 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to this next episode of The Therapy Show with myself Jackie Jones and the wonderful Bob Cook and we're going to be talking about the Traumatised Client in this week's episode. Yes we are and I think the last podcast was also about trauma but it was more specifically dealing with the trauma of sexual abuse. I do want to talk more, perhaps spread it out into a more generalised area of traumatisation. So that's what this podcast is going to be about and also specific techniques for dealing with trauma is other things I want to talk about. So if we're talking about trauma I thought well I'll go and find out and Google what they talk about in trauma and they brought it really when I put trauma in they came up with eight things which is number one give yourself time to talk about things. Number two find out what happened. Number three get support with other survivors well I prefer the word thrivers and survivors but anyway take some time out for yourself talk it over with people get into a routine and do some normal they're not normal but normal things with other people. So those all might be coping mechanisms but I want to talk about the therapeutic approach to trauma and the therapeutic approach to trauma is to go go into the trauma and look at how the past affects trauma and at the moment as I'm talking to you we are in what we call I would call a humanitarian crisis in Afghanistan what's happened there and we we can see the refugees coming from Afghanistan and we can start looking at the trauma that they will have been through and of course if we even go out further and I know you know a bit about this the armed forces people come back from many places where there's been huge trauma and so far from post-traumatic stress and I like to talk a bit about that but trauma if we look at what trauma is trauma can be an injury to the psyche can be an injury to the body and injury to the mind and an invasion of the very soul and often takes harbour in parts of the psyche and goes into hiding so people can survive and then get triggered by things that can happen in the present in relationships loud noises changes in the environment and then the emotions and the trauma comes out the person feels overwhelmed and can't function very well and then they go to a therapist or they might go to the doctor and medication to try and you know shut that door where the trauma is unfortunately the trauma a bit like pressure cooker has to find its way out and then you get flashbacks and then they go back to the doctor again so the question is if somebody comes to therapy from a traumatised place talks about their palpitations have anxiety they have fear they feel stressed they get flashbacks cognitive or emotional that means they can't function and they come to the therapist all those symptoms what does the therapist do with the first step is to help the person talk about their story now you might be in a difficult place because they might say well I don't know at the story what they mean by that is to deal with the trauma they've created layers of survival techniques such as dissociation splitting up parts of the trauma where they actually don't remember the trauma or find it very hard to have any cognitive expression of trauma yeah it doesn't mean that they don't know it means they're not allowing it means that they're not allowing themselves to know yeah and those those are two different things yeah not allowing yourself to know is the it's a way of coping and surviving against the trauma yeah so I said again not allowing yourself to know doesn't mean that you're not traumatised it means that you're helping yourself survive against knowing about the real trauma yeah now there are many techniques to get to those memories to get to those parts of the self which have been cut off through dissociation or splitting of the self so the person can survive and you know if we go back many many years ago about when I came to therapy you know myself and started to train as a therapist one of the major ways of doing with trauma back then was what was called debriefing yes now I know you know a little bit about this because the connection work with people the armed forces but if you go back in time and still maybe now debriefing is one of the management techniques of helping person deal with trauma now what is debriefing debriefing in many ways is helping the person repetitively specifically going over what they can remember yeah so they say it same thing over and over and over and over and over again so if that's so for example if they are let's take the armed force somebody's come back from say could be any ward tour place but and they've been in say you know an armed truck which blew up or something so you would take them to what they can remember and start there and get them cognitively go over what they can remember and gradually as you do that specifically and they start to debrief they start to remember more and more and more or if they can't remember more and more and more that technique may lead them to emotions the idea is to get the story and to get the connections between thinking and feeling so the person has a sense of understanding the whole yeah and that was called debriefing is that how you understand debriefing yes yeah yeah when you were speaking I was thinking I don't know whether things have changed you know recently around sort of mental health first aid and you know like in America if they've had a shooting in a school or whatever then there's like batches of counsellors and psychotherapists go in kind of within 24 48 hours yeah to to allow them to do that and I was just thinking is that so that the separation stuff doesn't kind of set in as a protection mechanism if if they're talking the the kind of yeah in their consciousness yeah yes yes yes so what the armed forces wasn't very good doing let's say the army but I'm going to say armed forces here a person to the tour of Ireland and the island in my day was when a lot of the trauma was and that come back and the army might say right let's do three weeks of debriefing or whatever ever time but compression no boss whoa see shows my age but they didn't do it very quickly and they didn't do it long enough no and that was the problem but you are right you are correct we've moved on and you get all the things you've just talked about there with the purpose of enabling the person very quickly to cathartically talk about their thoughts and feelings yeah yeah yeah yes and to