When treating post traumatic symptoms, we often reach points
where we find we have over-reached therapeutically and have to “back up the
bus” and slow the pace. But there
are some circumstances when we not only have to back the bus up, but actually
back it up into the depot and start from the beginning.
What I’m referring to are clients who experienced severe or
long term trauma and have developed Complex Post Traumatic Stress. In many cases when children have
suffered extended child abuse or child sexual abuse, their sense of self has
been either extremely distorted or even annihilated.
Many therapies that address post traumatic stress, such as
EMDR, TIR, TF-CBT and others use what is known as a “trauma narrative” - this
is basically having the affected person tell the story of their traumatic
experience or experiences, often repeatedly starting with small doses in the
safe setting of the therapy room, and working toward sharing the entire story
in a support group or with trusted loved ones. By doing this, they desensitize their trauma memories and
are able to integrate the experience into their life story. Though the memories will always remain,
they won’t have the life-altering emotional power they once had. But there are some individuals for whom
the trauma narrative is too much to endure - they simply cannot “tell their
story” without being retraumatized.
This is quite common among those who experienced early childhood trauma
- their trauma may have interrupted and distorted their developing sense of
self.
Without a healthy sense of self, a person’s resiliency and
ability to regulate emotions is drastically compromised or even absent. They are unable to turn away from the
trauma narrative and retreat into their safe place during therapy and are left
in a state of extreme distress that they are unable to escape from on their
own. Such clients may turn to
other means to break this loop of traumatic stress through drug or alcohol
dependence, self-injury, physical acting out, or suicide.
As therapists we must be cognitive of where our clients are
at with their sense of self before proceeding with any trauma focused therapy,
and we always must begin with breathing, relaxation, and mindfulness learning
and practice for our clients so they will be equipped to deal with the
distressing process of revisiting their traumatic memories.
Another aspect we must be aware of is the strength of
ego-states created as a defensive strategy during early childhood trauma. Dr. Bessel van der Kolk - a leading
clinician in post traumatic stress and its treatment since the 1970s - recently
stated that a child experiencing ongoing trauma, such as sexual abuse, will
develop multiple ego-states in order to survive, such as; one who can go to
school and get good grades; one who can foster friendships and play, and; one
who is a sexual slave to her abuser.
These are not to be confused with the distinctly separate personalities
sometimes found in Dissociative Identity Disorder [once referred to as multiple
personality disorder]. Instead,
these ego-states allow a child to function in the various roles that make up
their life.
The creator of the ego-state model, Dr. Eric Berne,
recognized that when a childhood ego-state remains strong - such as van der
Kolk’s example of being a sexual slave to an abuser - the adult may find
themselves shifting into that ego-state when triggered by stimulus that reminds
them of their trauma. It is
obvious that for a person struggling with Complex PTSD created by early
childhood trauma who also has a strong ego-state associated with it still
present, the use of a trauma narrative will not only be ineffective, it could
retraumatize by taking them back to that place where their trauma originated.
For these clients, we must first work toward integrating
those ego-states, starting with breathing, relaxation, and mindful meditation
to help them be firmly rooted and “Be Here Now”. We can then help them examine those ego-states and integrate
them into their life story so their sense of self is no longer fragmented, but
are all parts of the continuous evolution toward being a whole person.
Only once that sense of self is strong, can we employ the
trauma narrative and help them move forward.
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