The overt I’m anxious option. When anxiety becomes intolerable in session, clients tell me they are melting down/freaking out or whatever term feels right. Before we do anything else, we acknowledge the anxiety and deal with it: slow breathing, imagery, grounding work. If you aren’t familiar with these, that’s fine. Your therapist should know what to do if you’re anxious. The counselor will help you with in-session anxiety management as the first order of business.
The covert I’m anxious option. Clients aren’t as explicit about their anxiety, but they take the time needed to look around the office to get their bearings. We talk about this and that for a while as the client has opportunity to get somewhat comfortable with the therapist. Clients will ask questions about the process so I do more of the talking while they catch their breath. Other times, we may spend more time than normal talking about the parking situation at the office, or the weather, or the local sports team. If you need to tell me about an episode you watched last evening on Netflix for 10 minutes to get used to the session, I’m all ears!
The “create your own solution” solution. If your therapist is open to possibility, and agreeable to creative/playful solutions, check with yourself to ask what would be helpful. What would help to make the session do-able? Clients and I have brainstormed various possibilities that make therapy more feasible considering their anxiety:
We have play dough in small canisters for fidgeting (it’s fun too!)
We leave the office for a few minutes to run up and down several flights of stairs to burn off nervous energy
I have sat on the floor to feel less intimidating, or turned my chair facing away for clients who felt that any eye contact was too much
People bring in music they find meaningful, or art they have created, or letters they have written to give them something concrete to talk about
The point is, select a therapist that will understand your anxiety. Ensure your therapist has experience working with anxiety. Your counselor understands that it is part of their job to help clients that have anxiety be able to take part in counseling. It will be a partnership between the therapist and your very nervous self to get the process started.
If you’re anxious about the first appointment, and your anxiety feels like a runaway freight train, all the more reason to make the appointment. Use all the support you can muster to get yourself across the threshold.
The therapist will help you from there.
24
Counseling for Trauma: Dealing with the triggers that stop you
There are some people that all can agree are trauma survivors (even if these folks often choose to not self-identify themselves publicly as trauma survivors):
Combat military veterans
Immigrants who fled their country because of oppression, violence and political instability
Victims of horrific motor vehicle accidents that left them recovering for months with persisting permanent injuries
Victims or witnesses of gruesome crimes. They may have experienced harm, or they watched others die or were witness to ghastly violence
Sexual assault survivors
Not all who experience such trauma will experience a lasting trauma response—known as PTSD (Post Traumatic Stress Disorder). In fact, many who witness and experience horrendous trauma go on to live full lives without the periodic hijacking PTSD. They don’t experience the triggers or the chronic depression and anxiety that often accompany PTSD. It is not the severity of the traumatic event that predicts whether or not the survivor will have these symptoms.
Not everybody who has suffered a terrifying experience will have persistent symptoms. But some that have experienced trauma will have their lives painfully twisted around the memories.
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There are also trauma survivors that have lasting trauma symptoms that don’t always recognize those symptoms as arising from trauma:
Growing up in a home with an alcoholic parent or grandparent. When the family rules of addiction are: “Don’t talk, don’t think, don’t feel,” how is a person able to understand that even though he wasn’t violent, he wasn’t present and available—and that matters? When her drinking had her disappear into her bedroom for days at a stretch, and a person is left to fend for oneself and the siblings—would they even know how frightening that is for a young child? Would that child let him or herself remember how difficult that was? Would that child even recognize how hard it was?
Being pressured for sex, being called names, and consistently and subtly belittled by a former girlfriend. When men grow up in a culture where they cannot admit abuse, how is he supposed to know that this shapes a person?
Being unpopular in grade school, with people making fun of a person’s glasses, your skin color or even a strong aptitude for math. No one named it bullying back then, and everyone wrote it off as being a baby when that person brought it up.
Most people who struggle with symptoms of trauma would never see their trauma in news headlines. Trauma may be deeply painful without being dramatic to the outside observer. Many people experience symptoms of trauma without ever recognizing them as arising out of earlier experiences that their brains encoded as traumatic.
But—trauma is trauma.
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Trauma teaches our brain powerful lessons. Our brains are wired, foremost, to keep us alive. There are parts of our brain that steer us away from danger beyond our conscious awareness. Our nervous systems not only protect us from real and present danger, but from perceived and possible danger.
