NYC Psychotherapist Blog

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Monday, June 11, 2018

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma - Part 2

In my prior article, I began a discussion about the importance of establishing safety for clients in trauma therapy before trauma is processed. One of the requirements that I discussed in the last article for establishing safety is that the client's life must be currently stable.  In other words, s/he is not currently in a crisis or creating new crises.  I'm discussing this topic further in this article.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma

As I discussed in the prior article, clients who are currently in a crisis need help to out of the crisis and keep from creating new crises before they can process traumatic memories.

For instance, if a client has a parent who is in hospice with only a short time to live, the client will need help to get through this crisis and the grief following the parent's death before s/he processes unresolved traumatic memories from childhood.

Likewise, if a client is continuing to create chaos in his or her life, this would need to be addressed and resolved before any processing of traumatic memories from the past can be done.

Fictional Clinical Vignette: Trauma Therapy: Establishing Safety Before Processing Trauma
The following fictional clinical vignette addresses the issue of establishing safety for a client who wants to process traumatic memories but who is still in crisis:

After a tumultuous breakup in what she described as an on-gain/off-again emotionally abusive relationship, Ann, who was in her late 30s, started therapy to deal with the emotional aftermath of the breakup.  She requested EMDR therapy to deal with the trauma of that relationship (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

During the initial consultation, Ann explained to her psychotherapist that she ended the relationship three months ago and, as far as she was concerned, the relationship was really over this time. She was fed up with the name calling and the way he tried to shame her in front of other people a lot of the time.

Trauma Therapy: Why Establishing Safety For the Client is So Important Before Processing Trauma
Ann talked about her history of emotionally abusive relationships that began when she was in high school and continued into adulthood.  She explained that, immediately after she ended her last relationship, she began dating someone new.  She said her new boyfriend seemed nice at first, but lately he was verbally abusive with her too.

When her psychotherapist asked Ann to tell her more about the abuse in this new relationship, Ann told her that he wasn't nearly as abusive as her former boyfriends.  She explained that, although she was aware that she was in another abusive relationship, she was worried about getting too old to have children. Since her new boyfriend also wanted to have children, she wanted to try to have a child with this man before she got any older.

She said she feared that if she broke up with him, she might not meet anyone else and she might miss her opportunity to have a baby.  As a result, she would rather put up with his verbal abuse than breakup with him to find someone new (see my articles: Do You Have a Pattern of Creating Chaos in Your Life?How to Stop Creating Chaos in Your Life, and Remaining in Therapy Beyond the Immediate Crisis).

The psychotherapist explained to Ann that they could not begin EMDR therapy to deal with prior trauma because Ann was in another emotionally abusive relationship where she was likely to be traumatized again.  She explained that it was important for Ann to be in a stable situation before they could do EMDR therapy.

Ann said she understood the rationale for not beginning to process a history of trauma while she was in another relationship where she would probably be traumatized again, but she was not ready to give up her current relationship.

She told the psychotherapist that the thought of ending the current relationship and facing the possibility that she might not meet anyone new was too frightening to her. She said she didn't want to wait much longer to have children, and she would rather have a child with her current boyfriend than risk getting too old to have children.

Even though they could not do EMDR therapy due to Ann's current circumstances, the psychotherapist offered to work with Ann with her current relationship and her difficulty with taking care of herself in terms of choosing men who were emotionally abusive (see my article: Are Your Fears of Being Alone Keeping You in an Unhealthy Relationship?).

Since Ann was not interested in this, she decided not to come for any other sessions.  The psychotherapist gave her information about domestic violence. She explained that domestic violence was emotional as well as physical.  She recommended that Ann contact the New York City domestic violence hotline to deal with this issue.

Two years later, Ann contacted the same psychotherapist.  She told the therapist that she never contacted the domestic violence hotline.  Instead, she had a baby with the boyfriend that she was with at the time when she came for the initial consultation, and the abuse escalated from emotional to physical abuse.  She said she ended that relationship several months ago, and she moved back in with her parents, who were helping her to raise the baby.

When Ann returned to see the psychotherapist, she told the therapist that she regretted remaining in the relationship with her baby's father.  She said that, once the stressors involved with raising a baby increased, the baby's father was unable to handle it.  As the stress increased, his abuse escalated from emotional abuse to physical abuse, and she feared for their child's safety.

Ann explained that, after she left the baby's father and filed for child support, the baby's father disappeared and she didn't know where he was.  As a result, she received no child support from him and she couldn't afford to support the baby on her own, which is why she moved back in with her parents, who took care of the baby while she worked.

When she returned to therapy, she was not in a relationship.  She said that, since she had the baby, she was more aware than ever that she made poor choices when it came to relationships, and she didn't want to jeopardize her baby's well-being by getting into another abusive relationship.  As a result, she wasn't dating at the time.

Although Ann was clearly unhappy, she was safe in her parents' home, and she wasn't in a current crisis.  Since she didn't seem likely to get into another abusive relationship at that point in time, her therapist agreed to do EMDR therapy with her, and they began the preparation work to begin processing her history of trauma.

Some clients, who seek help in trauma therapy, are still either in a current crisis or they are creating new crises in their lives--sometimes knowingly, like the example above in the fictional vignette, and sometimes without their awareness.

The fictional example that I gave is just one possible situation where safety and emotional stability must be present first before EMDR or any type of trauma therapy can be done.  In the prior article, I gave other examples.

A trauma therapist can assist a client who is in crisis to overcome the crisis, but she cannot begin to do trauma therapy until the client's life is stable.

Even after the client's life is stable, every client who does EMDR therapy must go through the history taking and preparation phases of EMDR before the client and therapist can begin processing the trauma.

Since EMDR therapy is more experiential than talk therapy, the preparation phase of EMDR therapy helps to ensure that the client has the necessary internal and external resources to deal with the strong emotions that can come up when working on traumatic memories.

Getting Help in Therapy
Too many people who need help in therapy don't come because of they feel ashamed or they're concerned about the possible stigma of being in therapy.  They mistakenly believe that going to therapy means they're "weak" (see my article: Common Myths About Psychotherapy: Going to Therapy Means You're "Weak".

If you've been struggling on your own with an unresolved problem, you owe it to yourself to get the help in therapy that you need (see my article: The Benefits of Psychotherapy).

Once you have worked through your unresolved problems, you can be free from your traumatic history and live a more fulfilling life (see my article: How to Choose a Psychotherapist).

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 traumatic experiences.

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.