there nonetheless.
How does trauma manifest?
Trauma can show itself in multiple ways, in our physical bodies as well as our mental health. From cancer to autoimmune diseases and many other long-term or chronic conditions .
We may also see anxiety, depression, stress, problematic drinking or substance abuse, negative body image, smoking to name just a few.
We can accept unhealthy relationships, struggle with boundaries, expect perfection in others or self, and may even engage in unacceptable behaviour ourselves.
You may be a people-pleaser or unable to say “no” despite negative consequences. Also, responding passively-aggressively, lashing out, or retreating to isolation when feeling hurt is also how trauma manifests. The list is endless.
Now for the science bit…
Understanding some of the neurobiology might help you to make sense of how traumatic events become problematic for some. It also explains how talking, being heard and understood by those we trust, including in therapy for trauma, helps to heal.
When our bodies perceive a threat, the amygdala is activated and the ‘fight, flight, freeze’ response is initiated. Unfortunately, at this point, the parts of the brain that can make sense of what’s happening are out of action – after all we need to concentrate on dealing with the danger in front of us so no time for thinking! Those feelings don’t have language – the executive bits of our brain that do that kind of thing are located elsewhere and get into gear much more slowly. And then when we try to put some words to it, we don’t necessarily do that accurately.
Talking things through engages the hippocampus area of the brain that enables recording of events. Unfortunately, when we are dysregulated, when we feel unsafe or threatened, the hippocampus can’t record things accurately. This is why talking things through in a space that feels psychologically safe enables that process to work more effectively.
It is so important to find the words, and a good therapist can help you do that.
How does therapy for trauma work?
Sometimes you may have a specific event or period of your life where you want to be heard and understood. If you have plenty of secure, loving relationships outside the therapy room, but where it would be too difficult, painful or horrific for those close to you to hear, just a relatively few sessions of therapy for trauma can provide a sense of healing that you need.
In some cases it is the enduring therapeutic relationship that facilitates change which means it may be a long time before we get to an ending. Whilst we would all like the quick-fix over a few weeks, unfortunately that is rarely the case where adverse events have led you on a path to unhealthy relationships which further compound things. One way to think about it is that we are building new connections, rather then fixing old ones, and building something safe and secure takes time and energy.
We will work together to work at a pace that feels safe but allows you to “move your edges”. What I mean by that is to feel a sense of deeper understanding and progress without feeling too threatened or overwhelmed. To begin to record events in the memory banks differently, in a way that leads to a healthier, more fulfilled life.
In essence, asking someone “tell me the detail about exactly what happened” is likely to be crashing through the boundary of what feels safe to talk about, with no apparent option to refuse. Instead, you will hear me say something like “would it be ok to talk more about that time?” which gives you the explicit option to say no, but also allows you to just say a little about it without feeling too overwhelmed. So I don’t ignore a topic, but I respect your need for safety as my client.
Noticing subtle changes in energy are also a vital part of my work in this area. A comment, movement, change in body language or skin tone, as well as something I can’t quite label, I will notice, and gently enquire as to what is happening for them in that moment.
I often describe something I call “threads”. I almost see the image of a light luminous thread that’s telling me there’s something more in that moment, in terms of something that was said. That might sound a bit strange, but it may help to add that I am very visual and any images that pop into my mind is a significant resource in my therapy work.
All my clients know that I’m always working towards an ending, whether that be in a few sessions or an extended period. Through a secure connection between you and me, you are then able to generalise some of your learning to your broader life, and we will evolve to a natural ending of our work, with perhaps just the occasional check-in appointment when you feel it might be helpful.
Therapist competence
One vital aspect of therapy for trauma is the therapist’s ability to stay grounded during your sessions. Even if we don’t say anything to them, any energetic reaction will be perceived by the client. The importance of your therapist being able to regulate themselves and stay grounded in the present moment cannot be overstated.
That’s why, as part of my UKCP-accredited training, I was required to undertake 160 hours of personal therapy, as well as 3 hours of supervision for every 1 hour of client work during training. And even now I usually have at least 3 hours of supervision per month, and occasionally book myself in for some personal therapy, to make sure I am in the best psychological shape for your appointments.
Staying up to date with the latest in what is an incredibly fast-moving field of understanding is vital too. I’m constantly reading, watching videos, listening to podcasts by leaders in the field as well as attending training courses to stay current. My knowledge and understanding of the field of trauma has really become at the forefront of my work since qualification as I’ve deep-dived into research and publications.
A good relationship
If your therapist has some good qualifications and has done extensive work on themselves, then all you need to concern yourself with is whether you think you can get along with them. It is the unspoken heart-mind synchronicity between client and therapist that is needed for change, so that connection is vital.
For some of you, if you learned that being close to someone never leads to anything good, connection may well be a scary thing. A good therapist will understand this, and will welcome a conversation about it. With some clients we can spend weeks discussing what it feels like to be in therapy, and how they struggle to trust me – and that’s ok.
As part of our ongoing work, perhaps a client may say something then worry about what I might do with that information, or maybe I might have said something that went on to trouble them. By addressing all of these things together, we can establish that foundation of trust, which we need before we delve into anything else.
For others (and this was definitely the case for me when I first entered therapy) they may jump straight in – glad they finally had someone non-judgmental who would listen and try to understand.
I always hope my clients learn quickly that they can say anything to me and it’ll be ok – we’ll work through anything we need to. But I’m prepared to work at your pace, and it will just take as long as it takes.
Feel like it would be worth booking in?
If you would like to explore the possibility of exploring therapy for trauma yourself, I offer a free, no-obligation, initial telephone consultation, which you can book online. This gives us the opportunity for me to find out more, and to see if you think we could get along.
Inspiration
I’m inspired and guided by the work of Gabor Maté and Bruce Perry. If you would like to discover more about trauma, its origins and healing, I recommend exploring their work:
Bruce Perry/ Bruce D. Perry, M.D., Ph.D. (bdperry.com)
The Wisdom of Trauma – Dr. Gabor Maté (drgabormate.com)
In the summer of 2019, I was privileged to attend the ‘ACEs to Assets’ conference, where Gabor Maté was the keynote speaker. ACEs stands for Adverse Childhood Experiences, and the conference core topic was the impact of ACEs on mental health, and how we can heal. I also recently listened to a webinar ‘Healing the Wounds of Trauma: An in-depth conversation with Gabor Maté and Bruce Perry’ which was the finally inspiration to get writing this article on therapy for trauma.
Both Maté and Perry are globally recognised as leaders in the impact of trauma, how therapy for trauma works, and I would recommend taking a look at their work. Perry has particular expertise in the development of the child’s brain and neuroscience.
Therapy for Trauma
Therapy for Trauma