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Trauma Survivors Share Tips for Therapists Dealing with Trauma

Dear Friends:

Here are some tips and suggestions for helping trauma survivors from the survivors themselves. They've been reviewed by a seasoned therapist and she believes they would be very useful for other therapists and especially for student interns. I hope you will feel the same way.
Offer true validation - my therapist was the first person ever to offer me that.
I think that new therapists should consider treating each client as an individual with their own unique experiences and challenges. Don't treat someone like they are a diagnosis to be "fixed."
Be open to different approaches. My therapists have used sandboxes, and DBT along with CBT.
I initiated the artwork to express what I could not put in words.
Treat the client where they are in the recovery. Take clues from client on how hard to push. Be very aware of bodily clues and the various senses related to the trauma. Shame is a very powerful emotion. Validate, validate, validate whenever possible.
We cannot pull someone from where they are to where we think they need to be. Proceed gently and honor the individual for who they are and what they have been through.
A tip would be to treat me as a partner in my own healing...that I have something to teach you too.
Active listening- you know that thing we were all taught in counseling methods 101? Please use it. Clients can tell when you are sitting there just thinking up what you want to say and waiting on them to shut up. This is a LEARNED and PRACTICED skill that newbies often need time to polish- and a teensy internship is usually not enough. I had to learn it on the run too- I get it- I am just saying if you want your clients to feel you are "there in the RIGHT THERE" with them and not ignoring them while you dream up your next retort or what you will do about dinner tonight, Please master the open book look of active listening.
I personally wasn't able to fully invest my trust and give up 'control' until I was able to relate to my therapist. I'd been to ones before and they were good but we didn't click. When I found out two personal things we had in common and saw how healed she had become by trusting the process I caved. Relatedness, expertise, and grace won me over. Oh and calling me back within 24hrs or making sure I rescheduled a missed appt kept me going once the alliance was built.
I think therapists should have a library of books to check out - I know it is an added thing to do, but, it costs a fortune to read all books that come recommended.
I strongly agree that it's important to be treated as a partner and to be validated, since we're the experts on our own experience. But people (not just therapists) often don't recognize when they are doing something that is disempowering or invalidating. So, I would say it's important that a therapist a) not assume that there is one path, one right model/theory, to heal from trauma (no matter how exciting that cutting edge or old school model/theory may be), and b) not get too invested in the image of her/himself as a healer or a guide. A therapist is a co-researcher. Ultimately, we heal ourselves, find our own paths. So, when we're lost in the middle of our ugly, scary forests, it's not helpful for a therapist to just stand outside of it, at a safe distance, and (metaphorically speaking) yell, "This way!" because that may not be the direction we need to take. I think good therapists are willing to stand with us in that forest and witness our experience. They provide a second pair of eyes on the situation, teach navigation skills, and accept that progress will most likely be made using a hybrid of our perceptions/skills and theirs.
Something I hate as a former counselor (I am retired), is when my therapist keeps saying: you know what to do...I do not or I would have done it and I would not be paying you big bucks an hour to help me. Counseling others is one thing- but one cannot counsel one's self in the mirror. Especially when you have PTSD. I had a panic attack last night when someone knocked on my door. It lasted 45 mins. I am seriously considering making a sign for my door that says: PTSD patient within. DO NOT KNOCK.
I had a perfect therapist. One thing I loved about her is that she shared she was also a trauma victim. And she was not afraid to tell me she cared about me. She'd often hug me as I left her office and say I love you. She was always professional but she thought it was ok to really care. I felt like I was visiting a caring, wise grandmother when I went to see her.
I'd say, point out every tiny achievement/ step forward. My therapist does this. We chat about ways I've progressed regularly. It helps give me confidence when I feel like I'm drowning.
I would suggest to those working with abuse survivors and/or those with PTSD to take into account words by William Butler Yeats, "Tread softly because you tread on my dreams," but I would expand that into saying you tread on our hurts and vulnerabilities. We are strong in that we survived and delicate when it comes to memories. Take the time to get to know us... the uninjured parts, our strengths, joys, goals, wants and dislikes. When we know that you are truly interested in us as a whole individual and not just our damaged spots we will be more likely to share with you our tender areas, hurts, abuses, and traumas. Tread softly please.
Clients that miss an appointment without notice are not necessarily irresponsible or blowing you off. It is possible their memory has been affected by their condition. Compassion may be expressed by offering ideas that will help them remember and the suggestions should be
life-style appropriate. I purchased a bulletin board for post-its and haven't missed an appointment yet.
Help us find the appropriate words to express our thoughts and feelings. My therapist started my treatment off by giving me a list of sensation words and had me identify what that sensation meant to me. This ensured we understood one another and avoided frustrations.
Remember that research studies, treatment models, and approaches are based on statistical significance? but just because at least 51% of society has been proven responsive to a particular method does not mean it is okay to force such methods on the rest of the 49%.
I would tell them how important it is to get supervision either in a peer group or 1:1. It doesn't matter how many years a person has been a therapist, supervision is necessary to help prevent burnout and to work through counter-transference issues.
I think that human connection is key to any therapy. A therapist that does not relate to us on a human level can't, in my opinion be effective. I told mine I don't need to hear her problems but need to know that she is a human being and not an infallible super-being.
As someone who went into therapy not even knowing that I was struggling with CPTSD, just thinking that I was a really bad person, my therapist actually talking to me about the diagnosis and naming it, was huge. She gave me the jumping off point to start learning and understanding. Up until that point, I can honestly say that I had no idea that this is what was happening for me - I just thought I was weird and couldn't control my emotions. So that validation was important. The other thing was that I didn't get re-traumatized by my therapist or the therapy. She helped me pace my learning. The other thing for me was that my therapist shared some of her own human side, hugged me on leaving the office and made me feel cared for.
I did have to fire a therapist who consistently spent half the hour chatting about HERSELF. Not good. I was not there to treat HER.
Do your own work first. I can't tell you how many therapists I saw who needed therapy themselves. Clean out your own junk so it doesn't get in the way of your being an open channel to receive knowledge of what your client needs, and to be a mirror for them to see their own stuff without seeing yours.
I find it hard to put into words the qualities that make a great guide through the aftermath ... but when I think of my 'great sustainers', I think: Steady ~ presence ~ solid as an oak ~ quietude / calmness; unafraid of emotion ~ clinical smarts and excellence, and willingness to provide information re: professional background ~ relational integrity ~ the courage to listen ~ solid ethics ~ doing their own inner work and receiving supervision / collegial support no matter how long in practice ~ moderation in approach ~ being willing to 'go there', wherever 'there' is ~ respectful curiosity; active engagement ~ safety of all kinds in practice is paramount: tend to safety needs first ~ being a living example of what is possible, and being willing to share one's own experience where appropriate ~ be willing to acknowledge one's own limitations in expertise / clinical knowledge, and be willing to refer on if needed (Know and respect your own boundaries!!) ~ Pacing of the work: slow, gentle, and responsive ~ Willingness to work with the whole person ~ Self-care and apropos containment of one's own 'stuff' ~ provide a space that is quiet in setting, color, furnishings, etc. (sensory overwhelm is the norm with trauma) ~ provide water to drink ~ clarity and simplicity in language, direction, pacing, etc. ~ Enter another's experience / story only when and where you are invited in ~ Primary focus: on the present moment, present experience, and the whole person; small, moderate steps; lots of 'checking in' (i.e., "What's happening right now?"); allow pauses, gentle reminders to breathe; offer simple practices of sensory grounding in the present moment, and persist in the modeling and practicing of same (so important in re: dissociation) ... much of the work is about feeling safe enough to be present ~ A genuine "We're in this together" approach ~ A willingness to trust and accept experiential expertise of survivors ~ Be ready, always ready, for moments of epiphany, and mark them as vital milestones in the journey.
I expect my therapist to be healthy, to be able to have healthy relationships as I'm counting on him to help me see how I relate to others, which is largely based on very unhealthy relationships that I was initiated into life with, and to be there for me to work through all the ways that I need to in order to be able to truly connect with another person in a good, healthy way. I hope it works... , still a long way to go...and my therapist will comfort me by assuring me that he's not going anywhere for at least 25 years and he genuinely cares without making me feel "dependent" on that only, he doesn't try to save me.
When I bring you information in writing and ask you to read it first, please show me the respect of reading it first. I've spent a lot of time analyzing my condition and am trying to give you the clearest, most well-thought-out understanding of my situation as possible. I have trouble with transitions and going from "I don't know you" to laying all my problems out on the table right away is moving too fast for me – it's like "going from 0 to 60 in 2.5 seconds." Conversation is difficult for me – I get overwhelmed when people ask a lot of questions and I'm so busy trying to answer questions that I can't think straight – what I'm trying to tell you gets jumbled up in my head and I can't get it out straight. When a new therapist refuses to read my written info I get a sinking feeling in my heart right away.

