“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars”
Trauma in Simple Terms
Psychological trauma describes the experience of difficult and distressing events or extended circumstances that we have suffered in life with which we have been unable to cope, give a clear rationale, recover or learn from at the time they happened. Instead of being able to make rational and emotional sense of the events in a way that allows us to evolve and become stronger and better able to protect ourselves, we remain emotionally overwhelmed to the degree that we put the learning process on hold within the psyche. Our natural inclination to assimilate experiences is halted in this specific instance and a disjunction created between then and now. The purpose of this is one of coping: a means by which we are able to survive the event, isolating the experience within the psyche to be dealt with and ‘made sense of’ later.
In the meantime the experience of the distressing events can push or be stimulated into present awareness unexpectedly, giving rise to anxiety and stress responses as we attempt to defend ourselves from the original distress and our memories of it. Because it has not been ‘processed’ in our normal way, it appears to the psyche with the force and vividness of a new experience. The resulting struggle within ourselves between the unfinished business of the past and our need to ‘move on’ in the present gives rise to debilitating and distressing secondary effects from hyperarousal to dissociation: aversive behaviours, feelings of vulnerability, and phobic avoidance of perceived ‘triggers’ that re-activate the raw experience. In other words, we avoid or mobilise our energies against anything that reminds us of what we so desperately try to forget. The paradox is that our avoidance or hyperarousal both maintain the experience as trauma and post-trauma syndromes.
Where the trauma is compounded by being repeated or prolonged over time, or where there was no possibility of escape at the time (for example, as in the experiences of mistreated, neglected, abused or traumatised children and prisoners unable to flee their tormentors), the more recent qualification of ‘complex’ has been added as a distinction. Whilst treatment approaches differ, in either case similarities exist in difficulties experienced: difficulty managing emotions, relationship difficulties, insecurity and vulnerability, hyper-arousal or hypervigilance, dissociation, fear and flashbacks to the original event, self-harm and suicidal ideation, social withdrawal, anxiety and anger, derealisation and other adverse effects can be present to make life even more difficult for the sufferer.
- It is notable that complex Post Traumatic Stress Disorder can also be misdiagnosed as Borderline Personality Disorder by those who use psychiatric diagnostic categories. This, of course, raises questions about the accuracy, appropriateness and legitimacy of some other personality disorder labels.
Which Model is Best for Trauma?
As in all fields of endeavour there is much hype and marketing of quick or miracle ‘cures’ for everything from depression and anxiety to ‘trauma’. Therapy is not for everyone and some people prefer one approach over another where they do choose to go to therapy. A brief historical review reveals how anti-depressants, newer anti-depressants, lobotomies, CBT, ECT, hypnosis, NLP, EMDR, DBT, and virtually every other alleged ‘therapy’ has been heralded as the next wonder-cure for human suffering. Many of these approaches have been marketed on the basis of their alleged interface with specific psychiatric diagnoses, so that, over time we find ourselves speaking in catchphrases such as ‘CBT is best for depression and anxiety’, ‘Prozac is best for depression’, ‘ECT is best for intractable depression’, ‘EMDR is best for trauma’, ‘you must use a trauma-informed approach’ etc. These statements, and even the word ‘trauma’ itself, rely on the perpetuation of a medicalised, mechanistic view of human distress divorced from its social context, and ultimately a psychiatric formulation of human suffering where a medical-sounding or techno-mechanistic approach becomes the order of the day as the exclusive and best ‘treatment’ for an isolated ‘illness’.
“Our brains are wired for connection, but trauma rewires them for protection. That’s why healthy relationships are difficult for wounded people.”
— Ryan North
However, the human psyche does not easily lend itself to being treated in the same way we treat an organ or system in the human body. Human beings make sense of their experiences in unique, individual ways, connected to unique histories and circumstances, and as such should be respected and worked with from their contextual position and particular worldview. In other words, human beings are not to be related to as isolated problems to be solved if we wish to preserve a respectful, valuing way of relating to one another and our unique means of making sense of and being affected by the world and conditions around us.
As with therapies in general, some approaches work for some people and aren’t appropriate for others. And psychotherapies – like any form of helping – are not an ideal approach for everyone. Likewise, techique-based and symptom-management approaches are preferred by some people, and don’t work for others, and a distinction should be made between therapies that manage, mask or contain ‘symptoms’ and those which permit healing and recovery to full functioning as determined by the patient’s self-assessment.
In each case, many factors are typically at play in the ‘success’ of either recent or traditional approaches, including the patient’s belief that the therapy will work, the qualities the practitioner brings to the relationship, patient motivation and willingness to work with his or her experiences, the patient’s support network etc. Above all else, it is my direct personal and professional experience that healing after traumatic experiences is the result of fully coming to terms with the experiences and their consequences for our lives, and finding new ways to live post-trauma.
For these reasons I suggest great caution in approaching any one ‘model’ as being the ‘best’ treatment for anything, or investing in the notion of therapeutic shortcuts to trauma recovery.
Working with Traumatised Persons
What is required for working with human beings who have experienced traumatic assault on their psyche is not a specific model of therapy that someone has deemed ‘the best’, but a relationship of deepening trust, loyalty and understanding, acceptance and determination forged between two people where the experiences and toxic circumstances are seen for what they are; clarifying the responsibilities of those involved and acknowledging the harm or damage done and losses suffered. The patient’s worldview and ways of coping and creating meaning are central to the work.
