Emotional Trauma
by Deborah M. Courtney, Ph.D., LCSW, MA
In 2006, I began studying in an MSW program, naïve to the extent of interpersonal trauma that so many people endured. My graduate school field placements were in a domestic violence agency and inpatient adolescent psychiatric unit. Both placements were invaluable experiences, providing opportunities to learn counseling skills, strengths-based treatment approaches, and diagnostic and treatment planning steps, among other things. The supervision I received also enhanced my confidence as a budding social worker.
Most of the clients who came into my office had a history of extensive trauma, including childhood sexual abuse, physical abuse, domestic violence, neglect, and exposure to violence, among other difficult experiences. No matter what diagnosis the client presented with—whether depression, generalized anxiety, post traumatic stress disorder, intermittent explosive disorder—there was a commonality of an earlier traumatic life experience.
Early in my career, I felt strongly that this wasn’t a coincidence. I needed to learn more about how trauma affects us as human beings. This article highlights a few of the major points that I have learned about trauma. I hope it is helpful to you in your work as a social worker.
The Impact of Trauma
After much reading and training, I have simply glimpsed the tip of the iceberg with regard to traumatic experiences’ impact on the brain and body. The brain has the magnificent capacity to adapt in response to stimuli to help one feel safe and survive. During a traumatic event, the brain tells the nervous system to prepare the body for defensive action. This is known as the fight, flight, or freeze response, or the fight or flight response. These defensive states lead to significant changes in the body’s baseline functioning, such as increased heart rate, respiration, blood pressure, digestion, and internal temperature control. These physiological changes are normal biological responses.
Typically, when the event is over, the nervous system will turn off the fight, flight, or freeze response, and the body will return to a typical baseline level of functioning. For instance, think about a common experience, such as driving in the car and almost rear-ending the car in front of you. In that moment, you may feel your breath stop, your heart race, and your stomach drop. This is your body’s automatic reaction to the threat of the near car accident. It is likely that, shortly thereafter, your brain will be able to make sense that the event is over and everyone is safe. Consequently, the fight, flight, or freeze response will turn off, returning your body to its baseline level of functioning.
However, sometimes the brain cannot make sense that the threatening event is over. When this happens, the brain repetitively signals the nervous system that there is danger, continuing the fight or flight response (Herman, 1992).
Continued preparation for fight or flight leads to the development of disturbing physical and psychological symptoms. Imagine that long after that near car accident, you still had an elevated heart rate and that sensation in your stomach. Sitting with those feelings and experiences for days on end would likely start to feel like intense anxiety or eventually exhaust your system and feel like depression.
Let’s apply this paradigm to the thousands of children in the foster care system who have been diagnosed with disorders like ADHD, intermittent explosive disorder, and anxiety. Many of these children have been neglected, have not had a stable or safe home, and have been exposed to other traumas, such as abuse or violence. It is likely that their fight or flight response is continually firing, which could result in symptoms that mimic the above-mentioned disorders. “Fight” can look like angry episodes and aggression, whereas “flight” can look like difficulty concentrating, inability to sit still, and worrying.
I do believe that, in some cases, such mental health disorders are organic in nature, and medication can be very helpful. However, it is imperative in the assessment process to determine whether the symptoms of a disorder are rather the manifestation of trauma responses. If so, the treatment approach changes to one of helping the client settle the nervous system and turn off the fight or flight response. It is possible for this to be done through an integration of trauma-informed techniques. In social work, it is imperative that we do not allow the diagnostic model to stand alone, but to integrate it within a life span, systems, trauma-informed perspective.
Integration of Trauma-Informed Treatment Approaches
There are many effective trauma-informed treatment approaches that I highly recommend social workers learn if working with clients who have experienced trauma. Although exploring the theories and working mechanisms of each of these treatment approaches is beyond the scope of this article, I will briefly highlight a few as reference points. In my social work practice, I have learned that an integration of these approaches is most helpful to my clients. I would encourage all social workers to get training in whatever approaches resonate with them and then to integrate them through practice wisdom in the way that is most effective for their clients.
- Eye Movement Desensitization and Reprocessing (EMDR) is a treatment that integrates CBT, Somatic Experiencing, and neurobiological research to help clients process trauma and reduce present-day triggers and symptoms. Visit http://www.emdria.org for more information.
- Trauma Focused CBT is a trauma-informed cognitive behavioral model used with children, adolescents, and their caregivers. Visit http://www.tfcbt.org for more information.
- Somatic Experiencing is a model that focuses on relieving symptoms of trauma by focusing on the client’s body sensations. Visit http://www.traumahealing.org for more information.
- Ego State Therapy is a psychodynamic approach used to resolve internal conflicts that present as a “family of selves.” Explore Dr. Sandra Paulsen’s and Dr. Jack Watkins’ collaboration on utilizing Ego State Therapy to treat trauma.
- Meditation, Breath Work, and Energy Healing are mindfulness techniques that are helpful in settling down the nervous system and turning off the fight or fight response, which is crucial to reduction of symptoms. Visit http://www.mindful.org and look up Dr. Jon Kabat-Zinn for more information.
Important Lessons Learned
Beyond the research and treatment approaches, I have learned the most important lessons about trauma from the clients I have had the privilege to work with.
First, I have learned not to assume what has been traumatic to someone. For instance, death of a loved one may be very traumatic to one client but not at all traumatic to another. Clients are their own experts, and it is my job to learn about their lives from them.
Second, holding a non-judgmental, caring, safe, and consistent space for the client is the most important aspect of healing. The relationship that can develop in such a space is where growth occurs on both ends.
Third, I learned to move away from sympathy toward empathy, from empathy toward inspiration. Clients who have experienced trauma are some of the most resilient and wise people I have ever encountered. Coming from a strengths-based, empowered approach allows clients and me together to witness their resilience and strength and make meaning of difficult life experiences in a much more powerful way.
Fourth, self-care is crucial for us to stay lovingly committed to this work. I have learned to make it a priority to personally practice all of the coping skills and self-care techniques that I teach to clients. Walking the walk is important!
Finally, I have come to learn that no one on this life journey needs fixing, as none of us are broken. We are each a beautiful mosaic of life experience, given the opportunity to heal, learn, grow, and evolve on each step of the journey.
Book Recommendations
Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. New York, NY: Basic Books.
Levine, P. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books.
van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L (Eds.). (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society, New York, NY: Guilford Press.
Deborah Courtney, Ph.D., LCSW, MA, is an assistant professor of human services at CUNY-New York City College of Technology, practices with a specialization in trauma treatment, conducts social work continuing education trainings, and is the creator of the internationally utilized board game, The EMDR Journey Game.