8 Keys to Safe Trauma Recovery was written to the survivor of trauma—self-help reader and therapy client alike. The voice of the book is speaking directly to them. However, I hope that you will also find the philosophy and tools in this book of use as an adjunct to your knowledge and methods.
I gained my master’s degree in clinical social work in 1976 and pursued a general psychotherapy and body psychotherapy practice for several years before I began specializing in treating traumatized individuals in 1989. I started offering training and consultation to colleagues such as you in 1992. Over the years I have identified several areas for caution that I would like to pass on to you.
First, do not be overly influenced by the evidence base. It is meant as a guide, not as law. One of the biggest problems I see in the field of trauma therapy is the tendency to quote the evidence as the last word on what helps or hurts clients. If only it was that simple. Science is just not that exact—witness the medicines and medical treatments that are introduced and withdrawn on a regular basis. And, unfortunately, outcome studies—for better or for worse—are among the most biased research there is. However, arguing this point is irrelevant. Even if scientific evaluation was perfectly controlled, still there would never be any single method that would heal every trauma survivor, just as there is no single antidepressant that helps everyone, or even a majority. Thank goodness we have a wide variety of theories and methods to study and apply. Considering multiple tools is the only way to discover what helps an individual. Maybe it means taking a little from this and a lot from that. I wish that heaps of common sense would always be an ingredient.
Beware common mistakes of trauma therapy:
- Give ample time to Phase I (stabilizing) work. Sometimes when I teach or lecture on this topic, therapists will ask when I will get to the “real” trauma work. That always amazes me, as I regard the work we do to stabilize and make our clients safe as the most important real trauma work we can do. Often problems that arise are simply solved by revisiting this stage of trauma treatment or giving it more time.
- Contain curiosity. One of the most important tools you can have as a trauma professional is the ability to contain your curiosity. If you cannot restrain your need to know you could prematurely (if unconsciously) push your clients into discussing material they are not ready to face. Providing details of horrible events will be contraindicated for many of them. The only reason to ask for details is when processing such details will further a client’s recovery.
- Learn to pare down step size. Much of the frustration of trauma therapy is the result of steps being more than the client can manage. Frequently, what is actually too much for the client is misinterpreted as resistance. It does not matter whether it is the therapist or client designing the step. If success is evasive, reducing the pace could make a big difference.
- Bypassing current trauma to focus on past trauma. If your client improved with Phase I work but is now getting worse, reevaluate what you are working on. Is it what the client came in with, the current situation that motivated him to seek help? Or did you get distracted by an earlier trauma history? This is not an uncommon scenario and is responsible for many instances of client decline. One of the best tenets from the early years of psychotherapy is to always ask the client, “Why now? What was it that tipped the balance in your decision to get therapy?” That reason is always important. Even if there is a clear history of trauma, the recent event or situation that brought the client in needs attention. If you backtrack there, you may recoup your client’s earlier improvement as well as trust. After the referring issue is resolved, approaching an earlier trauma will be much safer.
- Do not assume that what was helpful for you will be helpful for your clients. This is one of the biggest mistakes we make as professionals. Of course what has helped us may be helpful to some of our clients. But jumping to the conclusion that what is good for you is good for them could cause you both lots of frustration. I often smile when I hear a colleague moan, “I know just what would help, but my client is resistant.” The more accurate statement would usually be, “I know just what would help me in that situation.” That is quite a difference. Projection is great for giving us ideas, but never mistake it for truth.
- Do not allow clients to push you to address memories with them prematurely, or to take any other steps you do not believe they (or you) are ready for. Most of us have regrets—I certainly do—for times we have let our best judgment be deterred. Listen to your own wisdom and common sense to reduce the chance of doing damage to your client (and yourself). Remember the medical precept: First do no harm.
- Maintain continuity of care. You may think it unnecessary for me to write this, but I have heard of far too many situations where this basic principle was not followed, and thus feel that I must mention it. The number of clients I have heard of being left high and dry by their therapists is of great concern. Many clients, especially traumatized clients, have reduced capacity and resources for getting the help they need. For many of them, that is why they are still suffering from trauma in the first place. All of us encounter clients we cannot help. If you become frustrated in working with one or more clients to the point that you no longer believe you can help them, make sure to secure referrals before you terminate with them.
Last, do not forget to take care of yourself. Trauma therapy is very taxing on the emotional and physical reserves of the therapist. Many of the keys in this book may also help you. For instance, pay attention to your own mindful gauges to help you identify when you need to slow down, take a break, take a vacation, and so on. Exercise as well as increased muscle tone may also help you to better manage the stress of your work. For more on this, you may find my book Help for the Helper to be of interest.