Trauma is a severe disruption to one's safety, creating a loss of control. Often this is accompanied by a disconnection from a safe community, creating a sense of isolation and intense aloneness. I take trauma very seriously and it is a skill that I have accumulated thousands of hours in direct and indirect client work. I can normally have a client prepped for trauma work in two sessions. Here is how I approach therapeutic conversations about trauma:
1. Safety
2. Self-care
3. Trauma work (or as I sometimes call it, "sitting in the muck")
4. Emotional reattachment / Identity work
Session One: Safety is first. I will not engage in trauma work until my client is safe and they have an extensive self-care plan. It can be dangerous doing trauma work - talking about intensely difficult things - and too often I have heard from clients who have been retraumatized by other therapists. (Sometimes counsellors can have a good understanding about trauma but insufficient understanding and training about how to work with trauma, how to safely support their clients through trauma work.) I make sure that we have addressed safety such as location of the trauma work, any potential distractions, any available supports, any history of suicidal ideology, and any mental health diagnosis that we will need to discuss and understand first.
Session Two: Self-care begins as psycho-education around the pleasure center of the brain. I teach the client how to access the pleasure chemicals of the brain in a natural way and normally we generate a handful of immediate things they can do so they can experience what I call "dopamine hits" long before the trauma work begins. The idea here that I present to my clients is that they need to schedule self-care prior to our trauma session and for right after our trauma session. This will make sure that we can keep the pleasure chemical levels high enough to make sure that the client can navigate the trauma work without becoming dysregulated.
When we begin the actual trauma counselling I use a variety of tools that I have developed according to the client's comfort level. With some clients we have to take very small steps in the work. I have tools to accommodate these steps. As I share with my clients, the goal of trauma work is never to make the trauma go away or to have you feel good about the trauma but instead to shift the narrative from the trauma story controlling you to you controlling the trauma story. Often after a trauma session, my clients will experience some disorientation for a day or so but then all tell me that they feel quite different when they think about the trauma. They are very much aware that something has shifted inside.
The emotional reattachment and identity work will be based on how dissociated someone is to their emotional experiences. There are a series of exercises and processes that I do with the client to help them fully reattach to their emotional self as well as to become fully differentiated - having a strong sense of self.
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