The Missing Ingredient in Trauma Treatment

Bringing the Client’s World into the Treatment Room

Mary Jo Barrett


In the past few decades, we’ve made important strides in our ability to help overwhelmed and hopeless people overcome the stigma previously attached to trauma symptoms, learn new thinking and self-regulation skills, and even find a new sense of restored well-being—at least for the period of time that they’re with us in our offices. But then they go home, and far more often than we’d like, when they’re back in their daily lives with family, friends, and coworkers, they don’t do so well. In fact, no matter what progress they make in therapy, once they leave the safe, rarified space we provide them in our treatment rooms, they frequently fall right back into the same old patterns of negative emotion and dysfunctional relationships.

Let me give you an example. Lucy, a therapist I supervise, recently came in to discuss a difficult case. Her client, Abbey, a 46-year-old women, suffers from severe anxiety and depression, abuses prescription drugs, frequently quits or is fired from jobs, and regularly alienates the few friends she has. Like many trauma sufferers, she’s easily triggered by her interactions with just about everybody she knows, especially her husband and two teenage children, who she says are “miserable, nasty human beings.” At home, she fluctuates between furiously attacking them—yelling hateful remarks, throwing things—and withdrawing into a sullen shell.

During sessions, Abbey dissociates while talking about her life, past or present. But through Lucy’s guidance and skill, she’s learned and practiced many mindfulness techniques that have enhanced her ability to recover and bring herself bring herself back into her body when she shuts down. Most days when Abbey leaves therapy, she’s calmer, exhibits some genuine insights into herself and her problems, and often seems to be discovering an embryonic, but real, sense of inner selfhood. By the next session, however, it’s as if she has amnesia for all that transpired in the previous week. So she routinely begins each session, week after week, in varying states of anger, despair, dissociation, hyperanxiety, or rock-bottom depression.

By any measure, Lucy is an accomplished, well-trained therapist, proficient in integrating a range of alphabet therapies into her practice. And Abbey is a willing client: she meditates daily, takes the appropriate medications, cooperates fully in sessions, and practices many of the skills Lucy has taught her—but the therapy is still stuck. “Help!” Lucy said to me during our consultation. “I don’t know what else to do. Why isn’t she getting better in her outside life?”

Most clinicians believe that the benefits of therapy should naturally transfer to the rest of a client’s life. But what if that’s not necessarily true? What if the positive interactions a person has with a therapist in the “inside” world of the consulting room don’t translate at all into the language of relationships conducted in the “outside” world of the person’s everyday life? In therapy, clients feel—often for the first time—truly seen, heard, and understood. It’s no wonder they might think, with a sparkle in their eye, that if only their therapist was their spouse (or parent or friend or child), their lives would instantly be better. It’s no wonder they might scream in the middle of a fight at home, “Well, at least my therapist understands me!” So why are we surprised when real-life spouses, parents, friends, or children, begin to see us—the all-loving therapists—as threats to the marriage, the family, the friendship? After all, therapists can unwittingly play into this ultimately damaging process.

Learn more about integrating families into trauma treatment in Mary Jo's full article, "Outside the Box: Bringing Families into Trauma Treatment" in the May/June 2014 issue of Psychotherapy Networker magazine.

Topic: Trauma

Tags: family therapist | family therapy | Mary Jo Barrett | trauma treatment

Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *