Trauma Work is Grief Work: How Psychotherapy will Re-work and Regrow your Life
“I didn’t know that what happened to me when I was 9 years old was abuse. I thought this was just love. He did this to me, and then the next day we would laugh and play - it was friendship, kinship, it was all I ever knew. It was childhood to be loved like this. This was what being a girl in my family felt like. Becoming a young woman felt the same way. I was welcomed into a life where my body was for everybody else. It was the legacy of my mother, the legacy of my grandmother, and the legacy of every woman after woman, passed down through the blood of connection in my family. I carried this inside of me for 40 years. It was a secret I didn’t even know I was keeping, but the pain was my bones, my cells, my history and destiny. I didn’t how how to detach from it because it was me.”
-Annonymous
Trauma is the mind and body’s response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self, and their ability to feel the full range of emotions and experiences. Trauma, however, is subjective, and the experience is unique only to you. While negative experiences of your life are remembered painfully, often traumatic experiences are forgotten. Trauma work isn’t just about what happened, it is about what didn’t happen afterwards.
It is about how you were harmed and then went upstairs to brush your teeth and go to bed. It is about how your developmental path was irrevocably changed in a matter of moments, and then you went and fixed yourself a snack. It is about the tasks of daily life continuing, yet something, often unnamed, has changed for you internally. It is about being solitary in your experience. It is about secrecy, being unwitnessed, being alone. This is where it all went wrong. This is what took away your God given right to be human, to have a voice that someone hears, to be connected to someone who acknowledges you being alive, to be loved by someone who can keep you safe simply by knowing you. Understanding where the path changed for you is what therapy is all about, and it is all grief work, as it is about mourning a life.
You might wonder why, now, your unconscious is trying to draw your attention towards a deeply buried trauma at the time when it does. Often adults who enter parenthood find themselves seeking treatment as their children reach developmental stages or ages at the time in which they, themselves, were harmed. Sometimes it is the familiarity of dynamics of your current family system, elements in your environment, a death, or certain times of the year that can bring these long forgotten, often unconscious, memories to your attention by bringing up very old, intense feelings that don’t seem to match the current state of things.
When we first meet, I always want the history of your life to unfold organically, so often it takes time to get a sense of the whole story. From many years of working with patients with histories of trauma, I have become highly attuned to particular patterns or trajectories of suffering that are only present when there has been some kind of trauma during the lifespan. Even without saying many words, trauma will make itself known rather quickly.
When I am entrusted with a new working relationship, there are a few specific factors I keep in my mind to assess if our work together will be a good fit for you. These factors are essential as you make the courageous step forward towards such a vulnerable, sacred space.
The therapy I provide is through talking, and that is all I do. I am a solo practitioner, currently seeing patients through telehealth since the start of 2020. I do not provide any adjunctive care, or have ancillary faculty, or facility support to offer patients with greater needs. The work that I do might seem minimalistic, but the power of this curative, relational connection alone can create lasting, foundational change.
From my first time meeting you, whether you have come forward with a known history of trauma, or if I am just getting to know you, the following are some imperative factors that I keep in mind to best ensure that you will be taken care of here:
Consent
1) The desire to talk about traumatic events has to be your idea. Your ability to engage in treatment willfully means knowing that you will be talking about events or feelings that might bring up the feelings of the event themselves. Sometimes it can feel like being revictimized by a clinician who is merely asking questions driven by a curiosity to know you. I want you to know that, in therapy, it is necessary to be able to say “no” to anything, including talking.
2) If in our initial session, you let me know that talking about what happened to you is not something you ever want to revisit, or if you are seeking a referral for medication or a more specified form of care, I consider that advocacy for yourself to be very crucial information that reveals to me exactly what kind of experience you are looking for, your limitations, and your current state of processing and readiness relative to what I am offering to you. This helps me to determine if I am the best fit as a clinician for you. I will always honor and respect your true intentions, and if it is determined that I am not the best fit for you, I will provide you with any referrals I might know about that would align more with your wishes, and will assure you clearly what I can and cannot do to meet your needs.
