Moving Forward: Why Trauma Survivors May Not Begin Treatment

Evening in the woods, a golden.The decision to contact a therapist, set up an appointment, interview the therapist and agree to move forward with treatment might seem to imply that a person is ready to pursue their goal of feeling better. Unfortunately, ambivalence surrounding the therapeutic process, as well as its outcome, occurs far more commonly than clarity around this pursuit. Healing would presumably be the obvious goal for all of us; why wouldn’t we want that, right? Clients have offered fairly good reasoning as to why not; if we hope to be able to move beyond the ambivalence and into confronting the trauma, the first step would be providing a space to acknowledge where the individual is, in regard to his or her process. Common reasons for not pursuing treatment, from the client’s perspective, will be discussed here as a means of normalizing hesitation while validating concerns about process and outcome.

Reason # 1:  The symptoms themselves are validating. Flashbacks, invasive thoughts, mood swings, isolation, dissociation and other symptoms all provide evidence to the individual, as well as to others, that something happened. Clients often express disbelief in their own perceptions; they cannot fathom their experience is real. Additionally, it is often in the best interest of families, society, and those who have perpetrated abuse to be dismissive of the survivor. Acknowledgement of trauma within a family system is disruptive for members as well as for the survivor. Those who failed to protect them are confronted with their own guilt and shame, which can be overwhelming. Perpetrators of abuse may fear prosecution, humiliation, and other consequences of their secret becoming public. Finally, those who have not experienced such atrocities may struggle with absorbing the magnitude of what actually happens to people; it may feel more plausible that there is something wrong with the individual who proclaims the trauma rather than that the story is true.

The survivor is thus left with the task of acknowledging his or her own reality while maintaining a position within the family and social system. The symptoms don’t allow the individual to forget the truth; however, therapist and client might work together to acknowledge challenges presented by doing so consciously. If a person has the space to explore integrating a complex history into his or her social structure, the groundwork for absorbing an overwhelming truth (the trauma), without internal collapse, begins to be established.

Reason # 2:  Symptoms are a means of holding the abuser and society accountable. Along with acknowledgement of painful events comes the failure of family members and society to protect and hold those accountable who have imposed what feels like irreversible pain. Survivors have often expressed concern that if they are healthy, they (whomever they are for the individual) will get away with it. Essentially, trauma symptoms are a means of saying “Look what you/they did to me!” Should the symptoms go away, how else might abusers, or those who did not protect the person, be forced to look at what happened? There is often a perception that accountability or public acknowledgement of trauma is a fundamental component to healing. Holding on to symptoms may paradoxically feel like the only pathway to health.

Reason # 3:  Illness is a pathway to nurturance. Survivors have often been forced into a position of extreme independence and self-reliance. Their injuries are ignored or intentionally hidden, thus receiving nurturance and comfort for what happened is often not an option. Self-regulation through various adaptive means (addiction, avoidance, cutting, escapism, isolation) is the alternative choice; however, at some point these adaptations foster additional trauma. Survivors often state that hospitalization was the only point at which they were able to experience nurturance and the only avenue to the hospital is illness. The desire for support, comfort, and safety is also often coupled with a distrust in self to be self-sufficient. Trauma symptoms are disruptive enough to provide evidence that they are, indeed, incapable of self-care and agency. Thus, survivors have to seek external sustenance because internal resources feel absent or untrustworthy.

Reason # 5:  My diagnosis makes me unique or special. It is who I am. Invasiveness of trauma is often unrelenting for survivors. A diagnosis provides a reason for why one feels the way he or she does and may offer some relief. In addition, this specific way of being in the world has often been existent for a long time, particularly with complex trauma. When people ask themselves to get better, to say goodbye to their symptom sets, it sometimes feels like they are saying goodbye to who they are (at least who they know themselves to be). Having survived a trauma (or concurrent enduring traumas) can be a source of pride that may not have been available through other means. Being special or distinctive may have been achieved through a diagnosis while pride may have been simultaneously unavailable through healthier means (positive esteem-building experiences, achievement, healthy relationships).

Reason # 6Fear of the Unknown. While people may come to us seeking change, what that may look like is unfamiliar. Additionally, the process of change (particularly trauma treatment) can be painful and rigorous. It disrupts all aspects of someone’s life, including the parts that are going well. Essentially, we are asking people, and they are asking themselves, to give up the bit of stability they have managed to grab onto for a process that may or may not render a better life. Clients often ask how this therapy thing works; how is it that talking about this stuff will make me feel better? “I don’t get that,” I often hear. Additionally, discomfort is comfortable for some survivors. It is familiar and predictable. In considering what many survivors have endured (chaos, the unknown, lack of predictability or contingency), it is evident why feeling better is frightening. It is not the thing itself (healing) that is the concern, it is that which is alien and the coinciding consequences.

