Specialities

Are you facing trauma and loss? Trauma-focused therapy and bereavement counselling can help get you back on your feet.

What is a traumatic event? Examples of traumatic events

Potentially traumatic events often involve intense fear and a threat to our physical survival. There is no doubt that certain out-of-the-ordinary events, such as being involved in or witnessing a major accident, natural disasters, physical or sexual assault, serious medical events, or an accidental or violent death of a loved one, can be traumatic.

Less obvious examples of potentially traumatic events include betrayals, break-ups, abandonments, humiliations, harassments, bullying, and discrimination. On these occasions, the traumatic event may involve a violation of trust, which leads to an emotional and social injury. A strong feeling of shame is also common in these cases.

Not everyone exposed to a potentially traumatic event will be traumatised. A history of previous traumatic events, our existing coping strategies, the support received at the time of the traumatic event, the severity of damage and loss inflicted in these events, and how long they carried on for are also relevant to how we react to potentially traumatic events. The relationship we had with the person inflicting the trauma can be important; the above events are highly likely to be experienced as more painful when inflicted by someone whom we felt emotionally close to.

What is trauma? What is PTSD?

While a traumatic event describes what was going on around us, trauma is about our own response to the event and what is going on inside us. Although our response to a traumatic event may seem hard to understand or extremely distressing, it is usually a normal response to abnormal circumstances and stands for our best efforts to come to terms with adversity.

The most well-known response diagnostically is post-traumatic stress disorder (PTSD). With PTSD, people experience difficulty processing the memories of the trauma, which often return as flashbacks or nightmares, high levels of arousal and irritability, staying away from what reminds them of the trauma, and negative changes in thinking and mood.

However, people’s responses to trauma fall within a broad spectrum, varying from feeling overwhelmed by distressing and difficult to manage emotions (in complex PTSD) to numbness, emptiness, and difficulty in recalling any memories about the traumatic event. Developmental trauma refers to the impact of chronic traumatic events in childhood, leaving the child exposed to a high stress level with caregivers not helping to reduce the stress (insecure attachment). Although there is no formal diagnosis of developmental trauma, some trauma specialists view it as the root of persistent difficulties in childhood, such as borderline personality and bipolar disorders.

The International Society of Traumatic Stress Studies provides useful resources to help you understand the basics about trauma, To find out more about developmental trauma, you may want to hear Dr Bessel van der Kolk’s talk.

If you suffer from PTSD symptoms or other trauma symptoms, ask for professional help.

Childhood emotional neglect

Emotional neglect is an invisible force in childhood and, unlike trauma, it does not concern what happened to us but what did NOT happen. We all have core emotional needs that are universal and need to be met in childhood to a good enough degree so we can enjoy a healthy self-esteem and helpful coping strategies and relate with others safely.

Schema theory tells us more about these needs, which include our need for physical and emotional safety and stability, autonomy and space to develop a sense of identity, freedom to express valid needs and emotions, spontaneity and play, and realistic limits and boundaries. While we think of a bad childhood as one that involves screaming, beating, and tormenting, in the case of emotional neglect the problem is that we and our core needs have been ignored.

Emotional neglect often happens so subtly that it is hard for people with a history of it to put their finger on what has gone wrong. Yet they have a sense of missing something and often experience a sense of emptiness and loneliness as adults. If you have suffered emotional neglect, break the cycle and stop neglecting your needs by seeing a therapist.

Dr Jonice Webb has done a great job explaining what emotionally neglect really looks like.
She has also written the first book explicitly addressing childhood emotional neglect.

Grief and loss. What is traumatic grief?

The worst loss is always your loss. When you are in the middle of your grief, you may feel pain like no other, regardless of the cause of your loved one’s death. However, you may feel surprised to find out you feel nothing, like a sense of numbness has covered all other feelings. Anger or fear are also common responses. David Kessler, a world expert in grief, explains how our grief is as unique as our fingerprint and there is no space for judgement when it comes to our feelings and reactions after a loved one dies. In many bereavements, grief is a normal response to the loss of a loved one and time helps to heal the wounds.

In the case of traumatic or complicated grief, mourning persists and may even become more intense over time. In these instances, the bereavement comes with signs of PTSD and depression. The exact circumstances of the death and the quality of your relationship with the loved one when alive will influence how your grief progresses. Traumatic grief is more likely to happen when a loved one has experienced a shocking, unexpected, or violent death, such as suicide or murder. If you think you are experiencing traumatic grief and feel stuck in it, seek professional help.

David Kessler’s website has free resources and online courses on grief.

You may also enjoy listening to David Kessler’s interview on grief with Brene Brown.

Trauma treatment

Trauma-focused therapy can take different forms and is designed to help with the impact of single or multiple traumas. The rationale behind therapy for PTSD is to help our brain process the traumatic memory and store it away so it does not interfere with our everyday life. Imagine that under normal circumstances, our brain processes ordinary experiences by running them along a conveyor belt, registering them and storing them away in our long-term memory, which is like a filing cabinet, so they can be retrieved when we need them. If, for example, someone asks you to think of what you had for dinner last night, it’s likely that you would need a few seconds to think back and remember, so you can look through your filing cabinet and then access the memory of having dinner. If you had not been asked, you would not necessarily have thought about it, as you would not normally go around thinking of what you had eaten the night before (unless it was a particularly yummy meal).

Things are different when it comes to a traumatic event. This is because these events are so out of the ordinary and emotionally overwhelming that our brain finds it hard to process them and store them away, as would usually happen. Instead, the memory of the traumatic event is fragmented and parts of it keep coming back suddenly when we come across something that reminds us of the trauma, such as a person, place, or sound. When the memory comes back, we may feel like we are re-living the trauma in the here and now and experience the same intense emotions, images, and sensations that we experienced back then. It’s also likely that the trauma has changed the way we see ourselves or the world, leading to a sense that we are no longer competent or we can no longer feel safe. Thus, trauma-focused therapy aims to help the memory process all the data from the traumatic event and store it away, so we can have control over remembering it, rather than being taken by surprise when it breaks through our consciousness.

Two of the most common forms of trauma-focused therapy are prolonged exposure therapy (Foa, Hembree, & Rothbaum, 2007) and cognitive processing therapy (Ehlers & Clark, 2000). Both therapies are part of what is often referred to as trauma-focused CBT, which is an evidence-based therapy, meaning that its methods have been well researched and have been found to be effective in major research studies for the treatment of PTSD. In prolonged exposure therapy, the main assumption is that our best efforts to deal with the trauma keep it going – we try our best not to remember the traumatic event because it’s so emotionally painful, but this stops our brain from processing it and storing it away. Via prolonged exposure therapy, you learn to be exposed to the trauma and its reminders in a safe environment again and again until you no longer feel that it is overwhelming. In cognitive processing therapy, there is more emphasis on how we have made sense of the traumatic event at the time and specifically ways that maintain a sense of threat and vulnerability or guilt and shame. If, for example, someone who has suffered rape thinks that this was their fault, this belief may contribute to the traumatic memory being stuck in the brain.

Compassionate-focused therapy for trauma can also be helpful, especially when self-blaming and shame are a prominent part of one’s reaction to trauma. Other therapies, such as schema therapy, can be particularly helpful for developmental trauma, where there is a less clear-cut traumatic event and the response to trauma may have become part of our longstanding coping strategies and personality. Psychodynamic therapy can also help with trauma, especially when it comes to understanding how the trauma has impacted our relationships with self and others and has led to longstanding difficulties in relationships, such as lack of intimacy, mistrust, or numbness, which prevent us from forming secure and fulfilling relationships. When someone experiences highly emotional reactions in response to trauma, some techniques to help them stay grounded may be necessary in the first instance. It’s not uncommon for trauma-focused therapy to require a combination of techniques from different treatments.