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Counsellors provide a vital service. In the UK alone, one adult in eight (12.1%) receives mental health treatment, with 10.4% receiving medication and 3% receiving psychological therapy. Some of the most important and rewarding work that counsellors undertake is with trauma survivors. Trauma can leave deep emotional scars, and counselling plays a pivotal role in helping survivors process their experiences and regain control over their lives.
A therapist who is trained in how to work with trauma survivors will be able to offer the best techniques to process and evaluate thoughts and feelings about the trauma. Some counsellors specialise in working with trauma survivors, whilst others will apply more generalised therapeutic techniques to trauma management. But it is important that all counsellors who work with trauma survivors are appropriately trained to do so.
This article aims to provide insights into the therapeutic approaches and techniques that can aid counsellors in supporting trauma survivors on their journey to healing and recovery. Here’s what you need to know:
Introduction to Counselling Trauma Survivors and the Importance of Specialised Techniques
Trauma is both hard and easy to define: Easy because trauma is described as a deeply distressing or disturbing experience and hard because what might seem traumatic to one person will not be traumatic to another. Examples of traumatic events may include natural calamities, accidents, and abuse. In the same way that different people will perceive trauma differently, not every person will react to a traumatic event the same way. For this reason, there are many trauma therapy techniques available to support trauma survivors.
From a counsellor’s perspective, counselling trauma survivors poses its own unique challenges and responsibilities. For example, listening to your client share details of particularly traumatic experiences can be emotionally draining for the counsellor and can even lead to post-traumatic stress disorder in counsellors who are not properly trained and fully prepared for the level of trauma that they might face. This is a phenomenon known as vicarious trauma. Counsellors are also responsible for protecting their clients from re-traumatisation during treatment, meaning that they must walk a very fine and often difficult line during their sessions.
For this reason, it is important that counsellors are fully qualified and have received specialist training to address trauma effectively before they are able to work with trauma survivors. According to the British Association of Counsellors and Psychotherapists, research suggests that Cognitive Behavioural Therapy (CBT), can be the most effective approach to trauma counselling, though there are other effective techniques that you could choose to adopt too.
The focus of this piece is to explore the best counselling strategies to adopt for trauma survivors. This will exclude examinations of different counselling techniques, advice on understanding trauma and its effects, and how counsellors caring for trauma survivors can also practise self-care.
Understanding Trauma and its Effects
Trauma can take different forms. Patients may present with acute, chronic, or complex trauma. Acute trauma is a single traumatic event, such as a car crash. Chronic trauma is prolonged or repeated traumatic incidents, such as combat or domestic abuse. Complex trauma is a combination of both acute and chronic trauma. People who present with complex trauma have often experienced trauma from their childhood, but they may have been triggered to seek therapy by more recent events.
In conjunction with having undergone a traumatic experience, or series of traumatic experiences, there are also psychological and physiological effects of trauma that can help counsellors to identify trauma survivors. Some of the most common signs and symptoms of trauma include:
- Being jumpy and on edge. trauma survivors are often easily startled and looking out for danger. They are concerned that something bad could happen at any moment.
- Disordered sleeping. Nightmares, night waking, and difficulty sleeping often characterise trauma.
- Intrusive memories. It is hard to forget the traumatic event, and memories of it often recur when you don’t want them to. These can be triggered unexpectedly and are difficult to control.
- Feeling overwhelmed. By intense feelings and bodily sensations that you feel you cannot handle.
- Feelings of guilt and shame. Trauma survivors often feel that what happened to them was their fault, they may also feel survivor’s
- Physical reactions. As well as the psychological responses, trauma can trigger physical reactions. These include feeling shaky, trembling, muscular aches, tiredness, difficulty concentrating, being forgetful, palpitations, shallow rapid breathing, dizziness, stomach upset, nausea, vomiting and diarrhoea, disturbance of menstrual cycle or loss of interest in sex.
- Drink and drugs. Sometimes trauma survivors will turn to drink or drugs to numb their physical and emotional reactions.
As well as presenting with trauma symptoms, trauma survivors may present with other established psychological conditions. Some of the most common disorders that can stem from trauma include
- Anxiety disorders.
- Depressive disorders.
- Panic disorders.
- Personality disorders.
Trust and Respect
One of the most important elements of any client–counsellor relationship is building a safe and trusting relationship. It is important to develop a rapport with your clients and ensure that they feel safe with you and able to share their thoughts and feelings with you. This is a process that can take time, but it is incredibly important to the counselling process.
Trustworthiness and transparency are vital in relationships between counsellors and trauma survivors because many trauma survivors have experienced secrecy, betrayal and/or ‘power-over’ relationships. Trauma can keep a patient from trusting their counsellor and this can slow down the therapy process. By working with a skilled therapist, individuals can gain insight into their experiences, develop coping skills, and begin to heal and move forward.
A strong therapeutic alliance can aid in the healing of trauma survivors when the counsellor accepts that healing and trust will take time, that the pace of the sessions should be set by the client and not by the counsellor, and that the role of the counsellor is to suggest exercises and techniques to support the trauma survivor, but they do not have to accept these until they are ready, if at all.
Trauma-informed Counselling Approaches
Even if a new counselling client does not disclose that they are a trauma survivor, counsellors should consider adopting a trauma-informed approach to greeting new clients. A trauma-informed approach recognizes signs of trauma in clients and responds by integrating knowledge about trauma into the setting, practices, and counselling approach.
