Finding Solid Ground: Overcoming Obstacles in Trauma Treatment by Brand Bethany L.;Schielke Hugo J.;Schiavone Francesca;Lanius Ruth;

Author:Brand, Bethany L.;Schielke, Hugo J.;Schiavone, Francesca;Lanius, Ruth;
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 2022-02-15T00:00:00+00:00

This chapter will address each of the above steps in detail, including practical techniques that the therapist can use with patients who are triggered.

Step 1: Identify the Earliest Signs That the Patient Is No Longer Grounded

When patients become triggered in therapy, if the therapist does not intervene early, patients are likely to become more and more triggered and less and less in touch with the present. The more a patient becomes lost in past trauma or dysregulation, the more difficult it will be to help them reorient to the present. The goal is to intervene early to help the patient to self-regulate before the patient enters an overwhelmed state of emotion or a deep state of dissociation from which it is more difficult to reemerge. To this end, it is important to be aware of the variety of ways in which dysregulated arousal can manifest in session, and to monitor the patient closely for the beginning of these manifestations. In this section, we will focus on somatic changes that indicate loss of grounding. The material on the neurobiology of trauma-related disorders (TRD) presented in Chapter 3 can provide a useful complement to this section, as it provides explanatory material that can help the therapist understand the mechanisms behind these changes and present them to the patient in easy-to-understand language. This allows the patient and therapist to collaboratively attend to and address these changes more effectively.

Therapists may be more used to attending to patients’ words than their bodies. Attention to the patient’s body (including both subjective sensations and objective changes noted by the therapist) is essential in working with traumatized patients but is often overlooked in traditional talk therapy. The body gives a wealth of information about how the patient is experiencing and remembering their trauma, and the body is clearly a site of trauma-related symptoms (see also Ogden et al., 2006a; van der Kolk, 2014). Many patients have disconnected from their bodies as a way of escaping abuse, leading to experiences of numbness and dissociation in day-to-day life. By communicating that the patient’s body is an important site of experience and memory, and teaching the patient about the ways in which trauma is held in the body (see Chapter 3), the therapist can help the patient to reconnect with and process their own somatic experiences, which gives them a powerful tool for recognizing their level of dysregulation. As they learn to attend to their body, they can gradually become more adept at recognizing earlier when they are becoming dysregulated, therefore providing themselves with more opportunity to regulate when it is easier to do so. This gradually leads to an increased ability to be present and to live a meaningful life (for further discussion of the importance of mindfulness, see Siegel, 2007, 2010).

One model for understanding the impact of trauma on the body, and the role of the body in dysregulated arousal, is the window of tolerance model (for a detailed discussion of this model, see Ogden et al., 2006a; Schore, 2003; Siegel, 1999).

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