Trauma Survivors and Therapy

Strategies For Clients With Trauma Histories
One of the undercurrents among therapists deals with the question of how much time do you profitably spend in finding and reexamining old memories. Many people come to therapy because they are suffering from maladaptive patterns in their lives that were developed in response to some kind of abuse or trauma early in their lives. It is a given that people develop defensive strategies and coping behaviors in response to fear, anxiety, or pain they have suffered. These strategies, which can be mental or physical in nature are designed to stop or reduce the fear, or anxiousness, to a tolerable level.
Some therapists believe that clients will always suffer from these undercurrents until they revisit the traumatic experience, get in touch with the feelings they had at the time, remember clearly and process those feelings in today’s world. The theory is that if this is not accomplished, they will only cosmetically massage the symptoms and that is not truly effective. For example, if a person has a phobia of spiders and goes to therapy for that issue, they may rid themselves of the phobia of spiders. But, a few days/weeks later they discover that they have a phobia of elevators. Or it might manifest itself as what is called generalized anxiety disorder. What has happened, therefore, can more genuinely be called symptom management, rather than healing.
Other therapists believe that it is not so necessary to focus on the causative or trigger experiences. They believe that re-living and re-experiencing early trauma or pain is not necessary for learning how to develop new coping strategies. The client can develop the ability to reality test one’s environment so that maladaptive defenses can be restructured into coping skills which enhance one’s life, rather than perpetuate a dysfunctional response which leads to the continuation of anxiety and causes the client to remain a victim of early childhood trauma in their adult lives.
My approach falls somewhere in the middle. I have worked with clients who suffered from severe childhood trauma, especially childhood sexual abuse. Many of these clients continue to be victimized in their adult lives by memories, flashbacks, and the dissociative process which perpetuate their victimization. They can work to learn new skills, to try new behaviors, and change how they respond. They learn to identify triggers that have always set off their maladaptive behaviors (such as drinking too much, acting out sexually, isolating themselves, or hiding in their closet for hours or days until the anxiety dissipates.) These clients can sometimes learn new strategies, especially if they have a good support system, so that when they have these overwhelming urges to behave in damaging or destructive ways, they can make different choices. For some clients this is what they need. They learn to manage their anxiety in new ways, they manage to eliminate their victim mentality, and make new choices in their lives.
Two examples of things that I have found that seem to help these individuals are learning meditation and relaxation skills. I teach them how to go through the sections of their body and relax each section. Often they do this while listening to soothing music. I explain to them that in the beginning that they may not be able to do it, they may get distracted, agitated, or they may even fall asleep before they complete the routine. That is all OK. If they keep trying, over time, they will get to a place where they can learn to relax and take what I call a “mini vacation” whenever they have ten minutes to set aside. Other clients respond better to an exercise ritual. They go for long walks or get on a treadmill for half an hour. Some listen to music. I have them make their selections into a mood tape they can use as needed. Additionally, I encourage them as soon as they start to get their bodies under control to develop a relationship with someone they trust. This person allows them to say, “ I am anxious, I am scared, I am angry” without trying to fix it or indicate they should not feel that way. A mantra I encourage the client to remember is “Feel it, label it, and externalize it.” If they can feel the forbidden or frightening feelings and call them by name (anger, sadness, fear, hurt) then feel that feeling which was forbidden or unsafe for them to experience before will absorb and pass. They learn through their experience that these feelings come in waves and go away, they do not linger and become destructive. They will realize that they are knowable, feel-able, and survive-able. The goal is to start to identify the triggers that set off the anxiety or fear. Often the triggers are similar events, situations, or people to those that abused them earlier in life. It might be something like the smell of brownies baking, the smell of a hot iron on wet khaki pants, a car backfiring, or the slam of a screen door. The client learns to reality test these stimuli in the present, looking at themselves, their lives, and their resources. They learn not to dissociate, go away, or act out in harmful and self -destructive ways. They learn to relax their bodies and minds because they have identified the triggers and felt the scary feelings. They learn to master the source of anxiety and fear, they learn to reality test, and to choose new patterns. In essence, they get better, they heal.
For other clients a different strategy is needed. These clients do need to spend time reviewing and re-experiencing and re-surviving their traumatic past. The thing for therapist and client to remember when working with these patterns is to validate, reflect honestly to the client that they are safe when they are with you and that they have an anchor to hold on to. The anchor might be something literal or figurative. You might give them a string or a rope and you can hold the other end. You can hold their hand. You can have them hold an ink pen, a stuffed animal, or a pillow. You can remind them to recall something in their lives that feels safe and strong, or something that makes them happy, like eating an ice cream cone, or petting their dog. These clients need repetitions of re-experience so that they can learn to survive. They can learn that the abusers no longer master them and can no longer hurt them. They may need to learn that the grown up part of them can protect the abused child part of them who had no protector when they were young.
These issues are fixable but they take work and must be individually adapted to the specific issues and strengths of the client. Be patient, be gentle, do not get lost in arguing about facts or try to be an agent for the police to find and punish the abusers. This is not your job. Your job is to make a safe holding environment for the client so that they can do what is required to heal from the abuse they suffered. This takes confidence, skill, and empathy. You must believe in both yourself and in the strength of your clients. You must emanate the quiet confidence that says life can change and things can get better if they will trust you and spend the time to work with you. You will be a better therapist and your clients will have better lives.
So the answer to the question should you spend a lot of time looking back and recovering and re-experiencing memories is–it depends. It depends on the strengths of the client and the philosophy and skill level of the therapist. The answer is slightly different for every client. There is not a specific one-size-fits-all formula for therapy to help these abuse survivors.

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