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Wednesday, March 14, 2018

Before and After Psychological Trauma

Many clients who start psychotherapy to deal with unresolved psychological trauma talk about life before and after their trauma.  Psychological trauma often changes a person's self perception as well as his or her perception of the world.  Whereas the person might have been self confident and the world around him or her made sense before the trauma, after experiencing trauma, self doubt and a feeling that the world is a precarious place can set in (see my article: Trauma Often Creates Negative Expectations For the Future).

Before and After Psychological Trauma
Assuming that a client was functioning at a high level before the trauma, one of the goals of trauma therapy is to help a client to get back to his or her former level of functioning.  If the client has other underlying trauma, like unresolved childhood trauma (also called developmental trauma), resolving these underlying issues is usually a goal of therapy (see my article: Working on Developmental and Shock Trauma in Therapy).

Fictional Clinical Vignette
The following fictional clinical vignette demonstrates this before and after effect of psychological trauma and how trauma-informed psychotherapy can help:

Cassie
Cassie started psychotherapy due to her recurring nightmares about her friend's fatal accident, which occurred more than a year ago.

Cassie explained to her psychotherapist that her friend, Nina, drowned while they were on vacation in New England on a beach that had no lifeguards.  They had been to this beach many times before.  They especially enjoyed that there were relatively few people on the beach early summer.

She told her therapist that Nina, who was a stronger swimmer, went for a swim while Cassie napped on their blanket.  Suddenly, Cassie was woken up when she heard Nina calling for help before she disappeared underwater.  Cassie said she ran into the water to try to save her friend but, she couldn't find her.

In a panic when she couldn't find Nina, Cassie ran back to the blanket to call the police on her cellphone.  Minutes later, help arrived, but they were unable to find Cassie.  The rescue team searched into the night and the next morning, but there was no sign of Nina.

A day later, the police came to the bed and breakfast where Cassie was staying and informed her that Nina's body washed up on the shore.  They told her that Nina was probably overcome by a strong undertow.

Cassie told her psychotherapist that she was devastated and, since that day, she had nightmares almost every night.  She said these recurring dreams were mostly the same:  She was in the water frantically trying to find Nina, calling her name, diving under the water to try to find her, yelling for help, but no one came (see my article: Understanding Shock Trauma).

She said she would wake up panting and in a cold sweat, and the effect of the nightmares tended to stay with her for the rest of the day.

Cassie said she kept replaying in her mind the minutes after Nina told her that she was going for a swim.  She remembered having the thought that Nina shouldn't swim by herself, especially because the water was rough, but she didn't say anything to Nina about this.  She assumed that Nina would be alright because she was such a good swimmer.

Now, all she could do is berate herself for not saying something to Nina or going with her for a swim so Nina wouldn't be alone, "Why didn't I tell her not to go in the water. I should have, at least, gone with her.  Why didn't I do it?"

Cassie said that, before her friend's fatal drowning, she was feeling optimistic about her life, looking forward to starting a new career, happy to be in a new relationship, and making plans for the future.  But, after Nina died, her whole world changed.

Even though she started her new career and stayed in her relationship, Cassie felt like she was just going through the motions.  On the surface, she tried to appear "normal" (her word), but beyond the facade she was trying to maintain, she felt confused, sad, and guilty.

Cassie was aware that her perception of herself and the world around her had changed dramatically since her friend's death, and she was tired of pretending that she was alright.  And, most nights, she was afraid to go to sleep because she dreaded her recurring nightmares.

When her psychotherapist asked Cassie about her family background, she described a loving family with no major traumatic incidents when she was growing up.  She felt emotionally supported by her family and her boyfriend, but she felt no one really understood what she was going through.

Based on Cassie's information about her family background and her description of the traumatic incident when Nina died, her psychotherapist concluded that there was no developmental trauma, so their work would be focus on helping Cassie to overcome the shock trauma related to the Nina's drowning.

Cassie's psychotherapist provided her with psychoeducation about trauma and explained that what she was experiencing were common reactions to a traumatic incident.  She also explained that trauma therapy, EMDR therapy in particular, could help Cassie to overcome her traumatic symptoms (see my articles: How EMDR Therapy Works: EMDR and the Brain and EMDR Therapy: When Talk Therapy Isn't Enough).

After they completed the preparation phase of EMDR therapy, Cassie and her psychotherapist worked on the traumatic memory of her friend's death, how helpless Cassie felt, and the guilt that remained with her.

Before and After Psychological Trauma

During the course of their EMDR work, Cassie revealed that, although a part of her wanted to feel better, another part of her felt she didn't deserve to feel better.  She was surprised at how strong the part was that felt she was undeserving.

Cassie's psychotherapist normalized this part that felt undeserving by informing Cassie that it wasn't unusual to feel this way under the circumstances.  She also explained to Cassie that they needed to do Ego States therapy (also known as Parts Work) to work with this particular part of her or it would create an obstacle to their work.

Cassie and her psychotherapist did Ego States work for the next couple of months to help soften this punitive part that felt Cassie was undeserving of feeling better.  After that, they were able to resume EMDR therapy and it went more smoothly.

The trauma therapy was neither quick nor easy, but her psychotherapist knew that experiential work, like EMDR therapy and Ego States work, is usually more effective and works faster than regular talk therapy (see my article: Why Experiential Therapy is More Effective to Overcome Trauma).

By the time Cassie completed therapy, she still felt sad about her friend's death, but she no longer felt responsible and guilty.  She regained her former self confidence and positive outlook on life.  She also felt worthy of making plans for the future and enjoying her life.  She also stopped having the recurring nightmares.

Conclusion
Most clients, who experience psychological trauma, report that they notice a difference in how they feel about themselves and the world around them after a traumatic experience.

It is as if there were a line that divides their experiences before the trauma vs. after the trauma.

As is often the case in trauma work, there can be a certain amount of ambivalence about getting better when an aspect of a client feels that s/he doesn't deserve to feel better.  This can present an obstacle to doing trauma work if it is not dealt with.

Fortunately, Ego States work, which involves the therapist and client dealing with this particular aspect of the client, helps to overcome this ambivalence so that regular trauma processing in therapy can resume and resolve the trauma.

Getting Help in Therapy
Psychological trauma doesn't usually resolve on its own, and ignoring it or hoping it will get better on its own usually makes the symptoms get worse over time.

If you're struggling with unresolved trauma, you could benefit from getting help in trauma therapy with an experienced trauma therapist who uses experiential therapy, like EMDR therapy (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs and How to Choose a Psychotherapist).

After you have resolved your traumatic experiences in psychotherapy, you can live a more meaningful and fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome unresolved 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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