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Saturday, September 26, 2015

Psychotherapy Blog: Developing Coping Strategies in Therapy Before Working on Trauma

Many people, who have a traumatic history, avoid coming to therapy because they fear being overwhelmed (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent).

That's why it's so important for psychotherapists to help clients develop coping strategies while working on emotional trauma so that they can overcome their fears and do the therapeutic work without becoming overwhelmed.

Developing Coping Strategies in Therapy Before Working on Trauma 

Before any trauma work begins in therapy, a skilled therapist will help clients to develop the internal resources needed to do the work.

Some clients, who engage in meditation, yoga or other mind-body oriented practices, might already have some internal resources.

Other clients, who might not know how to soothe themselves, will need help from a psychotherapist on how to develop these internal resources.

Internal resources are an important part of preparing to do trauma work.  They allow the client to switch, if necessary, from disturbing memories of trauma to relaxing places within themselves to take a break before resuming the processing of the trauma.

Knowing that they have a way to soothe themselves helps most clients to feel that the trauma work in therapy is manageable so they don't approach the work with overwhelming fear.

Unfortunately, many people who need help to overcome traumatic experiences don't know that skilled trauma therapists facilitate the internal resourcing process, so they avoid coming to therapy because they're too afraid of being overwhelmed.

If they do eventually come to therapy, it's often at the urging of a spouse, their doctor or their employer because the unresolved trauma is causing problems in other areas of their life.

Let's take a look at a fictionalized scenario that addresses these issues, which is representative of many similar cases, and I'll discuss how I work:

Tom
Tom sought therapy for the first time at the age of 35 at the urging of his wife and his medical doctor.

Despite growing up in a highly dysfunctional family where his mother gambled and his father was physically abusive with everyone in the family, including Tom, Tom did very well in college.

Developing Coping Strategies in Therapy Before Working on Trauma 

He established himself in a successful career, he got married and had two children.

Judging from outer appearances, anyone would think that Tom was leading a happy and successful life.  Having a loving wife and children and everything that he needed on a material level, he seemed to be living the American dream.

But, despite external appearances, Tom's inner life was in a state of chaos.  He was good at hiding his anxiety and deep sense of low self worth so that no one would have guessed at his deep unhappiness--except his wife and his doctor, who knew about Tom's panic attacks, anxiety-related stomach problems and his frequent nightmares about the childhood physical abuse he experienced at the hands of his father.

As time went on, Tom experienced an increasing disconnect between the happy facade that he managed to put on for friends and colleagues and his deep unhappiness.

His doctor, who knew Tom and his family for many years, provided Tom with psychoeducation about the Adverse Childhood Experiences Study (ACE) and talked to Tom about how his unresolved trauma from childhood was affecting him now (see my article:  Overcoming Childhood Trauma).

After Tom learned about the ACE study from his doctor, he was amazed that his experiences from so many years ago were still affecting him.

Before he learned about the ACE study, he felt like there was wrong with him since he have everything that he ever wanted, but he still felt anxious and insecure.

His doctor also told him that he could resolve his childhood trauma by getting help in therapy with a psychotherapist who specializes in working on trauma.

Tom was hesitant about seeking help in therapy.  He was afraid that he would be overwhelmed in therapy if he had to delve back into his painful childhood memories.  At the same time, he knew that he needed help.

If Tom came to see me for a consultation, I would explain how I work with clients who have unresolved trauma.

Before processing any traumatic memories, I would get a thorough history of the trauma and family of origin dynamics.  I would also develop an understanding of how the trauma affected him in the past and the present as well as his fears about how it could affect him in the future.

I would help Tom to develop coping skills which, in experiential therapy, is called "resources."

Most clients who come to therapy to work on trauma are usually relieved to hear that I help clients to develop coping tools before any processing of trauma begins.

Resourcing for Tom could include, among other things, helping him to learn how to meditate, learning to discover a "safe or relaxing place"within himself, working to help him integrate and reinforce positive memories about himself as well as helping him to develop imaginal interweaves, which involve imagining nurturing, protective and powerful figures in his life  (see my articles:  Why is EMDR? and Empowering Clients in Therapy).

Developing Coping Strategies in Therapy Before Working on Trauma

Usually, as I help clients to process their trauma using experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis, clients begin to experience and understand the connections between their current problems and their unresolved problems from childhood.

Experiential therapy is usually successful with helping clients to overcome trauma more effectively than regular talk therapy.

Getting Help in Therapy
People with unresolved trauma often don't realize that their fears of working on their trauma in therapy are usually based on events that already occurred in their life.

As adults, we all have a much greater emotional capacity to deal with trauma than we had as children.

When you look for a therapist, ask her how she works (see my article: How to Choose a Psychotherapist

In addition to finding a therapist who is a trauma expert, you also want to sense that the therapist is empathically attuned to you (see my article: A Therapist's Empathic Attunement Can Be Healing For Clients).  This could take a few sessions to determine.

In my professional opinion, experiential therapy, like EMDR, Somatic Experiencing and clinical hypnosis are the most effective forms of therapy for most people who have unresolved trauma (see my article: Experiential Therapy Helps to Achieve Emotional Breakthroughs).

Rather than continuing to suffer on your own, get help from a licensed mental health professional who is a trauma expert and who uses experiential therapy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialities is helping clients to overcome emotional trauma.

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.





























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