When I express loss, please do not respond in an offhand way or make a joke until you know me really well and know I'll find it funny. I understand that it is hard (and boring) to listen to traumatized /depressed people talk about loss but I'm trying to trust you enough to tell you how I'm really feeling. When a new therapist acts uncomfortable when I talk about loss I get a sinking feeling in my heart right away.

Please don't say "you need to..." when you're making suggestions. It comes across like you think you're my boss - you're not. I need you to be my trusted advisor, guide and partner in healing. I've had a lot of problems with heartless bosses so when it sounds like you think you are in authority over me I get a sinking feeling in my heart right away.
If you would like to offer your suggestions please send an email to

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Article Index:

Addiction | Adoption | Auto Accidents | Chaplains, Police, EMT | Childhood & Adult Sexual Victimization | Compassion Fatigue
Culture, Race, and Ethnicity | Domestic Violence and Sexual Assault | Grief | Journalists, Survivors, and the Media
Male Sexual Abuse & Domestic Violence | Partners & Families | PTSD Treatment & Recovery | PTSD and Health
PTSD and Workplace Issues | Recovery & Self Help | Resiliency | School Disasters
Spirituality & Trauma | Survivor Guilt | Trauma Responses in the Aftermath of Disasters | Veterans & Their Families

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Page created on 5 November 2012
Last updated by on 15 May 2019