“Fundamentally, words can’t integrate the disorganized sensations and action patterns that form the core imprint of the trauma,” says Bessel Van der Kolk (Wylie, n.d.). “The imprint of trauma doesn’t ‘sit’ in the verbal, understanding part of the brain,” he continues, “but in much deeper regions—amygdala, hippocampus, hypothalamus, brain stem—which are only marginally affected by thinking and cognition.” According to Van der Kolk, “If clinicians can help people not become so aroused that they shut down physiologically, they’ll be able to process the trauma themselves” (Wylie, n.d.). Experiential psychoeducational exercises, journaling, guided imagery, and psychodrama can stimulate memories and provide a safe arena in which they can be shared and processed.
When people have been traumatized, they may become afraid of action—drives towards action become layered in with feelings of fear or a sense of danger. When they become triggered, their whole body becomes the body that they inhabited at the time of the trauma. But as afraid as traumatized people are to reexperience the “forbidden” emotions that were shut down out of fear or even terror, they need to reexperience those emotions in order to knit together the fragments of memory that became disintegrated through the splintering experience of dissociation or psychic numbing. According to Van der Kolk, “To heal from trauma, we need to shift from our frozenness, from a collapsed, animal-like brain to a state in which we are remembering unfulfilled actions.” In other words, we need a device or therapeutic process that allows the animal brain to wake up and the thinking brain to make sense of what it is experiencing, to talk out powerful emotional urges rather than act them out or numb them with substances or addictive behaviors.
Experiential processes can allow clients to revisit their own numbed out emotions both psychically and physically so they can have the experience of tolerating emotions and body sensations that previously overwhelmed them, perhaps because of their size or their position in the family or in their social environment. They can reinhabit their own bodies and minds in a safe and clinical manner, along with therapeutic witnesses and allies who can buffer, support, and encourage them. One common misconception of psychodrama or role-play is that it is necessary to recreate the traumatic scene in order to access traumatic memory. This is not the case. It is only necessary that the client revisit themselves and their own sense of vulnerability, helplessness, rage or whatever they are carrying around. Revisiting the scene can be retraumatizing and is not necessary for healing.
Relational Trauma Repair (RTR): An Experiential Model of Treatment
We need to feel the story of our lives in order to heal it. Trauma shuts feeling down. Recovery wakes it up. Relational trauma repair (RTR) deals with frozen material that gets shut down through trauma; it deals with the disturbing body sensations that often accompany fear states, such as stomach aches, headaches, muscle tension, backaches, and sizzling or queasy feelings. It deals with the kind of despair and helplessness that we collapse into when we feel that our best efforts get us nowhere. It deals with our inability to connect feelings to words and words to feelings. It offers many small opportunities for feelings to emerge, grow in size, be converted into language, shared, reflected upon, and through understanding and identification and support from others, reregulated. It offers hope, healing, and a way out of that kind of chronic pain, anger, and hopelessness.
As we share, we feel less alone. As we listen, we identify and have a sense of being drawn from the isolation of imagining that we’re the only one who feels shame, hurt or humiliation, into a community of others who may share some of these feelings. We break our isolation and give voice to feelings that we may be avoiding or that may live within us in an indistinct state. Slowly, as shards of self emerge into the light of day, our dreams are born, our tender yearnings surface, and we listen, share, reach out, and communicate. This process helps us to regulate emotion through bringing it out, translating it into words, and reflecting on ourselves, on others, and on the group we are in.
Emotions lighten as we translate them into words and elevate them into our conscious awareness. Once they are in words we can think about what we’re feeling, reflect on it, and share it with others if we so choose. We have choices; we can bring the thinking mind to the task of understanding and ordering the limbic body-mind. We can gain insight and place our personal experiences into an overall framework of ourselves and ourselves in relationship to others.
The Healing Window
I find it most effective to work within what we might call a “healing window.” A healing window is a fluid state wherein the client is stimulated enough so that a fuller picture of the trauma experiences can emerge, but not so stimulated so that their thinking mind shuts down and their emotions freeze all over again.
