My Trauma is Over and Done with; Why Rehash It in Therapy?

              Trauma unveils the danger in this world. If raised in a sheltered and loving environment, we come to assume the world is basically safe. We know bad things happen. To other people. This premise allows for blissful ignorance and a feeling of calm and safety. And then something terrible happens. We are shocked. The blinds are raised and the danger appears ubiquitous. Suddenly you are vulnerable.

              There are some commonalities experiences many individuals have directly after a trauma. You are appalled that you didn’t see the danger. You are fearful that something else bad may happen, whether similar or different than the traumatic event. You are on edge now as you are assessing the safety of situations. We call this hypervigilance. You think about what happened. Over and over. You may have flashbacks to the event, nightmares, or intrusive memories that cause the same emotions you felt during the event to flood back. You avoid anything similar to the situation in which you were traumatized. Sometimes this means even avoiding leaving the house. Also there are a range of mental health difficulties stemming from this shock and distress. Sadness, anxiety, poor sleep, guilt, shame and the like are common.

              A common strategy for coping with a trauma is avoidance. Not only of places and people that remind you of the trauma, but also avoidance of dealing with your thoughts and emotions that come with it. We try to move on and forget it. Many minimize the impact of a trauma either because others have had it worse or they don’t want to be a victim. So they move on.

              Your therapist often meets individuals who have undergone a traumatic event a year after or later. They often don’t present to deal with the trauma but complain of the secondary symptoms that persist. “I can’t sleep”, “I’m depressed”, “my mind races and won’t shut off”, “I have trouble trusting others”. Your therapist will point out the timeline of the traumatic event and the onset of your symptoms. By that time it can feel stale. Patients want to keep it in the past. They don’t want to dig up old skeletons. Your therapist knows they often need to be dug up, examined, and then buried again.

              Processing your traumatic event and the impact it had on you is often essential. This processing can take the sting out of this wound and keep the trauma from continuing to affect you in the future. Unfortunately, emotional memories are stored in a different part of our brain than other memories and can be elicited by the slightest trigger. You smell something similar to the man who hurt you. Your wife scolds you in a similar tone used by your abuser. You are repeatedly being brought back to that moment, only to flee again in your own mind and bury the memory.

              I’m not sure of your therapist’s training but there are several more gentle approaches to working through trauma than we had in the past. If nothing else, your therapist is sensitive to the fact that working on a trauma can bring the same pain that was experienced during or shortly after the trauma. He might ask you to see the trauma as a video on a screen to distance yourself so you don’t relive it. He may ask you to tell the story as the survivor, not the victim. Tell me what you did to survive.

Unfortunately, at times you have to sit with the emotional pain for a while. Feel the pain until it inevitably dissipates. Imagine you were in a car accident and broke your foot. The pain is unbearable but you choose to just move on with your life and not go to a doctor. Slowly the pain improves. But you are left with chronic low-level pain and a limp. Years later when you go to the doctor, she may tell you to properly treat the problem it may require surgery, post-operative pain, and physical therapy. Then the bone can heal properly and the limp and chronic pain will go away. Your therapist wanting you to feel the pain again can be similar. He wants you to heal properly and move on with your life.

              Up until now, we have only discussed a singular trauma. What if you add a secondary trauma? Let’s use as an example a child that was molested by an uncle. In High School, there is a secondary sexual assault by a classmate. This is not a scenario of: it happened again and now I must go through this a second time. 1+1 in this situation does not equal 2. The second incident causes its own distress but also triggers the previous event. She now has to handle the classmate, what it means that she has been taken advantage of multiple times in her life, and wonder if she is partially to blame. It is much more confusing and compounds the distress.

              This is only with two traumatic events. Complex trauma is when you struggle with a series of big and little traumas. Your mother was physically abusive and this occurred over years. There was food insecurity at home. The family moved from homeless shelters to friends’ homes. A sibling succumbed to peer pressure and got involved in drugs and overdosed. This child’s sensitivity to adversity changes. You come to expect bad things are going to continue to happen and you act accordingly. Imagine living in a world in which you expected perpetual bad things to happen. Your fight or flight response is shot. It takes a large stimulus to get a shot of adrenaline. You developed learned helplessness and live by the mantra “Nothing I do matters”.

              Martin Seliman and Steven Maier conducted a famous study demonstrating learned helplessness. They had rats in one cage that received mild shocks that the rats could turn off with a lever. There was another cage with rats that received mild shocks and no matter what they did, they had no control of the shocks. Later, they placed the rats from both cages in an environment in which escape was possible and easy. The rats who could control their shock escaped, whereas the rats who had learned helplessness didn’t even try. They grew to be defeated and didn’t realize when they are in a different and safe environment.

              Your therapist works with individuals with complex trauma to reassess their environment and take back their control. The client is no longer a child and can protect himself. Or she is no longer in the abusive and controlling relationship. The soldier is no longer at war. Then comes the work to improve mental health and internal fortitude. To trust individuals, who are properly vetted, and accept some risk by leaving the house or going on a date again. Your therapist knows this is a long path and a past that will leave with permanent scars. But healing is possible.

              “What do you consider trauma?” is a question often rebutted to your therapist when asked about trauma and abuse history. The answer: anything awful that happened to you or you witnessed that still affects you today. We distinguish between horrific singular event trauma and the smaller, ongoing traumas by using the terms: Big T and Little t. Both are impactful and both are worth exploring. Many clients endorse a previous trauma but state that that was so long ago, it has no bearing on their current circumstances. Your therapist will be skeptical about this. Traumas affect us in little and big ways that follow us as we make decisions and allow others into our lives. Decades old trauma can flood back in a flash, as well. Your therapist can work with you to diminish that triggered emotional response. I often know the work is done when patients tell me, “I can think about it now and I don’t cry or freak out. It’s just a bad memory.”

              Trauma changes the way you see the world. Healing from it isn’t about pretending what happened didn’t matter. It’s about helping you remember the trauma without continuing to live inside it.

Feel better, y’all!