Note: This article, by Dr. Sandra Wartski, Psy.D, was originally published in Psychology Today.
Several metaphors can assist in some perspective shift about trauma treatment.
Key points:
Trauma can come from multiple sources and can present in numerous ways, but trauma consistently and significantly affects an individual’s emotional and physical well-being. As renowned psychiatrist Bessel van der Kolk notes, trauma is not defined by a particular event but by the ongoing, internal imprint of past pain, fear, and horror that continues to affect individuals in the present.
Trauma first began to be more seriously studied following veterans coming home from war; it was initially termed "shell shock" but later became known as PTSD (posttraumatic stress disorder). Not all individuals who are exposed to trauma go on to develop PTSD, and most individuals do not qualify for a PTSD diagnosis following a traumatic event; however, trauma is painful and can drastically hinder functioning, relationships, and overall happiness.
Choosing to enter trauma treatment is an important yet scary and multifaceted journey for most people. The decision to start takes bravery, especially since discussing unpleasant topics is not easy. A trauma-informed therapist is knowledgeable about the complexities and impact of trauma; they will aim to offer individualized, strengths-based treatment, taking pacing and personal situations into account. Feeling a sense of safety and solid support from a chosen therapist is paramount.
There is a wide variety of trauma-focused therapy approaches now available, including TF-CBT (trauma-focused cognitive behavioral therapy), EMDR (eye movement desensitization and reprocessing), IFS (internal family systems), SP (sensorimotor psychotherapy), and many others. There is overlap among the modalities in terms of goals, with all trauma-focused therapy being focused on helping individuals address symptoms and problems in healthier, functional ways.
Several metaphors are presented here for consideration by anyone thinking about or engaged in trauma work. Concepts are intentionally all-encompassing and broad, as each individual's process is naturally very individualized and will be guided, at least in part, by the type of treatment in which they are engaged; however, there are some general ways to think about the process with targeted visualizations that can be useful.
Turning Toward the Box
Most of us have boxes of old things that have been pushed into a corner of the closet or are collecting dust on some high shelf in a garage. We may not want to look at the contents or simply don't know what to do with the sundry items in the box. Sometimes painful memories are similarly stored in a metaphorical box and tucked far away, but often that box is leaking, taking up space or creating a tripping hazard. Turning to this "box" can ultimately be an important step to improving quality of life and relieving significant symptoms.
Many people are pleased to learn that working on trauma doesn’t necessarily mean having to review and recount every single, specific detail of the traumatic events. Clinical thinking is currently more focused on the processing parts of the traumatic memories to reduce distressing symptoms and increase a sense of meaning or control. The work does often involve facing some of the feared parts or sensations, but it can be helpful to know that many therapists are focused on targeting the way in which the situation affected the individual internally, more than over-focusing on the event itself. We do know that airing out hidden hurts and reducing avoidance improves anxiety, relationships, self-confidence, and stuckness.
A New Painting
If a particular painting is determined to be undesirable, we may not be able to remove the oils, acrylics, or watercolors; however, we can paint over the picture to create a new image. Some of the ridges or darker colors may show through, but a completely new appearance can be created. Add a different frame, and a whole new vision is created.
Similarly, we sadly can’t expunge human brains from pain and suffering; however, we can create new experiences, perspectives, and ways of approaching the world. Engaging in trauma work can be like “painting over” a picture that is no longer needed or wanted. There is sometimes impact that comes through or some shadows that can darken certain aspects of life, such as a literal or figurative startle response or a default interpersonal interactional style more rooted in fight or flight. But a more colorful life and reframing can occur.
Managing a Riptide
Getting caught in an ocean riptide can be scary and overwhelming, and the instinct for many is to swim against it to get to shore. Unfortunately, swimming against the current can lead to exhaustion, and so, the recommended course of action is to swim parallel to the shore until one can more easily walk ashore. There is apparently less of a concern of a riptide pulling someone underwater, but it can pull one further from shore than may be comfortable.
Trauma work can also be difficult and tiring, and it can feel like things are worse before they get better. It may feel like one is further away from solid ground for a bit, but the recommended course of action is to keep swimming without fighting the process and knowing that one will again walk on solid ground as the current settles.
An Upside-Down Turtle
An upside-down turtle is in a vulnerable and dangerous position. While turtles can sometimes turn themselves right side up on their own, there are also many documented accounts of other turtles coming to assist in flipping a distressed turtle back over. This socially cooperative behavior serves as a nice visualization for how humans, too, might sometimes need help in righting themselves, especially when going through hard times, such as when engaging in trauma treatment.
Humans in distress may not require literal flipping to get right side up, but they may need assistance in terms of a listening ear, distraction, laughter, a shared meal, or simple companionship. Asking for this help can be difficult for some, but most friends or family members are usually very pleased to step in when specific, tangible requests are made. Social support is not a magical cure and may not be as immediately momentous as flipping a fellow turtle right side up, but the pure presence of others is powerful.
Rock in the Pocket
The therapeutic work of processing trauma can allow the memories to become more manageable and the effects less interfering. Trauma or difficult past events may never be fully erased or undone, but they can generally be brought to a point where they are less overwhelming and less life-interfering. Instead of carrying a boulder on one’s back, the memory and impact might be able to become more like a rock in the pocket. Others may not see it, but you know it’s there. You can touch it and feel the contours of it periodically, but generally it is out of sight, mobility is not impeded, and fuller life functioning can return.