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Monday, March 12, 2018

Working on Developmental and Shock Trauma in Trauma Therapy

Shock trauma and developmental trauma are different types of traumatic experiences.  

In this article, I will define both shock and developmental trauma, discuss how clients often suffer with one or both, and provide a fictional clinical vignette to demonstrate how trauma therapy can help a client with both types of trauma to overcome his traumatic symptoms (see my articles: Understanding Shock Trauma and Overcoming Developmental Trauma).

Many People Experience Both Developmental and Shock Trauma

Shock Trauma vs. Developmental Trauma in Trauma Therapy
Whereas shock trauma usually involves a one-time traumatic event like a tornado, a car accident, being mugged, and so on, developmental trauma is chronic childhood trauma of neglect or abuse (or both) which occurs over time.

A one time experience of shock trauma with no other underlying issues and a high level of functioning  prior to the trauma is easier to resolve than chronic developmental trauma.  Under these circumstances, shock trauma without other layers of shock or developmental trauma can resolve relatively quickly with trauma-informed therapy.

Generally speaking, complex developmental trauma with layers of psychological trauma, will take longer to resolve because there is more than one traumatic experience.  There might be numerous traumatic experiences throughout childhood and also in adulthood.

Whereas it is easier to find a particular target memory in trauma therapy to work on for shock trauma because it is a one-time event, developmental trauma usually involves multiple memories over time.

In addition, if developmental trauma occurs early in childhood, the client might not have coherent memories of what happened due to the way traumatic memories are stored in the brain.

A person with preverbal (before the individual develops language) developmental trauma might only have access to conscious memories of one sense and no other senses.  For instance, he might only have a memory of a sound with no other sense of the memories (no visual, tactile, auditory, olfactory experiences are available).

This also occurs sometimes in shock trauma.  For instance, a client who was hit by a car and who never saw the car coming before he was hit, might only have a vague memory of hearing the siren of the ambulance.  Even so, in most cases, shock trauma is easier to resolve in trauma therapy than developmental trauma when it is a one-time event.

An experienced trauma-informed psychotherapist can work with whatever experiences a client brings to therapy, even if it is only a partial memory or a vague sense of what occurred.

There are also frequently cases where people come to trauma therapy to deal with shock trauma and they also have underlying developmental trauma.  So, it's not an either/or situation--it can be both shock and developmental trauma.

A Fictional Clinical Vignette:  Working on Developmental and Shock Trauma in Therapy
The following fictional clinical vignette is an example of a combination of shock and developmental trauma to illustrate how trauma therapy can help:

Ron began psychotherapy 17 years after the 9/11 World Trade Center attack.  He explained to his psychotherapist that he had been on the 10th Floor of the North Tower in the World Trade Center early in the morning on 9/11 when the terrorist attack occurred.

Working on Developmental and Shock Trauma in Therapy
He had vivid memories of feeling the impact of what he later learned was a plane as it crashed on the upper floors of the North Tower, his fear and confusion about what was happening, and how he and his colleagues ran down the stairs to safety shortly after the attack.

Afterwards, as he and his colleagues stood outside the North Tower, they were shocked to see a fire on the upper floors and the sound of fire trucks racing to the scene.  They were also shocked and upset to see people jumping from the Tower.

As he walked away from the building to safety, he tried to call his best friend, Joe, who worked on the 95th Floor of the North Tower, but there was no cellphone service.  So, he and several colleagues continued to walk north to the Brooklyn Bridge so they could get away from the scene and walk home to Brooklyn.

Less than 20 minutes later, Ron remembered hearing another crash.  The impact of the crash was so strong that the walkway shook and the bridge swayed.  When he turned around, he saw that the South Tower was also on fire.

Still not knowing what had happened, he stopped a police officer on the bridge, who told him that both towers were hit by planes and it appeared to be a terrorist attack.  Before Ron could ask any more questions, the police officer, who had been listening to his radio, began to run in the direction of the World Trade Center.

During his psychotherapy session, Ron told his psychotherapist that he and his colleagues, not knowing what else to do, continued to walk over the bridge with many other people who were trying to get away in a scene that felt surreal to him.

