Forget the can of worms. Safe first steps for trauma recovery (Part 1 of 2).

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In this week’s post:
About safety before even starting trauma work:

  • Be safe, now.
  • Pick the right time.
  • Go slow and start small.
  • Master coping skills.
  • Medication.
  • Plan for emotional responses.
  • Trauma crisis contacts.

For years I’ve delivered lectures and workshops about trauma, madness and recovery.

Without fail, at least one person will always be concerned about whether it’s safe to ‘open the can of worms’. But isn’t talking about trauma too risky? people ask. What if people become unwell? Isn’t keeping people well our first priority?

Similarly, I’ve had many survivors tell me that they know, without doubt, that trauma sits behind their experience of madness. But they are just too scared to address it. I don’t think I can do it, people will say to me, I might never come back from that.

I get it. Of course I do. I am one of those people who put off addressing trauma for most of my life. When I finally opened up, I didn’t do it in a safe way. Frankly, I am lucky that I’m still alive to talk about it. Mind you, I did survive, and my life is immeasurably better for having done this horrid, hard but, for me at least, essential work.

 

A different metaphor that’s easier to open

shutterstock_46811851_open soda can

I am sick of the can of worms metaphor. I mean, why would anyone even want to open a can of worms? This metaphor keeps all of us stuck.

I prefer the can of cola metaphor. We all know that if a can has been shaken, over and over and over, that we need to be careful when we open it. We know there’s a risk of getting cola everywhere. But if we’re thirsty, and there is no other drink around, then sooner or later we’ll have to open that can. We might let it sit for a while. Sometimes for a long while. We’ll open it just a teeny, tiny crack to express air, then let it sit again. And eventually we’ll be able to open the whole can, and take that drink.

In this metaphor, the thirst is our madness, and trauma work is like opening that can of shaken cola. The longer we’ve kept our trauma a secret, suppressed it from ourselves, or the more it’s meshed in with our emotions and thinking, then the more shaken we are, and the more careful we need to be. Sure, we could choose to never open the can. But that drink inside the can may just hold our emotional and mental freedom. Without it, we may always be thirsty.

What can help before you do anything

flying_shutterstock_111806477 - CopyJudith Herman, author of ‘Trauma and Recovery’ (1992) says that ‘[T]he central task of the first stage [of trauma recovery] is the establishment of safety.’ By the way, the next two stages are remembrance and mourning, and then reconnection with ordinary life.

I’m 100% in agreement. Start with safety, because trauma work is a tough journey. This post is not about how to do trauma work. It’s all about safety for when we first start to think about whether we even want to disclose that trauma has happened.

In writing this post I’ve tried to think about what may be useful for survivors, for friends and family, and for mental health workers.

My own experience of trauma disclosure and safety

I was so inspired by the stories from my peers about recovery from trauma that, once I had decided to disclose my story, I did it fairly quickly.

Mind you, it still took longer than I imagined. It was months from the time I decided that I needed to do something until I was able to speak the words to my therapist. I went to session after session planning to start my story, but every time I couldn’t find the words. Eventually I sent my therapist an email, telling him that I was struggling to bring something up in our sessions. I asked if, at our next session, he could ask me to talk about ‘that thing that happened when I was thirteen’. It worked, and we talked.

For therapists and other workers, it may be worth remembering to ask us, from time to time, if there is anything that we have been wanting to talk about, but have found difficult to raise. This may just give someone the opening they need.

Sadly, both I, and my therapist, thought that I had already come so far in my recovery journey that I would be able to handle telling this story. I had developed enough coping skills to come off all psychiatric medication. I hadn’t been in a psychiatric hospital for over five years. I was working, living a good life. I seemed to have my shit together. But we were both wrong. Within a very short space of time after starting our work, I became suicidal and my voice became louder and more terrifying than ever before. I ended back in hospital, back on antipsychotics, and I terrified myself and the people who love me.

Regardless of all of the personal work I had done, there was some important work that we should have done first. It’s standard practice in trauma therapy. But we didn’t. I cannot travel back in time and say whether this would have made enough difference to keep me safer, but I am fairly certain it would have.

I do not for a second regret having done this work. I would do it again in an instant – even if it meant doing it in the same, unsafe way – because my life has become so enriched as a result. But if I could, I would do it more safely.

