The Process of Therapy

But What are We Going to Actually Do?

Trauma Therapy Explained

People tend to know they need counselling for a long time before they reach out to start it up. Making that initial phone call can stir up fear and uncertainty. And once an appointment is scheduled, actually attending it can stir up anxiety and doubt. I believe it does take a tremendous amount of courage to start up counselling: to entrust your story to a stranger invites vulnerability. Yet for each courageous soul that takes the first step, there is hope. Hope says “This will help”, and “I can get through this”.

So for all the folks out there wanting to take that first step but feeling weighed down by uncertainty, I’d like to demystify the counselling process.

When it comes to working with trauma, I use the Three Stage Trauma Recovery Model, which was developed by Judith Herman in the 1980’s. I use the model as a framework within which all therapeutic interventions launch from.

Please Note: Each client is unique, and therefore counselling is not a one-size-fits-all service. While you read the following information, please know that it might look a little different for each person. Also, rarely do we move through the model in a fully linear manner, (stage 3 often initiates during stage 2 work).

Stage 1 – Safety and Stabilization

Counselling often begins with history taking. I typically ask about what brings a person in for counselling, and gain an idea of their history in a “newspaper headline” manner. I use the newspaper headline approach because at this point, I am still a stranger to the client, and he or she may not yet feel comfortable sharing a detailed portrait of their life. Then, we collaboratively develop treatment goals.

Within the first stage, the focus is on safety and stabilization. That refers to external (living environment) and internal (emotional safety). Elements in this stage may include:

  • External safety: advocacy, growing a support network, information-sharing on topics relevant to the individual client
  • Internal safety: Resourcing to tap into and foster inner strengths to shift out of strong emotion. This involves learning to regulate emotion and manage symptoms that may be causing suffering or causing a person to feel unsafe
  • Information sharing to assist folks in understanding symptoms, their felt sense of emotion, and the effects of trauma
  • Exploring impacts to core beliefs
  • Developing and strengthening skills to manage painful and unwanted experiences, and minimizing unhelpful responses to them.

According to Judith Herman (1982) the goal of stage 1 trauma work is to create a safe and stable life-in-the-here-and-now, which can enable folks to safely remember the trauma, and not continue to re-live it.

I often have folks tell me they want to jump right into trauma processing. They feel a sense of urgency to “feel better” or to “heal this right now”. However, there is great importance of stage 1 work, and we can not skip over it. Think of it this way: If you had a car with shoty brakes, no seatbelts or airbags, no horn, bald tires, and a foggy windshield – you could still get from point A to point B. However, you would likely feel terrified the entire way. The resourcing and affect regulation strategies of stage 1 are like the safety features in a car: they enable you to get from point A to point B without full-blown panic and emotional overwhelm.

Stage 2 – Coming to Terms with Trauma

Once an individual has developed the ability to regulate emotion and achieve a level of internal emotional safety, trauma processing can begin. As we work through a trauma, I keep a keen eye on resourcing to ensure a client isn’t become too flooded with emotion. Techniques are used to modulate this process, and I employ several end-of-session strategies to assist folks in stabilizing emotion prior to leaving the office. Here are some elements stage 2 may include:

  • Trauma processing using EMDR
  • Art, play or sand tray-based approaches (for children and teens)
  • Exploring and re-working the inner trauma narrative
  • Working with negative cognitions resulting from trauma and movement towards installing positive adaptive beliefs and cognitions

Stage 3 – Integration and Moving on

As we work through trauma processing, elements of the third stage begin to show up. Some of these elements include:

  • Working to decrease shame
  • Developing a new narrative and life goals that reflect post-trauma meaning making
  • Working to foster a greater capacity for healthy attachment and decreasing alienation

As a result of doing the work of trauma therapy, the trauma starts to feel farther away, as something that happened but that is no longer a daily focus disrupting life.

If you are thinking of starting up therapy, and have some questions, please feel free to reach out and ask. The decision to move towards self-growth and healing can be empowering and freeing. I hope you give it a go!


