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Tuesday, January 21, 2014

Untreated Emotional Trauma is a Serious Issue: Part 5: Overcoming an Impasse in Trauma Therapy

Prior to writing this article about overcoming an obstacle in trauma therapy, I wrote Parts 1-4 about untreated emotional trauma, including The Negative Consequences of Untreated Emotional TraumaUnderstanding the Impact of Untreated Emotional TraumaStarting Therapy to Deal With Untreated Emotional Trauma and Starting to Process the Trauma in Therapy.

Untreated Emotional Trauma is a Serious Issue: Overcoming an Obstacle in Treatment

In this article, I'll focus on what happens when there is an impasse in trauma therapy because of a client's blocking belief that becomes obstacle that develops in treatment.

Continuing with the same composite vignette about Joe from the prior articles on this topic, at this point in his treatment, Joe reached an impasse where he was unable to go any further with EMDR because he was blocked by a belief left over from childhood that caused him to feel ambivalent about overcoming the traumatic effects of the memory we were working on.

Overcoming Blocking Beliefs Which Become Therapeutic Impasses
Therapeutic impasses are frequent occurrences in therapy--no matter what type of therapy a therapist is using with a client.  When faced with a therapeutic impasse in therapy, the challenge is to find a way to overcome this impasse so the work can continue.

In the composite case that I've been writing about, as I mentioned in my last article, Joe had a blocking belief that, as a child, he had spared his mother a beating at the hands of his father by taking the beating himself.

So, the beating and the emotional impact of that trauma became almost like "a badge of courage" that Joe carried with him and that a part of him felt needed to remain as it was without changing.

As I mentioned in the last article, now that Joe was an adult, he realized that this childhood belief was a distortion, but knowing this on a rational level didn't help him to overcome the effect of this blocking belief.  He remained stuck.

Cognitive interweaves, which are often successful for many EMDR clients in helping them overcome this type of blocking belief didn't help Joe.  So, even though Joe had made a lot of progress in reducing his discomfort with the memory, we couldn't proceed any further with EMDR at that point.  In order to continue with EMDR eventually, we first had to deal with the blocking belief.

Working With a Self State That Carries a Blocking Belief
In order to overcome the blocking belief, I knew that we had to deal with the part of Joe that was still holding onto this belief.  So, I provided Joe with psychoeducation about the concept that we have many different aspects of self that all of us carry inside of us.

This type of work in therapy is often called parts work, ego states work or self state work, and there are many different ways to approach working with the multiplicity of selves that is in each of us.

Just a word to avoid confusion:  When I talk about parts or states of self in this context, I'm not referring to multiple personality disorder.  Rather, I'm referring to what we all experience at various points, which is the different aspects of ourselves that express themselves at different times.

In Joe's case, there were at least two self states that were in conflict:  There was the part of him that came to therapy and wanted to work through his trauma.  And there was also the other part of him, which originated when he was a child, that felt that overcoming this particular traumatic memory would be disloyal to his mother because he would feel that he was letting go of something very important that he did for her--namely, taking the beating from his father and enduring the emotional aftermath of that beating, which he saw as part of protecting his mother.

Overcoming an Obstacle in Trauma Therapy: Helping a Client to Understand About Self States

As human beings, we're complex creatures and, as most of us know, it's often possible to hold onto two opposing feelings at the same time.  And knowing, rationally, that one feeling is distorted often doesn't help to overcome it.  And, unless a person understands that this is a normal part of being human, s/he could feel like it doesn't make sense and s/he is "going crazy."

So, it was important to provide Joe with psychoeducation that having conflicting self states is a common experience, and rather than thinking of the younger self state as being something to be gotten rid of, we needed to do the opposite:  We needed to find out what that self state needed.  Only after we could determine what that self state needed could that self state begin to be integrated and stop creating obstacles.

As I've mentioned another article about self states, it's usually best to think of uncomfortable self states as having a purpose whose intention is benign.  Usually, the purpose is to preserve the self in some way, but this state, despite its good intentions, ends up having a negative impact.

In Joe's case, as he and I continued to work together, we discovered that this earlier self state's purpose was to feel that the beating he endured from his father was not in vain.  Even though he was powerless to stop his father from beating him, the feeling that he was protecting his mother helped to compensate for his feelings of powerlessness for himself.  And, this is what made letting go of this feeling so hard.

Fortunately, Joe was very motivated in therapy and he stuck with the process.

Using clinical hypnosis, I helped Joe to become more in touch with this earlier self state.  As we worked together on this, like most hypnosis clients, Joe maintained a dual awareness of the here-and-now (in the therapy room with me) as well as an awareness of his earlier self state, and he was completely in control of the process, which is very important to clients who have been traumatized.

Very often, by paying attention to an earlier self state and having a "dialogue" with it in terms of its well intended motives and what it needs, the self state ceases to be an obstacle.  And this is what happened with Joe.

After we did the parts work, this self state became a more integrated part of Joe's personality stopped being an obstacle in the work.

Then, over the next few months, we were able to process the traumatic memory we were working on by using EMDR once again, and Joe was able to work through the trauma.

As an aside, it's important to understand that self states are, by no means, always problematic.  There are times when we want to access certain self states that are positive, empowering and help to advance the therapeutic work (see my article: Reclaiming a Lost Part of Yourself).

Getting back to Joe:  After we worked through the traumatic memory, we went back to the other nine traumatic memories that Joe had brought in as part of the EMDR work.  There were a couple of other memories to work through, but most of the memories were cleared by working on the earliest memory that had the most emotional charge to it.

Then, as part of the EMDR work, we worked on the phase of treatment that deals with the Future Self, the way that Joe wanted to be now that he processed the trauma.  Not only did Joe want to feel more empowered in his life in general, but he wanted, specifically, to be more socially adept.  So, we began to work on this.

Gradually, Joe became less fearful of allowing other to get close to him.  Unlike how he interacted with colleagues before he came to therapy, he was able to relax more, interact more comfortably, and accept invitations from colleagues to go out socially when they got together after work, which improved his interpersonal relationships on the job.

Working Through His Emotional Trauma, Joe Was No Longer Affected By His History

Eventually, Joe began dating a woman that he really liked and, after a year, they started living together and talking about getting married.

By working through his childhood trauma in therapy, Joe was no longer at the mercy of his traumatic history.  He was no longer affected by traumatic memories that held him back in his life.

The Mind-Body Connection in Trauma Therapy
The vignette about Joe that I've presented in these articles is an example of just one way of working with psychological trauma, and not all cases work in the same way.

As I've mentioned before in other articles, my experience as a trauma therapist has been that therapies that help clients to make the mind-body connection, whether they are EMDR, Somatic Experiencing, clinical hypnosis or other forms of mind-body oriented therapy, are the most effective in helping clients to overcome therapy.

Getting Help
EMDR, Somatic Experiencing and clinical hypnosis are all mind-body oriented types of therapy that help therapy clients to overcome psychological trauma.

If psychological trauma has become an obstacle in your desire to lead to fulfilling life, you could benefit from getting help from a licensed mental health trauma therapist who can help you to work through the trauma so you can go on to live a happier and more satisfying life.

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

I also work adjunctively with clients who have primary therapists who are not trauma therapists.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.