Establishing Safety in Trauma Work
MEGAN DAVIES, MA, Registered Clinical Counsellor - VITALITY COLLECTIVE VANCOUVER THERAPIST
Imagine a sprinter with an injured leg, in order to help this person walk again, we will do different things. Firstly we would provide them with a cane or a crutch to walk, then we would help them strengthen their muscles through physiotherapy. And when they have gained enough strength and when it is safe to do so, only then would we ask them to run again. We would not expect them to run with a broken leg, if we did then we would do more harm than good.
Asking traumatized clients to work through memories early on in therapy, is similar to asking the sprinter with the broken leg to run when they cannot even stand. Sharing traumatic experiences can leave individuals vulnerable to becoming dysregulated and at times re-traumatized. Trauma memories should not be addressed before the individual is equipped to manage the distress. Babette Rothschild, author of ‘The Body Remembers’ uses the analogy of teaching a new driver to be really comfortable with the “braking” system in a car before “accelerating.”
Trauma can destroy your assumptions about safety.
According to Maslow’s hierarchy of needs, your sense of safety is established early in life and trauma shatters that safety and trust. The purpose of the first stage of trauma therapy is to help re-establish your basic sense of safety. Trauma survivors cannot teach themselves how to be safe and stable because they have no baseline or meaningful experience of what the words “safe” or “stable” mean.
No recovery from trauma is possible without attending to issues of safety and care for the self. It’s normal to feel the need to move through this first stage quickly and get to the healing, but safety and stabilization are critical to having success during the trauma work later. We need to build up the skills to withstand the distressing symptoms before we do trauma work. I want you to think of your trauma as all the fizz in a shaken up 2-litre bottle of pop. What happens if you twist the lid off all at one time? Pop goes everywhere, no control over it. But what if you slowly, a little at a time, in a controlled way, unscrew the lid? The fizz slowly goes out and you can open the pop with no explosion, just like how we want a safe and controlled way when we discuss memories in trauma work.
There are many factors to consider and assess during the stabilization stage, I’m going to be discussing two of them with you.
Psychoeducation
Psychoeducation is a very important and key part of stabilization work. Psychoeducation allows therapists to teach patients about the symptoms as well as a way to decrease shame and confusion around their perceived mental health issues. Psychoeducation allows individuals to learn how to recognize their trauma symptoms, how to anticipate their trauma symptoms, what they mean, and most importantly, how to manage and contain them.
Through psychoeducation, knowledge brings power and power brings control and the re-defining of an individual’s role within their life from that of a victim to that of a survivor. We want to teach people about trauma in a way that feels empowering and empathetic. Validating experiences and coping skills that YOU learned by yourself, as a child, to keep yourself safe and survive those terrible experiences, is resiliency & strength.
Containment Exercise
Containment is a key regulatory skill that helps you tolerate trauma symptoms that can be dysregulation and overwhelming. Trauma symptoms can come out of nowhere. Typically, they pop up when you don’t expect them and they can happen at very inconvenient times. The main goal of containment is to stay within the window of tolerance. The Oxford dictionary defines containment as “the action of keeping something harmful under control or within limits.” Let’s think about these limits as the outer edge of our window of tolerance. Containment focuses on recognizing, reducing, and managing trauma symptoms. Containing the traumas does not mean denying them. The skills both acknowledge the symptoms while creating distance to the memories.
The most common way to do this is the containment exercise using a safe or vault. I want you to close your eyes and imagine a container, any container that feels safe to you, that could be a safe, a chest, a box, maybe a small vault … You can place all that is “too much” in that container and lock it away. You can imagine this container to be in a house, maybe a bank, or maybe it’s hidden with magic.
It helps to go into detail when you imagine your container. What is it made of? What is the size and shape? What colour does it have? How can it be locked and opened? Is there a key or a code or maybe a password? It is important to make a conscious step to place your thoughts, feelings, pictures or others inside the container and lock it well. Imagine stepping away from it, checking if there is something to add, then leave the building and continue with life. This will not contain difficult things for you forever. It’s not meant to. Sooner or later you will have to look at it. This exercise gives you the freedom to decide the “when” and “where” not the “if.”
So remember, the goal is to learn to manage before we move through trauma symptoms. The next time you are experiencing your trauma symptoms, I want you to remember that you are a survivor. How you adapted and learned to cope with these terrible experiences is a testament to how strong you are.