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

Last week I talked about how much I dislike the common trauma metaphor of ‘opening a can of worms’.

It keeps everyone fearful and stuck.

Instead I proposed a new metaphor: slowly and gently opening a can of cola that’s been shaken. No-one really wants to open a can of worms. Why would they? But if life is a constant struggle, then we have a kind of thirst to make sense of our experiences and find peace. Being able to slowly and gently open a can and satiate that thirst is what trauma work is about. If we open the can too quickly or without care, then we risk losing control of the contents. But by taking our time, and using the right strategies, we can do it safely.

IMAGEI shared six strategies last week that can be useful ways to prepare yourself to do trauma work. These included:

1. Be safe, now
2. Pick the right time
3. Go slow and start small
4. Master coping skills
5. Consider medication carefully
6. Plan for your responses

You can read the full ‘Part One’ article here.

This week I’m sharing the remaining six strategies:

7. Learn to brake and accelerate Quick link
8. Pick the right support people Quick link
9. Impacts on others in your life Quick link
10. Your goals for the process Quick link
11. Tell your story – or don’t – choice comes first Quick link
12. Learn the facts about trauma and its impacts Quick link
hare and tortoise page width

Learn to brake and accelerate

This is the first of two strategies I am sharing from the renowned US trauma psychotherapist, and trauma survivor, Babette Rothschild.

Working through trauma, even talking or thinking about it, can dramatically increase our emotional and mental pressure. In other words, we can end up feeling really overwhelming emotions, and a whole range of difficult and distressing experiences in our bodies.

For example, talking about trauma has affected me in the following ways depending on the situation:

My mental & emotional responses My physical body responses
My voice would start attacking me: calling me a rapist or a whore, telling me I was evil, saying I had to be destroyed Dissociation – feeling numb, like I wasn’t in my body, starting to float away
Difficult to think clearly, hard to find specific words that I wanted to say Pressure around my neck, like I was being choked
Feelings of self-hatred & self-disgust, overwhelming shame Nausea, sometimes actually vomiting
Urges to self-harm, and sometimes urges to suicide Feeling sudden extreme fatigue
Feelings of fear that people would hate me and reject me if they knew the truth Faster heartbeat, faster breathing, feeling like I couldn’t take a breath
Doubting myself Feeling like an abyss was opening up inside my torso, or that feeling you get when a lift suddenly lurches

Rothschild recommends two useful skills to learn before we start to talk too much about trauma:

a. Be able to recognise when psychological pressure is increasing (acceleration)
b. Be able to slow down (apply the brakes)

Essentially, learning these two skills gives us survivors much more control over how and what we think and talk about. If we return to the ‘can of cola’ metaphor, this strategy is about being able to notice, as we slowly open the can, that the pressure is still high, and be able to put it down again for later. Sometimes we can handle being in this kind of state for an hour or more – but sometimes 30 seconds is more than enough. By learning to brake and accelerate, we can build greater personal control over how long we expose ourselves to these uncomfortable, distressing experiences.

Rothschild says that we can develop these skills by practicing body awareness. These are all things that you can practice – either on your own or with a trusted support person:


  • Learn to notice how your body feels when it is calm
  • Notice how your body feels different when you talk about trauma
  • Get as specific as possible about different body sensations, in particular breathing, heart rate and temperature. The more you notice, the sooner you can know when to put on the brake
  • Physically strengthen your body (eg. with weights, yoga, self defense training) – this can aid body awareness and build physical confidence

My therapist and I didn’t do any of this practice before starting my trauma work. But down the track, when it was evident that I was losing control, we did practice some of this work. It was much harder to do it later rather than in advance, but it was still hugely helpful.

For example, we noticed that I would frequently dissociate during sessions, and from there I would become increasingly frightened. Together we started paying attention to the first signs of dissociation, and we realised that I would begin by starting to stare at the power point on the wall under my therapist’s desk. My therapist asked for permission to point out if he noticed me looking towards the power point, and over time I started to notice when I did this myself. Once I noticed that action I was able to notice how my body would feel when I first started to dissociate: things like numbness and a light head. We took these facts as cues to stop and think about whether we had done enough work for the day, or whether we could practice some grounding exercises and then keep going. This was a really simple strategy, but made the work a lot easier for me.

This is work you can practice before you even start doing trauma therapy.

These strategies are described in much greater detail in the book called ‘The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment’ (Rothschild, 2000). The book is written in technical psychological language, but I still found it very useful to read for myself. It’s a great book for any mental health professional to read as well.