A child bitten by a dog becomes frightened and anxiously avoids all dogs. Further, dreams of dogs are, by definition, nightmares. And even discussions of dogs are off limits because they send the child into uncontrollable tears
A person falls through ice on the river and, narrowly escaping death, is pulled out by rescue personnel narrowly escaping death. It’s understandable when no amount of objective knowledge about the safe thickness of the ice will get this individual skating on the river the next year. They may avoid all winter sports. They may even avoid watching a sports channel that has winter sports.
When there is a topic that creates cold shivers within you, when there is a story that you can’t bear to remember, never mind speak of, going to a therapist to talk about it seems counterintuitive. Therapists invite you to talk about your problems, don’t they? Then it surely seems foolish to spend time with a therapist, when you order life in ways to not talk or think or remember those experiences.
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Therapy is for a person’s good. While counseling often isn’t uncomfortable, it is not re-traumatizing. Therapy can be difficult, but if you find your symptoms of trauma getting worse, something needs to change. Talking about it may not seem like a good idea, but the symptoms of PTSD can include:
Nightmares
Cold sweats
Flashbacks
Anger outbursts
Shallow relationships
Avoidance of triggers
Substance use/abuse
Insomnia
Anxiety
Depression
Dissociation
—those are no picnic either, are they?
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Therapists who are experienced in working with those who have trauma know that to ask details of the story of the traumatic experience early in therapy is not helpful. Some clients will come feeling like they are supposed to narrate the most terrifying moments of their lives to get better. Often, if clients feel like they need to start spilling it all therapists will stop clients. It’s important to not tell the horrific, traumatizing stories early in therapy—not because they are too hard to hear, but because they are too hard to tell.
Therapy from counselors familiar with trauma-informed therapy will focus first on resourcing the client as they deal with their symptoms. Trauma-informed therapy supports a trauma survivor as they negotiate their day-to-day existence, helping them to feel less isolated and more supported. The relati
ng of the specific details either happens much later in therapy or not at all.
If a therapist asks you to tell the story of that which traumatizes you, inquire if they are familiar with therapy with trauma survivors. Decline to tell the story if you don’t feel ready. If you perceive that the nightmares will be too intense, or it will be too hard to function in the days following, that is a flashing red sign to not talk about it. Listen to your gut and let your therapist know that you won’t let the therapist override your inner sense of knowing. The conversation can focus on the part of you that knows you need to keep your foot on the brake.
Look for a therapist experienced in working with trauma if you are worried about talking about the painful stories.
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So much of what creates trauma happens within the context of human relationships:
A spouse’s infidelity
Racism, homophobia, misogyny
Bullying
The carnage created in relationships as the result of an addiction
Abuse of any kind (physical, emotional, financial, spiritual) from anyone (partner, parents, boss, etc.)
People avoid experiences that feel, sound, or look like the trauma they experienced. Frankly, often it was a relationship that was harmful. So, for many trauma survivors it would likely be potentially be very triggering to talk to anybody—especially a therapist—about the trauma. There may be ways in which a potential client (consciously or beyond conscious awareness) has learned:
Not to get too close to people
Avoid letting others in to access tender parts of themselves
Not believing people will be supportive
Assuming others will be judgemental, critical, or mean
Simply not trusting that anybody will act in your best interests—including a counselor
Instinctively, as a trauma survivor’s brain seeks to keep them safe, that brain often says: “Therapy is not safe”. Our brains would far rather be wrong by keeping us away from something that could be safe than be wrong by allowing us to do something that seems safe, but turns out to be harmful. Brains err on the side of caution and so generally, brains are suspicious of therapy. Brains all over the globe tell the heads they inhabit: “Do not go to therapy. Do not trust this person. Do not trust the process. Stay safe by pulling back from anything vulnerable like therapy.”
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Let me give you some information about trauma-informed therapy that may help you talk to the part of your brain that says: “NO WAY” to therapy.
There are 5 principles of trauma-informed therapy that competent therapists that can work effectively with you will know:
Safety: Therapists will instinctively know that therapy is risky and has an inherent danger for you. They will create safety for you. They will do that in a whole variety of ways. The counselor will let you know about their style so you know what to expect. They will invite you to ask questions whenever you have one. They will ask you to tell them when something is uncomfortable or you don’t want to answer a question. At our practice, we have a lot of information on the website to allow people to know what to expect. We have a book in our waiting room that is available online[10] that educates people about what to expect in the session that you might find helpful. A trauma therapist will notice when you start to get upset or disconnect from reality and work to help you start to feel OK again by grounding you. They will understand that in order to proceed forward, they can’t push you. A therapist will know that a sense of safety builds slowly. Trust is built over time. Trustworthiness is important. Therapists know it requires some time in therapy before the hard stuff can be approached, and we are prepared to wait.
