Lynsey Lowe Counselling, Psychotherapy & Clinical Supervision Nottingham

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Ten things a trauma therapist should be doing with & for the client

    1. Consider safety. No-one can benefit from therapy if they are outside their Window of Tolerance and unable to process. So it’s imperative that the therapist has an understanding of this and is able to work with a client to recognise important elements of safety and stability, whether that’s actual physical safety or feelings of safety.
    2. Use the Three Phase Approach to Trauma Therapy as a touchstone for the work.
    Safety & Stability
    Remembrance & Mourning (what we might now call processing the memories)
    Reconnection & Integration
    Judith Herman wrote her classic book Trauma & Recovery in the 1980s and pretty much every trauma therapy model is based on it or has some link to it.
    3. Prioritise safety & stabilisation above all else. This is part of the 3 phase approach and is crucial as we can’t process trauma memories or work on coping strategies if we aren’t feeling safe.
    4. Pacing – work at a pace that is appropriate for each individual client. Going too soon into trauma processing can be retraumatising.
    5. Seek to empower. This is critical for anyone who’s been traumatised and particularly those who have experienced abuse. This means working in the client’s frame of reference and helping them to understand power dynamics.
    6. Recognise coping strategies & don’t remove them without being sure the client has new and less harmful ones in place.
    7. Psychoeducation about trauma. Understanding what trauma is and how it impacts on the body and mind can be hugely beneficial to anyone who has experienced it but isn’t aware of what it means for them. One big element of any trauma therapy is to aid understanding & normalising what the impact is.
    8. Utilising the Window of Tolerance as a resource to aid understanding. This is a fairly new concept and many therapists may not have heard of it or understand what it means. It can be revolutionary as a tool for understanding our responses to stress.
    9. Ask about what’s going on in the body. We feel emotions in our bodies as well as mind. But people who’ve experienced significant trauma often don’t feel very much in their body. Sometimes the body tries to tell them something is wrong through illness. Being able to work with the body is necessary when working with traumatised individuals.
    What are they noticing?
    Where do they feel something?
    What feelings does it bring up?
    10. Listen more than talk. This links to respecting the client’s process but not at the risk of colluding with them and avoiding meaningful work. This requires high levels of attunement, empathy & congruence.


Anxiety

Anxiety is a normal human response. It causes problems when it's out of balance.
Too much anxiety is a common problem many people face. We may think there is no point to it and it's just a nuisance or worse... but that would be to misunderstand its purpose.

Anxiety is a normal and useful reaction to a threat: it puts the body on alert and enables us to respond to danger. It’s often referred to as the “fight or flight” response. It can literally save your life – for example if you have to run to make it across the road because a car is speeding too fast towards you! However problems arise when the threat is in our minds rather than a real physical danger, and when our thoughts and behaviours reinforce our anxiety instead of helping it melt away.

Some people live in a state of constant low level anxiety, which is exhausting. Anxiety involves thoughts, bodily reactions, and behaviours.

Some common symptoms of anxiety are :

  • Worrying a lot
  • Loss of self-confidence
  • Self-consciousness
  • Inability to relax
  • Constant feeling of dread
  • Irritability with others
  • Loss of concentration/focus
  • Forgetfulness
  • Fear of criticism/rejection
  • Nightmares
  • Fear of being alone
  • Fear of being with people
  • Sleeplessness
  • Loss of sexual interest
  • Always “wound up” or “on edge”
  • Afraid to face the day
  • Avoidance of situations

    Anxiety which is causing a problem is a vicious circle of anxious thoughts (T), anxiety sensations(S) and anxiety maintaining/increasing behaviours (B).

    Therapy aims to break this cycle by changing the thoughts, reducing the physical sensations and changing the behaviours. All too often we get into a cycle – and we tell ourselves we can’t do anything about it. BUT a thought is something in your conscious mind – which can be changed. A physical sensation can be changed by doing something else and a behaviour is something we do – so that can be changed too! That’s not to say it is easy and it may take a lot of practice to change a cycle that’s been around for a long time – but it is possible.

    T - Challenge your Anxious THOUGHTS
    S - Calming Your Physical SENSATIONS
    B - Change Your BEHAVIOURS


    Working through these things with a therapist can be a way to manage your anxiety. I have a longer version of this ‘information sheet’ on coping with anxiety which I utilise with my clients.

    Some people find books helpful – these are a few suggestions if you are interested.

    Coping Successfully With Panic Attacks by Shirley Trickett
    Coping with Anxiety and Panic by Jordan Lee
    The Anxiety and Phobia Workbook by Edmund Bourne
    Feel The Fear and Do It Anyway by Susan Jeffers
    Overcoming Anxiety by Helen Kennerley
    When Panic Attacks by Aine Tubridy

  • Trauma & Abuse . love

    Self-esteem

    Self-esteem is a phrase that comes up a lot when I'm counselling...

    If you are trying to improve your self-esteem what can you do?

    Understanding why you have low self-esteem helps some people – but not everyone. Often it’s about the messages we grew up with – never being good enough. Or it could come about because of bullying at school – a very common reason. If you really want to uncover some of this then counselling can be really helpful, but it’s important to find the right therapist for you.

  • Learn to recognise what happens when you become stressed & ways to reduce the anxiety or stress. We all suffer from stress at different times, and in fact, stress is necessary. But it’s when it gets out of balance and becomes too much to cope with that it causes problems.

  • Make positive affirmations – even if you don’t believe them at first! Say to yourself “I am a strong and confident person.” Some people put post-its around the house or office to remind themselves of these messages. There is evidence to show if you tell yourself something often enough you will eventually believe it!

  • Make a list of things you like about yourself. This can be a really tricky one for some people. I encourage my clients to explore the reasons why they can’t find things they like about themselves but also we narrow it down until we find even the smallest thing that they like! Nice feet! Being kind… they all count!

  • Nothing improves self-esteem like being able to do something that you didn’t think you could. I recently saw a young woman who had been a victim of domestic violence give a talk in front of hundreds of professionals. When she came off the stage she was buzzing! You could tell it had improved her self confidence and self esteem immeasurably to do something that she found scary – but she did it!

    This is a really brief look at a huge topic. It can take lots of work to improve self-esteem but it’s definitely worth it! And working with a counsellor or in a self-improvement group can really help.


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