Pick the right support people

IMAGEThis is always a tough one, especially if you have been diagnosed with some type of mental illness. Our mental health services remain, mostly, poorly informed about trauma. It is difficult to find professional people who understand that responses to trauma are meaningful, and are not just bio-chemical symptoms of illness.

Similarly, there are trauma experts out there who tend to work mainly with Post Traumatic Stress Disorder – but may not recognise the trauma links for diagnoses such as borderline personality disorder, or psychotic disorders.

But have hope. There aren’t enough good people out there, but they do exist. Options can include:


  • Peer workers
  • Psychologists
  • Counsellors
  • Support worker
  • Psychiatrists trained as therapists
  • Specialist trauma services: There are not specialist services for every type of trauma, and they are not in every area. But major cities usually include specialist counselling services for survivors of sexual assault, child abuse, family violence and refugees. Check out the crisis page on my website for links to these types of services.
  • Close friend
  • Trusted family member

How do you decide if someone is right for you? I think the principles of trauma informed care are a good guide. There are different versions of these principles, I like the ones listed below by SAMSHA. Have a look at this list, and think about whether the person is likely to understand, respect and provide you with these things, in the way that matters most to you:

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice and choice
6. Cultural, historical, and gender issues

Do I have to find someone? The short answer is no, but it’s more complicated than that. Most people experience trauma recovery without any kind of professional intervention. There are loads of self-help books and online resources about trauma recovery that you can use too. So if you really prefer exploring trauma alone, it can certainly be done. However I would caution that if you think your trauma is wrapped up with your mental health experiences, and if there have been times in your life when you have felt suicidal or lost control, then it’s probably safest to do this work with another person. Plus, if you experience shame about your experience of trauma, then I think it’s almost essential to do some of your trauma work with at least one other person. Shame is a social emotion because its about whether we think we are good or bad in the eyes of others. Because of this, one of the best ways to work through shame is with other people. Shame tells us to hide away, but healing from shame requires us to come out into the light.

Impacts on other people in your life

Disclosing a history of trauma is not just a huge thing for ourselves – it can also create lasting ripples of impacts for people in our personal lives. We don’t always know what these impacts will be until we start, but some forethought might help to work out who you want to tell and what the impacts might be.

If trauma happened in your family – who to tell. It is important to acknowledge that while much trauma occurs outside of families, a significant amount of trauma does of course happen within families, particularly domestic violence, childhood physical abuse, childhood emotional abuse, and childhood neglect. Childhood sexual abuse also occurs within families, but also by family friends, extended family, acquaintances/neighbours and other people. Sometimes these forms of abuse continue into adulthood as well.

As a result of abuse and trauma, some people distance themselves from their entire families. Others distance themselves from a family perpetrator/s but stay close to trusted family members. Still other people stay in close and ongoing contact with abusers within a family. If you have experienced abuse or harm from a family member who is still in your life, or is in the lives of those you love, then telling other people may raise real concerns about your safety, about blame within the family, about whether people will take sides, and a whole raft of other concerns. If this is the case for you, you may want to take it very slowly, or seek some therapy or counselling to help you through this process. You may decide not to disclose to family members. Or maybe only to some or even just one of them.

Impacts on those we love. Those people who love us may experience shock, concern, fear, disbelief, shame, guilt, anger or a whole range of other emotions. If the people you tell actually know a person who hurt you, then this may add a lot of complexity to their reactions. In turn, this could add to your own emotional pressure of disclosing.

I was never able to disclose to my mother about my own traumatic experience of abduction and rape. The family narrative was that I was a wayward child who ran away from home at thirteen and ended up living with a man. I was found by the police, brought home, and punished. End of story. We never spoke about it, and that was it. During Mum’s last months when she was dying of cancer, I tried to tell her what had happened.

‘Mum, I want to tell you what happened when I ran away from home…’, I started, hesitantly.

But she stopped me cold. She put her hand in the air, stood up, and as she was leaving the room she said, loudly, ‘I can’t hear this!’.

At the time this was shocking and saddening for me. But these days I think back on it a little differently. The strength of her reaction tells me that, on some level, she knew what I was going to say. She knew what had happened. I was angry that she hadn’t done anything, hadn’t talked to me about it. But I have decided to believe that she couldn’t hear it because she felt unable to think about her daughter being hurt in this way, and couldn’t bear being unable to do anything about it. While my mother and I had a volatile relationship, at base she always loved me and always tried her best to protect me. As much as she didn’t give me what I wanted by listening to my story, she did give me a message of love. Perhaps I am misinterpreting the message, but I don’t really care. Sometimes we can choose what to believe, and this works well for me.

