THE THERAPEUTIC PROCESS IN A NUTSHELL
Depending on the goal of the therapy, whether it is to work with fear of driving after a traumatic motor vehicle accident, or to better manage panic attacks that arise after a major surgery, or to better manage work related stress, the therapist would invite the client to share relevant account of history and from there would utilize various therapeutic techniques to help the client piece apart the information to provide clarity to the circumstances, behaviors, thoughts, feelings, and sensations in the body involved, all in a safe environment. The therapist would hold space for the client without judgment, and work with the client to effect shifts in thoughts, behaviors, or find ways to better manage the triggers of previously overwhelming events, towards a more positive and thriving outcome, so that the client could heal and go back to living life in the present. The number of sessions required depends on the goals of the client and the severity of the issues.
ROLES AND RESPONSIBILITIES IN THE THERAPEUTIC PROCESS
Psychotherapy is about change. Therapy will be most effective when the client is prepared to play an active role in the process: keeping to scheduled appointments, having a curious and honest mindset towards the experience and possibilities, and potentially performing actions or behaviors outside of therapeutic hours as part of the process to effect change.
The therapist's role in the therapeutic process is to provide a safe space, support and guidance to help the client work on the issues towards desired outcomes. Depending on the issues and goals, the therapist may engage different therapeutic modalities and methods in working towards our goals. These are research-backed methods including talk therapy, somatic therapy, and hypnotherapy. With the approval of the client, touch may be used in cases where the therapist deems appropriate. Any touch involved is solely for the purpose of therapy to provide support and aid in the healing process.
If at any time during the interaction the client is uncomfortable or has any questions or concerns about any aspect of the process, the client should bring them up as soon as they arise. Psychotherapy involves commitment of time, energy and money, it is important the client feels safe to work with the therapist and any concerns or questions should be promptly addressed.
BENEFITS AND RISKS IN PSYCHOTHERAPY
Psychotherapy can have benefits and risks. In general, the benefits of therapy include, and are not limited to, getting a deeper understanding and gaining more insights into oneself and the relationships of others with oneself. Through the therapeutic process, the client could potentially find solutions to specific problems, better manage negative emotions, build better relationships, heal from past instances of trauma, and ultimately live a fuller life.
The risks include uncomfortable feelings such as anxiety, sadness, guilt, anger, frustration, loneliness, or helplessness that may surface during the therapeutic process as memories surface as the client works through certain issues. The negative feelings usually don’t last and the client often takes the opportunity to learn to observe and manage the feelings as they come up.
More often than not, the benefits of psychotherapy outweigh the risks. Nevertheless, the therapeutic experience varies from client to client depending on the goals of the client and the history and life experience of the client.
WHAT IS TRAUMA?
Trauma happens when a person’s ability to respond to a threat has been overwhelmed; when a person enters a state of high arousal due to real or perceived threat that overwhelms the person’s ability to cope and process the energy of arousal through the body.
One does not have to go through war or a tsunami to experience trauma and in fact, trauma is a lot more common than we envision. The effects of a series of ‘small’ traumatic events can be more damaging than the effects of a catastrophic event. Trauma is not only about what happened to a person that should not have happened but also what should have happened that didn’t happen. For example, the effects of experiencing medical procedures in childhood, falls, instances of emotional neglect in childhood (events that may be deemed ‘normal’ to many as part of growing up) can be traumatic for a person, and may result in various symptoms of trauma, some of which are mentioned in a latter paragraph.
What may be traumatic to a person may be a ‘normal’ event to another, or even exciting to yet another. Falling off a child scooter may seem to be a ‘normal’ event. To a 5-year old, it may have felt traumatic. Doing a bungee jump may be exhilarating to some, but the same activity may be the equivalent of death to others. The factors that contribute to each person’s response to threat include genes,
Shock or acute trauma is due to a singular event that happens in the person’s life. Examples include high impact motor accident, dental and medical trauma, made-made or natural disasters, sexual assault. Chronic and complex trauma results in the person’s prolonged exposure to the threat, many cases of which are relational in nature. Examples include adverse childhood experiences (ACE) such as childhood neglect, abandonment, physical, emotional or sexual abuse, domestic violence.
Symptoms of an overwhelming event may include hyperarousal (manifested physiologically as increased heart rate, difficulty in breathing, panic attacks, extreme fear and anxiety, emotional dysregulation), hypervigilance, sudden increase in thoughts (excessive rumination), prolonged tension in body or parts of the body (stiff neck and shoulders). In more severe cases, we see feelings of helplessness and dissociation manifested in disconnection between thoughts and feelings, or between thoughts and physical sensations, or both. In the long run, if the trauma remains unresolved, the symptoms may become more and more complex and less and less related to the original experience, through a process called kindling (Scaer, 32). Ultimately, it is not uncommon to see symptoms manifested in mental and physical illnesses such as constant feelings of dread and fear, a perpetual deadening feeling, various kinds of phobia, depression, chronic pain, migraine, vertigo, autoimmune disease, irritable bowel syndrome, fibromyalgia, and the inability to stay in the present and enjoy the little things in life. When this happens, life will just pass us by.
“Trauma is a fact of life but it doesn’t have to be a life sentence” a famous quote by Peter Levine, founder of Somatic Experiencing.
The good news is that trauma can be healed. There are different modalities used by psychotherapists to help clients in the healing of trauma. Some bottom up and top down approaches include Somatic Experiencing, Hypnotherapy, EMDR, Internal Family Systems, Cognitive Behavioral Therapy.