By Sarah Elaine Zimmerman, LCSW
● Trauma ● PTSD ● EMDR ● DBT ●
Will I Feel Safe? Potential clients seeking therapy for their PTSD or Complex trauma symptoms often want to know if therapy will require frequent re-experiencing of the trauma memories in order to get better. They want reassurance that the therapy process is not going to feel like re-victimization when they are seeking relief from the debilitating triggers and flashbacks in the first place. The therapeutic relationship itself can feel frightening because it is a process of getting to know the therapist and forming a new personal attachment over time. It takes so much courage to even ask for help. However, I can provide some hope and clarification that it’s possible to make life-changing progress in therapy without re-living traumatic experiences in a way that feels dangerous and flooding.
During trauma work I’m focused on attunement to my clients, both from what I observe and the feedback they share with me about their needs. I’m prioritizing their safety and stabilization. We slow the pace, as needed, on processing the traumatic memories. It’s like letting the air out of a balloon slowly and carefully. It’s also a balancing act of working on the past and it’s current impact while maintaining a sense of grounding in the present. It’s like sitting on a fence with a leg on both sides. Staying within this space is called the Window of Tolerance (Dr. Daniel J. Siegel’s term). If therapists don’t pay attention to this, clients may feel too unstable to continue the work. They can feel hyperaroused (extremely emotionally reactive) or hypoaroused (dissociative/numb). I want clients to have awareness of the present time, place and access to the adult self, as much as possible.
While there are many well-researched therapy options, I want to share three here. In my opinion, these techniques support survivors with feeling safe and more in control of the therapy process and have effective results.
Eye Movement Desensitization and Reprocessing (Dr. Francine Shapiro, PhD) is a mind-body approach providing bilateral stimulation (BLS) of the brain, often using eye movements, to reprocess trauma. The intervention includes several protective and strengths-based resourcing methods. We work with positive qualities, identify a calm, safe place and use a container exercise for ‘storage’ of unfinished trauma work between sessions. The traditional protocol starts with an image of the target memory, but can be modified to reduce the exposure to disturbing traumatic images and memories. Clients can shift, shrink or blur the image with BLS/dual attention during the desensitization phase. The Flash Technique (Philip Manfield, PhD), can also be used in the preparation phase for EMDR. Flash requires even less focused attention on the intensity of the traumatic material.
Dialectical Behavior Therapy (Marsha Linehan, PhD) is a toolbox of skills that teaches clients to regulate emotions, practice mindfulness, improve interpersonal relationships and develop distress tolerance strategies for crisis situations. The behavioral skills are practiced regularly and tracked so clients learns new coping ways to handle difficult emotions, behaviors and thoughts. This is useful for decreasing disturbances in identity/self, emotions and relationships. Most trauma symptoms were once important survival skills but might not be the best options in clients’ present lives.
Cognitive Behavioral Therapy (Aaron T. Beck, MD) focuses on identifying negative beliefs, triggering situations, cognitive distortions and traumatic themes. Clients log/track their thoughts across situations to increase insight into their own patterns of thinking, cognitive distortions and corresponding emotions. Beliefs are challenged with finding evidence or facts to the contrary, and reframed. These positive replacement thoughts support the creation of new, healthier behaviors.
The ultimate goal of therapy is to provide a warm, welcoming therapeutic space where someone can begin to release the hold and impact of past trauma, truly live in the present and dream of the future. I want to see clients move forward believing in their own worth, creating healthier boundaries in relationships and having coping strategies for whatever lies ahead.
Disclaimer: This post is for informational and educational purposes only and does not constitute a therapist-patient relationship. This comment reflects my professional view and opinion. It is one of many possible perspectives and is not a substitute for seeking mental health services.