What’s important here, like all the other strategies, is to take it slow, and think through what’s most important to you and your own healing. You might also like to think about who the safest and most trusted people are that you can disclose to first. That is, don’t start with the hardest challenge, but also prepare yourself for the reactions of other people.

Is trauma work about blaming families?

man family small

Thinking that trauma work only blames families is a real barrier to the truth and to healing. It can be used to silence victims of trauma.
Nevertheless, this is a common belief. Mental health services are supposed to work with families / carers as well as those of us with the mental health issue – and many services don’t know how to be ‘family friendly’ and deal with trauma at the same time. There is a long history to this type of thinking.
Mental health services have a poor history in how they treat families, and some of today’s barriers to trauma informed practice are a reaction to this history. For a long time the idea of cold and uncaring families, especially mothers, affected mental health services. Many family members of people diagnosed with mental illness, especially those who have been involved with services for several decades, have experienced blaming and exclusion by mental health professions. Even today this continues for some people.
Addressing trauma does not and cannot mean a wholesale blaming of families.
Blaming is not always helpful for healing, anyway. This is not to say that families are not often the source of trauma, because they often are. Families are not perfect, by any means. But even if trauma has occurred within a family context, most typically the perpetrator is only one person, or perhaps two. Family members may also have been victims themselves (think about domestic violence), or may have known nothing about the abuse. When trauma within families comes to light, other family members may also need support.
We must find ways to support people to address the truth of trauma while at the same time support families fairly and appropriately.
We need a mental health system that can work comfortably with ALL of the facts: Trauma is a widespread issue for people diagnosed with mental illness and it must be acknowledged. Strong, loving families can be one of the most important recovery supports for people. Abuse occurs in many families, but not all. People in caring roles deserve support. People receiving mental health treatment have to right to decide who to involve from their family. Not all trauma is related to childhood abuse, but a lot is. Every person and family is unique.

Your goals for the process

IMAGE
Doing trauma work is big. It might be one of the biggest, hardest things you ever do. It might pay you back with great emotional rewards, but it might also bring you a lot more pain along the way.

So, before you start, think about where it is that you want to end up. Think about what you are prepared to tolerate and what you are not.

I started my trauma work because I wanted to have the kind of life that I heard leaders in the hearing voices movement talk about. And mostly I have been able to achieve this. I have made sense of what was previously just meaningless madness. I feel stronger, like a survivor. I have wholly new ways of living with what I used to think of as ‘symptoms’. The absolute most important benefit for me was coming to understand that I am not an evil person.

On the other hand, my trauma work has opened up new vulnerabilities for me. Now that I understand my madness, trauma is on my mind more often than it used to be. It has led me to do work like writing this blog, because my sense of justice and what’s right demands it. I love this work – but it probably isn’t the most balanced life, either. Some days are still really hard. Trauma work did not magically make the pain just go away – I am not sure it can ever do that.

There are many possible goals that you might have. At the end of the day your goals might be making sense of your madness or mental health, accessing justice, finding truth, learning to live with your past, connecting with other survivors, changing your self-talk, changing your relationship with your voices, learning to love yourself. You might have goals along the way like being able to tell one other person, or being able to access therapy, or even being able to tolerate thinking about your past. You might have social goals, like wanting to be more a part of the world, being able to work, or study, or have relationships. For many survivors of sexual abuse, a common goal is being able to have and enjoy intimate relationships and sex. You might want to find a way out of mental health services, away from hospitals or medication or involuntary treatment. You might want to stop self-harming, or be able to laugh again, or feel able to trust other people.

There are no right or wrong goals, but there will be some that matter most to you. Think about this, because it will help guide you in how you tackle trauma work.

Tell your story – or don’t

A common misunderstanding about trauma work is that it involves telling the graphic details of your traumatic experience over and over. This misunderstanding prevents many people from ever starting trauma work, because it sounds so scary.

The need to tell your story in graphic detail is true for some people, but it doesn’t have to be. Some people just tell their story once – sometimes in detail, but sometimes just in generalities. Some tell it and explore it many times. And for some people, retelling their story even once can be seriously re-traumatising and is not necessary (this doesn’t mean that trauma work isn’t valuable, just that the graphic details aren’t always necessary).

