Retraumatization (Svali Blog Post)
This information is mirrored from https://web.archive.org/web/20120426042037/http://archive.suite101.com/article.cfm/ritual_abuse/81275
This article addresses how we, as therapists and counselors can unawarely retraumatize our patients, even when they have told us clearly this is what we are doing. The question will surely be asked, “How could I continue to damage my client in such a way if they have told me this is happening ?”
The answer is obvious. You weren’t listening!
I have written an article on listening that might help in elucidating this statement but if it hasn’t been read, then I will add that if we are not truly listening and attuned in to where our client IS and the message he/she is telling us both verbally and non-verbally, then we can be guilty of retraumatizing again and again with disastrous results for our patient and the therapy.
If we cannot think of an incidence in which we have thus treated our patient, it might be helpful to review some of the ways in which it could be done.
I am not speaking to overt retraumatization such as unprofessional loss of control where there has been yelling at the client, inappropriate sexual behavior towards them, or sudden termination of therapy without explanation or closure. I have dealt with the aftermath of all of these, the last being perhaps, the most damaging when a therapeutic alliance has been formed, and there has been good rapport between counselor and client(s) with progress being made. I am remembering when in the position as Clinical Supervisor at an Adolescent Day Treatment Center, one of the staff simply did not return. The subsequent effect on his clients and the whole group was devastating. But this is overt retraumatization.
I am speaking to the more subtle, and insidious ways in which we, as therapists can miss our cues and do harm to our patients unwittingly and unawarely unless we keep in mind the pitfalls and potential of causing unnecessary suffering to an already suffering patient.
It would be impossible to name all the ways in which we can rehurt and throw our clients back into reliving former traumata. The ways are as diverse and numerous as there are individuals, simply because what is traumatic for one person is not necessarily true for another.
However, there are commonalities in the therapy arena we could use for general headings which could be explored. I will touch only on four and leave it to the reader to do some honest and rigorous self-examination to discover others.
1. Triggers 2. Reenactment. 3. Transference/Countertransference. 4. Failure to truly listen.
Triggers can be myriad and often are. They may be people who resemble past abusers, surroundings similar to places where abuse occurred, sounds reminding the patient of a certain tone of voice used before or during abuse, certain music that was playing during abuse, sights and smells encountered that evoke conscious or unconscious memories of past traumas. For victims of Mind Control, colors, numbers, words, phrases,gestures,(e.g.hand signals) etc. can be very triggering and set off programs layered one on top of another.
In the case of DID ( Dissociative Identity Disorder) alter personalities might come out in an effort to cope with, protect from and resist, what is perceived as a potential or real danger or unbearable pain. Again, different things can trigger different alters depending on the experiences they hold.I addressed Triggering Procedures in an article about Emergency/CasaultyGuidelines where hospital per se with its personnel, equipment, smells and procedures are vivid reminders of torture and abuse for Ritual Abuse,Satanic Ritual Abuse and Mind Control survivors. ( see website: www.survivng.org.uk under Dissociative Identity disorder)
In the Therapist’s Office any one or more of these triggering catalysts can be found, spoken or seen. Therapists who treat cult survivors need to be very sensitive to anything that could remotely resemble ritual activity. Having masks hanging on the wall, pictures depicting any kind of sacrifice whether mythological or ancient art form, burning incense of particular fragrance, blood red coloring in decorations and furnishings, wearing a black robe-like garment, etc.
This is not saying a therapist should redecorate their office or minutely change any POSSIBLE trigger ! I am saying that we, as therapists, should be sensitively aware of our client’s body language, facial and eye expressions, anything that denotes terror, unease, dissociation, and not MISS these cues but inquire what is going on.
To miss these cues because the client cannot verbalize the fear, and continue to allow an easily removable object to remain during session time is retraumatizing at a level that can put the healing process back months. To continue to ignore any verbalization of fear around any object is willful retraumatization unworthy of professional standards.
A client of mine told me a picture I had threw her into a state of panic, so I turned the picture round to face the wall for session time and that worked fine.
