What Keeps People from Seeking Trauma Therapy?

A person sits next to a Golden Retriever and looks out across water toward arced stone bridge Recently I was discussing with somebody the question of what holds people back from seeking treatment for trauma. This article is a brief introduction to my thoughts on that topic. Perhaps some of it will resonate with you.Whether you’re currently in therapy or are a therapist yourself,

Many mental health labels and diagnoses, outside of those that are biologically based, are driven by the accumulation of unhealed emotions, images, behaviors, thoughts, sensations, and “old stuff.” Traumas, in other words. They are clusters of aspects of a variety of unhealed past material, and it is the cumulative effect of these traumas that causes distressing symptoms.

It stands to reason we may be more likely to seek help for the more obvious traumatic events—what some trauma therapists call “Big T” traumas—than for an accumulation of distressing experiences. In the absence of education regarding the neurology of unprocessed, chronic distress and its ability to chip away at mental and physical health, relationships, productivity, and many other aspects of life, folks may dismiss their symptoms as insignificant or “just something that’s a part of me” and thus suffer in isolation.

Another big factor that prevents people from addressing trauma is under-the-surface fear of being in a calmer or more relaxed state. The concern may be that if you’re not revved up, you’re not ready to take on the next distressing event or experience. Therapy for trauma can help instill the belief that it is possible to be both relaxed and ready, without hypervigilance.

When I ask people in trauma treatment what they do to achieve calmness, they tend to say things like, “I go to the bar,” “I veg out in front of the TV,” “I play video games,” “I sit and stare into space,” or “I watch porn.”

But these activities do not represent a state of calm. They describe a state of numbness. Shutdown mode.

When we are calm, we are present and engaged. Our breathing is slowed. Our heart rate is down. We are in the moment. We are relaxed. And we are ready.

But if we don’t have the ability to get to calmness, or if we avoid it, we may not have the tolerance for the difficult emotions—sadness, helplessness, grief, etc.—that arise. Calmness is the brake that allows us to slow down, stop, and process what happened. It’s how we keep the traumas from gumming up our systems and running us off the road. It’s how we heal.

Calmness is the brake that allows us to slow down, stop, and process what happened. It’s how we keep the traumas from gumming up our systems and running us off the road. It’s how we heal.

Without a brake, unhealed traumas shut down. Parts of us shut down with them. Certain emotions recede inside us, until something comes along that causes them to resurface, wanting to be healed.

In any environment or culture where emotional responses must be turned down or off in order for us to be able to do what is necessary—in other words, when we shut down the internal in order to manage the external—we go against our biology’s social engagement system, the body’s front-line response for processing traumatic events. Community is our natural go-to for healing. It’s the mitigating factor.

Without having the skills needed to achieve calmness, the tolerance for it, or a place to go for social engagement, emotions may be seen as dangerous as opposed to the normal and understandable reactions they are. This keeps us shut down, dissociated, and prone to unhealthy coping behaviors that distract us—albeit temporarily and often ineffectively—from the distress.

When the ability to tolerate calmness increases, so does the ability to tolerate and actually process emotions. This cannot be learned cerebrally; this is learned via an active, experiential process. We have to get to the limbic system.

If you are in therapy, perhaps this gives you some ideas of what to discuss with your therapist, especially around your thoughts on what “old stuff” may be contributing to your symptoms. Does the description of being fearful of calmness resonate with you?

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  • Rita B S

    Rita B S

    October 18th, 2016 at 6:26 AM

    Would like to recommend the book Replacement Children: The Unconscious Script, that I wrote with co author, psychiatrist Dr. Abigail Brenner. it deals with how trauma after a loss of a child ( physical loss or
    emotional loss ), can affect subsequent
    children or an older child already in the family.
    My interview ( Rita Battat Silverman )that

    appeared in the Huffington post on July 18 will summarize the book and the topic. A child born after the loss of another is NOT
    automatically a replacement child. The term replacement child, coined by to psychologist
    in the 1960s, refers to an actual
    psychological/emotional syndrome.
    We provide critical information on how this experience can be the underlying root of numerous emotional issues and provide guidance for families. Thank you, Rita

  • Becki

    Becki

    October 18th, 2016 at 2:02 PM

    For me it is that fear of having to relive that same trauma over and over again.

  • Gayle

    Gayle

    October 19th, 2016 at 7:11 AM

    For me, it has been a number of things, ranging from inability to afford copays for trauma specialists, being referred out when my case has been deemed too complex due to comorbidity with a dissociative disorder, lack of mental health parity, misdiagnosis by some therapists in the past along with mistreatment and unethical practices which causes lack of trust in professionals who claim to treat trauma, the fear and frustrations involved with blaming the victim when discussing events that are outside of our control no matter how many boundaries or coping skills are set, the overemphasis on coping and cognitive skills and the underemphasis on cultural issues connected with trauma coupled with the underemphasis of validation for the unjustices, the lack of team approaches whereby a therapist consults with psychiatrists and medical doctors for more comprehensive trauma treatment, the complexity in not wanting to be too dependent on a person but also wanting to feel a sense of stability and good therapist-client alliance, the fear of the therapist wanting to be your surrogate parent because past therapists have tried that technique on you, the fear that you will be in therapy for the rest of your life because you are deemed either treatment-resistant or dependent on treatment due to the therapist assuming that trauma treatment takes decades, the lack of confidence on the therapist’s part to understand that their trauma client might be intelligent enough to figure out some things on their own and is instead almost infantilized because they are perceived as being immature due to childlike emotions that may surface, and the list goes on.

  • Cara

    Cara

    October 19th, 2016 at 8:21 AM

    The thought of living in a perpetually frightened and agitated state just seems so foreign to me, only because my life has been pretty sedate thus far. I can imagine that having to live with these emotions at all times can be very frightening to many people, making life not the wonderful experience that you would want for it to be.

  • Dirk

    Dirk

    October 19th, 2016 at 10:28 AM

    Not sure that most of us understand just how deep many of these wounds can hurt us, and we think that we are strong enough to get through an event like this on our own, never stopping to think that almost everything is better when you have someone else with you being there to support and love you. This is not a time to be a martyr and go it alone. Let the others in your life help you when you need it the most.

  • Patrick

    Patrick

    October 20th, 2016 at 10:43 AM

    I don’t know why no one has mentioned money because for me this is always the problem in a nutshell. I don’t have the money to pay out to heal me when there are other bills to be paid.

  • benjamin

    benjamin

    October 21st, 2016 at 10:35 AM

    I have a friend who was date raped and I don’t think that she has ever sought out any kind of help with that because she is afraid and always has been that no on really believes her. I mean she told people but the guy would always say that it was consensual so you know, it has always been her word against his and I guess he is the one that more people believed. I don’t know , she has some good days and bad days but I am really kind of scared for her that this experience will be one that she can’t ever get past and that the possibility of her having a strong relationship in the future could be hard because of this and staying unresolved.

  • Deena

    Deena

    October 24th, 2016 at 10:41 AM

    I know that there are good therapy resources that you can find online but I still think that there are those who struggle with being able to find someone who can or will work with their schedule. When you have a crazy work schedule yourself it can feel a little intimidating trying to find someone who is willing or able to work around that.

  • irene M

    irene M

    October 25th, 2016 at 10:30 AM

    Shame I would say

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