It was useful for me to tell my story – but it wasn’t the most useful thing. The witnessing of my story validated my truth and helped me to see that others didn’t judge me the way I judged myself. But what was most important was exploring how I had made sense of what had happened, and coming to understand why it still affected me so powerfully so many years later. For example, understanding that I blamed myself for what had happened, so I felt a crippling shame and self-hatred, and this played out in what my voice said and in my self-harm. This was far more important and useful.

Eight Keys to Safe Trauma Recovery, by Babette Rothschild. Rothschild’s self-help book, ‘Eight Keys to Safe Trauma Recovery’ (2010) has a whole chapter about this, called ‘Remembering is not required.’ If you are worried about sharing your story, I strongly recommend reading this chapter. Rothschild talks about the importance of building stability in your life before remembering, and she asks readers to consider:

1. Do you want to revisit your traumatic memories?
2. When you pay attention to the past, do you lose connection with your present life?
3. Some people become decidedly worse from attention to their past

The remainder of the chapter provides a set of categories to help readers identify where they might fit in terms of their own readiness to remember trauma, and some exercises to help you identify what is right for you, and how to build readiness to talk about trauma if that is what you want.

If you have another look at the principles of trauma informed practice listed above, you will see that empowerment and choice are listed. This is really important for trauma work because one of the core experiences of trauma is having our power taken away from us. So effective trauma recovery work must always place the power with us. Share your story if that is your choice. But never feel pressured to do so if it is not your choice. Don’t let a fear of going into detail stop you from other pathways to healing from trauma.

Learn the facts about trauma and its impacts

A large part of my own healing process involved nothing more than learning facts.

I am eternally grateful for those who shared those facts with me. I also live with frustration that it took me 27 years to learn some simple information that helped set me free. I continue to wish that EVERY mental health service, EVERY GP clinic, EVERY community centre and EVERY school had a brochure stand filled with facts about trauma. Facts like the prevalence of trauma. How trauma affects emotions and mental health. How the process of grooming works. About Stockholm Syndrome. About how our bodies typically respond to sexual assault.

Those last three sets of facts completely transformed how I made sense of what happened to me. I learned that I had completely misunderstood the impacts of my trauma, and this helped me begin to let go of the shame that held me prisoner. It was difficult to read about these facts, but so life changing.

There may be topics you can learn more about in terms of aspects of your own trauma and how it has affected you. Below are some links to more information that you might like to consider. If accessing this type of information feels too hard to do on your own, or is practically difficult, this is something you could work on with someone you trust like a support worker – or perhaps it’s just a step for later on in your journey.

Websites
For more links see the resources and the crisis pages on my website – or just get active on Google.

Domestic Violence Resource Centre
Men with experiences of childhood sexual assault
Sexual abuse and assault
Refugee experiences
Refugees as survivors of torture and trauma
Bullying
Women’s information – WIRE
LGBTIQ

Books
There are many books about trauma that are designed as self-help books, or are at least written for survivors. The ones I think are most helpful include:

Bass, E, and Davis, L. The courage to heal: a guide for women survivors of child sexual abuse. Random House, London.

Herman, J. (1992). Trauma and Recovery. Basic Books, New York.

Rothschild, B. (2000). The Body Remembers: The psychophysiology of trauma and trauma treatment. WW Norton & Co, New York.

Rothschild, B. (2010). 8 Keys to safe trauma recovery. WW Norton, New York.

Campbell, J, and Coleman, R. (2011). Reclaiming our Lives: A workbook for males who have experienced sexual abuse. P&P Press, UK.


 

In closing

In summary, this is the full list of 12 ways that you can prepare for doing trauma work in a safe way:


1. Be safe, now
2. Pick the right time
3. Go slow and start small
4. Master coping skills
5. Consider medication carefully
6. Plan for your responses
7. Learn to brake and accelerate
8. Pick the right support people
9. Impacts on others in your life
10. Your goals for the process
11. Tell your story – or don’t – choice comes first
12. Learn the facts about trauma and its impacts

Ultimately, what you decide to do about your history of trauma is up to you. Think it through, put your wellbeing first, and never forget that healing is always possible. I wish you well on your journey.

IMAGE

To keep oneself safe does not mean to bury oneself.
(Seneca the Elder)

I told her once I wasn’t good at anything. She told me survival is a talent.
(Susanna Kaysen, Girl, Interrupted)

If you don’t feel safe, please contact someone for support. Helplines and useful websites are listed for different countries on my crisis page.


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1 Comment
  1. Thanks Indigo! Great advice as always.

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