Trauma Therapy – How Fast Should We Go??
Psychotherapists choose their profession to help others find their way through the muck of life’s various mental health challenges.
Trauma therapists in particular have a strong sense of compassion for those who have been severely wounded, thus carrying deep emotional and psychological scars. It becomes the duty, or calling even, of these clinicians to help their clients heal these wounds in trauma therapy. But also restore their lives to one of peace and personal agency.
Unfortunately, there are well-meaning therapists who—with a strong desire to help—end up going too fast too soon. They do this while diving deep into a client’s trauma that they end up getting worse. Or, on the other end of the spectrum, therapists are weary of “going there”. As a result, they lead the client through the work too slowly. Then they never actually get to the root of the problem which therefore persists in perpetuity.
Of course, throughout my own journey of professional development, I have been on both sides of the equation. I have learned a lot about this subject through practice and experience. The truth is there are risks to going too fast and risks to going too slow. This article will share and expand on some important things to keep in mind when considering therapeutic pacing in trauma therapy.
Risks of Going too Fast
Perhaps stating the obvious, caution must be taken when processing trauma with clients who present with safety concerns such as suicidality and self-harm. As you can imagine, many clients are often suicidal as a result of their unresolved trauma, with a sense of futility and despair when they imagine living the rest of their lives in their current state of anguish and suffering. Clients who engage in maladaptive behaviors such as cutting are at increased risk of doing this behavior during states of acute distress stemming from revisiting traumatic memories.
It is often difficult to instill hope in clients unless they are able to achieve actual relief from their pain. This often leaves therapists with a dilemma. One where they know they need to help their clients address these past wounds while also knowing that in doing so there can be an increased risk of self-harm. Finding the right balance of keeping clients safe while also resolving a painful memory is extremely important.
Relapse or Acting Out Between Trauma Therapy Sessions
Dredging up and opening some of these old boxes of yuck can lead to a ton of emotional and physical discomfort. Therefore there is an increased risk of clients developing urges to act out with maladaptive coping behaviors. These can include compulsive behaviors such as drinking, substance use, compulsive gambling, sex, or eating disorders.
As in the section above, clinicians are faced with a dilemma. To help clients heal from their trauma (which we all know fuels these behaviors) while maintaining clients enough stability to prevent relapse. Individuals in recovery from substance use disorders or process addictions would benefit from increased caution as well as ramping up their recovery efforts to cope with some inevitable distress.
Flooding, Dissociation, and Re-traumatizing
This section refers more to considerations regarding the pacing of therapeutic work done within sessions. Therapists use their skill and experience to help clients stay in their window of tolerance for emotions for optimal reprocessing of traumatic memories. While some clients have wide thresholds for feeling their feelings, many severely-wounded, complex PTSD clients have very narrow windows. This means that they can easily become flooded into a state of hyperarousal (sympathetic nervous system activation aka “fight or flight”). Dissociation or immobility can occur (dorsal vagal shutdown) as well as the potential retraumatizing of clients. Of course, so much powerful healing occurs near the upper edge of a client’s window of tolerance. So great skill and experience are often needed to facilitate this delicate work effectively.
Dropping out of Trauma Therapy
Even clients who stay within their windows of tolerance during trauma reprocessing can have an uncomfortable-enough session that they are scared to continue the process in subsequent sessions. They may want to avoid this work or drop out of therapy altogether. Of course, then the client definitely doesn’t heal from their trauma. They may even be reluctant later in their lives when a future therapist proposes it.
How often have you, as an EMDR therapist, proposed reprocessing a new client’s trauma only to have them tell you that they tried it before and had such a negative response that they refuse to try it again? It is the responsibility of the seasoned therapist to pace the work. This inevitably will be uncomfortable to some degree while avoiding a non-therapeutic experience.
Risks of Going Too Slow
We’ve just discussed a variety of reasons to avoid going too fast. Let’s take a look at the risks of going too slow!
Reinforce Avoidance or Phobia of their Trauma
There are many reasons why a therapist may be reluctant to “go there” with their clients. Perhaps fearful of a client falling apart, fearful of witnessing powerful emotions… choosing to overly err on the side of caution may lead treatment to be unnecessarily delayed, thus perpetuating a phobic avoidance of one’s traumatic memories. A therapist may inadvertently send the message to the client that they don’t believe they can handle it. Or, a message reinforcing the commonly-held negative belief that “I am weak”.
Of course, if a client is truly not ready and in need of additional time and effort in the preparation phase of treatment, then by all means take whatever time is necessary to develop adequate strength and resources. But as clinicians, our assessment regarding the client’s ability to handle doing this work must be objective and based on fact and not merely our own fears or hesitation.
Delay Resolution of the Client’s Condition
The longer we avoid getting at the root of the problem, the longer the problem will exist (click here to see why we named our practice Mangrove Therapy Group). This makes me think of one client I worked with who suffered for years from classic post-traumatic stress symptoms. and who had seen numerous therapists during that time. I assume that directly confronting and targeting these memories (which were objectively horrific) were avoided for a variety of reasons, some having to do with the client’s perceived stability and some having to do with the therapists’ own trepidation. Of course, once we reprocessed these memories with EMDR therapy the client was able to find some relief. We must not avoid or delay the work unnecessarily for the risk of prolonging the client’s condition.
Exhaust Financial Resources
Let’s be honest – therapy is expensive! And most clients have limited resources, especially in today’s challenging times. Delaying treatment and the reprocessing of a client’s trauma can lead to running out of money before their issues are resolved.
In trauma therapy, there are risks for going too fast and risks for going too slow. Finding the right balance is difficult. It often comes only with years of practice and experience. Plus, effective training and mentorship. Find someone who you can work with who understands these dynamics. Someone who can accurately assess your emotional capacity to find just the right therapeutic pace. And let’s get to work!
Schedule an Appointment for Trauma Therapy in Delray Beach, FL
At Mangrove Therapy Group, we believe it’s possible for you to resolve your trauma symptoms and let go of past emotional wounds. Our team of therapists is trained and experienced in putting together a trauma treatment plan that is comprehensive, safe, and effective. All of our therapists are trained in EMDR therapy and in addressing simple and complex presentations. To start your therapy journey, please follow these simple steps:
- Contact Mangrove Therapy Group to meet with a caring therapist
- Check out our pages on What is “Trauma” and on EMDR Therapy
- Take a look at some of our blogs on EMDR for Substance Use and Addiction, EMDR for Panic Attacks, and EMDR for Body Image Issues (and Body Dysmorphia).
- Start overcoming your issues!
Other Services Offered with Mangrove Therapy Group
Trauma therapy isn’t the only service our team offers at our Palm Beach County practice. Our therapists are experts in treating addiction, depression, body image issues, anger management, anxiety, low self-esteem, group therapy, and much more. We are also happy to offer DBT, CBT, and substance use disorders. Please feel free to learn more about how we can support you by giving us a call or visiting our blog page today!