teach them sort of emotional first aid yeah it's kind of like with a Manchester bombing attack you know what I mean there was there was that much put in place quite early on as in what annoys me most is that somebody comes out of say that one of those bombings that you talked about and then a reporter says well what were you feeling no they have no ability to know to be able to process so what they do often in an attempt to ask that space to the question is to go to a cognitive answer to that question and they appear dissociated zombies but in fact they're attempting to cope with what was unimaginable yes yeah so when these people do flood in from the emerging services they will have been hopefully taught to will say decompress or debrief and whatever he was but it's to help them really connect the different parts of themselves which they've disconnected to survive yeah yeah and I think that survival part of it is really important that they're doing what they need to do in that moment to survive yeah so another take a more modern technique which is used is EMDR yes yeah so I thought you know and not an expert on EMDR but it means eye movement desensitization and reprocessing yeah yeah so that's a modern much more modern technique for dealing with trauma and to help the person um through looking at the rapid movement of their um their process of their their eyes if you want to look at that way but it's the same thing it's helping the person get to um be able to process the the disconnections between thinking feeling behavior through the eyes yeah so EMDR is taught uh very extensively and very successfully I think as a way in to helping the person deal with trauma yeah and for me you know any anything we're not 2D you know beings we are 3D and some things work for some people and other things don't and you know for me I think any any tools that we can have in our toolbox that are going to aid the client is brilliant I I love transactional analysis but I'm not precious about it's the only thing that's going to work some people need different techniques some people need different methods yeah because if if we think about it this way that for person psychologically to deal with trauma what happens instinctively is that they cut off from that trauma yeah to survive yeah but the cost of that is that they give away spontaneity they give away part of themselves yeah and they shut off the trauma and spend a lot of energy shutting off the trauma yeah and keeping it short yeah maintaining it that that's right whether it's EMDR whether it's debriefing whether it's hypnotic induction yeah any of these techniques we talk about they're all the same in the the end result is always going to be the same to help the person make connections with parts of the self that they've split off with to enable themselves to cope with dealing with the trauma yeah so yes you're absolutely correct how we get there is going to be different with the many individuals but the end goal is to help them become whole yeah to process the trauma and to do that you've got to get to the part get to enable the person to get to the parts of the self which they've split off yes yeah and that will take time one of the real lessons I learned in dealing with people with trauma ties and it was a big lesson for me is that I went I used to go far too quickly in the early days and the problem with that is that the person then can easily get overwhelmed and go underground and split off even further and you may never know it yeah yes yeah so it needs to be really slow steps with debriefing you would spend many many many many sessions going specifically over things in a very repetitive way to hopefully get to different or get alongside different layers a bit like peeling an onion yes in the next layer yeah EMDR same thing have not a conduction the same thing and then eventually of course helping them attempt to understand the uns and understandable which is a really strong process and you know sometimes uh in you know you have to move to what I would call spiritual to bring a spiritual part into this because some things are not explainable yeah yeah and that can be quite difficult for some clients very yeah yeah right however I do believe I've not come across a person that if you change the language as a therapist you can get to the inner inner part of yourself the higher being we could change languages yeah yeah that's the important thing yeah there isn't a client that I haven't met a client who hasn't believed or hasn't has a sense a part of themselves which is external to themselves in other words you know it doesn't have to be a higher being it could be in a part of the self it could be in a child it could but we can find many different languages yeah yeah now and again that comes with knowing the client the language to use that's that's going to resonate for them yeah yes but yes yes and if you are washed into do uh trauma what people like of the Manchester Boeing we'll just talk about moment or the what you just took about mouths and a mug whatever they might ask that question they might say do you have do you have a belief in God yeah in an attempt to find a way of meeting the client because some things are unexplainable yeah without a spiritual connection in some way yeah and often you know with trauma do you think that that's what people are looking for an answer when you say we can't explain I think most people I've ever met so I suppose I'm saying 100% but I would say definitely most people I've met they need not so much an answer Jackie but a way of understanding what's happened to them yeah yeah and I think we yes I think it's a way of understanding and if we can't get to that place that is where we may move to some aspect of a higher self or a spiritual understanding or inner self or whatever language you want to use in an attempt to help the thriver survivor understand what was ununderstandable yeah yeah one of the things I talk with clients about not necessarily around trauma but often is that you know I were I were brain or I were mind needs to make connections and I think that's part of if it can't hang it on something or connect it to something we kind of flounder so having that spiritual you know bigger than us what's the point type of conversation can be quite helpful very helpful yeah now to get there you have to go through the trauma first to get there but down the line yes yeah yeah and in a way from the beginning most clients I've ever seen are really talking about trauma of one form or