The presentation of trauma symptoms can feel muddled, frenzied, and overwhelming. Consideration of the logic behind what a person brings to the table may offer internal compassion on the part of the client as well as clarity for the therapist. Allowing the space to air these concerns, with a sympathetic ear, normalizes a person’s experience while building trust and safety. The therapist is facilitating the development of a new type of relational experience, both internally in the survivors’ understanding of their emotional motivation, as well as a felt sense of being accepted by another.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Athena H. Phillips, MSW, LCSW, therapist in Portland, Oregon

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 16 comments
  • Leave a Comment
  • carmen

    carmen

    January 6th, 2012 at 11:30 AM

    interesting take on trauma…its not too easy to digest at first but yes these things are logical and would definitely be real…but I think such cases will be far and few but handling them is tough as crazy.

  • Rae

    Rae

    January 6th, 2012 at 4:03 PM

    There are some people who stew around in their problems for so long that I am convinced that the fear to change comes from not knowing how to live without those issues controlling them anymore. They have let these problems become how they identify themselves and identify with others. So if they don’t have these anymore they honestly don’t know who they are anymore. I think that more people would make an effort to heal if it was not for this holding them back. They have become so accustomed to living with those issues on them that they are scared to move forward without them.

  • ELEnA

    ELEnA

    January 7th, 2012 at 7:44 AM

    Don’t you think that for most people it really is about that fear of the unknown that holds many people back from seeking treatment? They are so afraid of the present that the future definitely is daunting to them. So they get complacent and do not think that things could get any better, or if they do get better they may be afraid that they themselves are not good enough to deserve that so it is easier to stay with the status quo. That and the fact that they are just afraid to move forward with their lives.

  • Regina Ellis

    Regina Ellis

    January 8th, 2012 at 10:31 AM

    How can healing ever be seen as something bad? I can’t see that at all. It may be hard to deal with but it is never wrong or bad.

  • Athena Phillips

    Athena Phillips

    January 9th, 2012 at 1:08 PM

    Thank you so much for all of your comments! Rae and ELEnA seem to have a similar take, that fear of the unknown might be a significant reason for holding back. I do see that often in working with my survivors, however it is often coupled with or superseded by a fear of the process of trauma work. There is a fear of emotion itself, as though it will consume or completely take over (which does happen with trauma so I get why survivors have that concern). In response to Regina, the focus of the article was intended to be speaking on from the perspective of a survivor who has serious concerns about the work they will be doing and are at the same time untrusting that it will be a benefit. You are absolutely right that healing isn’t bad or wrong, however the process can be experienced that way by some survivors. If I can see that as their therapist, then we have a chance to talk about it, normalize it, and move past it. Thank you all again!

  • ERIC

    ERIC

    January 9th, 2012 at 1:30 PM

    Although the journey may be painful, the destination is cure and the journey has to be undertaken. If it is something similar to physical health problems wherein the doctors cannot perform some surgery due to a weakness or something in the patient then the favorable conditions are awaited and the surgery undertaken. I have to imagine is there something similar for psychological issues as well?

  • Athena Phillips

    Athena Phillips

    January 9th, 2012 at 11:41 PM

    That is exactly right ERIC; good intuition. Timing in trauma work is critical; therapist and client agree to undertake that work once certain things are in place and when the individual is stable enough to manage the work. The beginning of trauma therapy is hopefully focused on building safety and trust and when the timing is right we get to work.

  • Russ

    Russ

    February 23rd, 2013 at 4:46 PM

    This is a very harmful, destructive therapy that has destroyed families, and still does to this day. Google “Castlewood Treatment Center lawsuits” and you’ll see what this kind of “therapy” has wrought, and it’s often perpetrated on young women who are very vulnerable, in this case women with eating disorders. The same harmful therapy is being used at Mercy Ministries residential treatment program as well…I know that because my daughter has been a victim of that same therapy…a therapy that led her to attempt suicide, her response to “memories” that never happened. I know of several other families being impacted at both Mercy Ministries and Castlewood Treatment Center whose daughters have yet to realize the truth because they have been brainwashed. Life is hard enough for these young women without them having to deal with things that aren’t even real. Besides destroying their family relationships, it is a grave disservice to the patients because it keeps them from dealing with the REAL issues in their own lives. This kind of bad therapy MUST STOP.

