A trauma is an experience of severe damage to the psyche caused by a distressing event. It usually involves gross violations of the values and expectations of an individual and leads to a state of disconnect from one’s thoughts and emotions. It shatters core believes about how the world works and the individual’s place in it. The consequences can be psychiatric symptoms from a wide spectrum, from anxiety to dissociations, which are feelings of being disconnected from one’s own body or personality. Frequent are feelings of derealisation, the sense of being separate from the world or a feeling of ‘otherness’.
Since we are essentially dealing with a situation of disconnect an important task is to get reconnected in a meaningful way. ‘Meaningful’ means relevant to the values and aspirations of the client. A good working relationship between client and therapist can represent such a reconnection. The experience of a good meaningful relationship motivates and helps to reconnect with other people in one’s social environment.
The sense of being able to build strong relationships is important after a trauma. Only if I believe that I can build relationships that are strong enough to hold the fears and anxieties I have in the presence of someone else, can I use relationships to help me in dealing with the trauma. An important relationship is the interaction we have ourselves, and like relationships with other people it depends on my belief to build good and meaningful relationships. After severe trauma people often withdraw from social life completely, sometimes even for a life-time. The brain tries to focus inward to resolve the conflicting thoughts and emotions on the inside. However, unlike animals in the wild we live in a complex world with complex interactions, resulting in complex thoughts, and this complexity often makes it impossible for an individual to resolve the footprints of the trauma in a meaningful way. Meaningful communication, as should be practised in therapy, can uncover that there is really no substance to the fears and anxieties in the present, as they are just remnants of our emotional reactions to the trauma.
What causes many of the fears and symptoms in trauma victims is the perceived existential threat to one’s individuality. It is as if one’s sense of self was under a constant threat of devastating attack by an invisible and thus frightening adversary. But this is only a projection of the perceived threat on the inside into the outside world. Understanding this process can take away a lot of the fear in dealing with the world and help trauma victims to find their way back into the web of social interactions which are effective in surmounting the trauma.
Trauma and Psychotherapy
Through a meaningful interaction with the therapist, the client gains the insight that the outside world cannot affect how we see ourselves and cannot take away our fundamental sense of being a distinct individual. But what it can do is trigger emotions and thoughts in us that change how we feel and think about ourselves. The solution to the problem is to be in a meaningful relationship, such as a therapeutic one, where I can experience my ability to communicate in a meaningful way, one I understand as relevant to myself. If you talk about a topic you feel strongly about, the interaction itself reassures you that you care about an issue that is relevant to yourself. You feel your distinct self with distinct wants and values. To a traumatized person the sense of a coherent self is an important step in the recovery process.
The next step is to address what has happened without risking another traumatization. This requires reflecting on the relationship and the interaction with the client to determine the speed of the process to avoid moving too fast or too slow in the therapy. It also requires that the therapeutic relationship between therapist and client is strong enough to reduce fear and anxieties about the process. Empathy and an understanding attitude helps to make the client feel safe enough to approach the distortions in the self and the emotions and thoughts associated with them. As long as there is an open communication between client and therapist, fears can be kept at a minimum. It is necessary to understand that what made the traumatic event psychologically so devastating in the first place is that a meaningful communication about the negative thoughts and emotions associated with trauma could not fully occur. A meaningful interaction is not just an outburst of emotions or words, but one that is relevant to the values, needs and aspirations of the trauma victim.
Reintegrating an individual who has been traumatized into a healthy network of interactions reactivates important forces of healing. People who have lived through incredible traumata, like wars and rape, often live lonely lives or create unstable and damaging relationships around themselves. Meaningless relationships and one-night stands may help one to avoid confronting the hurt from the trauma that might be revisited in a real relationship, but they are seldom satisfying. Instead, many trauma victims actually have a craving for loving and caring human interactions and the same desire for stable long-term relationships like everyone else. Therapy can help a client understand the emotions beneath the fears and that the fears really not much more than a reaction to these emotions. As adults we can largely create our own social networks and our own worlds. This, however, requires good communication skills and empathy, which can be compromised by the psychological damaged caused by the trauma.
Most of the psychological damage is actually caused by the mind’s reaction to a trauma. The mind tries to integrate the information of the trauma into the information from all the other experiences. It does so because integrating information and making associations is what it is designed to do. Thus the brain establishes a links between components of the trauma and aspects of our other experiences. There may, for example, be dreams that combine elements of the traumatic situation and other experiences in new situations that are fearful because of the emotions attached to the trauma. One client may visualize his current house burning down, if he almost drowned on a boating trip fifty years ago. This is how the trauma can reach into the present with all the negative emotions that have been evoked by it. Psychotherapy can help a client to understand the various parts of the trauma to release these emotions and thoughts. This essentially finishes the mind’s work of integrating the elements of the self that have been rendered apart by the trauma and one’s own reactions to it. The symptoms usually break down and disappear once the trauma has been understood and accepted. Communication is the instrument that allows the identification and understanding of the trauma and all the components that are associated with it.
In the counselling sessions the emerging understanding of the trauma and the mind’s reaction to the trauma can leave a stronger sense of self than before, which also offers a greater resilience in stressful situations. It is like learning to swim. We do not need traumatic experiences to grow, but they can give us a sense of direction and a feeling of our inner strength as we learn more about ourselves.
Some categories of trauma, however, can be so destructive to the psyche and an individual’s basic trust in the world that it seems like a miracle if people recuperate from them at all. After first-hand experiences of the atrocities of war, for example, an interest in human relationships has to be re-established before any meaningful work can be done in therapy. Building a stable therapeutic relationship and reconnecting the person with humanity is effective in reducing the dissociation and withdrawal, the sense of being empty of feelings and frozen in time.
In the last stage the individual’s reactions to the traumatic experiences have to be given meaning to reduce the unchecked influence they hold over the emotions. To give them meaning means to integrate them into the story of one’s life so that the loss and pain from the trauma can be recalled, but rather than taking away from life, they enrich it.
This paper is solely a basis for discussion and no medical advice is given. Always consult a professional if you believe you might suffer from a medical condition.