What A Trauma Survivor
Needs From A Clinician
By Kim Kubal
Executive Director, Your Strength to Heal and Activist
This is based on my 21 years of therapy and recovery and is a general description of the needs of a trauma survivor in therapy:
1. Safety and Stabilization
A client needs to feel safe and trust the clinician first. The survivor does not need to be judged, but needs empathy, listening, caring and respect. Trust takes time and is a process. Their trust has been totally destroyed, so the client will need a period of time to trust the clinician. The survivor also needs to be stabilized by:
a. grounding or centering techniques
b. coping strategies for dealing with suicidal and
c. establishing safety within oneself, with others and
with one’s environment
d. calming the body and mind
e. learning to anticipate stressful and triggering events
f. learning to be present in the body and stay in the present
g. survival kit (stuffed animals, affirmations, friends to call (call list), take a walk
h. separating flashbacks/memories from the present
i. explanation of PTSD, dissociation (psycho education)
j. safety contracts – plan for self-protection
k. warnings about visits to the dentist/obgyn/lock down hospital psych units.
l. self-care e.g. sleep, exercise, good nutrition, financial security, management of
PTSD symptoms, control of self-destructive behaviors.
m. Careful review of important relationships in client’s life and assessing each as a
source of protection, support or danger.
2. Clinician needs to be a positive role model – someone who will provide structures for learning, education about PTSD symptoms, skill building, empowering the client to take charge of their process. By doing this, the clinician can help the client to decrease feels of shame, craziness and chaos.
3. Clinician needs to genuinely care for the client, show an interest and treat the client as an equal. Treating the client as a subordinate only reinforces the abuse by the perpetrators.
For me, over the 21 years of therapy and working through the trauma memories, it was not the knowledge of the therapist so much, as their love, respect, treating me as an equal and with dignity that mattered the most. When I was in severe emotional pain and distress, this is all I needed, knowing that I had the support and encouragement to walk through “the darkness of the soul” and that I was not alone.
4. The clinician needs to have done their own inner work – this enables the clinician to be more present to the client and to recognize when they are in the Drama Triangle i.e. when the clinician gets pulled into the role of victim, rescuer or aggressor by the client. This enables the client to feel safe and will be able to share.
5. Client needs to have their story believed, validated, honored, to take the time to tell their story. I believe stabilization is critical at first, then after a period of time, the memories may come up, particularly after addressing addictions. This is a process and cannot be rushed.
6. The clinician needs to be careful in misinterpreting trauma symptoms or making too early diagnoses or judging the client by initial contact.
7. Therapist to be honest with their client. Oftentimes the client is hyper vigilant and may know intuitively they are not being told the truth. This establishes trust in the clinician.
8. The clinician needs to let the client make their own decisions. This is the process of therapy for the client to empower themselves. The therapist can give options, however, ultimately the therapist is not there to fix, control or feel responsible for the client.
9. The therapist needs to be calm and relaxed, and listen in an empathic way, otherwise the client picks up on this and does not feel safe.
10. The process of trauma recovery cannot be rushed. If it is rushed, it will only retraumatize the client.
11. Although this may not be advisable for all clients, confronting the abusers is also a process itself and although empowering for the client, they may well then deal with feelings of rejection and disbelief on the part of the abuser.
12. Forgiveness cannot be pushed – this is a process and is similar to a person going through the 5 stages of grieving by Elizabeth Kubler-Ross. This is especially true if the client confronts the abuser and deals with rejection by the abuser.
13. Knowledge of 12 step recovery programs is often crucial, particularly as trauma and addiction are inter-woven.
14. The client needs to establish positive peer support, be it friends, church, working as a volunteer or 12 Step recovery groups in order to help with the feelings of isolation that arise during the trauma recovery process.
15. The clinician needs to explain other types of therapy such as EMDR, body work, somatic work so that the client can make healthy choices for themselves as to which healing modalities they will also use.
16. Clinician needs to trust their intuition and follow their inner guidance.
17. Clinician needs to understand working with the inner child, and explain this to the client, which will help them learn to be more in touch with their feelings and body.
18. Clinician needs to be comfortable with their own spirituality. If questions arise such as “Why did God allow this to happen?” the clinician can share with honesty and compassion.
19. The clinician needs to be open to changing their own beliefs, so that they can work with the client in reforming that person’s beliefs, e.g. a client sees a Higher Power as abusive, based on how they were treated by their parents and transferring that belief onto a Higher Power.
20. The clinician needs to be non-judgmental, particularly making assumptions based on race, culture, work status.
21. The clinician needs to understand and inform the survivor that various types of medications such as anti-depressants can help to alleviate depression, panic attacks, lack of sleep, and huge mood swings. This should be monitored by a psychiatrist who has experience with trauma survivors and understands that each survivor is different. Initially the survivor may need to try various medications to find the right dosage and what works for that person. In the long term medications can offset suicidal tendencies and huge mood swings which in turn can help the survivor complete a deeper healing of trauma.
22. It is crucial for the clinician to take care of oneself outside the therapeutic arena, particularly in terms of doing their own inner work, exercise, sleeping well, spiritual practices, professional support system, recreation. No one can face trauma alone. If this is not done, both the client and clinician suffer.
23. The clinician needs to set boundaries with the client e.g. keeping scheduled appointments, emergency phone contact, being clear and up front about availability and how the client might deal with crises when the clinician is not available.
24. It is helpful for clinicians to be able to identify their client’s dissociative difficulties and then help that client understand those difficulties.
25. For short-term therapy, the clinician needs to set realistic goals for the client at the start, which includes clarifying existing issues, skill-building and referral, and how many sessions the client has with the clinician. The terminating session needs to be labeled as such, incorporate a review of the therapy process, where the client goes from that point on, how the client feels and saying goodbye.
26. Finally, it is crucial for the clinician to take care of oneself outside the therapeutic arena, particularly in terms of doing their own inner work, exercise, sleeping well, spiritual practices, professional support system and recreation. No one can face trauma alone. If this is not done, both the client and clinician suffer.