If you’d like to learn more about the Three Stage Trauma Recovery Model by Judith Herman, check out these resources:

Mindfulness

The Shortlist Series: How to get Unstuck from Negative Looping Thoughts

The quote in the image above describes an idea that is so simple and yet not very easy. When we find ourselves stuck in negative looping thought-patterns, we often need a way out – a life preserver of sorts to pull us to safety. Here are  four suggestions that might help you exit those negative thought cycles. And as always, if you have a strategy that works for you to healthfully exit negative looping thoughts – please add it to the comments.

unstuck

1. Anchor to the Present Moment

When we find ourselves stuck in negative thinking, we may be ruminating about the past or worrying about the future. We can not change the past, and when we worry about the future, we are robbing today of its strength. Returning to the present moment may be just what you need to let your nervous system settle. Once you shift out of that worry or fear loop, your problem-solving brain can come back on-line, and the negative loop is interrupted. Not sure how to get back into the present moment? Here are some ideas:

5-4-3-2-1: Look around the room you are in, and carefully describe 5 things you can see, 4 things you can touch (actually move around and touch the items), 3 things you can hear, 2 things you can smell, and 1 thing you can taste.

Ground with Colour: Look around the room you are in and take notice of everything you can see that is blue. Go slowly, pausing to notice what the item is and its particular shade of blue. Move on from blue to notice everything that is green, then orange, and so forth until you have gone through all the colours or until the looping thoughts have settled.

Letter Association by Word: Pick a word any word, and then break it down letter by letter, coming up with as many other words that start with each letter of your chosen word. (For example: if your word is COPING, start by thinking of as many words as you can that begin with the letter C, then O words, then P, then I, then N, then G.)

(These strategies are helpful because they focus our attention in a directive manner, and thus can interrupt the negative or looping thoughts that so often accompany anxiety. And the result? You return to the present moment, and the looping thoughts are interrupted.)

2. Connect with Compassion

When we are caught up in negative looping thoughts, our heart tends to be closed off. In other words, we might be thinking about the worst-case scenario, putting ourselves down, feeling as though things will never get better, and even thinking negatively of those in our lives. To exit the negative loop, try mixing in some compassion. Dr. Kristin Neff writes, “instead of mercilessly judging and criticizing yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?”. Having self-compassion means that you honour and accept your humanness – not self-downing but just being present with loving kindness. Not sure how to connect with self-compassion? Here are some ideas:

  • Talk to yourself the way you would talk kindly to a small child
  • Talk to yourself the way you would talk kindly or encourage a friend or someone you care deeply for
  • Try this breathing exercise for self-compassion: As you exhale, picture yourself exhaling stress, anger, worry, and frustration. As you inhale, picture yourself inhaling peace and acceptance. Continue slowing and deepening your breath, exhaling the worry, etc., and inhaling what you need.
  • Look at a picture of yourself at a younger age and remember you were once a child deserving of kindness and understanding
  • Look at a picture of a loved one (or look at them if you are near them) and think of 3 things you love about them
  • If you have a pet, take a few minutes to pet or play with them, and soak up some impromptu pet therapy!

3. Refreshen Self-Awareness

What is beneath your upset? Are you feeling unheard, unworthy, or unaccepted? Sometimes when we are caught up in a negative cycle, we start telling ourselves things that serve to keep the cycle going. These might be called thinking traps, negative core beliefs, or psychological defences. Regardless the name you use – take a moment to deepen your self-awareness and tune in to the narrative you are telling yourself. If it is negative, take a few moments to breathe deeply and return to the present moment with loving-kindness. You might want to question that negative narrative. For example, is what you are telling yourself 100% true, 100% of the time? What would you rather be telling yourself, or what could also be true instead? The latter question will start you down the road of connecting with the positive belief you would like to build.

4. Let it out

Sometimes talking it out can help. Is there someone in your life that you could vent to? Not for advice (unless you want it) – but rather a sounding board who can witness your tidal wave and be waiting on the shore as you ride the surf out. Emotional settling can occur when we connect with a caring friend or family member and feel heard.

If no one is around, try venting by writing out what you are feeling. You can also draw, doodle, scribble, or paint. Click here if you haven’t used writing to vent and want to hear some ideas on how to get started.

Have you discovered some ideas that help to healthfully shift out of negative looping thoughts? If so, please add what works for you in the comments.