Each of the following sections are about things you can do before you even start doing any trauma work at all. They all add to your safety, so that if and when you are ready to do this work, you are much more likely to be in a better place. If we go back to my ‘can of cola’ metaphor, each of these are different ways to let the can sit for a while, and to open it very, very slowly.

Be safe, now.

Are you still in a situation where you are experiencing abuse, threats of abuse, or other types of risk or harm? The first step in healing from the impact of trauma is to be in a safe situation. Look for emergency shelters, contact a crisis support service, reach out to friends and natural support people in your life.

It is never your fault. Getting out of an unsafe situation can be the hardest challenge of all for many people. There are reasons for this – and it is not your fault. Abusers manipulate us in all sorts of ways, which can leave us feeling responsible for their behaviour. It’s not uncommon to think that abuse is your own fault, or to feel ashamed, or to think that you somehow deserve it. Sometimes we think we can change the person who abuses us, or feel some sort of responsibility to them. These are really common and understandable feelings, but they are not helpful or true. You are never to blame for someone else’s behaviour – they are. You have a right to be safe.

There are ways to escape. Many other people are trapped in unsafe situations. This may be because of fear of retribution, or a lack of financial resources. There are services that can help in these situations. There’s not enough of them, but they are there. See the crisis contacts section at the bottom of this post for phone numbers and websites in different countries. Most of the websites include a ‘quick exit’ button and advice about how to keep yourself safe while you reach out for support.

Pick the right time.

For me, it was a good time in my life to begin addressing trauma. I had stabilised much of my life, I felt stronger than I had in years, I had supportive people around me, and some economic security. I didn’t have too many other stresses.

I’m not sure if these things are always necessary for everyone, but it helped a little to know that the basics were OK in my life at the time. Ultimately, it’s up to you to decide when the right time is, but it’s worth thinking about what would make the time right for you.

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Go slow and start small.

This was the biggest mistake I made – I dived right in and shared my entire story of trauma, with a therapist, then with friends and family, then with colleagues – over and over. It was far too much, far too quickly. If I could travel back in time, I would start very small, sharing snippets of my story in separate chunks, and then seeing how I reacted, and working on myself to stay well after each chunk.

One way to start really slow is to acknowledge to yourself that trauma has played a role in your life and in your emotional and mental health. You might acknowledge that in the future, when you are ready, you are going to address this. Another strategy might be to tell someone you trust that you have a history of trauma that you want to explore in the future – but make it clear that you are not ready to go into details just yet. This is a gentle way to ‘open the can’ just a tiny little crack.

In next week’s post I’ll write about more strategies for sharing a little at a time, and how to know when you’ve shared enough. I’ll also share ways to heal from trauma without having to go into the details of your story.

Master coping skills.

Coping skills are simply ways that we can learn to live with difficult experiences. They can be as simple as taking a deep breath. It can take years to develop some coping skills, and yet sometimes we can learn a useful new coping skill in a matter of minutes. Everyone is different, every coping skill is different.

I had learned lots of coping skills many years before I disclosed my story. But I didn’t stop to refresh my knowledge or skills before disclosure. I didn’t stop to anticipate how I might react, which skills could be most useful, and how I would know whether I might need to use them.

Later on I had to do this work, but it was much harder because I was so unwell. Read my coping skills info sheet for more about coping and what can help. Practice the skills that work for you – building your mastery is a great way to prepare for future trauma work.

The Drowning Metaphor: Coping versus Medication

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Lots of people don’t get why coping skills matter when we have medication. So this is how I like to explain the difference…

First, imagine you are drowning out in the middle of the ocean. That represents madness. You really need a hand – this is a crisis. Eventually recovery will involve learning to swim to the shore. Doing trauma work will help you understand how you ended up in the ocean and how to avoid being there again.

But right now you are drowning. Swimming is too hard, and there’s no time to think. In this scenario, medication is like a life jacket, dropped down by the doctors hovering overhead in a helicopter. We put it on, and if it works, then we may just be able to keep afloat. It won’t get us out of the water. And it may be so big and overblown that it creates new problems. But it might be life-saving.

So where do coping skills come into it? Coping skills are like learning to tread water. In other words, coping skills are ways that we can keep ourselves afloat – either instead of, or in conjunction with, a life jacket. Like treading water, coping skills can be hard work and tiring. But they can also bring a much greater sense of personal strength, choice and independence.

