What things are important in trauma therapy / in the therapeutic relationship?

[Freemartin]

Hey guys, I wonder if you can give me a hand with this. I recently started trauma therapy with a new T after a not-so-successful attempt with a different T. This new one is just brilliant and I've made some decent progress already. I can see how this changing t's can make a world of difference.

So, today she asked me to contemplate on the question: what makes a good trauma therapy or a good therapeutic relationship. I guess she wants me to ponder on the theme in order for the both of us to get a clue on what I want and need from her and the process. Also, she is preparing her thesis on the subject and would welcome some insight. She knows I hang around on the forums with my extremely insightful colleagues, so I promised to raise the question here.

I know for me it's extremely important that I can trust my T to maintain control of the situation. I easily go down some really nasty rabbit holes when addressing trauma sh*t. So it feels awesome to be able to trust her to have my back. This is what I Iacked with my previous T, so I really see the difference.

Other stuff: it's immensely important that the T genuinely respects me. Not in a generic, benevolent-healthcare-professional way but as the real, f*cked-up and glorious person that I am.

So, this is what I managed to cook up. Let's hear your thoughts!

 

[Teamwork]

Before I began seeing my t, I could not of made a list, however after years of being with the same guy I can say this. He offers what I missed out on and says so. So he will let us know he’s being consistent in his attitudes, meeting times, quality of time etc. He doesn’t change just because I’m doing well or not so well. He doesn’t do my thinking for me, but let’s me know what he is wondering about so I can choose to wonder about it too or catch up to that later. He sees us as equals, something I really struggle with as I’m more apt to see myself as less than. He reminds me frequently that I’m not alone and genuinely means it without having to be there for me all the time. He has clear boundaries that are flexible. For example on his social policy blurb on his website he’s clear about no email contact to rehash sessions, prefers email to cancel an appt etc, and discourages contact by email in between sessions, but I know in my case he is flexible and answers me quite a bit in between sessions, and frequently at the end of a session says I can email him if need be. Finally, when the money from criminal injury board ran out but I was no where near ready to leave he went to pro bono. Criminal injury paid for about four years though before they said no more. So he essentially did not abandon me just because money ran out.

 

[Freemartin]

Thanks, @Teamwork!
So, to you it's important that you t is consistent and reliable.
He respects you as an equal.
He is there for you and has clear but not rigid boundaries.
He was willing to work with you pro bono and didn't abandon you.
These seem like really important things. Thanks again!

 

[bellbird]

Trust, definitely.
Transparency
Kindness
Sincerity
Empathy
Patience

:)

 

[Freemartin]

This question has proved to be quite difficult for me. I really struggle with attachment and being seen as needy. So it's a real struggle to admit that I actually want and need things from my t.

Making sense of stuff on a cognitive level often alleviates my fears, so I decided to approach this theme using window of tolerance as a starting point.

As I mentioned, I find it immensely helpful to be able to trust my t to keep things safe. She is quite skillful at keeping me in that window of tolerance, which basically means she knows what to do if I start to get hyper-/hypovigilant. With my previous t, she just sat there quietly watching me lose my shit and get retraumatized. It was up to me to regulate and come back from that rabbit hole. Which didn't work out so great.

This new t actively intervenes whenever I seem to det dysregulated. She encourages me to pay attention to my bodily reactions and asks me to describe them. She uses grounding techniques to keep me in the present moment. If I get hypovigilant, she asks me to move my limbs of stand up.

Also, and this is difficult for me, she encourages me to connect with her. She wants to activate my attachment system :)eek:), which, seemingly, downregulates the fight/flight flashback'y stuff. It actually works.

I guess there's this dimension of offering what I've previously missed out on, as Teamwork said. Which might help heal the attachment traumas... Yeah, this is complex.

So guys, does this resonate with you? Is the theme of the window of tolerance relevant in your therapy? How do your t's make processing safe for you?

ETA: cross-posted with @bellbird: Thanks! The things you mentioned seem relevant on the attachment point of view also.

 

[bellbird]

she encourages me to connect with her

Mine does this too.

If we cover something big, afterwards she'll ask me to stop and check in with her - let her know how I'm feeling, notice my surroundings.
Or if in the midst of covering something big she notices I get way overwhelmed, she'll ask me to do the same - pause, take a couple of deep breaths (she'll breathe with me), ask me to focus on something in the room; her feet for instance, if I'm looking at the floor, and to remind me that she's there with me and we are in a safe space.
Or actually before we tackle something big she'll often do the same.