another yeah I used you know for a very very very very long time and as a therapist I used to believe old trauma was a bit like poison in other words you can take a beaker of poison or drop poison and it's still trauma however I have come to recognise that some trauma is so huge unimaginable that it takes a different level of processing yeah but if we just take the most class you ever see you'll be dealing with trauma you know I've had an assessment today with somebody who's from the beginning the end was just talking about loss and trauma you know dad had died two years ago and you know we could go on on more clients you see will really be talking about some form of trauma loss or change yeah how we deal with it number one place of course is listening yes yeah yeah and then we start to help them look at what they've given up to cope and usually what they've given up to cope is they split off part of themselves yeah and that's what makes perfect sense why you would do that well to survive yeah absolutely but you know clients that from my experience you know why would I why why would I do that and to try and you know again it's not the the guilt and the blame and the shame and everything it's it's like you did that so you would survive but now in the here and now there's a better way of you to manage by connecting with that split off part and integrating and moving forward that way but it's done its thing because you're still here where you're going to come across usually first is denial yeah and the best way to deal with denial is to listen to their story yeah which again can take a long time yeah timing is the key yeah as a psychotherapist you can't teach timing actually I don't believe you can you can you can talk about timing I've been trained to be I've been training therapists for a very very long time and I've been talking about timing for 30 years but until class starts sorry until third we start to see clients I don't think they really fully appreciate what I've ever been talking about yeah it's like when you learn how to drive you can be taught the mechanics but getting in a car and actually driving is a whole different ball game so it 100% agree yeah timing is something which you learn by experience with trauma it is essential to learn you know about the importance of when to say things and when to listen and when not to say things yeah and I suppose maybe if there are any people listening here that are trainees or you know early on in in the therapy career it's about you know being confident in knowing where your limits are and not taking on certain clients in the early days you know that 80-20 rule of you know well you can only take on class I think that you've been trained to deal with yeah and you know one tip would be to shut up if you can't think about what to say in other words to listen listen listen listen and to inquire inquire but certainly with this if you feel out of your depth people then I think you need to refer on the whole aspect of training so we're dealing therapists will deal with trauma every day yes every client they ever see they are dealing with different levels of trauma yeah yeah and I like that analogy that you said about you know that you can take a lot of poison or a little bit of poison still trauma it's still trauma yeah yeah and everybody has a different capacity to you know to overcome things well you see that's another story oh I thought you were going to talk about the how the therapist protects themselves from taking the vicarious trauma on which is perhaps another podcast but you meant something very different from that yeah but that that is a really valid point you know again well something I wrote down when you were talking right at the very beginning of this was you know trauma can be a person going through a trauma or the observer if somebody's observed a trauma that also is you know worth looking at as well very traumatic I remember one of the most traumatic one of the most traumatic times in my life was when I found the found the body of somebody I knew and had known for many years kill yourself yeah and I found the body and that was one of the most traumatic times in my life so you know therapists need to take themselves through therapists in other words well I mean if they feel vicarious trauma or there's some sort of triggers to their own traumatic history they need to go into their own therapy yeah yeah 100 yeah and that's a really really important thing perhaps another podcast is how therapists protect themselves from you know vicarious trauma yeah I think it is a really good topic for a podcast so you can put that on the list I'm putting it because we've run out with the list now Bob we don't have anything left on the list we don't meet me whiteboards empty we have nothing left on the list now oh well I'm going to give you a few more but how are we getting on with trauma is there anything else to I think I think that's I think we've covered over the the last two podcasts I think we've covered lots of things and I think it's a nice place to end you know what do we do to protect ourselves I think we're talking a lot about the clients but as far as the therapist working with because we've done narcissistic borderline you know we've gone through an awful lot of clients now maybe we can turn it around and look on on the table I did not come out on the list but I can think of many more you know one of the areas which I think that you know a lot about and Steph knows a lot about and she said she's quite happy that's my wife could do another podcast was working with children yeah yeah that's how about making that the next one maybe that is a good one because you know with the 18 months two years that we've had I think it's impacted an awful lot on our younger generation yeah yeah and what about eating disorders yes let's make those the next two okay Steph says she'd quite happily do the child one yeah if you'd have her on again of course I would she's welcome anytime and then I can happily talk about I don't happily but I can certainly talk about what how we work with eating disorders for my frame of reference okay so those are the next two topics for the listeners we'll do we'll do working with children and then eating disorder yeah okay thank you so much again Bob you're welcome wealth of information seriously I learned something new every time we talk so I want to say thank you for that bye so thank you okay speak to you soon speak to you soon bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode