It is often associated with combat stress or child abuse and is effective with all types of trauma and for such things as major accidents, rape, violence and all kinds of extremely shocking events.
Client Readiness & Safety Protocols:
1). If trauma is related to: crime, a victim or a police officer and there has been a critical incident that will need a legal deposition, or a trial testimony, that maybe required, because under trauma therapy the image of the event may fade or blur or even disappear completely. Although a patient may be able to tell what has occurred they may not be able to offer a vivid or detailed account of the event.
2). Trauma disturbances in therapy: Patients should realise and hold onto the knowledge that an uncomfortable disturbance in session or between sessions, is when the trauma material is being ‘released’ and then be able to feel comfortable in experiencing a high level of vulnerability, or a lack of control and any physical sensations from the event/s that may well be part of the historical trauma. It means that the patient must be willing to tell the clinician the truth regarding what they are experiencing. Although patients do not need to disclose details of their trauma, it is imperative that they are willing to experience the emotions in front of their clinician and reveal whatever emotions emerge and to report accurately the nature and intensity of these emotions.
3). Feeling Raw between sessions: When the patient withholds they are more likely to experience higher abreaction–level material, in session or between sessions, without the appropriate clinical support. Therefore suicide ideation or suicide attempts are more likely when the patient withholds information from the clinician, about the intensity of emotions. Patient’s need to know they should call on the clinician if difficulties are experienced between any trauma sessions and therefore may need to be prepared for additional urgent sessions to reduce disturbances. There is a need to maintain a strong therapeutic alliance with clinician due to the potential for additional between sessions disturbance.
4). Dissociative Disorders – Dissociative Identity Disorder (DID) also previously termed as a Multiple Personality Disorder, also Mutism, or other disorders occurring. Please ensure patient fills in the Dissociation Questionaire form, particularly if experiencing major disturbances, like combat stress.
5). Debriefing: It is important to have enough time to debrief a patient at the end of each session regarding the individual trauma and experiences, if not then the client could continue the processing between sessions at a higher level of disturbance. In extreme cases where client is experiencing major disturbances there may be a need to take double sessions while abreactions come into normalised processing and to readjust session bookings in light of this information.
6). Patient Log: Please keep a log of any memories, dreams, thoughts, and situations that are in any way disturbing. Keeping a journal helps the clinician to target obvious needs that should be treated. It will also point out to your clinician any dysfunctional patterns of behaviour that may need attention. Patients should realise it is important not to proceed too quickly and yet to understand that further disturbances are a natural part of trauma processing. And it is important for patients to “let whatever happens, happen” as it’s all part of the healing process, so if there is disturbance, or if none, its ok.
7). Medications: If patient is already being stabilised by GP / Psychiatrist / CPN, on medications such as benzodiazepines, or alternative SRI’s, etc. although meds do not appear to completely block the trauma therapies, nevertheless, traumas need to be reprocessed after patient comes off meds as Clinicians have reported that if a patient is asked to reaccess the treated memory after meds have been discontinued, trauma can return with approximately 50% of its original associated disturbance. Therefore a combat stress with a SUDS (Subjective Units of Disturbance) level of ‘10’ after reducing to ‘0’, when patient came off meds it could return back to a ‘5’ on the SUDS scale. Therefore Patient’s and GP’s especially need to know that prescribing meds for trauma will often increase the overall time scale of psychological trauma treatment.
8). Patient support check: It is important that the patient has support (family or friends) to be around, to check on patient over the time of extreme trauma work being done, to monitor the SUDS level of disturbance with patient and continue to support and to particularly remind patient that the necessary reprocessing continues to release trauma and therefore there may be some disturbing material brought to surface which should be released naturally, in-between therapy work sessions. This is usually discharged through sleep in the dream state. My saying is ‘The Dreaming Brain keeps you sane’. Good sleep therefore is imperative. Ensure you have our sleep tips ‘Annex A’ handout. The clinician will deal with informed disturbance in the following session.
9). Trauma abreactions - Symptoms to be aware of:
Imagine a field suddenly being ploughed up. The emotions are being stirred up like this and much comes to the surface. Different affects such as physical tiredness, which comes suddenly as the body begins to relax, whereas previous to trauma therapy there was an emotional holding on (even aggressive or controlling behaviour). Now as there is a resurfacing and gradual resolution of trapped emotions, with therapy, other affects may manifest, we call this post traumatic reaction. Affects may be; Irritability, Swings or Low in Mood, Depression, Jumpy, Night (or sleep) Sweats, Shakiness, Low/High level Dissociation, Distracted, Intrusive thoughts, Anger, Denial, Tearful, Sad, Confused, Forgetful, Sleepy. And possibly Grief, Loss and often Guilt and Shame. All this is expected and yet some may experience very little disturbance, only pure relief.
10). Monitoring effects & Concluding Therapy:
Our patient/clinician contract states a need for you to give at least 4 week’s notice, to end therapy treatment, or regular sessions, this covers our duty of patient care and the normal demands of our business flow with patients/client work. There is a need to monitor the withdrawal of our support and to tie up any ends or discharge any emotional issues brought up in or around your therapy. We also have a duty of care to monitor the longer term effects of the trauma work, with follow up appointments, at intervals of 1 month, 3 months and specifically about one year after trauma work.
11). Safe Trauma Containment:
It is crucial for your safety, that you are able to properly relax, with the clinician’s normal help, and be able to hear well (inform us of hearing problems) and be intellectually able to follow and fully submit to clinicians instructions (let us know if you don’t understand). It is very useful to practice your breathing ‘Benson Technique’ between sessions night and morning and to be able to sit still in therapy and be able to use your imagination, before we attempt therapy each session. We use mainly soft Low Intensity Therapy (LIT) and if necessary, we use High Intensity Therapy (HIT).
12). Children & Adolescents:
We will work with Adolescents between 16-18 with parental consent. But we need parents to stay with children (under 16) by watching at a safe distance (we will inform where to observe therapy).
12). Emergency Contact Number: 07799 847720. In case of difficulties between sessions.
Call this number and Give your name and phone number (repeat in case it’s a bad line) and explain briefly the problem and we will try to text you to make another appointment or call you back.
NOTE: We usually leave some space for emergency appointments on Fridays so that you have extra cover, if required, prior to the weekend where you would have to attend A & E for urgent help.
We use different methods for different types and depths of trauma and we are not contained with methods mentioned as new methods are developed at Convergence College of Psychotherapy.
Why Suffer in Silence?