The Body Remembers

1. Trauma Therapy Requires Safety First

First and foremost: Establish safety for the client within and outside the therapy.

Safety as the Foundation. Establishing a sense of safety, both within and outside the therapy session, is the most critical foundation for effective trauma treatment. This involves ensuring the client's physical and emotional well-being, as well as creating a secure therapeutic environment where they feel protected and understood. Without safety, clients cannot effectively engage in the therapeutic process or process traumatic memories.

Practical Steps for Establishing Safety:

• Assess the client's current living situation and address any immediate safety concerns.
• Develop a clear understanding of the client's triggers and coping mechanisms.
• Establish clear boundaries and expectations for the therapeutic relationship.
• Teach clients grounding techniques to manage anxiety and dissociation.

Safety is an Ongoing Process. Creating a safe environment is not a one-time event but an ongoing process that requires constant attention and adjustment. Therapists must remain vigilant in monitoring the client's safety and be prepared to adapt their approach as needed.

2. The Therapeutic Relationship is Paramount

Develop good contact between therapist and client as a prerequisite to addressing traumatic memories or applying any techniques—even if that takes months or years.

The Relationship as a Healing Force. A strong therapeutic relationship is a powerful predictor of positive outcomes in trauma therapy. This alliance provides a safe and supportive space for clients to explore their experiences, build trust, and develop coping skills. Without a solid therapeutic relationship, clients may not feel safe enough to address the terror of their past.

Key Elements of a Therapeutic Relationship:

• Empathy and understanding
• Respect and acceptance
• Authenticity and genuineness
• Clear boundaries and expectations

Relationship Building Takes Time. Building a strong therapeutic relationship can take time, especially with clients who have a history of trauma. Therapists must be patient and willing to invest the necessary time and effort to establish a solid foundation of trust and rapport.

3. Brakes Before Accelerators: Containment is Key

Client and therapist must be confident in applying the “brake” before they use the “accelerator.”

Containment Prevents Retraumatization. Before delving into traumatic memories, it's crucial to equip clients with "brakes"—techniques for managing and containing hyperarousal. This ensures that the therapy process remains safe and prevents retraumatization. Clients who know they can stop or pull back from unpleasant memories have more courage to address them.

Examples of "Brake" Techniques:

• Grounding exercises (e.g., focusing on the senses)
• Breathing techniques
• Safe place imagery
• Body awareness exercises

Control is an Antidote to Trauma. Giving clients control over the pace and intensity of therapy is essential. This helps to counteract the out-of-control nature of traumatic events and empowers clients to take an active role in their healing.

4. Resources Mediate Trauma's Impact

Identify and build on the client’s internal and external resources.

Resources as Protective Factors. Resources act as buffers against the negative effects of trauma. These can include internal strengths like resilience and coping skills, as well as external supports like supportive relationships and community resources. Helping clients identify and cultivate their resources is crucial for promoting healing and resilience.

Types of Resources:

• Functional resources (adequate locks)
• Physical resources (strength or coordination)
• Psychological resources (sense of humor)
• Interpersonal resources (friendships, family)
• Spiritual resources (belief systems)

Resource Building is Essential. For clients with limited resources, building these from scratch may be a primary focus of therapy. This can involve teaching new coping skills, connecting clients with supportive networks, and fostering a sense of hope and self-efficacy.

5. Defenses are Coping Strategies, Not Obstacles

Regard defenses as resources. Never “get rid of” coping strategies/defenses; instead, create more choices.

Defenses as Adaptive Mechanisms. Defense mechanisms are strategies for dealing with adversity. They are like old, dependable friends, helping us to deal with stress and getting us through hard times. The problem with them is that they tend to be one-sided, allowing only one choice for action.

Creating Additional Choices:

• Instead of eliminating defenses, help clients develop more adaptive coping strategies.
• Encourage clients to recognize the situations where their defenses are helpful.
• Help clients to expand their repertoire of responses to stress.

Defense mechanisms are strategies for dealing with adversity. They are like old, dependable friends, helping us to deal with stress and getting us through hard times. The problem with them is that they tend to be one-sided, allowing only one choice for action.

6. Reduce Pressure, Don't Increase It

View the trauma system as a “pressure cooker.” Always work to reduce—never to increase—the pressure.

Provocation is Counterproductive. Confrontational or provocative interventions can be detrimental to clients with PTSD. These individuals are already at the edge of how much they can handle. To further provoke a PTSD client’s fragile system through confrontation or provocative interventions can further damage her; the possibility for retraumatization when using such interventions is great.

Strategies for Reducing Pressure:

• Focus on containment and stabilization.
• Avoid pushing clients beyond their comfort zone.
• Prioritize resource building and coping skills.