Less than an hour later while still on the Brooklyn Bridge, Ron and his colleagues heard and felt a tremendous crash, which they initially thought was an earthquake.  They looked in the direction of the Towers and saw that the South Tower was collapsing in on itself.

Ron and his friends felt momentarily paralyzed in place as they stood in shock, not quite believing what was happening.

Throughout it all, Ron kept trying to call his friend, Joe, but neither Ron's nor his companions' cellphones had a signal.

By the time Ron got home, he turned on his TV and heard that the North Tower had also collapsed.  He also discovered more details about the terrorist attack.

Since his office was closed for the rest of the week, Ron watched news coverage non-stop for rest of the week.  Every so often, he continued to try to reach Joe by phone, but his calls kept going to voicemail.

A few days later, he received a call from Joe's sister to let Ron know that Joe never came home.  The family was hoping that he would turn up, but they feared that he was trapped and killed at the World Trade Center site.

As Ron spoke to his psychotherapist about the events of that day and the following weeks, he was surprised at how emotional he still felt after almost 17 years.  He told his psychotherapist that he eventually learned from Joe's family that he was dead, which was a terrible loss.

He explained to his therapist that he "powered through" during the next several months without the help of therapy.  He thought he was managing, but he was surprised that he recently began having nightmares about the events on 9/11.

His psychotherapist provided Ron with psychoeducation about how people can develop traumatic symptoms many years after a traumatic event.

In subsequent psychotherapy sessions, Ron's psychotherapist asked him about his family history, and Ron revealed that his father was emotionally abusive throughout Ron's childhood, which left Ron feeling that he was powerless and unlovable.  He said that he continued to feel that way as an adult.

Ron also told his psychotherapist that he also felt powerless on 9/11 because initially he didn't know what was happening and he couldn't reach his friend, Joe.

Ron's psychotherapist provided Ron with additional psychoeducation to inform him that he was suffering with both shock and developmental trauma.  She explained to Ron that his earlier childhood trauma might have made him more vulnerable to the shock trauma that occurred as a result of 9/11, especially since he felt powerless as it related to both the shock and developmental trauma.

She recommended that they use EMDR therapy to work on the shock trauma first and then they would work on the chronic developmental trauma (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

After the preparation phase of EMDR therapy, Ron and his psychotherapist talked about which 9/11 memories were the most disturbing and agreed to work on those memories first.  After a few months, they completed the EMDR processing of the 9/11 memories, including the loss of his friend, Joe.

Then, they proceeded to use EMDR therapy for the developmental trauma, which was more complex since it was ongoing throughout Ron's childhood and he continued to feel the emotional impact of his father's abuse as an adult.

Ron came to his psychotherapy sessions every week and worked hard in therapy and between sessions for the next several months.  The work was neither quick nor easy, but by the time Ron completed therapy, he was no longer was having nightmares, he no longer felt powerless or unlovable, he grieved the loss of his friend, and he no longer was affected by his childhood trauma.

Whereas shock trauma is usually related a one-time event, developmental trauma is childhood trauma that occurs over time, like physical abuse or emotional neglect.

People who experience developmental trauma are often more susceptible to developing shock trauma if they are exposed to a shocking or traumatic event.

It's not unusual for trauma-related symptoms to show up many years after the trauma, which can be confusing for anyone who experiences this.

Getting Help in Therapy
EMDR therapy is an effective type of trauma therapy to assist clients to overcome traumatic symptoms in both shock and developmental trauma (see my article: The Benefits of Psychotherapy).

Although EMDR therapy tends to be faster and more effective than regular talk therapy to overcome trauma, when there is complex developmental trauma, it can take time to overcome the traumatic symptoms.

If you have been suffering on your own with traumatic symptoms related to shock trauma, developmental trauma or both, you owe it to yourself to get help from a licensed mental health professional who is a trauma-informed psychotherapist (see my article: How to Choose a Psychotherapist).

Once you have worked through your traumatic symptoms, you have a chance to live a fuller, more meaningful 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 am a trauma-informed psychotherapist who works with individual adults and couples.

I have helped many clients to overcome the both shock and developmental trauma.

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.