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Hi, this is my addition to the first ever Therapeer Content Event! Each of us answers the same question. Please give the other entries a read to get more thoughts on this topic! You can find all the other entries right here. The question we each addressed is this -
My Answer - Nope.
This is the angle I took on the question - no, it's not necessary. And simply telling the narrative could actually be harmful/retraumatizing. And I mean that very literally. If it was just saying the story out loud that helped in therapy, the client could just stay at home and do that. Even over and over again. But that doesn't sound super helpful.
Before I go further - "Just retelling the trauma" means if the client did nothing else but share the trauma story. What's helpful isn't actually the sharing of the story. It's the other pieces of therapy. No, I am not saying that clients should never tell the trauma story or that is is always retraumatizing.
Just exposing a client to his or her traumatic memories and having the person relive them [is], at best, unnecessary... and at worst retraumatizing... -Peter Levine, In an Unspoken Voice, p24
Peter Levine makes the case that the trauma narrative actually doesn't even need to be shared. Period. He says that one can work with their own inner sensations to resolve the trauma and release the stuck freeze energy. I highly recommend reading his books for more on this, especially Healing Trauma, Waking the Tiger and In an Unspoken Voice. This line of thought is really the domain of Somatic Experiencing, which I recommend you look into.
I think the trauma story can have a place in therapy. I'm not saying to ignore it. But I agree with Levine that it's not necessary. A client may say they want to "face it" or "get it out" by sharing the story. If the therapist and client agree to use the story as an intervention, I don't see a problem with that.
Though I also find that it comes up naturally through the process. Clients will disclose traumas that are not known at the outset of therapy. And they may feel compelled to share some of the trauma as a result. So this article is really for us talk therapists that are incorporating somatic awareness into our modalities (and our clients).
There are pieces to the trauma narrative to consider before delving into it:
The strength of the vagal brake
Fear and sympathetic energy may be stuck
Readiness
A little at a time
Co-regulation has to be available
Mindfulness needs to be an accessible skill
The strength of the vagal brake
This is a polyvagal term. You may know it as the window of tolerance or distress tolerance or something else. But in the polyvagal world, it means something very specific. It's referring to the influence of the social engagement system ("ventral vagal" or "safe and social state") on the heart. With a strong social engagement system, it keeps the heart beating at a calmer pace. If the vagal brake is removed, the heart rate goes up. The vagal brake is removed when there is actual or perceived danger. This makes sense because when there is danger, a higher heart rate is necessary for survival through running or fighting.
In other words, if we perceive we are in danger, the flight/fight energy kicks in. Our social engagement system turns off and the sympathetic system turns on. As long as the social engagement system is turned on, our heart rate will be calmer and the flight/fight energy won't activate or won't be as intense and out of our control.
Before going into the trauma story, therapists need to ensure that their client's vagal brake is working! Meaning, that they have access to their social engagement system. That their social engagement system is strong enough to tolerate the flight/fight energy and not turn off entirely.
It's easy to tell if a client has access to their social engagement system. They smile, they laugh, they make eye contact, have a relaxed posture and their voice has a nice, full range. Now, it's not very often I meet with a client that has full access to their social engagement system and is able to hold it. Probably never in all honesty; maybe toward the end of therapy.
But a client doesn't need 100% access to this state of safety. They just need to have enough and that is going to look different from client to client. The way to build the strength of the vagal brake is to spend more and more time in it. To exercise it like you would a muscle.
Otherwise, your client is probably going to be spending a lot of time in a defensive state. And then expecting them to share the trauma story is simply reinforcing the defensive state or possibly worsening it. Not to mention putting some serious holes in the therapeutic relationship. But let's focus on the sympathetic energy.
Fear and the sympathetic energy are stuck.
As we all know, the trauma story is not simply an objective retelling of events. The story itself, the memories, are not just words - It's a reliving. I asked my followers on a #5WordFriday - "What do you mean by 'triggered'?" and got some really intense and illustrative answers. One of the themes of the answers was around being taken back in time to the event itself. Not just the event, but the fear and defensive states that came along with it. Repeatedly, people commented on being taken out of the present moment and feeling the intense energy of the past moment(s) they survived.
Retelling the trauma narrative, in and of itself, is obviously triggering. Clients are potentially time traveling to the past or their past feelings are time traveling forward to our present. In polyvagal terms, they are dropping down the ladder into a sympathetic flight/fight state. Their bodies are becoming primed for running or using force. Because that's what may have needed to happen in the past... but wasn't able to. That instinctual sympathetic energy has been laying dormant for however long, ready to be used.
That stuck energy that emerges is intense to say the least. The client has to be ready for it. If not, they may go into a panic, rage, overwhelm, or shutdown place.