I, personally believe, that to insist on keeping an object or anything that is obviously triggering for my client, and in so doing retraumatize them, reveals only that I have a control issue, my own agenda and the erroneous belief I can change in the mind of my client the memory that object reminds them of.
Whatever memory a trigger taps into, the patient relives that memory as though it were today. It is the sad delusion of some therapists to think they can erase a memory by attaching a new meaning to the trigger object.
NOTHING can replace the memory. It is the MEMORY that needs working through, not a substitution for it.
This applies to ritual dates. It is futile for a therapist, however well meaning, to think they can change the meaning of a date to something better, safer or different. For one thing, a therapist cannot change ANYTHING. Change comes from within the client with the help of their counselor.
Trigger dates whether ritual ones or anniversaries of trauma such as rape, murder, accidental death and so on, require the therapist to remember when such dates occur. To schedule session, activities or other events on trigger dates is retraumatizing – willfully so if the dates are remembered and still kept as a scheduled plan. I am notoriously bad at remembering anniversaries and birthdays but I try to keep up with the tramatizing dates of my clients and be sensitive to special needs surrounding them.
The vital lessons here are:
a) Do not MISS the trigger through preoccupation, lack of observation, insensitivity, or having ones own agenda.b) Explore what the trigger is connected to if possible. If the client is not ready to process whatever the original trauma was, file it away and return to it later. Never force a recollection of a trauma tiggered that does not come into consciousness without fear. If the connection is recognized and accepted then it can be worked through.
c) Work through the memory and don’t try to “make it better” or substitute another experience.
d).Remember at all times that mishandling of triggers is retraumatizing.
We, as therapists, have a great responsibility and task in our commitment to our clients. They teach us, criticize us, commend us, frustrate and anger us, bring out the best and the worst in us. .But it is easy to look only from this perspective and omit realizing what we can do to them!
We all make mistakes, say the wrong thing, make a wrong judgment, assume, guess and be miles off track. Sadly, in many of our weaknesses and failings we retraumatize our patients who have experienced just such weaknesses and failings in those who are the reason for them being in our office.
We reenact for our clients, the rejecting parent, the loved one who does not hear the child’s cry of unmet needs. They find we do not truly listen so they are thrown back into the place of unimportance, invisibility and Therapist Attention Deficit!
We are apt to talk too much, to theorize, interpret and explain things and effectively silence our clients as they were silenced by abusers and adults who “knew better.” We put on the paternalistic or maternalistic cloak of authority and retrraumatize those who will do anything to please their therapist just as they did anything to please their abusers, and as long as we continue this role they come back to be retraumatized over and over again.
Nothing is accomplished except lengthening the healing process and time, but far more damaging, is that our patient will never gain an insight into something DIFFERENT. While we as therapists do not recognize the power position we hold and because of this non-recognition manipulate, control and dictate to our clients, we retraumatize and the fault is OURS, not theirs.
It is good to be brutally honest with ourselves in looking at the interaction between us and our clients. Is there an equality of give and take, of respect, of openness to the other’s views and perceptions? If there isn’t, we cannot but retraumatize through reenactment.
3.TRANSFERENCE AND COUNTERTRANSFERENCE It might be interesting to note here that there is the possibility not only of retraumatizing our clients but also ourselves if we do not deal effectively with our countertransference. I hope there is not one therapist who would deny a history of personal trauma in one form or another.
When I write that we can retraumatize ourselves I mean that if we do not recognize what our clients have raised in us positively or negatively, if we do not see how to keep the boundaries in the transference of our patients and we do not seek skilled supervision, we are in danger of losing perspective, insight and growth. In so doing, whatever traumas we may have sustained in the past or present there is the potential of remaining STUCK in their effects. We wouldn’t be experiencing countertransference if our past has been worked through. We experience countertransference because it hits us where it hurts the most, where we are the most vulnerable and where we HAVEN’T healed ourselves. So it is good to remember what we can do to ourselves as well as our client.
