The word trauma has increased in usage over past two decades in part to criticisms of traditional therapy models that have promoted the talking cure. Trauma creates the experience of being locked into the past. The adverse and disproportionate reactions to situations we see in the present moment may have a base in our past experiences.
Well-meaning practitioners often misdiagnose trauma-related symptoms due to a lack of training and competency in this area. This article intends to help individuals seeking treatment, interns, graduate students, and practitioners looking for ways to explain trauma to their clients. In graduate school while I was pursuing my master’s degree the topic of trauma received a little attention. Psychopathology and the nature of the disease model of mental health were the primary foci. Helping individuals to change their thinking, manage emotions, and thus change their dysfunctional behaviors into adaptive ones were the foundation of counseling as I knew it.
The clients who entered my office received a form of treatment that did not meet their needs often because the inclusion of trauma was missing. Thankfully, supervisors and agencies I worked embraced trauma treatment and taught me principles that changed my approach.
Between 1995 to 1997, Kaiser Permanente’s Adverse Childhood Experiences (ACE) Study , examined 17,000 healthcare participants in Southern California. Each participant was given a survey exploring their childhood experiences and current health status, and behaviors. The study demonstrated the impact of childhood abuse, neglect, and household changes on long-term wellbeing and health status changes in later life. The questionnaire asked participants about experiences with emotional, physical and sexual abuse, household challenges to include mother being treated violently, substance abuse and mental illness in the home, parental separation and divorce, incarcerated household member, emotional & physical neglect. The study showed changes to health status in later life and an increase in death rates for individuals who had higher ACE scores. This research suggests a dose-response relationship between the experience of negative life events described above and negative outcomes for an array of health and psychological issues.
Within the last three decades researchers have confirmed traumatic memories are stored deep within the body’s architecture. Bessel van der Kolk’s seminal book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, elucidates how our experiences of difficult life events coded deep within the fabric of our muscles, tissue, ligaments, and cells often create a flight, flight, freeze, or submit response within the traumatized individual. Those experiences remain in trauma time.
Symptoms like hyperarousal, hearing voices, intrusive memories, anxiety, depression, avoidance, nightmares, detachment from people and emotions, somatic complaints, difficulty concentrating, impulsivity, risk-taking, substance use, mood swings, irritability, recurrent images of the events, and anger may be signs of a traumatized individual rather than traditional diagnoses of major depressive disorder, generalized anxiety disorder, bipolar disorder, psychotic-spectrum disorders, and substance use.
When I notice an individual I counsel has been in and out of treatment without successful outcome I begin assessment for trauma, dissociative symptoms, and a holistic look at the person’s life and needs. I tend not to define clients as resistive to treatment as what I have noticed is their history of trauma has not been part of their past treatment plans.
Compartmentalizations and dissociation add to the complexity of symptoms identification and amelioration. Understanding dissociative experiences is crucial to the success of treatment of traumatized individuals. Trauma is often not a simple one and done experience. Rather individuals have had multiple experiences that leave their clinicians confused about the cause of their symptoms.
Consider the following examples from substance use treatment:
Jane, a 38 year old, Asian female active in her addiction to IV Heroin presents to my office for substance use disorder treatment. She endorses extreme levels of anxiety with no known cause. Teaching standard coping tools like mindfulness increased her anxiety and restlessness. She begins to disclose her past history of sexual abuse and recent relationship issue that has unfrozen past traumatic memories. She carried the diagnoses of opioid use disorder, severe, major depressive disorder and generalized anxiety. Her primary care doctor decided to start her on a course of medication. However, her symptoms persisted. The symptoms she endorsed were caused by trauma. Until she sought treatment for the underlying trauma she could not stay sober.
Another case was Juan, a 45 year old Hispanic male, who was active in his addiction to cocaine, alcohol and unhealthy women. Juan sought out high risk behaviors and often could not consider the consequences. Doctors diagnosed him antisocial personality disorder and effectively wrote him off. In the course of our treatment Juan disclosed that he had been sexually abused in childhood. The impact of this and other similar events were impeding on the present moment. He used drugs as a means to escape the painful reality of his past. Juan no longer could numb with drugs. Recurrent nightmares, internal voices, hyperarousal, sexual dysfunction, difficulty sitting still were often at the forefront of each session.
What these cases have in common is the missing component of trauma treatment to help treatment the underlying symptoms. Trauma treatment does not mean we abandon traditional treatment modalities. What it does mean is taking on a new lens to examine and explore an individual’s behavior.
Trauma informed treatment follows a stage model to include:
Phase 1: Safety and Stabilization: Individuals often do not feel safe in their own bodies. Sometimes the individual may struggle with self-soothing or experiencing difficult emotions. Some resources to help with this area include: 1) Mindfulness-Based Stress Reduction, 2) Sensorimotor Psychotherapy, 3) Focusing Therapy, 4) Chi Qong, 5) Trauma-Sensitive Yoga, 6) Acupuncture
Phase 2: Remembrance and Mourning: Putting words and emotions to what happened. Processing the trauma. Providing space to mourn losses associated with traumatic events. Emphasis is to stay within thee window of tolerance for each individual.
Phase 3: Reconnection and Integration: Creation of a new sense of self and a new future. The last phase of trauma treatment involved a shift in self-definition and meaning in the world in context of meaningful relationships. Trauma is integrated into the individuals experience but does not define them. Post-Traumatic Growth occurs during this stage.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy and Progressive Counting are phase-oriented treatment models designed to help the individual unlock the past and move more peacefully into the present and future. A metaphor I use with my clients is that of a tree that is wreaking havoc in one’s backyard. One way we undue the effects of the tree in the backyard is often to uproot that tree and dispose of it. Trauma works in the same way. Until, the underlying issues and symptoms are dealt with at their roots the issues will continue to grow and manifest in daily life.
Effective treatment that adds the dimension of trauma produces undeniable results for the client. We are more resilient that we give ourselves credit. Healing from past trauma has the power to allow each of us to tap into inner strength, resources, and wisdom that we might not have considered we had.
If you have been experiencing symptoms related to trauma and stuck stuff, consider reaching out for help.
May you find a meaningful life. May you know you are good, holy, and blessed. May you find a quality of life free of the bondage of the past. May you take a step to redefine your life. May you find your inner wisdom and strength.
Please feel free to share in the comment section below your own experiences with past treatment. How did your progress change when you started to work on the underlying traumas and negative life experiences.
Thank you for reading!