My intent in sharing my story was to help therapists understand the needs of a trauma victim and to suggest techniques and strategies to meet these needs at each stage of recovery.
Stage One: Compassion, Hope, and Information
Immediately following a traumatic event, a person experiences a sense of unreality, an intense range of emotions, and anxiety that life will never be normal again. The victim’s thinking is disorganized and chaotic. Offer compassion, hope and information. Don’t underestimate the stabilizing power of the therapist’s clarity.
Reassure the client that what she’s experiencing is understandable and not pathological–explain that there is no “correct” response and that recovery is a process. The recovery process includes, but isn’t limited to, exploring feelings, learning how to contain them so that they’re more manageable, accessing strengths, developing coping skills, and integrating the trauma into the narrative of life. Offer the expectation that full recovery is possible.
Explain the neurochemistry of trauma. Trauma causes the release of many stress hormones, which alter one’s normal neurochemical balance. The balance will return during recovery.
Assess the need for medication, especially if a client isn’t sleeping.
Be patient with the slow, uneven process of recovery. The therapist’s acceptance promotes self-acceptance, an essential ingredient for healing.
Stage Two: Strategies to Contain Feelings and Promote Healing
Help a client access his strengths. Explore how he’s handled adversity in the past. From the stories of previous successes, extract the principles of his coping style and help him apply this knowledge to the current situation. Identify things that anchor a client in his life and build upon these. Set small, achievable goals to promote a sense of mastery.
Promote strong relationships with friends and family. If these relationships were problematic before the trauma, address the issues.
Teach mind-body techniques, such as deep breathing, hypnosis, meditation, and EMDR, to develop the client’s capacity to self-soothe.
Encourage participation in scheduled activities, whether a weekly tennis match, cooking classes, or a series of symphony concerts. Draw on the client’s spiritual and religious beliefs for comfort and perspective.
Stage Three: Integration
Discuss existential issues in the context of the client’s spiritual beliefs–why bad things happen to good people, the reality of malicious intent, or how unfairness may go unpunished.
Identify the client’s life purpose and meaning. Focus attention on being the author of one’s own existence and away from being a victim.
Shift attention from painful feelings to positive changes that have resulted from the trauma–new skills, stronger relationships, an increased sense of confidence. Foster a sense of appreciation of new strengths and gains.
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Janice Starkman Goldfein
Janice Goldfein, LMSW, ACSW, is in private practice and specializes in trauma recovery, parent-child conflict, marital and family problems.