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This week, I’d like to offer some suggestions about what to do when clients start to prematurely reveal graphic details of their abuse or neglect experiences. When clients who have been silent for years recognize that their therapists can be compassionate, nonjudgmental witnesses to their pain, it’s not uncommon for the “dam to break,” releasing an intense and uncensored account of the trauma.
Trauma survivors often have histories of violated boundaries and weren’t given many opportunities to feel safe in childhood. As a result, in therapy they often plow ahead with potentially triggering narratives without any regard for their emotional or psychological wellbeing. It becomes the responsibility of therapists to create and hold boundaries, and to introduce the concept of safety in the therapy process.
During intake or an ongoing assessment, if a client starts to unload graphic details of their abuse or neglect, therapists should try to do the following:
- Slowly put up a hand and encourage the client to “pause.” This will feel less invalidating and abrupt than saying “stop.”
- Use a simple hand gesture to non-verbally put on the brakes so the session doesn't become a “runaway train.”
- Invite the client to take a few slow, deep breaths to reactivate their parasympathetic system, evoke a sense of calm, and reduce a fight, flight or freeze response.
- Explain the rationale for pausing is to avoid re-traumatization and to model pacing so the work unfolds safely.
- Reassure the client that the full story can be explored and witnessed in as much detail as they need, as long as that process stays manageable for them.
- Model the concepts of boundaries and pacing by encouraging the client to just start with the title of the traumatic experience- not the details.
- Explain that disclosures are genuinely healing when they happen within the context of a safe and trusting therapeutic relationship and that takes time to develop.
- Invite the client to put any images they associate with the trauma “on a computer screen across the room.” This helps the client get some emotional distance from the memory by observing it rather than participating in it.
Rushing through a trauma narrative can inadvertently reinforce the idea that what happened wasn’t all that important and isn't worthy of much attention. The steamroller approach to a disclosure can be a re-enactment of the abuse itself: relentlessly painful without any regard for safety or the emotional impact. When clients rush through their painful stories they may also be re-enacting the coping strategy of “hurry up and get it over with.” This is a mindset many trauma survivors have to cling to while their abuse is unfolding. Slowing down the process allows the client to get a safe, titrated release, and lets therapists get a beginning idea of the trauma so they can offer words of compassion and support. At the same time, it keeps the work boundaried until the client has learned some basic skills for self-soothing and containment.
In the next, and final installment, we’ll look at some additional ways in which therapists can respond when trauma is revealed in therapy.
Click on the corresponding link, if you missed any of the previous parts in this series: Part 1; Part 2; Part 3; Part 4; Part 5; Part 6
