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Monday, May 11, 2015

Psychotherapy Blog: Regaining Your Sense of Self After a Traumatic Event

It's not unusual for a change to occur in the way you see yourself after a traumatic event.  Assumptions that you made about yourself, whether these assumptions were conscious or unconscious, can seem off when you experience an event that was out of your control or beyond what you were able to handle.

Let's take a look at an example of this to demonstrate what I mean.

The fictionalized vignette shows how a traumatic event can change the way you feel about yourself and how I work with this kind of issue to help to integrate the experience and to help a client regain her sense of self:

Sandra
Sandra was a woman in her early 40s when she came to therapy to deal with the loss of her husband who had died a few years before in a car accident.

Regaining Your Sense of Self After a Traumatic Event

She attended cognitive behavioral therapy (CBT) a few months after her husband's death, and from that therapy she realized, on an intellectual level, that her husband's death wasn't her fault.  But on an emotional level she was still feeling deeply guilty, and she felt as if she didn't know herself anymore.

She described to me how, before her husband died, she felt like a competent person who was the one that others usually turned to for advice of help.   But after the car accident that killed her husband, Sandra was plagued by self doubt, self blame and a sense of foreboding about her future--even though she knew intellectually that she wasn't to blame.

On an emotional level, Sandra felt that she could have prevented the accident if only she had insisted that her husband get the brakes checked immediately when he said that he heard the brakes making a strange sound.

She did, in fact, tell her husband that until he got the brakes checked, he should use her car to drive to work.  But she felt that she didn't insist enough.  Her feeling was:  If only I had really insisted, he would be alive today.

As we went over the sequence of events, Sandra revealed that, even though her husband told her the night before that he would use her car because he didn't have time to go to the mechanic with his car, he left her a note the next morning while she was asleep that he decided to use his car because he didn't want her to be without her car for the day, and he said he would see the mechanic that night after work.  He told her not to worry--he was sure that everything would be okay.

That same morning, while Sandra, who worked from home on a business call, the police appeared at her door and told her that her husband was in a fatal car accident.  Even though she heard their words, she felt like she was in a surreal dream.

It was only after the police left that Sandra found the note that her husband left her on the kitchen table and she realized this was the last communication she would have with her husband and she felt the deepest sorrow she had ever felt in her life.

In our first session, Sandra spoke about feeling "crazy" that she could know one thing (she wasn't responsible for her husband's death) and, at the same time, she could feel the opposite (she was to blame).

Regaining Your Sense of Self After a Traumatic Event

I normalized Sandra's experience by letting her know that this is a common experience under these circumstances and she wasn't alone in thinking one thing but feeling another among people who had experienced this type of trauma.

Then I spoke to her about EMDR, Eye Movement Desensitization and Reprocess and how EMDR is used to process trauma (see my articles: What is EMDR? and How Does EMDR Work?).

During the next few sessions, Sandra and I worked on helping her to develop coping skills to work on the most traumatic event of her life, the death of her husband.

After she learned to do the Safe Place Meditation and she developed other emotional resources in our work together, we began to process the memory that she chose, which represented the worst part of her husband dying, which was the day the police came to her house and informed her that her husband was dead.

Part of the protocol in EMDR therapy is to ask the client what negative beliefs they have about themselves as a result of the traumatic memory that we're working on.

In Sandra's case, she said her negative beliefs about herself were, "I'm helpless" and "I'm a bad person."

As previously mentioned, before the traumatic event, Sandra felt like a good and confident person who could handle whatever came up in her life.  But after the accident that took her husband's life, Sandra felt just the opposite about herself.

As we processed the memory, Sandra experienced waves of sorrow that she didn't know were still there.  But she also experienced waves of deep relief between each wave.

This is what usually happens when people process loss during experiential therapy, like EMDR.  The emotional activation usually comes in waves with a build up, a peak and then a release of emotion which usually provides a sense of relief between waves.

Many people have the misconception that emotional activation will just peak in therapy and remain at that peak.  This misconception discourages some people from coming to therapy to work on their problems because they think it will be overwhelming, but for most people this isn't so.

Sandra went through feelings of guilt, self blame, and sorrow.  Then, as she continued processing the memory in our sessions with EMDR, to her surprise, she felt a sudden surge of anger towards her husband that she had never been aware of before:  "Why did he do this?" and "How could he do this to himself and to me?"

There was no question that it had been an accident, as opposed to a suicide, so this wasn't the issue.  The issue was that Sandra couldn't believe that her husband had been so irresponsible.

Even though these feelings were uncomfortable for her, this was a turning point in Sandra's therapy because, after her anger surfaced, she realized, on a deeply emotional level, that it actually wasn't her fault.  She realized that she had urged him to get the brakes checked and he was the one who chose to wait.

Regaining Your Sense of Self After a Traumatic Event

This turning point was very important to our work together because it was the first time that Sandra felt on a visceral level, as opposed to an intellectual level, that she really wasn't to blame and she said she realized, "I did everything that I could, but I couldn't stop him from choosing to drive the car with the faulty brakes."

Our work continued and Sandra was able to work through her sadness, self blame and anger. Using EMDR, she was also able to regain a sense of herself as a good and competent person. She also realized that there would be things in life that she wouldn't be able to control and she would have to accept this.

Summary
The vignette above about "Sandra" reveals that a traumatic event can dramatically change how we feel about ourselves, but experiential therapy, like EMDR, can help to restore that sense of self.

Unlike other types of therapy, like CBT, which might only provide an intellectual understanding, like it did for "Sandra," experiential therapy helps clients to have a visceral felt sense of what's real, which is what leads to people getting better in therapy.

Getting Help in Therapy
Many people live their whole lives with a diminished sense of self after traumatic events because they don't get psychological help.

If the issues that I've discussed in this article resonate with you, you owe it to yourself to get help from a licensed mental health professional who has experience working with emotional trauma and who uses experiential therapy, like EMDR, Somatic Experiencing or clinical hypnosis.

Getting help in therapy could make the difference between continuing to suffer with a diminished sense of self and feeling good about yourself.

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

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.