Trauma Therapy Demystified - part 1
writings are based off of common themes, however, are in no way specific to client stories to protect confidentiality.
"I’ve been to therapy most of my life, and I feel like there’s this alluring concept of getting better”.
Allison sits across me, her body tight, shoulders leaned forward. I remember the first time we met, her eyes had darted across the room looking for danger, feeling hyper-vigilant, her body stuck in fight and flight response.
For this moment though, something is keeping her put. She digs her feet deeper into the soft carpet beneath her feet. She slowly uncrosses her arms, opens her shoulders, and peers at me with a softness in her eyes that hadn’t been there when we met a few sessions ago.
“Please explain to me how this “getting better” works."
Allison is one of the many voices that ask about what healing really means, an inquiry that echoes from the depths of the soul. She asks the questions many others have asked before, “When will I have myself back” or “Will I experience the joys others do? I see the pain in her eyes and although I wish I can offer magical fairy dust powder that can heal all wounds, I know she’s on the pathway to a better life.
Trauma recovery offers the individual the capacity to live in the present moment without being overwhelmed by thoughts, feelings or behaviors from the past.
Trauma healing constitutes restoration of inner safety, empowerment and trust, offering skills, newfound confidence and compassion. However, recovery does not mean complete freedom from all post traumatic effects, it does however, allow for smoother movement through those experiences and provides reduction in symptomatology that impede the building of a good life.
Healing is a journey and therapy is an invitation to healing.
Since clarity is the antithesis of darkness and confusion, I find it important for individuals to understand their trauma process. “Allison, remember the spiral staircase metaphor?” She nods. Metaphors have a playful yet wise way of giving over sometimes difficult concepts. The spiral staircase is helpful in explaining trauma recovery, as the progression of trauma healing is nonlinear in nature.
Given the spirilic nature of healing, you may be revisiting issues previously addressed with a greater level of stability, increased skill set, and improved personal integration as we explore the next phase of work. In trauma healing, Dr. Pierre Janet, and later Dr. Judith Herman offer a three-pronged approach to successful trauma work (Herman, 1997).
The first phase of treatment focuses on reducing negative symptoms and stabilization. When in pain, we often want a quick fix or to “rush” through trauma healing. Even if that was possible, it would cause more harm than good. This phase isn’t simply a preparation phase, or a “dress rehearsal” for trauma processing. The skills learned in this phase are foundational to begin healing, building resources and support, providing the bedrock for lasting relief. In this phase, the focus is on building a solid therapeutic relationship with a trauma trained specialist.
In therapy, you’ll learn to practice ways to express and process emotions in a healthier manner, develop compassion for self, reduce self-shaming beliefs and rediscover innate strengths. You begin processing the side effects of your trauma by engaging in better routines, self-care patterns and by challenging the negative beliefs that steal your energy. You begin to develop yourself as a resource, amongst other resources, as well as practicing new coping skills that will help you better manage triggers and emotional overwhelm.
You learn to utilize connection, engage in healthy relationships, appropriately using them for attunement.
Babette Rothchild compares emotional overwhelm to a shaken bottle of soda. To release the pressure, we need to slowly open and close the cap, with intention, focus and caution (Rothschild, 2000). The struggle of self-regulating and self-soothing is a side effect of trauma.
Trauma shakes the nervous system, interrupting the body’s natural form of working through, processing and making sense of experiences and emotions.
This is why the first step to restoring safety in the body is teaching ways to regulate, and stay in your ‘window of tolerance’.
“I know what you mean, about the emotion regulation piece. When my heart beats quickly and my palms get sweaty, I’m usually in hyper-arousal, right?”
In treatment, this patient has willfully engaged in tracking her thoughts, feelings and body symptoms, also known as somatic expression. We practice mindfulness, paced breathing and improve-the-moment skills to reduce intense emotions and bring the mind, and body, back to the "here-and-now". Doing this slows down the heart rate and brings conscious awareness to the present moment.
“After I filled out the trigger log for a few weeks I started realizing what factors were causing my body to go into this state.” Those symptoms are from my body’s alarm system telling me to slow down and check for safety.”
Tracking your trigger points are important in learning to “cope ahead” (Dialectical Behavioral Therapy, Linehan 2015).
This is a skill Dr. Marsha Linehan teaches in Dialectical Behavioral Therapy (Linehan, 2015). “If I know I’ll be facing a trying situation later in the day, I will prepare skills ahead of time so that I’m equipped.”
And then, with a slight laugh she references mindfulness, a practice that re-shapes the mind, by slowing down and paying attention on purpose to whatever you are faced with.
“I had initially thought mindfulness seemed silly. But practicing it has helped me in calming down, and learn to check the validity of my thoughts and feelings”.
Mindfulness, a practice, that offers maximum relief when practiced on a daily basis.
By utilizing mindful techniques and mindful awareness, you are teaching you mind and body to slow down, thereby creating expansion and distance from what is happening, letting go of attachment or judgements.
Dr. Pat Ogden and Dr. Janina Fischer explain mindful observation, “Identification invariably intensifies any emotion or evokes shame. Learning to describe an experience without “identifying with it” allows clients to …hold a curious or even compassionate attitude toward feelings or reactions…” (Fischer,2017).
By practicing mindfulness, we invite compassion, a newfound understanding of ourselves, and replace judgement with curiosity.
In addition to trauma focused therapy, deep breathing, yoga, dance movement, creative arts and poetry writing are additional ways to help shift emotional intensity and offer emotional relief.
Trauma recovery begins the moment you commit to taking small, consistent steps towards healing. The next blog (part 2) will discuss the deeper dive into healing, exploring Phase Two and Phase Three of trauma recovery.
Curious about next phases of trauma therapy but seeking relief today? Reach out to Esther Goldstein to schedule a free consult and to book your counseling session at her Cedarhurst office in Long Island.
Fisher, Janina. (2017). Healing the fragmented selves of trauma survivors.New York, NY: Routledge.
Herman, Judith. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York: BasicBooks.
Linehan, Masha. (2015) DBT Skills Training Manual, Second Edition Second Edition, Available separately: DBT Skills Training Handouts and Worksheets, Second Edition
Rothchild, Babette. (2000).The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Norton Professional Books (Hardcover) 1st Edition