What are the effects of trauma?
MY NAME IS SARAH LEE AND I'M A PSYCHOTHERAPIST WORKING IN MANCHESTER CITY CENTRE IN THE UK AND ON SKYPE.
I'm Sarah Lee, a UKCP registered psychotherapist. I work in Manchester City Centre helping people suffering from depression, anxiety and low self esteem. I have a special interest in working with clients with depression and survivors of long term abuse. If you're further afield you can work with me on Skype. If you have any questions, you can call me on 07853490358 or send me a message.
It’s worth noting that people who are traumatised often have difficulty concentrating and understanding. They can frequently feel ‘lost’ and might be unable to do simple tasks that they know well such as forgetting how to make a cup of tea or being unable to speak. If this is you, please go easy on yourself and go slowly. This is because when people are traumatised or retriggered, they don’t have access to the thinking parts of their brain. You are not stupid, you are just feeling overwhelmed. Wait until you feel better and try again or try on a different day, or ask someone to help you.
When you are traumatised, you get stuck. Your brain does not understand that the trauma is finished, it treats it as an ongoing incident.
Trauma and memory
Traumatic memories are far more likely to be stored as implicit memory; these are emotional responses, unconscious awareness and triggered unintentionally and linked to instinctive responses (described below and available as attempts to protect you).
Non traumatic memories, such as what you were doing last week, are far more likely to be stored as explicit memory; which is categorised and organised and whereby you have access to parts of your brain that help you think, rationalise and plan. This is why traumatic memories are often fragmented, disorganised and difficult to recall - you simply cannot access them in the same way as you can other memories.
What this means, is that you either don’t feel safe in the present or can easily be triggered to literally re experience the past. The more traumatised you are, the more difficulty you will have with staying in the present and knowing the difference between your past and your present.
Trauma responses are widely misunderstood; you have probably heard of fight or flight - fighting back against the threat and running away. In reality there is also, friend - seeking help or presenting as non threatening, freeze (think rabbit in the headlights) - this often happens in sexual trauma and other trauma experts have also added flop; when freeze doesn't work the body literally switches off and goes floppy.
In children who have been traumatised a common response is to blame themselves in some way. Far better for them to continue believing that the world (and adults) is a safe place and that they are at fault, that to believe the world is unsafe and they are blameless. In this way, they are still able to feel in control.
You will hear this very frequently when talking to people who have suffered trauma ‘I shouldn’t have made him angry’, ‘I did something wrong and that’s why he reacted like that’, ‘if I hadn’t have got in bed with him, he wouldn’t have raped me’, ‘I was a difficult child, that’s why my parents weren't very affectionate’. These are all attempts to have some kind of control. If the victim is at fault, they can change, they can do better! If they had/have no control, they will need to accept that people they trusted failed them (or that sometimes, terrible things happen for no reason such as accidents, natural disasters, death etc.)
This can be a very scary place to be, particularly if you do not have much support. In terms of trauma when something bad is done to you by someone you trusted e.g. parental abuse as a child - they might be the person you were relying on to take care of you. It can be enormously isolating and lonely.
HOW I work with trauma
When I work, I go very slowly. I tell people not to go into details about trauma so as to avoid retraumatising themselves, particularly at a time when they don’t know me and don’t know if I am reliable or a safe person.
I work relationally, which means that the relationship (or alliance or connection - whatever you want to call it) is very important. Please note that this is a strictly professional relationship, although I care very much about my clients I keep to professional boundaries. I work with people who have frequently not felt like there was anyone on their side. This might be their first experience on having someone that will listen, care and be non judgmental.
Trauma can be isolating for many reasons. It is so badly misunderstood that you will frequently hear people say ridiculous things. One of the most common ones I see is ‘if anyone tried to rape me, sexually assault me I’d punch them in the face’ or advice to people who have experience sexual assault as ‘next time someone does that scream and poke their eyes out’. For this reason, I would caution against listening to people who don’t know what they’re talking about. The danger of this is you might not find you have many people left.
I am sorry to say that trauma recovery often takes a long time. This is probably not what you want to hear but I find it best to be honest. You may simply be expecting too much too soon. It takes time, to understand your brain responses, develop strategies to stay in what is called ‘the window of tolerance’ (in a mental space where you feel ok and not overwhelmed). As I said this can, in my experience be done in ‘regular’ therapy (assuming a good therapist, a good therapeutic alliance, knowledge of trauma and how it affects you).
I am biased in preferring therapists who work relationally, because that’s how I work (therapists have a tendency to prefer their own styles). I’ve also received other types of therapies in the past and found them too ‘cold’. Anyone who has been traumatised by a parent relationship or as a young child may struggle with this approach in my opinion. It can leave the client feeling abandoned which can reenact past traumas for them.
Your trauma responses (whether you subconsciously choose ‘fight, flight, freeze, flop or friend’) will be affected by your past experiences and whether they have ‘worked’ or ‘not worked’ for you in the past. This is why it is so cruel when people suggest that repeat trauma victims fight back. If you tried and failed (for example if the perpetrator was more powerful than you e.g. adult vs. child) to defend yourself you are less likely to be able to defend yourself or attempt an active trauma response (fight/flight). This is not a conscious decision; you are not choosing to do this. Unfortunately, it is also true that you are more likely to be traumatised if your brain opts for a passive approach (friend, freeze or flop). So now, you are not only traumatised, you are blaming yourself for not having done more (and if you couldn’t do more it is quite likely that you couldn’t because you were previously traumatised). And to top it off you are surrounded with misinformed people telling you your should have done better. It is a perfect storm.
There are many excellent resources on trauma such as these two excellent articles by Zoe Lodrick. One explains trauma and the other is about guilt in trauma survivors. She specialises in sexual trauma but they are relevant for anyone who has experienced trauma.
I also particularly like these flashback management techniques by Pete Walker. He specialises in CPTSD but again these can be relevant for many people.
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