She also knows that I often am (irrationally) really afraid that she will be angry/upset/disappointed in me when I talk about things from my past, so in those instances she'll ask me to take a look at her face, when I am able, and see that there is not the slightest bit of anger there.

 

[Freemartin]

she'll ask me to take a look at her face

Mine does this too. It often feels really difficult, but actually is quite a powerful grounding tool. She also asks me if I know who she is and asks me to say her name. (Y'know: "Say my name, bitch!" :hilarious:) But seriously, I can get into these states when I'm only partly there and even have difficulty knowing where I am. It's really grounding to say it aloud. Sounds weird, I know... :rolleyes:

 

[bellbird]

Sounds weird, I know...

No, I get it.
I've never said my T's name out loud in those instances. But when I wake up from a nightmare, I say out loud my full name, address and that I'm safe to try and ground myself. It has a much greater effect that just thinking it.

 

[Teamwork]

This question has proved to be quite difficult for me. I really struggle with attachment and being seen as needy. So it's a real struggle to admit that I actually want and need things from my t.

Making sense of stuff on a cognitive level often alleviates my fears, so I decided to approach this theme using window of tolerance as a starting point.

As I mentioned, I find it immensely helpful to be able to trust my t to keep things safe. She is quite skillful at keeping me in that window of tolerance, which basically means she knows what to do if I start to get hyper-/hypovigilant. With my previous t, she just sat there quietly watching me lose my shit and get retraumatized. It was up to me to regulate and come back from that rabbit hole. Which didn't work out so great.

This new t actively intervenes whenever I seem to det dysregulated. She encourages me to pay attention to my bodily reactions and asks me to describe them. She uses grounding techniques to keep me in the present moment. If I get hypovigilant, she asks me to move my limbs of stand up.

Also, and this is difficult for me, she encourages me to connect with her. She wants to activate my attachment system :)eek:), which, seemingly, downregulates the fight/flight flashback'y stuff. It actually works.

I guess there's this dimension of offering what I've previously missed out on, as Teamwork said. Which might help heal the attachment traumas... Yeah, this is complex.

So guys, does this resonate with you? Is the theme of the window of tolerance relevant in your therapy? How do your t's make processing safe for you?

ETA: cross-posted with @bellbird: Thanks! The things you mentioned seem relevant on the attachment point of view also.

Sounds the same as what my t does, he just doesn’t label it as well as you just did, but from reading this I can see it now that he does this

 

[piratelady]

When I first read this post I couldn't think of an answer. Then as I read the replies I could see a lot of what my therapist does in other people's answers.

Another thing is mine doesn't follow some strict regimented treatment plan. If I get off track or need to talk about something different we can. Also, he always asks permission to talk about trauma before we do. Even if I lead the conversation there he will stop and ask if it's ok to talk about it before we proceed.

Is the theme of the window of tolerance relevant in your therapy? How do your t's make processing safe for you?

In my appointments, he usually lets me pick the topic at the start of the session by asking me what we should talk about. After that I let him set the pace. Looking back, I can see that he changes the subject a lot if I start to get overwhelmed. The opposite is true too, he will start asking more about my feelings, stuff like that when I'm minimizing (I think that's the right word). The thing about how he does this, is he never says, "P, you're dissociating, we can't talk about this anymore let's talk about...." Instead it just feels seamless, like a conversation. I didn't even notice he did that until I tried to switch to a new therapist who just said, "You aren't stable enough for any of this..." and shifted the conversation. In that instance I felt like I failed therapy. I immediately went back to the good therapist and can see the value in his approach now.

With my good therapist, as we get towards the end of the session he always shifts to lighter, present day content and when possible we end laughing about something.

 

[Freemartin]

Also, he always asks permission to talk about trauma before we do.

Yes, this is important. I find it immensely valuable that therapists, doctors and what have you don’t just assume they have the right to tamper with any and all of our stuff. Asking permission shows respect and care.

 

[bellbird]

If I get off track or need to talk about something different we can.

With my good therapist, as we get towards the end of the session he always shifts to lighter, present day content and when possible we end laughing about something.

Yes and yes, for me too.
My T always makes sure I'm in a state where I feel able to walk back out into the world after a session.
So if we've covered something really big, she might stop me at 10 min before the end just so we have time to reground.
She also always asks me what my plans are for the rest of the day; something I've noticed my GP does too. I think it's just another way of gauging how I will be when I leave her office.