  • Athena Phillips, LCSW

    Athena Phillips, LCSW

    February 26th, 2013 at 3:44 PM

    Hi Russ,
    I wanted to respond to you specifically. I’m so sorry to hear about your daughter! I am assuming you are referring to IFS because I believe that is related to the Castlewood lawsuits. I don’t know the specifics around that but have caught wind of it. I want to first clarify that none of my articles are a treatment modality or type of therapy; rather I am hoping to promote a more strengths-based way of thinking about trauma. All of my writing is my own, although I did draw from some of the concepts of IFS for the trilogy articles. I am trained in it as well, so I acknowledge that. I am glad you said something because I do get responses that assume my articles are a type of therapy, and again, I just want to shift how we would typically think about trauma a little. I am again, so sorry to hear about your daughter. Feel free to post further thoughts or questions! ~Athena

  • Heather Schwartz

    Heather Schwartz

    April 27th, 2013 at 9:21 PM

    Athena,

    What a wonderfully-informative and clarifying article! Thank you for this contribution; it’s illuminating and helpful for me, even as someone who has worked with clients with trauma for many years.

  • Laura Frizelle

    Laura Frizelle

    April 30th, 2013 at 2:24 PM

    Wow. This is so helpful. Thank you.

  • Raye J

    Raye J

    May 1st, 2013 at 3:40 PM

    This makes so much sense to me. I’m 22, and my memories of trauma resurfaced at age 17. I THOUGHT I wanted help right then, but it’s only recently that I feel ready, that I feel strong enough to conquer my PTSD.
    I have severe physical illness in addition to my mental illnesses. This summer I was forced to realize that being sick had become who I was. It was a central part of my identity, that I was ill and needed SO much help and understanding. Gods forbid I got better – then I’d have to take care of myself!
    Since my illness is heavily effected by stress, I NEEDED my PTSD there, so I could draw on it if anyone dared doubt me. It was as if I was saying “How DARE you? Now you’ve stressed me out so bad and brought up these awful memories and I’m stuck in bed and it’s YOUR FAULT” I didn’t do these things CONCIOUSLY. I wasn’t even aware I was doing them, but I still did them. I probably still do, but I’m more aware of it and I try to catch myself.
    Conquering the physical stuff is gonna take time and depend more on doctors than what I can do myself, but the PTSD is something I can work on, and if I can face those demons, that’s one HUGE stressor I can get rid of, and it won’t have the power to make me physically sicker anymore.

  • Michelle

    Michelle

    March 20th, 2014 at 5:23 AM

    Just thought I’d mention a fear that I have, which is the fear that, if I were to do the work, & come out “healed”, then find out life was infinitely better, I’d have to mourn all the wasted decades spent at a very suboptimal level through my own fear, laziness, mistrust, etc. That’s actually a big one for me.
    Also, I have a phobic level fear that I will have to verbalized what happened in treatment, which I can’t even do out loud by myself!
    Great article! Wish I’d had the good fortune to find a therapist this insightful when I was young.

  • Donna

    Donna

    January 5th, 2016 at 8:18 AM

    I stopped reading because it felt like a pointed finger. There is healing. How does one come to the corner in life and arrive? The moment where it’s comes together as in finding a teacher, a counselor, a guide who will escort you out of the dark forest. This person is a lantern. Before teacher I was lost. I graduated in 1995 with my masters. The new brain science was not there to learn in college. Now there is mindfulness tools and skills. I learned to meditate, not just a y meditation but insight. Where I can step back behind the waterfall no longer becoming one with my thoughts, feelings, and body sensations. I am more. I have a core. Spiritual awakening along with healing much of my broken pieces where finally much Light came in. Love is the strongest power on earth.

  • Cracks let the light in ...

    Cracks let the light in ...

    December 15th, 2016 at 2:07 AM

    Therapists need to stop approaching survivors as broken people with check-list-offable issues and instead treat them with the dignity, respect and understanding they deserve.

    The consequences of trauma hoisted onto us by our abusers are bad enough, but to then be treated as mentally ill is reprehensible.

    Survivors are just people who’ve been hurt, their life-disrupted, reacting in ways not much different than ANYONE who’s been hurt and traumatized.

    Many symptoms relent when a survivor is just allowed to be a person who’s been hurt — when the whole person inside, who never goes away, is just let to breathe and exist as they are — a multi-faceted, unchecklistable human being.

    All of you need to stop pathologizing the traumatized. Just the fact that that person is sitting in your office after going through what they have, still alive and trying, means there is a hero, an amazing person in your midst who can teach you a lot about strength and perseverance in this sometimes cruel yet beautiful world.

  • Caroline Paltin PhD

    Caroline Paltin PhD

    July 29th, 2017 at 2:05 AM

    This is all based on a rather flawed premise that the traumatized individual is “choosing” to stay traumatized. This would be akin to believing that a person with a spinal cord injury is “choosing” not to walk. There is an abundance of neurological research clearly demonstrating the structural and functional changes to the brain and nervous system of individuals impacted by complex trauma. As much as we would like to see all things as a choice, we must understand that trauma by its very nature has left a catastrophic impact on the psyche, and trauma patients do not desire to live in this misery. I would ask the therapist who believes this to examine their own desire to blame the victim in this manner.

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.

* Indicates required field.

 

Advanced Search

Search Our Blog