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Monday, January 20, 2014

Untreated Emotional Trauma is a Serious Issue: Part 4: Starting to Process the Trauma in Therapy

I've written three prior articles on the topic of untreated emotional trauma, including: Part 1:  The Negative Consequences of Untreated Emotional Trauma, Part 2: Understanding the Impact of Untreated Emotional Trauma  and Part 3: Starting Therapy to Deal With Untreated Emotional Trauma.

Untreated Emotional Trauma is a Serious Issue: Starting to Process the Trauma in Therapy

To understand how, as a trauma therapist, I help clients with psychological trauma, in my last article I discussed the resourcing phase of treatment during the initial stage of therapy.  As I mentioned, the purpose of the resourcing phase is to help clients to develop internal resources, also known as coping skills, to deal with the processing phase of psychological trauma.

In this article, I'll continue with the vignette about Joe, who represents a composite of many different clients who have come for trauma therapy, and I'll look more specifically at the initial stage of processing the trauma in treatment.

Joe
Joe made progress during the resourcing phase of trauma therapy to the point where, instead of automatically lapsing into dissociation (i.e., "zoning out" or numbing himself emotionally) whenever he felt emotionally uncomfortable, he was able to tolerate remaining present more often.  There were still times when he dissociated somewhat, but he was somewhat more resilient now as compared to when he first started treatment.

He practiced the Safe Place Meditation that he learned in our prior therapy to help calm and soothe himself.  He also practiced the Square Breathing exercise I taught him to help him relax.  In addition, he mentally rehearsed positive memories from his life and noticed how focusing on these memories often shifted him from a state of anxiety to a more relaxed state.

Beyond Developing Coping Strategies:  Why Process the Trauma?
At this point, many clients often ask why, if they've learned better coping skills, they need to process the trauma.  They want to know:  Isn't it enough to be able to know how to cope when they feel upset?

Usually, what I tell clients is that, even though they've gotten better at dealing with uncomfortable feelings by developing better coping skills, the traumatic memories are still there to be triggered in their current life.

In other words, it's great to be able to calm yourself, learn to relax and shift your emotional state from one of anxiety to a more relaxed state, but you're still vulnerable to getting emotionally triggered whenever what would normal trigger you emotionally in the present.

Getting back to Joe:
Now that Joe had developed better internal resources, we were ready to process his psychological trauma which stemmed from an early childhood history with his father, who was often rageful and drunk.

As part of the earlier psychoeducational phase of our work together, Joe had already begun to develop intellectual insight into the affect that his family history had on him.  Now, it was time to help Joe to understand his trauma in a more integrated way where his understanding wouldn't be just intellectual.

In this phase of treatment, he would develop more of an integrated felt sense for the impact of the trauma and work through the trauma so it would no longer affect him.

Starting to Process Psychological Trauma
I have different ways of treating psychological trauma that are part are considered mind-body oriented psychotherapy, including EMDR, Somatic Experiencing, and clinical hypnosis.

My clinical expertise told me that it would be best in Joe's case to start with EMDR, Eye Movement Desensitization and Reprocessing, which has a structured protocol, developed by Francine Shapiro, Ph.D., in the late 1970s as a treatment specifically for trauma.

EMDR has eight phases of treatment, which you can read about in more detail on the EMDR website. Joe and I had already completed the history taking and resourcing phases of treatment, and we were ready to start the processing.

I asked Joe to bring in 10 memories that related to his traumatic experiences with his father, and after we went over these memories, I asked him which one still had the most emotional charge for him.  Joe responded immediately by choosing a memory from the time he was five years old.

He told me about the memory:  His father became enraged with him after Joe accidentally dropped a crystal vase that had been in his father's family for many years.  Joe's mother had given Joe permission to look at the vase, which his mother had placed on the dinning room table as they waited for guests to arrive for dinner.  She told Joe that he could look at it, but she also told him not to touch it.

Being a curious boy, Joe waited until his parents left the room and then he picked up the vase so he could look at it more closely.  But when his father came into the room and yelled at Joe for touching the vase, Joe got so startled that he dropped it and it shattered beyond repair.

When Joe's mother saw the father running towards Joe to hit him with his belt, she stepped between them and told the father not to hit Joe.

Then, a big argument ensued between between his parents where his father came close to hitting his mother.  But, instead, the father grabbed Joe, dragged him into another room, locked the door so his mother couldn't intervene, and he spanked Joe hard with his belt.

This was Joe's earliest traumatic memory and it also had the most emotional charge for him of the 10 traumatic memories that he brought in.