A Gradual Approach is Best. A slow, gentle approach that gradually reduces pressure while increasing resources is more likely to lead to positive outcomes. This allows clients to open up their fragile systems without experiencing an explosion or decompensation.

7. Adapt Therapy to the Client, Not Vice Versa

Adapt the therapy to the client, rather than expecting the client to adapt to the therapy. This requires that the therapist be familiar with several theory and treatment models.

One Size Does Not Fit All. Trauma therapists should be well-versed in a variety of theoretical models and treatment approaches. This allows them to tailor their interventions to the specific needs and preferences of each client.

The Risks of a Single Approach:

• Clients may feel like they don't fit the therapy.
• Therapists may miss important cues or fail to address underlying issues.
• Clients may experience additional harm through feelings of helplessness and failure.

A Multidimensional Approach is Key. By drawing on a range of theories and techniques, therapists can create a more flexible and responsive treatment plan that is tailored to the individual client's unique circumstances.

8. Theory Informs Technique, Enhances Intuition

Have a broad knowledge of theory—both psychology and physiology of trauma and PTSD. This reduces errors and allows the therapist to create techniques tailored to a particular client’s needs.

Knowledge is Power. A deep understanding of the psychology and physiology of trauma empowers therapists to make informed decisions about treatment. This knowledge reduces the risk of errors and allows therapists to create techniques that are specifically tailored to the client's needs.

The Importance of a Broad Theoretical Base:

• Reduces reliance on rigid protocols.
• Enhances the therapist's ability to adapt to unexpected situations.
• Allows for the creation of innovative and effective interventions.

Theory as a Foundation for Intuition. A strong theoretical foundation can also enhance the therapist's intuition, allowing them to make more accurate assessments and develop more effective treatment plans.

9. Individual Differences Demand Respect

Regard the client with his/her individual differences, and do not judge for noncompliance or for the failure of an intervention. Never expect one intervention to have the same result with two clients.

Avoid Blaming the Client. When an intervention fails, it's important to avoid blaming the client or attributing the failure to "resistance" or "secondary gain." Instead, therapists should assume that the chosen method was not the right fit for that particular individual.

Respecting Individual Differences:

• Recognize that no two people are alike.
• Avoid making assumptions about what will work for a client based on past experiences.
• Be open to trying different approaches until the right fit is found.

The Importance of Flexibility. Therapists must be flexible and willing to adapt their approach based on the client's individual needs and responses. This requires a willingness to let go of preconceived notions and embrace the unexpected.

10. Presence Over Protocol: The Power of Just Being There

The therapist must be prepared at times—or even for a whole course of therapy—to put aside any and all techniques and just talk with the client.

Human Connection as a Healing Force. Sometimes, the most effective intervention is simply to be present with the client, offering empathy, support, and understanding. This can be particularly important when clients are overwhelmed or struggling to connect with their emotions.

The Limitations of Technique:

• Over-reliance on technique can create a distance between therapist and client.
• Technique can sometimes overshadow the client's individual needs and experiences.
• Clients may feel like they are being treated as a case study rather than a person.

The Value of Simple Human Contact. For some clients, the best therapy is simply simple, unadulterated, human contact. This can involve listening, validating, and offering a sense of connection and support.

11. Body Remembers: Integrating Somatic Awareness

The body also remembers traumatic events. Body sensations that constitute emotions (e.g., terror) and physical states (e.g., pain or ANS arousal) and the patterns that make up movements (e.g., fight, flight, freeze) are all recorded in the brain.

The Body as a Repository of Trauma. Traumatic experiences are not just stored in the mind but also in the body. This can manifest as physical sensations, muscle tension, and altered autonomic nervous system responses. Integrating somatic awareness into trauma therapy can help clients to access and process these embodied memories.

Techniques for Integrating Somatic Awareness:

• Body scans
• Mindfulness exercises
• Movement therapy
• Somatic Experiencing

The Importance of Safety. When working with somatic memories, it's crucial to proceed slowly and carefully, ensuring that the client feels safe and in control. This can involve teaching grounding techniques and establishing clear boundaries.

12. The Goal: Integration and Resolution

Integration and resolution of traumatic experiences in both mind and body is the goal of trauma therapy.

Integration as the Ultimate Aim. The ultimate goal of trauma therapy is to help clients integrate their traumatic experiences into their sense of self. This involves processing the emotional, cognitive, and somatic aspects of the trauma, and creating a cohesive narrative that makes sense of what happened.

Resolution as a Process, Not an Event. Resolution is not a one-time event but an ongoing process that unfolds over time. It involves learning to live with the memories of trauma without being overwhelmed by them, and developing a sense of hope and possibility for the future.

A Holistic Approach is Key. Achieving integration and resolution requires a holistic approach that addresses the client's mind, body, and spirit. This can involve a combination of therapeutic techniques, lifestyle changes, and supportive relationships.

Last updated: February 27, 2025