One of the most traumatizing thing we can do to our clients is to project our own countertransference on to them as being their transference. In so doing, we not only retruamatize them by reenacting previous experiences in which, and because of which, they feel blamed and that they are to blame for whatever is happening, but the saddest part of this phenomenon is that the therapist remains blinded to their own issues and the need to self-examine. It is one of the easiest cop-outs for a therapist to avoid looking at him/herself by turning errors back onto their client, e.g. “due to your abuse, I can see how you think this, behave in such a manner, preceive me as doing whatever”. How often have we relieved a twinge of guilt by projecting onto our clients, what we need to look at in ourselves? We retraumatize ourselves and don’t even know it! I am not proud of the fact that I have done this.
Retraumatizing a client who transfers to us all the emotions, reactions and behaviors that were felt and shown to significant figures long since removed from their life either literally or figuratively, occurs in different ways.
It can be in not recognizing at what developmental stage such feelings belong; in the therapist garnering adoration to her/himself because of the need to be idealized, needed, admired etc. There could be an inability to handle intense and sometimes primal emotions such as rage, terror, indescribable emotional pain and in the response to any of these on the part of the therapist by unrecognition, avoidance, neglect, dismissal, denial of them being real, said therapist can reenact the exact responses shown to their patients. Shown at a time when they were too small to comprehend such lack of understanding from those they loved, or too afraid to question what didn’t make sense in the abuse, punishment and total lack of love and nurturing.
Retraumatization of a client in the deepest phase of transference is decimating and simply relives in them all the horrror, disbelief and terror of someone they either love to desperation, fear to the point of paralysis, or both. If the therapist cannot handle, recognize or appropriately care for their client in this stage, the damage caused is irrepairable.
Reenactment doesn’t need to be a physical repeating of a past trauma, a broken heart is far more traumatizing and difficult to heal than a broken limb. In the delicate and sensitive condition of a patient in the throes of emotional transference it behoves the therapist to treat their client as they would a container of Dresden china, ” FRAGILE. Handle with CARE”. If we do not do this, we are guilty of retraumatization.
In an article I wrote about Listening, (see www.surviving.org.uk), I posited that perhaps the greatest gift we could give our client, friend or stranger is the ability to truly LISTEN and to enable them to feel without a shadow of a doubt that he/she has been HEARD.
It is my belief that the worst thing that can be done to someone is to ignore them. Ignoring is an umbrella for rejection, silencing, making another feel invisible, less than nothing, unimportant, unrecognized, unloved, unheard and unwanted. Ignoring is TOTAL dismissal and recognition of a person’s presence and being.
If we, as therapists are not fully present and focussed on our client in their session time, if we are preoccupied, wandering off on some thought and agenda of our own ( even if it concerns our client) we are, in reality, ignoring them. We are ignoring what they are telling us because we hear only part of what is being said, and sometimes none at all, our attention is somewhere else and often our eyes are likewise. Our clients are not stupid and they sense how present we are with them, how much we are paying attention, and it is easy to convey the feeling that in one sense they are being ignored. Our response to their questions, our comments on their affect and the content of what they are relating, our body language, and expressions all tell a tale. It is my firm belief that the worst kind of retraumatization I can commit upon my patient is to in any way ignore them by not listening with 100% of my mind, heart and attention. If I am not listening carefully, I will miss the triggers, fail to recognize the transference process and reenact traumatic responses already experienced by past abusers – it is the culmination of how to retraumatize a client.
The positive thing about all this is that NONE of it need happen!
It depends entirely on how willing we are, as committed therapists to work on our own “stuff”, with honesty and integrity, to take our concerns to a skilled supervisor and train ourselves to be constantly self-aware of how we are with our clients. It is when WE get in the way that our clients get OUT – out of the place of healing, progress, understanding and growth.
I do challenge my colleagues to test their honest integrity in self-examination from which we are so prone to run. May we remember the emotional, psychological and sometimes physical life of our clients depends on it.
May we give sober and serious thought and consideration to how we can better help those we work with that we do not add to their dilemmas and suffering by willful or unaware retraumatization.