Where psychotherapy might be appropriate, the psychotherapist’s value lies in his or her ability to manage the therapy in order to allow the patient to be as secure in their journey as possible. The therapist’s depth of experience and creativity, understanding of the deep insecurities traumatised people suffer, (especially so in survivors of childhood complex trauma), the neuro-psychological functions and responses associated with trauma, and empathic understanding of what it is to be psychologically traumatised are also key. Some practitioners are, in fact, survivors of their own trauma and complex trauma and offer both an insider’s view of their own journey to healing as well as a professional’s overview and reflective analysis of the experiences of others. It is the psychotherapist’s job to sensitively build a safe relationship within which he or she uses the wisdom and experience necessary to help, where possible, the suffering person transcend their own suffering to a place of greater empowerment where this might be possible.
Trust, Truth, Safety
In terms of actual work, the process will involve the establishment of a trusting, authentic relationship where difficult, painful things can be looked at in safety, where the safety is felt by the patient. It will start with a detailed assessment of needs, existing support, risk and circumstances to determine whether psychotherapy is appropriate, followed by a problem formulation and plan of approach that makes sense and is acceptable to both parties. It will entail a pacing of any work according to that which the patient is best able to cope, with adequate psychosocial support and circumstantial stability in place between sessions.
Calming the Brain
Therapy proceeds by emphasising the importance of disengagement from de-stabilising, volatile, anxiety-provoking, or drama-provoking situations that serve to maintain hyperarousal and underactivity in centres of the brain affected by trauma. These areas govern emotional arousal, our ability to distinguish past from present, and higher reasoning and meta-awareness functions. The brains of traumatised persons tend, for example to have an over-active amygdala, and under-active hippocampus and medial prefrontal cortex. Creating a reliable and accessible sense of stability, calmness, groundedness and present awareness are crucial as foundations for any work as they help the brain begin to rebalance these functional centres.
What makes things worse:
- engaging with ‘drama’, scandal and argument e.g. via social media, gossip etc
- unstable circumstances
- engaging with circumstances that created the original trauma
- engaging in conflict
- mood de-stabilising substances including heavy use of caffeine, sugar/ simple carbs, cigarettes, alcohol, recreational drugs etc
- engaging with toxic people
- engaging with unhelpful or stigmatising institutions or services
- excessive stress
What aids recovery:
- calming activities
- good, regular sleep
- regular, healthy meals
- staying hydrated
- visualising a desirable future
- healthy physical contact
- caring for something or someone e.g. partner, pet, garden
- Spending time in nature
- helping others and being of service
- yoga, dance, moderate exercise
- playful activity
- creative activity
- developing gratitude and appreciation mindsets
- music: listening and playing an instrument
A variety of methods (tailored to the particular needs, worldview and circumstances of the patient) can help the person establish reliable ways to ensure their sense of security, sense of self, and present awareness before beginning to examine and understand the sequence of past events of the original trauma, where this is acceptable and helpful to the patient. This can be done using a plethora of methods at the disposal of the creative therapist (verbal and non-verbal, creative and systematic) in the service of beginning to explore and analyse them in detail over time; doing any necessary work in expressing the emotions and needs that will invariably be contained within the traumatic memory via, for example, powerful feelings dissociated and held in the body as tensions and physical symptoms (somatic experience).
Loss and Reality
Coming to terms with the loss of opportunities and difficult consequences that can follow traumatic events is part of the healing process. This can often be a substantial part of a person’s distress and difficulties socially, physically, materially and economically. Clearly, no amount of psychotherapy can fix the latter and it is beyond the scope of therapy to do so. However, a varying degree of personal empowerment follows recovery from trauma and coming to terms with the injustices and losses suffered, that can in some cases allow the person to recover and improve their circumstances by freeing up energy that was previously used in managing distress.
Reviewing and Learning
Reassessing the ‘version of ourselves’ that was engaged in the original traumatising event, clarifying responsibilites (who was responsible and who wasn’t), learning lessons, and forming new, empowering and self-protecting ways of being can also be crucial for many people in the final stages of recovery, with the overall goal of building new skills to equip and arm oneself against a world that can and does inflict suffering upon both the deserving and undeserving alike. Such skills, awarenesses, and external supports and protections were likely unavailable to us at the time we suffered our trauma but which many of us can learn to employ as a feature of our recovery to a better, more peaceful place.
No Quick Fix
In my opinion, there are no shortcuts or quick ways to working with the effects of traumatic experiences, as often traumatic events impact us not only psychologically, but physically, economically, socially, educationally, even spiritually, and in other unseen ways that compound our struggles and sense of aloneness. But when examined soberly we realise that the process of assimilating sometimes horrendous experiences is fundamental to the kind of learning that helps us survive. And that we all must engage in throughout our life if we are to recognise painful truths about the state of our world, to evolve as wiser, stronger human beings increasingly able to defend ourselves against the very real injustices life can throw at us.
The distressing features of post-trauma experience are often the undifferentiated elements of the traumatic experience ‘pushing into’ our present awareness and our counter-resistance to it. This push-pull can manifest as, for example, anxiety, panic attacks, flashbacks, avoidances and a wide variety of physical ‘symptoms’ that are responses to old events, felt keenly as if they were happening in the present and held at arm’s length for fear of our being engulfed by them once again. For many people, leaving such experiences unaddressed maintains the suffering and can keep us stuck in the fear, anger or vulnerabilities associated with the original assault upon our psyche. Only the sufferer can decide how and when to deal with this.
Photo: ‘Ambivalence’, oil on canvas by the author
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