Many people are afraid of receiving treatment for trauma. I want to spend some time discussing this fear and explaining what can be expected in the treatment of trauma. This will hopefully assist you in deciding whether or not you need treatment and if necessary making the appointment.
Is it a valid fear?
Yes, without doubt is is a completely understandable and valid fear. It takes an enormous amount of courage to eventually decide you need treatment and to seek help. When badly traumatized, you have been exposed to an event or events which have overwhelmed your ability to cope. You will have spent much energy on trying to avoid thinking about what has happened to you, because it is so overwhelmingly bad. Now you are going to have to talk about it and think about it. You know that you will be overwhelmed by the memories. If you have PTSD you may even find that when you think about the event that you relive it to such an extent that you are no longer aware of your present surroundings.
When do I have to get help?
When the trauma you have gone through is affecting your life. If you find that it is dominating your thoughts, affecting relationships, disturbing your sleep and so on, it is time to get help.
What can I expect if I decide to see a psychologist?
You will first have to find someone to see. You can get names of possible people from your GP, from friends and family, and you can do internet searches. Please make sure that the person you decide to see works regularly with trauma. To check this, phone them and ask them. Ask them what psycho-therapeutic approaches they use in dealing with trauma. Those most commonly used with good research are prolonged exposure and EMDR. However, when you talk to a possible therapist you want to hear that you are recognised as a person with individual problems and that you will be treated in that way. You want to be sure that you will not be submitted to a cookie-cutter, one-size-fits-all approach.
If you feel happy with the person, make the appointment. You will probably be very apprehensive going to the first appointment and consider cancelling or simply not going on numerous occasions. Go. You still have to decide if you like the person and whether you can work with him or her.
In the first appointment the psychologist should ask you why you have come in. They should take down a history of the development of the problem as well as your family, education, relationships and work history. They should find out about other possible emotional or physical problems you have had. They also need to find out about previous trauma and how you have managed it.
After you have given the psychologist a brief outline of your life, he or she should look at possible diagnoses of your problem. These have to be explained to you. Possible treatments then have to be discussed with you with all your questions answered. You need to be told of risks in the proposed treatments. The possible consequences of choosing not to treat the trauma have to be discussed. Please make sure that you are given alternatives and that all your questions are answered. You should also make sure that the treatment the psychologist is proposing is scientifically validated. You are entitled to ask what research has been done on the proposed treatment. You are also entitled to ask the psychologist what training and how much experience he or she has in the proposed treatment.
Treatment may include both medication and psychotherapy. Ask questions and ensure you understand why medication is being suggested. You may be referred to your general practitioner or to a psychiatrist for medication.
If you decide on psychotherapy, the psychologist must explain exactly what it entails and what you may experience. You should never feel unsure of what is happening or going to happen. Traumatized people already feel that their lives are out of control and should be assisted in regaining control.
The process of psychotherapy
The relationship you have with the psychologist is critically important in treatment. Before any intrusive or difficult work is undertaken, a good working relationship has to be established. You need to know that you are safe in the relationship and that he or she will be able to handle what you bring in.
The trauma may be focussed on early in treatment if it happened recently. Otherwise, the focus initially will be on gathering more information, consultations with family members if necessary, and teaching you skills to cope with the emotions, images and physiological reactions you have when you think of the trauma.
These containment skills are extremely useful. Generally trauma-work will not be done until you are feeling emotionally stable and competent in using containment skills.
Very often the therapist will group the traumatic events if you are confronting more than one type of trauma. This makes it easier to manage them, and if events are targeted correctly, can lead to a domino effect where events you have not targeted are automatically better once core experiences are dealt with.
If you have multiple traumas, your therapist may start with one that is less upsetting to establish a “way-to-go”. Alternatively he or she may start with an event which happened when you were very young, or with something very bad. Starting with the worst and resolving it often makes all other traumas immediately more manageable. Initial traumas are often useful to target as disabling beliefs are laid down then.
Confronting trauma in psychotherapy is generally upsetting. The material is bad, and it would be unreasonable to expect to feel good while confronting it. However, this is one of the reasons you have been taught containment skills. Use them to control the bad feelings, particularly between sessions or when feeling overwhelmed during a session. Always communicate these feelings to your therapist.
Traumatic events should be targeted specifically. It is often not possible to work in a generalised fashion with trauma. It is also easier to measure whether you have achieved what you set out to do when you confront the event directly. You can check whether you feel better when you think of the traumatic events or not.
Although confronting trauma is a very frighting thing to do, it should be a controlled process in which you know exactly what is expected, what is happening and recognise improvement in yourself.