Readiness
Healing cycles can only be opened up to, watched, and validated; they cannot be evaluated, manipulated, hurried, or changed. When they get the time and attention they need, they are able to complete their healing mission. -Peter Levine, Waking the Tiger
I hear from the teens I work with about their prior therapy experiences when it comes to trauma. Not just from my clients, but also from listeners/followers who have messaged me. And there are some bad bad stories out there. Consider these two, based on real examples:
Imagine a young adult walking into a session for the first time. The therapist already has the information of their trauma on a document in front of them (possibly from the parent or probation officer). The therapist jumps straight into the trauma, asking about the details and how long ago it was, how old they were and how they responded to it and so on.
Imagine an adult client has entered therapy for the first time, full of unease and not knowing the process of therapy or that they can refuse. The therapist says she expects the client to share the trauma story twice during session, then write it out daily between sessions.
These two examples don't exactly seem right, do they? The interventions or the timing of the interventions may not be helpful. But besides that and what I want to focus on is the readiness of these two clients. Were they ready for these interventions? Or did they need something else to happen beforehand? Maybe even multiple somethings, like: stronger rapport, agreement on the treatment approach/goal, knowing they can refuse, knowing other options, a safety resource, distress tolerance (vagal brake) and on and on.
Therapists need to be attuned to the client's readiness and willingness to talk about the traumatic events. Therapists should not be assuming a client is in therapy and ready to delve into their painful pasts. Walking into the therapy room is potentially the first step among many before ever sharing the trauma story.
Before telling the story (if telling the story), the fear needs to be manageable. The sympathetic energy needs to be tolerable. By the time they are ready to share the story, they should have enough understanding of their tolerance to the memories and the bodily sensations that will come along with it. The client (and therapist as well) should be able to identify when it's time to stop, pause or continue after using a grounding skill/resource that has shown to be successful in the past.
A little at a time
The other thing to consider before going into the trauma narrative is that there is no rush. Therapeutically, rushing the process can be retraumatizing. This is a delicate process that requires patience and a significant lack of pressure. If we're putting pressure on the client to share the story, we're really mirroring the pressure/discomfort of the original event. I mean that very literally as well, especially considering that the same emotions from the original event are brought up along with the pressure to tell the story.
So if they are going to share the story, therapists need to be attentive to the energy of the client and their capability to tolerate the distress. I'm not saying we coddle the client and protect them from painful feelings. Those feelings are simply going to happen; it's par for the course with trauma work. But we also don't want to see clients going into a catatonic freeze in the therapy room. We're looking for something in the middle.
In that middle area, the client will be able to notice and hold the sympathetic energy, while still retaining access to their safe and social system. The aim is to drop into the flight/fight energy a little at a time, then to come back to safety.
This noticing, then coming back to safety, then continuing is a key piece of what helps. Because it's not just telling the story that helps. It's building the strength of the vagal brake; the social engagement system. As that system strengthens, there is a greater capacity to handle the sympathetic energy that comes along with telling the trauma story.
So having a safety resource is extremely important. Having a safe environment and a safe therapist are extremely important. Co-regulation is a must when it comes to this.
Co-regulation needs to be available
This means the therapist needs to be able to maintain access to their own safety state. If they can do so, they will be able to feel along with the client what they are going through (though not exactly, of course). The therapist will drop into their flight/fight energy while also having a firm hold on their safety state.
In the beginning, for many people, climbing [the ladder] is really difficult... They need a co-regulator. They need somebody to accompany them. Deb Dana, Polyvagal Podcast interview
The image in my head is of a therapist and client walking into a dark cave. The therapist has a rope tied around their waist on one end. The other end is tied securely around a rock on the outside so they never lose their way back to the light of day. The cave represents the sympathetic energy that comes along with the trauma story. The rope represents the therapist's access to their safety state. And the client and therapist represent... well, the client and therapist.
As long as the therapist has access to their safety state, they can be with the client. They can feel the client's experience on some level while also feeling their own experience. They can notice their own thoughts and what comes up for them that is separate from the client. The therapist can problem solve in the moment, they can remind the client of the safety resource and lead them in grounding skills.
With finely tuned co-regulation happening, the therapist will notice subtle shifts in the client that indicate they are dropping into unmanageable flight/fight energy. The therapist will be able to pause the process and bring mindfulness to it before venturing further.
Co-regulation does not mean the therapist takes over and directs the process. Ideally, the client is also able to notice their limits and swing back to a safety resource before returning to the story. Both client and therapist have a responsibility here, but I'll always put a bit more on the therapist. We're the ones the client is coming to and trusting to bring them out of the cave, ultimately.
But both the therapist and the client have to be very mindful of the inner sensations.