Trauma-informed counselling considers all clients’ trauma and its impact on their behaviour, mental health, and ability to engage in treatment. In trauma-informed counselling, the assumption is made that all clients will have some form of trauma in their past and counsellors will treat them accordingly. This doesn’t mean asking them directly about their trauma. It means taking extra steps to avoid inadvertently triggering or re-traumatizing the client in treatment.
Some examples of trauma-informed approaches that counsellors often adopt include psychoeducation and strength-based perspectives. Some therapists might ask clients not to dig into the details of their trauma in the first session. This is because they want to ensure that the client has the skills to cope with whatever feelings come up before exploring the trauma itself. A trauma-informed therapist will explain this approach and will redirect your session if you explain that you feel uncomfortable and are not ready to discuss your trauma at this stage.
Grounding and Stabilisation Techniques
You may not have heard of grounding in therapeutic terms, but it is a therapeutic technique that involves doing activities that “ground” or electrically reconnect you to the earth. For this reason, it is sometimes referred to as earthing. The practice involves lying on the ground or submerging individuals in water. You can also use grounding mats, sheets, or other equipment. Grounding is a relatively under-researched scientific approach but it is often used in the treatment of trauma survivors, as well as for individuals with anxiety of PTSD.
This is because grounding is an approach that encourages both mindfulness and sensory awareness. The purpose of grounding techniques is to allow a person to step away from negative thoughts or flashbacks. Techniques such as these can decrease the intensity of a person’s feelings or trauma by distracting them using the five senses.
Some of the three main grounding exercises that counsellors can recommend to their trauma clients include walking barefoot, lying on the ground, or submersion in water. These exercises are all easy to do, and give clients control as they can do these independently and between sessions.
Processing Trauma Memories and Emotions
Once a supportive and trusting relationship has been established, counsellors can introduce therapeutic approaches that will help their trauma survivors process traumatic memories. Two of the main therapeutic approaches adopted for this purpose are exposure therapy and EMDR (Eye Movement Desensitization and Reprocessing).
Exposure therapy is a technique in behaviour therapy that is often used to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Of course, this does not mean exposing trauma survivors to car accidents or rape, for example. But someone who has suffered a car accident could be encouraged to sit in a car or take a short ride in a car, again.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories. It is one of the very few therapy techniques designed specifically with trauma survivors in mind. During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Looking at emotionally disturbing images in this way can desensitise the trauma reaction to them.
It is important that counsellors, regardless of the techniques that they offer, provide a safe space for survivors to express and validate their emotions. These techniques can be effective but should only be introduced to patients who are emotionally robust enough to accept the level of exposure that they involve.
Promoting Post-traumatic Growth and Resilience
Beautiful flowers can grow in the worst conditions. And trauma survivors can continue to demonstrate remarkable resilience and growth post-trauma. Counsellors play an important role in promoting this post-traumatic growth.
Some of the main factors that counsellors can encourage that will promote post-traumatic growth include sharing negative emotions with others, adopting cognitive processing techniques to deal with any negative or intrusive thoughts, introducing positive coping strategies, and promoting positive personality traits.
Counsellors can help trauma survivors to accept and acknowledge that circumstances may continue to be both challenging and frightening. Posttraumatic growth occurs because negative experiences can often spur positive change. Personal strength, the opportunity to explore new possibilities, and a greater appreciation for life are often positive experiences that can emerge from trauma. Highlighting these possibilities is a key role of the counsellor in this process.
Self-Care for Counsellors Working With Trauma Survivors
Working with trauma survivors is incredibly important and valuable work. Many counsellors choose to specialise in this sector because it is so rewarding, and because you have the opportunity to see the real impact that your interventions are having. However, working with trauma survivors can also take a huge emotional toll on counsellors, and it is important that they take the time to focus on their own needs. Self-care should be prioritised among trauma counsellors.
Counsellors who don’t take adequate time to focus on their own needs may suffer from burnout, compassion fatigue, and decreased job satisfaction. Some self-care strategies that trauma counsellors can adopt include being able to say no when you have enough on your plate, taking time to enjoy hobbies and pastimes that are not related to your work life, take care of your relationships outside of your workplace, and keep in mind that self-care is a good thing. There is no need to feel guilty about self-care, and this guilt may even negate the benefits of the self-care practice.
Self-care is not only important for counsellors but ultimately for their patients too. The more that counsellors prioritise their self-care and well-being, the better able they will be to provide effective care and support to their clients.
Conclusion: Empowering Survivors on Their Healing Journey
Specialist trauma counsellors play a vital role in empowering trauma survivors. They can adopt specialist techniques to help them to process their trauma and ultimately reclaim their lives. Building a safe and trusting relationship with a counsellor can give you the safe space that you need to begin to process your lived experience.
There is a wide range of techniques and therapeutic approaches that counsellors can adopt to treat trauma survivors and you will be encouraged to process traumatic memories at your own pace. It doesn’t matter how fast or slow your progress is: making an appointment to see a counsellor is the first, and most important, step.
No trauma survivor should ever suffer in silence. Seeking professional help is a vital step in helping survivors to embrace their resilience in the face of trauma.