3) If you feel hesitant to engage about traumatic events because of fears, worries, or difficulties about talking about such personal and vulnerable topics within a new working relationship, that is not just understandable, but expected. If this is the case, it can be very enlightening to initially talk about those hesitations and fears without talking about the events themselves. When beginning a new treatment, I am highly sensitive to your complicated relationship with trust and your anticipation of being mistreated, harmed, or disappointed. It is my utmost dedication to be kind, clear, and attuned.
Stability
1. Environmental:
a) Has your trauma stopped? Have you changed the physical space where the trauma occurred so you can assure your physical and emotional safety?
b) Are you currently living in a safe and secure environment?
c) Do you have access to resources of time and money to support an insight oriented psychotherapy that will meet 1-3 times per week? Do you have insurance you will be using?
d) Do you have have adequate support (family, friends, support groups, community support, etc) outside of treatment?
2) Emotional Regulation Skills:
a) How does you manage yourself when difficult feelings arise in-between sessions?
b) Do you have a history of acting out at times of exceptional distress (sexually, legally, placing yourself in dangerous physical situations, financially, or with drugs or alcohol?)
c) Can you tolerate the feelings that will come up after and in-between sessions in a way that feels productive for you?
3) Coping Skills:
a) How do you cope when distressing feelings come up?
b) Do you have 1-5 faithful coping skills that you can count on at times of distressing emotional states to assist you in deescalating yourself?
c) Do you have coping skills that you have historically utilized to help regulate your feelings that are not helpful or cause further harm?
4) Substance Abuse and Medication:
a) What is your relationship with substances? Does you rely on substances as a means of emotion regulation? Do you have an honest relationship with yourself about how you engage in substances?
b) Do you have a prior history of substance abuse (inpatient or outpatient rehab, medical detoxification, AA or similar)? And if so, what were those experiences like for you? Did you feel that helped your sobriety? Are you currently utilizing any of these supports? Are you currently engaging in substance use?
5) Interventions:
a) Have you ever utilized alternative methods to assist in regulating your emotions? (EMDR, tapping, CBT, DBT, hypnosis, biofeedback, yoga, etc?) How were these experiences for you, and what did you like or not like about them?
b) Have you been previously treated with psychotropic medication to manage symptoms associated with traumatic events? When did this intervention begin? How long have you been taking these medications? What are these medications and what purpose do you feel they serve for you currently? When did you initially seek psychiatric care and how was it understood what you were being treated for? What are your feelings and relationship to this medication currently?
c) Have you ever been either voluntarily or involuntarily hospitalized for moments of distressing emotional states? What was that experience like for you? How many times did that happen? Do you find yourself driven to medical intervention of some kind when you feel disregulated to this magnitude?
d) I make a large distinction between feelings about death, wishing about death, fantasies about dying, feeling the struggle of being alive versus taking actions towards ending your life. How do you identify with this statement? What are your feelings or experiences regarding suicidality? Have you ever attempted to take your own life? Have you ever created a plan beyond fantasy of ending your life?
It is unnatural for me to refer to checklists and rigid frameworks when approaching a whole, complex life, but it has been my experience over the years of working with patients with a history of trauma that it is helpful to consider some fundamental truths as early on as possible in service of the best possible treatment opportunities for you.
“Violators cannot live with the truth: survivors cannot live without it. There are those who still, once again, are poised to invalidate and deny us. If we don’t assert our truth, it may again be relegated to fantasy. But the truth won’t go away. It will keep surfacing until it is recognized. Truth will outlast any campaigns mounted against it, no matter how mighty, clever, or long. It is invincible. It’s only a matter of which generation is willing to face it and, in so doing, protect future generations from ritual abuse.”
If you are interested in learning more about beginning psychotherapy, please feel free to contact me. I am happy to talk with you and answer any questions you might have.
