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"We don't see things as they are, we see them as we are!"
Anaïs Nin


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CASE STUDIES


Case Studies. differentperspectives

"We don't see things as they are,
we see them as we are." Anais Nin


I have worked with clients seeking to recover from all sorts of traumatic incidents. Sometimes we use a highly structured time limited EMDR approach and at other times processing trauma memories forms part of a more openended psychotherapeutic approach, paying particular attention to the quality of the therapeutic relationship.This is sometimes necessary when a person has lived through years of chaotic and distressing experiences where betrayal has played a major role. Below are listed some examples of the kinds of traumatic experiences clients have brought to therapy over the years:


Assault
Traffic accident
Animal attack
Plastic surgery
Rape - including date rape, drug rape and childhood sexual abuse
Domestic Violence
Murder
Home invasion
Sudden death of a loved one
Combat Trauma
Bullying – including racist, homophobic, sexist and workplace bullying
Workplace difficulties - including whistle blowing
Criminal acts
Betrayal
Divorce
‘Acts of God’ /’Acts of Nature’ such as house fires, floods
Illness – and treatment for illness



ARTICLES

Case Studies. flowersinsnow

How do Trauma Therapists make therapy safe for their clients?


How do trauma therapists help people feel safe when they have experienced terrible and overwhelming events? Where do they begin? Some clients know they are looking for a place where they feel safe but other clients may not be able to say how they feel due to a lack of confidence. Sometimes traumatised clients will hide their true selves, even in therapy, until they feel it is safe enough to emerge. Consequently trauma therapists understand the importance of creating safety for their clients and do so in many ways.

How does trauma affect our sense of safety?.
Traumatised people have often lost their sense of connection to their true selves, to others and to a meaningful world. Their recovery requires that they rebuild those connections. Many clients come to experience the safe therapeutic space as a haven, which offers protection whilst they recover.

Clients often describe therapy as a safe place where they feel free to be themselves. A place where any emotion is possible and one is not punished for speaking the truth. One feels listened to, wanted, valued and validated. This makes one feel calm, and the body feels relaxed and aligned, ’true’. It is a relief to be heard and challenged gently. There is a warmth of connection, rapport and compassion. Sometimes this experience is tinged with sadness because it feels so rare. This is because many trauma clients describe how, in their lives, they have felt unwanted, unheard, misunderstood and excluded. Some clients have had experiences where they felt trapped and wanted to escape, or tried to hide. Trauma often leaves people feeling profoundly unsafe and sometimes even life itself feels pointless.

Creating safe therapeutic space.
As a result, trauma therapists create a safe therapeutic space by paying attention to both the physical and psychological dimensions of therapy. They are sensitive to what is known as ‘the frame’. The frame of therapy is everything that contains the therapeutic work. This includes the relationship between therapist and client, thoughts, feelings and sensations, and the agreements about practical matters such as time, fees and most importantly, ethical practice. Defining the therapeutic task from the outset clarifies what is possible within the frame of the therapy. This adjusts unrealistic expectations towards more realistic outcomes but it also offers hope.

Therapists attune to their clients, helping them to reflect on what has happened to them and this shared understanding helps clients to repair what feels ‘broken’. Trauma therapists also help to regulate the client’s emotional arousal. If the client starts to feel uncomfortable or distressed about their experiences, the therapist helps them to self soothe. This is not unlike an attentive mother attuning to her baby and helping it to settle if it is distressed. Or, if you prefer a different analogy, it is like a sports coach helping his athletes to stay relaxed as well as focused as the big game approaches. The ‘therapeutic attitude’ of the therapist holds important boundaries of time, space and ethics, and this creates an environment that feels like a protective membrane – this helps clients to feel that it is safe to work.

Ethical practice
Creating and protecting safe therapeutic space is a normal part of therapy, so it can become a place where one can develop and grow. Safe therapy entails working to values and ethics. These are expressed by how we treat people. Ethical practice ensures therapists work to the best interests of the client, protecting the therapy from influences that might intrude or harm the client. As Dworkin (2005 p.47) has noted, trauma by definition is noncollaborative and non-consensual. Trauma therapists therefore design their therapeutic frame to protect clients’ freedom, choice and control.

The safe environment
How the therapy rooms look and feel, their aesthetics, matter because they communicate meaning. If a space can be loved and taken care of then so might a person. Safe spaces are consistently described by clients as quiet, private, warm, comfortable, relaxing, pleasant, with objects of beauty, well maintained and clean. Chairs are firm, supporting and positioned to respect personal space. The everyday rituals of cleaning, watering plants and general care, have the effect of creating and maintaining the safe therapeutic space.

Therapist selfcare creates and protects safety
Experiencing their own personal therapy gives therapists insight into what protects safety as well as providing them with their own safe space. One’s own full life of pleasure and relationships is vital. Clinical supervision helps therapists to feel grounded in their role, to remember their task, and to empathise without getting drawn into difficult dynamics. Therapists look after themselves by having reflective time between sessions, pacing themselves and making opportunities to do something different such as gardening, reading, sport or enjoying the theatre and other arts. Many trauma therapists have a deep love of nature.

Safe therapeutic approaches for processing trauma
Trauma therapists tend to use a wide variety of approaches that help process trauma safely. These include EMDR (Eye Movement Desensitisation and Reprocessing), relaxation techniques, teaching people about the effects of trauma on the brain and body, use of metaphor, narrative and imagery and therapies that acknowledge people’s individual styles of relating to others. Trauma therapists cannot afford to be purists as trauma affects every aspect of the person and integrative approaches provide an excellent way of adapting to the needs of the client. This broad knowledge and skills base installs resources and confidence in the therapist. This communicates itself to clients who then feel they are in safe hands.

If a person feels safe, they can begin to follow their path towards recovery, resilience and growth.

This article is adapted from the author’s 2010 research dissertation for the MSc in Psychological Trauma at the University of Chester. ‘Freedom and oppression in therapeutic space: How do trauma therapists protect the therapeutic milieu? A heuristic study.’



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