Margaret Martin is a social worker that I have known for nearly a decade. Over that span of time we have shared many clients and I have always found her to be warm, brilliant and highly effective as a therapist. Recently Margaret posted a blog on trauma therapy which is a speciality of hers. I wanted to re-post the blog here so that my readers can learn from her expertise on this very important subject. What follows is her post:
Over the years I’ve found that there are some frequent misconceptions among clients seeking treatment for trauma. Based on outdated ideas of trauma therapy and a misunderstanding of the process, any one of the following beliefs could be enough to keep an individual from seeking treatment for trauma. So I want to challenge them here.
“I have to tell my whole story in order to heal.” Nope, not true. In fact, telling the story, especially all at once or repeatedly, can be re-traumatizing. Some approaches to trauma (most notably Prolonged Exposure Therapy) promote the belief that healing comes from the repeated re-telling of the trauma story. However, many clinicians see exposure therapy as simply creating a state of habituation or desensitization, a kind of “numbness” to the trauma, rather than true recovery or restoration. Desensitization not does not necessarily equal healing. Somatic Experiencing (SE), developed by Peter Levine, PhD, is one approach to trauma treatment that not only does not require the re-telling of the traumatic story but discourages moving in a way that might be re-traumatizing for the client. SE provides a compassionate approach, allowing clients to test the water and dip their toes in and take them out again, rather than diving into the deep end of the trauma pool.
Several years ago I moved away from using Eye Movement Desensitization Reprocessing (EMDR) as my go-to weapon in the fight against PTSD, particularly with clients with complex trauma. Although EMDR is still the best choice for some clients, I now use SE more frequently because I see it as much more gentle on the nervous system, especially for those with few coping skills or who currently function at a very limited capacity. Healing from trauma is hard work, but the process should not leave the client feeling raw, overwhelmed or exhausted. When that happens the process is moving too fast and needs to slow down. This does not mean that healing happens more slowly; it means the process is less painful.
“If I can’t remember what happened, or I’m not sure, I can’t heal.” Many people don’t remember the details of a traumatic event. Sometimes people have symptoms of PTSD and don’t know why. Others have vague, dream-like memories that frighten them, but for which they have no context. If trauma occurred before an individual was able to process the information verbally (any time prior to age 3-5) the memories are “implicit” rather than “explicit,” and typically have no language attached. Memories of early life events may also take on a more mythical form, such as being smothered or attacked by a shadow or monster, or hiding from an unknown danger. All of these are normal responses to trauma. Healing from trauma can happen whether or not the client knows “what really happened.” Many clients doubt their own stories or memories. This too, is normal, especially if the experience has been invalidated by other family members or friends. The reality is that symptoms of PTSD don’t occur without reason. Luckily we don’t have to know or fully understand the reason in order to heal.
“Therapy won’t help or it will get worse before it gets better, and I can’t handle that.” Jumping right in and pulling the scab off the wound can absolutely result in the experience of PTSD getting worse before it gets better. That’s why we don’t do it that way. We go gently, slowly, making sure that before we consider abandoning old coping skills, even those that are unhealthy, we work on healthier coping skills to put in their place. We create a safety net and anticipate what kinds of triggers or experiences might be “too much” or something the client “can’t handle.” Although there are times when even the most careful approach can feel overwhelming, I’ve found that especially with SE that is not often the case.
“I’m going to have to confront the perpetrator (if there is one) in order to heal.” In my experience this is a much less commonly held belief but one that can certainly dissuade someone from seeking treatment if they believe it. It’s also not true. In many situations confronting the perpetrator could be dangerous, either physically or emotionally, or could have other negative consequences. Unless confronting the perpetrator holds a clear benefit or gain, such as protecting others or taking legal action, clinicians specializing in trauma often discourage it. It certainly needs to be postponed until the survivor has explored his or her motivations, expectations, and all possible outcomes. Unless they’ve changed significantly, a perpetrator, and those who support and protect him or her, will continue the denial, rationalization, and thinking errors that allowed him or her to engage in the abuse in the first place. Expecting an apology or compassion is unrealistic and potentially risky.
I hope that if you or someone you love has been avoiding therapy due to fear of the process this perspective will be helpful.
Many thanks to Margaret for her words of wisdom. As always if you have benefitted from this information please click on the "like" button below to like it on Facebook, click on the Twitter button below to tweet it or click on the "Comment" button below to add a comment.
Wishing you health and happiness,
Dr. Jordan
Over the years I’ve found that there are some frequent misconceptions among clients seeking treatment for trauma. Based on outdated ideas of trauma therapy and a misunderstanding of the process, any one of the following beliefs could be enough to keep an individual from seeking treatment for trauma. So I want to challenge them here.
“I have to tell my whole story in order to heal.” Nope, not true. In fact, telling the story, especially all at once or repeatedly, can be re-traumatizing. Some approaches to trauma (most notably Prolonged Exposure Therapy) promote the belief that healing comes from the repeated re-telling of the trauma story. However, many clinicians see exposure therapy as simply creating a state of habituation or desensitization, a kind of “numbness” to the trauma, rather than true recovery or restoration. Desensitization not does not necessarily equal healing. Somatic Experiencing (SE), developed by Peter Levine, PhD, is one approach to trauma treatment that not only does not require the re-telling of the traumatic story but discourages moving in a way that might be re-traumatizing for the client. SE provides a compassionate approach, allowing clients to test the water and dip their toes in and take them out again, rather than diving into the deep end of the trauma pool.
Several years ago I moved away from using Eye Movement Desensitization Reprocessing (EMDR) as my go-to weapon in the fight against PTSD, particularly with clients with complex trauma. Although EMDR is still the best choice for some clients, I now use SE more frequently because I see it as much more gentle on the nervous system, especially for those with few coping skills or who currently function at a very limited capacity. Healing from trauma is hard work, but the process should not leave the client feeling raw, overwhelmed or exhausted. When that happens the process is moving too fast and needs to slow down. This does not mean that healing happens more slowly; it means the process is less painful.
“If I can’t remember what happened, or I’m not sure, I can’t heal.” Many people don’t remember the details of a traumatic event. Sometimes people have symptoms of PTSD and don’t know why. Others have vague, dream-like memories that frighten them, but for which they have no context. If trauma occurred before an individual was able to process the information verbally (any time prior to age 3-5) the memories are “implicit” rather than “explicit,” and typically have no language attached. Memories of early life events may also take on a more mythical form, such as being smothered or attacked by a shadow or monster, or hiding from an unknown danger. All of these are normal responses to trauma. Healing from trauma can happen whether or not the client knows “what really happened.” Many clients doubt their own stories or memories. This too, is normal, especially if the experience has been invalidated by other family members or friends. The reality is that symptoms of PTSD don’t occur without reason. Luckily we don’t have to know or fully understand the reason in order to heal.
“Therapy won’t help or it will get worse before it gets better, and I can’t handle that.” Jumping right in and pulling the scab off the wound can absolutely result in the experience of PTSD getting worse before it gets better. That’s why we don’t do it that way. We go gently, slowly, making sure that before we consider abandoning old coping skills, even those that are unhealthy, we work on healthier coping skills to put in their place. We create a safety net and anticipate what kinds of triggers or experiences might be “too much” or something the client “can’t handle.” Although there are times when even the most careful approach can feel overwhelming, I’ve found that especially with SE that is not often the case.
“I’m going to have to confront the perpetrator (if there is one) in order to heal.” In my experience this is a much less commonly held belief but one that can certainly dissuade someone from seeking treatment if they believe it. It’s also not true. In many situations confronting the perpetrator could be dangerous, either physically or emotionally, or could have other negative consequences. Unless confronting the perpetrator holds a clear benefit or gain, such as protecting others or taking legal action, clinicians specializing in trauma often discourage it. It certainly needs to be postponed until the survivor has explored his or her motivations, expectations, and all possible outcomes. Unless they’ve changed significantly, a perpetrator, and those who support and protect him or her, will continue the denial, rationalization, and thinking errors that allowed him or her to engage in the abuse in the first place. Expecting an apology or compassion is unrealistic and potentially risky.
I hope that if you or someone you love has been avoiding therapy due to fear of the process this perspective will be helpful.
Many thanks to Margaret for her words of wisdom. As always if you have benefitted from this information please click on the "like" button below to like it on Facebook, click on the Twitter button below to tweet it or click on the "Comment" button below to add a comment.
Wishing you health and happiness,
Dr. Jordan
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