If clients are momentarily stuck, it can be useful to say things like the following:
- “What’s going on in your body?
- “Where is it going on? Can you put your hand there?”
- “If that part of your body had a voice, what would it say?”
Once the body starts talking through the mouth, the head can quiet down. Once the client knows that it’s okay for the body to open up and tell its story, the cortex can take a break and work at normal speed, where it can simply do its job of making sense of experience. It can do what it should do, which is to make meaning out of actual experience rather than work overtime as a way to deny, intellectualize or distance experience.
Another question that I find is useful to ask clients is, “What does your body want to do?” Here again is a moment to allow the body to have a voice. Here are some examples:
- “What do your legs want to say? What do they want to do?”
- “What words are caught in your throat?”
- “If your heart could talk, what would it say?”
What we want to do is to help the traumatized person calm down enough so they can tune in on what’s going inside of them and begin to become curious, rather than want to avoid it or get rid of it. This will allow them to articulate it and begin to read their own emotional cues, whether they are a tight gut, confused thinking, a wish to run or an overwhelming desire for approval. In this way they can find the ways and words to heal themselves and come to understand both what is happening to them and the process of working it through so when they get triggered outside of therapy, they can process what might be going on rather than become retraumatized, freeze, self-medicate or act out the same old trauma related dynamics. This helps to integrate fragments of memory and modulate the intensity of the whole response system, namely the thinking feeling and behavior that can get triggered into unconscious action.
A Good Beginning
Because the types of trauma that occur in homes often constitute ruptures in relationships and often are at the hands of primary caretakers upon whom a child depends for nurturance and survival, the implications for treatment are complicated. That is, the very vehicle that will lead them eventually back to health—such as connection with others, relationships in therapeutic situations like one-to-one or group therapy, or Twelve Step programs—are those situations that have become fraught with pain and anxiety.
Due to the deeply-embedded psychological defenses and memory loss that often accompany trauma, it may take considerable time and therapeutic work before the client is able to come to terms with it. What happens in treatment is a beginning—long-term healing will need to take place through setting up a secure support network that is sustaining enough to help the client to hold and process the emotions and memories that will inevitably continue to come forward and to adopt and practice new skills of self-regulation through activities like Twelve Step meetings, exercise, yoga, meditation, and quiet time.
This is why it’s important to educate as well as provide for healing, so that the client can wrap their mind around their own recovery process and take responsibility for their own healing. The experiential exercises in RTR are psychoeducational, meaning they teach the theory beneath the subject area being explored. The personal journal can be used in treatment and taken home as a personal memoir of one’s healing journey, guided imageries can be used in treatment in group settings and/or privately.
Resolution of trauma is seen to occur when people are able to direct their attention toward or away from traumatic life material with choice rather than being run by it unconsciously or needing to avoid it at all costs. Clients need to learn two important life skills:
- To stop retraumatizing themselves by recreating and reenacting past pain in present relationships
- To repair pain in the moment that it occurs or within a reasonable time framework so that pain doesn’t fester and build
In our final stages of healing from trauma, we let go even of our trauma healing narrative and learn to live
in the present—to cease to be the trauma survivor, the healed rape victim or the child from a dysfunctional family and simply be. We no longer define ourselves in terms of “damage.” The field’s shift from calling individuals “victims” of trauma to “survivors” of trauma reflects a recognition of this need to get past what could be a negative self-label. This is easier said than done.
It is a challenge for any person to train the mind and body to live in the present; it has been the work of saints and sages for centuries. However, it is also what makes trauma resolution a spiritual journey. We’re using our trauma story to motivate us to value, appreciate, and take care of the life we have, relinquishing identities that constrain our ability to live freely and fully in the present. When we face our own inner demons we open doors that, once we walk through, we never wish to turn back from. Doors that enlighten us to the beauty and mystery of life that was always surrounding us, but we weren’t awake enough to see. Futhermore, we gain the courage that is the inevitable outcome of not running from ourselves.
Wylie, M. S. (n.d.). The limits of talk. Retrieved from http://www.traumacenter.org/products/pdf_files/networker.pdf