In some way or another most of what we do in psychotherapy is related to some form of trauma. Most anxiety, panic, depression, and personality disorders are trauma related. We seem to feel that trauma survivors are an exceptional group of people who have wittingly or unwittingly exposed to some awful and super traumatizing events like war and rape. Those are extreme forms of trauma but most of us have been around or in traumatic events like alcoholism, drug addiction, bullying, community violence, disasters, early childhood, intimate and medical trauma. Most of us have experienced some form of trauma by the pandemic, political events, violence in our world and country and personal violent acts.
So, each person has a unique relationship to traumatic events. Therefore, we must find a customized therapy that meets the needs of individuals in need. There must be a trauma map of when, how and where these events happened and how they affected each person. If someone was traumatized at one month old or ten years old, it is vastly different. The intensity of trauma and for how long it went on matters as well.
All children blame themselves for any trauma that occurs. They are subjective, everything is them. They do not have the brain development to be objective. That does not happen until after eleven years old really. If a child was sexually abused, they believe they brought it on somehow. If a child was beaten, they believe it was their fault. Here is where shame comes into the picture. Trauma survivors feel a great deal of shame, they are inadequate if they are neglected, they are bad if they feel blamed, they feel weak if their parent is overbearing.
As we peel back the layers of trauma experiences, we see an entire range of reactions to individual events. There are three main types of traumas. Acute trauma that results from a single incident, chronic trauma that is continuous like child abuse or violence in the home or complex trauma which is about exposure to a variety of traumatic events that are invasive or personal. If we had a meter from one to a hundred, we could more accurately assess the force of an event or more importantly how the individual responds to those events. Some people have more natural resiliency than others. We can see in families that have a violent or chaotic environment that the children will all experience it differently. We observe that out of eight children six of them are drug addicts and two are neurosurgeons. Some people have very few natural defenses or are “skinless,” while others have a very thick skin and can absorb a great deal of punishment and keep on going.
There are different forms of realizations that also can affect how we uniquely respond to trauma. The realization that we experienced trauma is the first step. Then how we were affected by the trauma by recognizing the symptoms of our own trauma and whether we can accept the fact that we’ve been traumatized are critical factors in developing an approach to treatment. Being able to talk about our experience and feel that our symptoms are valid and were caused by real events. There are several effects of trauma. One is numbness and the other is loss of memory. Many incest and rape survivors do not remember the actual event. Being able to talk about it and feel validated will often open virtual memories of the actual event. This is a freeing experience and the person who remembers feels sane again. It is not unusual for mothers and families to deny that it ever occurred even though they know deep down that it did. I have observed this many times and when the victim of abuse recognizes that it did really happen their lives change completely.
Years ago, a 23-year-old woman came to my office suffering from high anxiety, sleep deprivation, and depression. As she was talking to me, she kept whisking her arms like there was lint or flies on her. She talked about strange dreams with demons and large objects threatening her. I had no idea what was going on and just kept listening to her. We never lead a patient to abuse we let it come out on its own. We started talking about her dreams and describing the features of them. At some point she decided that she would not sleep. She started to hallucinate and wanted to kill herself. Then one night as we were talking, and her face went white, and her mouth dropped open. She realized that she was repeatedly raped at seven years old by her cousin when she went to stay with her aunt and uncle. She got up and hit the door to my office so hard that she put a hole in it. She raged and cried and cried. We found her cousin who was serving a sentence for rape and let the authorities know and he went away for a longer time. As we worked it through, she got better and better. She lives a normal life now. The recognition of what happened to her was essential to her treatment.
The treatment of trauma requires many things. The first and foremost is safety. Trustworthiness, support, and collaboration are also critical elements in treatment. The patient must feel a sense of empowerment and choice in the way they choose to deal with all the elements in their treatment. Cultural and gender issues also play a role in treatment. The importance of feeling the grief, restoring memories, and restoring a sense of health are the driving goals toward a sense of wellbeing. The collaboration and mutuality of support not only in therapy but in peer relationships can be particularly crucial elements in recovery. The final part of recovery is restoring lost relationships and becoming a part of a community are valuable health practices.
Trauma can be very obscure and even invisible. It can control our thinking without our realizing it and play an immensely powerful role in our relationships. Coming to terms with our history, our symptoms, and our relationship with ourselves can help us to free ourselves from the power of traumatic injuries.