Traumatization and Psychotherapy

I've thought twice and three times about whether to put this on the Web. The likelihood of getting more out of it than what I risk may be disproportionate, but as they say, "Fortune favors the bold." As I say, I've met too many fearful and hesitant therapists to want to join the ranks of the fearful and avoidant.

In considering what this new virtual web forum may provide, I keep coming back to traumatization as a topic because it is so important, so complex, and so misunderstood. One psychologist that I asked estimated that only approximately 1 in 7 working therapists were familiar, competent, and prepared to handle traumatization. I can say that less than that many students in my masters program were prepared--myself among them. (In case this seems like only criticism on my part, the field is moving in a number of hopeful directions concerning trauma recovery.) And the majority of folks I've met who have seen therapists for trauma recovery have been sorely disappointed.

Now, this is partially because of where I've been and who I've met. I believe there are some (1 in 7 or so) who are doing a better job than the field in general. But I also believe that the field in general needs to do a better job in communicating how to prepare future therapists as well as doing a better job in preparing clients to face the full-on impact of traumatization. Here's my question: is psychotherapy the best milieu for dealing with trauma recovery? Think about this. I don't know that the answer already exists. A parallel question exists for me: what is psychotherapy in different forms best at?

Having trained in a well-respected graduate program, and (I believe) having done fairly well in that program, I found my preparation wanting and the state of the field unsatisfactory. What I found most odd is the nature of terror and the avoidance of terror.

With the types of traumatization that are caused by long-term or chronic influences, we may be more likely to end up dealing with what is currently diagnosed as "personality disorders". But with shock trauma, our willingness to face being overwhelmed is very important, it's scary, and it's hard to get a handle on without the right approaches. I believe that Peter Levine's (author of WAKING THE TIGER) insistence that trauma is primarily physical is correct, at least concerning shock trauma. If this is so, part of psychologists' avoidance and fear of trauma may involve the basic fact (if this is a basic fact) that traumatization is not primarily psychological. It may simply lie outside their current area of expertise.

But I seriously wonder about terror as an avoided or hidden or deprioritized aspect of traumatization and recovery. Having worked with states of oneness consciousness that are not normally included in graduate school education, I feel pretty safe to wonder about terror. My experience is that there are many states that are overwhelming, but I've survived all of them so far and benefited from most of them--as unsettling as they might have been at the time. I wonder how much of trauma recovery is either intentionally or unintentionally centered around a client's willingness to face terror. Now, this is never easy to do, and it's not a popular topic of conversation, but it seems like good trauma therapy involves building the psychological tools it takes to find this willingness and skillfully--not brashly--"go into the breach".

Too many people just try to jump right in, feel pushed in, or try to avoid it altogether. Interestingly enough, the path taken by graduate students often mirrors that brash, jump-in-with-both-feet, approach. If this were a recipe for failure, I think you'd bake an award-winning cake every time. Unfortunately, more is on the line than cakes and awards. Prospective therapists end up going through similar experiences (of being overwhelmed) as their unprepared clients do through a phenomenon called "emotional contagion". Unskilled students--who usually receive almost no direct training in trauma per se--find themselves immersed in various situations where they are often dealing with the most extreme client cases in the field. This occurs partially because the better-trained and more experienced folks move themselves into more comfortable positions.

Now, it makes sense to me to move into better positions as your career advances, but it does not make sense to me to avoid the centrality of traumatization in therapy. It seems to me that a little more transparency and group effort may be called for and eventually effective. Part of the difficulty lies in the nature of trauma and that of research. It is impossible to run genuine experiments involving trauma because you might actually lose "subjects" to suicide or just to horrible experiences if your experimental method is not all that successful. So we can't fully apply the scientific paradigm.

But it seems to me that a focus on the pathological aspects may remain largely because it has been difficult to collect the wisdom and understanding of those who are resilient, of those who have faced potentially traumatizing situations well, those who have come through perhaps a little weathered but feeling whole.

There is a constant underground dialogue going on concerning what has worked for whom and what does not work. I wonder: what is the best situation for addressing traumatization, what needs to be included? How do people face adverse situations without being traumatized? Is the willingness to face terror actually central? What needs to be known about emotional contagion before our preparatory programs actually prepare students to face trauma and succeed--rather than just preparing them to face trauma? Is it possible for the public to provide more complete answers sometimes when the academy must focus on specifics?