Medication.

Psychiatric medication can be really helpful, or just partly helpful, or not at all helpful or even harmful. This varies by person and situation. Like coping skills, medication will not solve underlying issues such as trauma. But it may provide a way of keeping safe – and if it does this for you then it’s worth it (just make sure you are well informed about medication risks). Be careful however, about how medication affects your thinking and emotions. I know there were times in my history when my medication doses were so high that it was hard to feel anything, let alone think anything with clarity. I felt like a zombie.

In order to do trauma work, you will need some capacity to think and to feel. It is part of the process of healing. So if you use medication, talk with your doctor about ways to get on the right dose for what you want and need. Changing medication can take a long time, so this is another way to prepare for future trauma work. If you want to learn more about reducing psychiatric medication, the Icarus Project have a great online publication called ‘The Harm Reduction Guide to Coming Off Psychiatric Drugs’.

Anticipate and plan for emotional and mental responses.

I had absolutely no idea about how I would react to disclosing trauma. But had I stopped to think and plan better, I could probably have worked out how I would be most likely to respond – before I started. Take some time to think about how you have reacted to the most distressing experiences in your life. What typically happens when you experience extreme emotional or mental distress? What emotions do you feel – and are you able to identify them? If you hear voices, how do they react? If you have a history of self-harm or suicidal urges, what happens? If you experience anxiety, what happens? What are the earliest signs for you that your distress is increasing?

Planning allows you to think about all the ways in which you might react – before it happens. You can then take time to think about how you can prepare for each of these possible situations (for example, by developing and practicing ways to notice your emotions), and also how you plan take control in each of these possible situations (for example, making a list of who to contact in a crisis, a list of coping strategies for different responses, or preparing an advance statement to give to your mental health workers about what you want to happen if you should become unwell).

Some of the most common emotional responses to talking about trauma are shame, fear, anger and despair – sometimes all at the same time. Shame was the major emotional issue for me, followed by fear. Learning to understand shame was a really helpful process for my recovery and healing. You can read more about difficult emotions in this free booklet ‘Living with Difficult Emotions’ on my website.

You can do this work on your own, but I think it’s a useful conversation to have with someone you trust – like a support worker, a therapist or a trusted person from your personal life.

Part Two next week…

Next week’s post will be Part Two of ‘Forget the can of worms. Safe first steps for trauma recovery’. Part Two will include:

  • Braking and accelerating skills (Babette Rothschild) – knowing when and how to slow down and speed up
  • How to find and pick the right support people
  • Flow-on effects for people in your personal life
  • Work out what you want to get out of the process
  • Understand that telling your story isn’t mandatory for healing
  • How to learn more about trauma and its impacts (when it comes to trauma recovery, information really is power)

 

Trauma Crisis Contacts

 


If you need help, please don’t be alone. Contact someone you trust, or reach out to one of the crisis support services listed below.

AUSTRALIA

National Sexual Assault, Family & Domestic Violence Counselling Line (24/7)

Phone:

1800 737 732

Website: www.1800respect.org.au
Website includes:
• 24 hour online counselling
• Advice on making a safety plan, how to increase online safety
• Information for family and friends
• Advice for professionals
• Links to support and crisis services in every Australian state

Lifeline (24/7)
Phone:

13 11 14

If you or someone else are in immediate danger please call 000 now


UNITED STATES

National crisis hotline for domestic violence (24/7)
Phone:

1-800-799-SAFE (7233)

Website: http://www.feminist.org/911/crisis.html

National Sexual Assault Hotline (24/7)
Phone:

1-800-656-HOPE

If you or someone else are in immediate danger please call 911 now


UNITED KINGDOM

National Domestic Violence Freephone Helpline (24/7)
Phone:

0808 2000 247

Website: www.nationaldomesticviolencehelpline.org.uk

Rape and Sexual Abuse Support Centre national freephone helpline
Phone:

0808 802 9999

(12-2.30pm and 7-9.30pm every day of the year)

If you or someone else are in immediate danger please call 999


OTHER COUNTRIES

International Directory of Domestic Violence Agencies
(available in over 110 languages)


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And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. (Anais Nin)

 


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