Mindfulness needs to be an accessible skill
It's not enough to know that we have inner stuff going on. We also need to have a keen awareness of inner sensations. A conscious attending to what our bodies are saying.
One of the direct benefits of mindfulness is that it actually helps to release the stuck energy.
Simply being more aware of the self in the present moment allows some safety to come in and for some of the freeze energy to come out.
Conscious awareness accessed through the felt sense provides us with a gentle energetic discharge just as effective as that which the animal accesses through action. -Peter Levine, Waking the Tiger
Think about it - wild animals are nothing but the felt sense. They don't have the anxious thoughts to take them away from it. They don't have negative judgments about themselves. They are very attuned to their inner sensations as well as the outer world. Because if they're not, they become prey. Wild animals feel the impulse to run when they are in danger. They don't stop to think about what might happen if they do x, y or z. And they don't have limiting beliefs to stop the impulse from being carried out. They use their sympathetic surge of energy to escape or fight.
Human beings have the same fundamental capability, but we have to deal with all the human stuff. Once we can become mindful of the present moment fully, we can then allow the stuck energy to discharge. That doesn't mean we need to run or fight. But that does mean we have to allow that energy to run its course.
This mindfulness stuff is true for both the therapist and client. The client is developing this mindful awareness. The therapist, in my opinion, should already be there. Or well on their way in the process.
Because the therapist is not only going to have to be able to hold and manage their own stuff, but also the client's. The therapist is going to need to be able to hear the client's words and attune to their autonomic state. This attunement is going to bring the emotions that the client is experiencing on some level. Being able to hold these emotions with curiosity is extremely important. Not dismissive. Not minimizing. Not providing an explanation for the emotions or a rationale for what's happening in the story. But being able to sit with the emotion while retaining access to the social engagement system and the therapist's own feelings of safety.
On the therapist's end, none of this happens without a mindful awareness of self: body, emotion and thought.
The same applies to the client as well. It is so easy to get sucked into the pain of the story. A mindful awareness of their own inner sensations, thoughts and feelings is important for the client as well. If they're able to, they can feel when it's time to pause and hold a sensation. Or to consciously choose to hold another sensation that is needed in the moment. Then return to the more painful ones.
As one begins to open gradually to accepting one's intense sensations, one enhances the capacity for healthy aggression, pleasure and goodness. Peter Levine, In an Unspoken Voice, p89
Sharing the trauma story is not just the facts of the event. It's not just the emotions of the event. Nor the thoughts of the event. And not just the state shift either. It's all of it. And what the person is left with afterward. It's an overwhelming thing to revisit and share with someone. It's so easy to get lost in any of those pieces. Being mindfully present is imperative. And specifically, to the present moment.
We must always assist the client to returning to the here and now. To feeling present in the moment. To being present in their bodies. Again, we've got the rope that's tied to the rock outside of the cave.
Mindfulness exists in the present moment and the present moment only. Because that's where we exist. We don't exist in the past or the future. It may feel like that, but we exist now. And no time else than now. I know our thoughts dwell on the past and anticipate the future, but our physical bodies stay firmly in the present. We just need our thoughts and emotions to align with where our bodies are. In the here and now.
Once we are in the here and now, we can climb our polyvagal ladders into our social engagement systems. Once the client is feeling connected to a safe co-regulating therapist, then getting unstuck can begin. And maybe that's sharing the trauma story.
Point being, if the client loses access to their mindfulness, it's not the time for sharing the trauma story. If they've lost the present moment, they're probably simply reliving the trauma all over again. That's not the time to keep going. That's the time to swing back to safety, then return to the story when back in the present moment and ready to continue.
Retraumatizing
As I said at the outset, I think just retelling the story could be retraumatizing. If the client does not have the other pieces I've laid out here in this non-exhaustive list, they're simply reliving the experience. All the stuck energy is get sucked right back within, adding a new layer of fear. And now, not just fear of the event, not just fear of the memory, not just fear of the feelings... but also fear of therapy. Fear of the process. Fear of a potential helper.
If we are pushing clients to share more than they are willing or capable of, we're mirroring the process of the trauma. What was supposed to be a safe, trusted professional has now become an unsafe, untrustworthy professional. And that reflects not just on that individual, but on the profession as a whole.
So do I think telling the trauma story is necessary? No, I don't. And I think just telling it - without these other pieces - could actually be retraumatizing.
CHECK OUT MORE FROM MY THERAPEERS!
I hope you've enjoyed and benefited from my entry into the first ever Therapeer Content Event! Please please give some of the other entries a read/listen/watch. There was a lot of fun energy around this from a lot of people that care and wanted to volunteer their time to share their thoughts. Find the rest of the entries here. I am amazed at how many kind individuals were willing to contribute. We've got some amazing therapeers in the world.