The importance of choosing an early memory with the most emotional charge is that, by working on this memory with EMDR, the work can have generalizable effects so that, ideally, a trauma therapist doesn't have to work on every traumatic memory.

As we worked on developing the EMDR protocol, which included identifying an image that represented this memory, the emotions that go with this memory, where Joe felt these emotions in his body (an important mind-body aspect of EMDR that helps to make it a more integrative experience), Joe came up with another part of the protocol, which was the negative feeling that he had about himself in relation to this memory (called the Negative Cognition in EMDR) and that was:  "I feel powerless."

Joe realized that feeling powerless was a feeling he carried around with him much of the time without even realizing it.  He also realized that this was how he felt whenever he was in social situations or when he even thought about allowing others to get close to him.  He sensed this not just in an intellectual way--he had a felt sense of it.  In other words, he felt it on a visceral level.

This is an important part of EMDR and other mind-body oriented types of therapy as compared to talk therapy.  Clients often say they have a more visceral sense of their problem when they're being treated with a mind-body oriented therapy, and this gives them a more holistic sense of their problem.

So, when we talked about how he would like to feel about himself when he completed therapy, he said, "I would like feel more empowered in my life."  So, this gave us a goal to work towards in our work together.

As part of the EMDR protocol, the trauma therapist asks the client about their current subjective experience of the memory.  So, I asked Joe how disturbing this memory was for him now on a scale of 0-10, and he said it was a "9," which is very disturbing.

When I'm doing EMDR, I often use a small device called a Tac/Audio Scan that clients hold in their hands.  It provides the bilateral stimulation in EMDR that helps to process the trauma (click this link for more information about the importance of bilateral stimulation in EMDR).

So, Joe held the Tac/Audio Scan tappers in his hands and began by focusing on the image that he had chosen that represented this memory for him, which was the locked door in the room where his father dragged Joe.

An Obstacle in Processing the Trauma
Over the next few months, Joe made progress in processing this traumatic memory.  There were times when he felt the need to imagine an "ally," in addition to having me there with him helping to process the memory.  So, he imagined that his former coach and mentor was sitting next to him and he felt empowered with this imagined presence.

But, after a while, Joe began "looping" in his processing of the memory.  Even though his subjective experience of his disturbance about the memory was now a "5" instead of a "9," he couldn't seem to go beyond this.

Part of the goal of EMDR is to process the memory so it's no longer disturbing to the client, ideally getting to a subjective disturbance that the client feels as being either a 0 or 1 (on a scale of 0-10).

As we talked about what was happening for Joe at this stage of the therapy, he said that he had just realized that part of the memory was that, even though he was terrified of his father and the beating hurt, he was willing to take the beating because he felt that, by enduring the beating, he had spared his mother from getting beaten up by his father.

As an adult, Joe knew objectively that this was probably a distortion in his thinking as a child because there were plenty of times when his father hit his mother.  His father could have hit his mother on that day too if he wanted to but, on that day as a child, Joe felt he made this sacrifice for his mother.  And, now that we were processing the memory, there was a part of him that was ambivalent about letting it go.

He recognized that a part of himself felt this way even though this was probably a rationalization that he created in his own mind as a child to console himself about the beating.

This obstacle in the treatment was another example of how Joe (or anyone of us) can know something on a objective, logical level and yet, what we feel on an emotional level can be very different, and it can become an obstacle in the treatment.

I tried a common method in EMDR called a "Cognitive Interweave" where Joe tried to think of the incident as having occurred to another small boy, instead of to him:  Wouldn't he feel that this person, who is now an adult, deserves to be free of the effect of this traumatic memory?

Joe responded that he would, if it was someone else.  He felt that clearly.  But when he thought of it for himself, he couldn't overcome that part of himself that felt he had taken this beating to spare his mother from being hit by the father.

And if we processed the memory so that it was no longer disturbing, he felt that, on some level, it would take away from what he did for his mother.

Bumps in the road in trauma therapy are very common, and it helps if the trauma therapist has different ways of working to overcome these obstacles.

In a future article, I'll continue this discussion and discuss a particular intervention which is often helpful for overcoming obstacles in trauma therapy.

Getting Help
If a traumatic past is having a negative impact on you now as an adult, help is available to you if you work with a licensed mental health professional who is a trauma therapist.

Processing the trauma will help to free you from history that is creating obstacles in your life now.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.  I have helped many clients to overcome psychological trauma.

I also work adjunctively with clients who are already in therapy with a therapist that they want to remain in therapy with but who might not be trauma therapists.  

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me: josephineolivia@aol.com.
























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