Choice: Trauma therapists understand that often trauma was as difficult as it was because you were trapped. You had no options and you felt cornered. Trauma-sensitive therapy will provide you with the ability to make decisions in therapy. Some of our clients like to walk outside during their sessions. Other clients request that we not look at them, or avoid using certain words, or they like to talk about something innocuous for a few minutes at the beginning of each session. Some like lots of humour, some none at all. Some prefer to pay at the beginning of a session, or book at the end of the hour—or the email us the following day. Whenever it works for us and is helpful for the client, we work to accommodate the needs of the client.
Collaboration: Trauma therapy happens with close cooperation between therapist and client. The therapist checks in with the client to see how they are doing or asks for signals if something gets too uncomfortable. We establish goals and strategies that work together with you, monitoring regularly and inviting feedback to ensure that a client isn’t flooded. Trauma therapy isn’t done to a person, but rather with a person. The therapist is attuned to the client and makes constant adjustments as each conversation unfolds.
Trustworthiness: A therapist will know that a sense of safety builds as trust is built, over time. Trustworthiness is important. At our practice, we seek to be upfront, clear and consistent to avoid surprises around policies regarding cancellations, scheduling, payment etc. We show up for appointments as scheduled. I ask clients to tell me if they feel like I said something hurtful or offensive so that we can talk about it. I will apologize if we discover I made a mistake. While therapists do their best, they are also human, and so will make mistakes. Give your therapist an opportunity to own their error. We know that trust is developed like drops into a bucket, and that breaking of trust empties it by the cupful. We invite any perceived or actual breaking of trust to be brought up in the therapy to clarify misunderstandings and to repair any ruptures in the relationship between therapist and client.
Empowerment: Therapists who have worked with survivors of trauma know that there is a wisdom and extreme capability that has helped a person survive. The strength and insight of a trauma survivor is respected and valued. A therapist partners with the resilient and courageous parts of the client to do therapy. It only makes sense to include the client in the decisions, and to value all of who the client is. We build on the survivor’s natural and real strengths as therapy moves forward.
Therapists don’t relate to you out of these principles as a gimmick. It’s a fundamental style of clearly relating to you in a way that understands: Safety first. We relate to you out of these five principles because it’s how we show that we care.
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It’s not only acceptable, it’s expected for survivors of all sorts of trauma to be skeptical of therapy. Suspicion and hesitation for therapy is standard for trauma survivors. Make sure you do your research. Identify the qualifications and experience of the therapist. Do what’s necessary to soothe the part of your brain that has concerns. Address those concerns respectfully with knowledge. Assure your brain that you are keeping yourself safe by choosing a therapist carefully and that you will advocate for yourself in therapy to maintain safety. The therapist that is suitable for you will not only tolerate caution but encourage you to be careful.
Go ahead and take care of your brain and the rest of you. Listen to your body and take care of it. Help it learn to deal with the trauma in a way that is, in itself, is a lesson in calming that terrified part that only wants the best for you.
25
Counseling for Addictions: Getting help for a problem you can’t admit you have
If you’re reading this chapter, chances are that you are angry. Enraged. Furious. Someone has suggested that you get treatment for an addiction. You might think:
“How dare they hint I have a problem with _____?”
“Don’t they know how hopeless it is for me to stop? If I could stop, I would have stopped a long time ago!”
"What do they know about how much/little I use?”
"They are so ignorant of my back story. If they knew what I had to deal with, then they would get it and stop griping at me.”
Or you’re incensed at yourself that you have allowed yourself to get to where you fear this chapter may be for
you.
Can you feel your rage, let it be exist and also to read this chapter? Can you honor both your feelings and the feelings of the person who expressed the concern?
No one signs up to have a problem with alcohol or gambling or meth or shopping or pornography or food or sex or prescription pain medication or anything else.
No one, including you wants to be an addict.
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Everyone wants to believe that they are in control and that they could stop if they wanted to stop. (They just don’t see the need to stop, so they won’t.)
Everyone wants to believe that no one understands.
When someone asks how much _____ (alcohol, weed, shopping, etc.), they tell them, mostly. (Except not exactly the whole truth, because if they did, others would make such a big deal of it, wouldn’t they?)
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One of the most poignant learning moments about addiction happened in the couples counseling class I took for my therapy degree.
Hell No to Hmmm, Maybe Page 18