Don't know how to start trauma therapy

[BluebellJumper]

Without straying into personal and private issues, can anyone explain what a session might involve? How do you know where to start if you've blocked years out? Is hypervigilance and jumping out of your skin at everyday noises enough? What support is there if the floodgates burst open? Terrible anxiety and physical feelings have surfaced in the last 3 months, and I know that I need to find someone I feel safe with. don't want to consider cbt (at least not currently) also would a therapist start with the here and now/adult life or always go to childhood first?I can't imagine finding anyone to trust as I've always been alone with this.

Usually, you would discuss all of this as you start with a therapist. They would help you find a good place to start that doesn't feel too overwhelming. Therapists need to ensure that their clients are well enough supported to deal with facing particular issues and may help them work on ways of feeling less dissociated, and ways on which they can soothe hypervigilance before trying to address the deeper issues. They should support the client not to be so overwhelmed with their feelings that they become re-traumatised.

Hi OP
It really depends on the therapist and the type of therapy they do. I can speak from personal experience of what I have done so far.

The first year or so was spent building trust and safety and a relationship. It was spent dealing with the way the trauma impacted me day to day and helping me to ground and stay connected and in the present. It was practising grounding and working out what was helpful to me. We rarely talk about the actual trauma still after nearly 4 years working together. There’s too much and a lot of it is fragmented and dissociated. We work somatically and do lots of physical movement things to help me connect with my emotions and to express myself. We write and create art. When things are very difficult and I’m struggling to cope my therapist is very responsive to emails and phone calls outside of the session to help me ground and remind me that she is there as a safe person. It has been the relationship that has been healing for me rather than what we talk about. Knowing there’s a safe person who cares and can handle my trauma and doesn’t judge has had a huge impact on how regulated my nervous system is and how well I can now function from day to day.

Are you paying privately? The reason I ask is that will more likely enable you to build up some time and a relationship with a therapist first. I had trauma-focused CBT but it was at least a couple of months before we even touched on the traumatic event(s) and we went incredibly slowly. Which was exactly what I needed.

I'm not a therapist but I do work with trauma. Some people feel that they need to explain everything that happened (and their reasons why they think it happened) in great detail. Some people are sick and tired of talking about it because it doesn't change anything and some people don't want to talk about it at all. Every approach is valid and appropriate.

Trauma happens when the mind can't make sense of an event or series of events at the time it happened. In order to avoid it ever happening again, the mind will attempt to make sense of it by revisiting everything in minute detail and from every angle - hence the flashbacks, dream and distressing thoughts that many people suffer from; these in turn fire up the fight or flight physical reactions (because the body has no idea if you are in actual danger or not, it simply reacts to what the mind is thinking). The body responses, then your mind thinks there must be something horribly wrong because the body is behaving as though it's in danger and you're in the vicious cycle of stress and anxiety.

When the mind can rationalise the event(s) it will stop this programme running (the car accident happened because the other car had defective brakes or the driver was drunk, for example) but if what happened was completely random and/or the people involved can't or won't explain their role the mind will keep working to find a solution - not to torment you but to protect you from it reoccurring.

I was skeptical about digging into the past when I started therapy, but the way my therapist led me was to start with what’s causing problems in the present, then you sort of work back through the limiting beliefs and feelings that are causing the problems which developed in the past/early years. So it’s more of a meandering back and forward.

Also you don’t dig back into trauma until you’re feeling safe and stable in the present, so that could mean building rapport and trust with the therapist first, or feeling into a little bit of difficult feelings and learning to tolerate those before digging into really difficult feelings. So it can be a meandering in and out in that way too.

Basically going slow is always the fastest way to do trauma therapy.

Look up Irene Lyon’s on ‘titration’ as she describes quite well the idea of going tiny bit by tiny bit - the speed of your nervous system, not capitalism!

Also can’t remember who first used this analogy but it’s like opening a shaken up bottle of coke - in theory your therapist should be really tuned into how you’re coping so they won’t push you into a place where your floodgates burst open - it’s more like easing the lid off the bottle really slowly so the fizz dissipates bit by bit.

can’t remember who first used this analogy but it’s like opening a shaken up bottle of coke

Babette Rothschild - The Body Remembers