Sometimes, Trauma…

Overview

It can be hard building confidence to work with various presentations of trauma, to build a thriving Private Practice or even to complete the intensive therapy training to feel equipped for what might arrive in your therapy room. Working dynamically with trauma requires a more proactive and involved approach and this can feel especially tricky if your initial training has encouraged you to focus mostly on offering core conditions, to watch out for directions that might lead to your own agenda, or where too many questions can be seen to detract from the client’s own decision making. Finding a comfortable working model isn’t always easy.

A Trauma Modality

Often, a Trauma-Informed approach isn’t central to therapy training (which makes sense from a safety-first point of view, given we don’t often know what we are really doing when everything is new!). Later though, even training for “relational” deep work can sometimes encourage holding back from a client, waiting so that they are making the connections themselves. This is a good approach – unless you don’t have the skills to notice a client isn’t “thinking helpfully”, but is instead dysregulated. A client may not be processing the story they are telling you with a connected brain, but from a triggered place.

Theory and Automatic Trauma Responses

We may know a lot of psychotherapeutic theory, but that needs to be placed next to information about triggered responses, the impact of attachment and trauma on the development of a child’s brain or what a desensitised telling of a narrative looks like.

If a client goes into a “Flop” or “Freeze” response, it might be easy to think that we are offering a helpful silence, when the client may be stuck in a flashback and might feel awful for hours after. If a client is very agitated and angry, (in a “Fight” response), we can sometimes hold back: when stepping forward and helping with a controlled breathing exercise or bringing them more directly into the room or their bodies might help better. 

Likewise, many therapists, (and clients), are unaware of the existence of the “Fawn” response. In the therapy room with a client whose brain predominantly chooses this survival instinct, you may even believe that you are doing great work – because for the client constant appeasement is the only way to seek safety. They have learned to subjugate their true feelings when with someone who feels powerful.

Your Own Integrated Modality

When first working with clients, sometimes even checking the clock, pausing a client or managing time boundaries with a very verbal client can feel intimidating! Being in the therapist’s chair is always brave work – but how much more so it might feel terrifying to proactively introduce the idea of the Window of Tolerance or to ask a client to get up from their seat and swing their arms around!? I know that I struggled to feel natural introducing a breathing exercise. These tools can feel hard to use.