Presencing Trauma in the Client Experience
As a young college graduate I worked as a counselor with juvenile females at a residential wilderness facility. Each evening we made a campfire for group counseling sessions where the girls had a chance to share their stories and receive some group feedback. All the girls had lived through tremendous trials, but there was one story I’ll never forget hearing. I was sitting across the fire from a young woman who always seemed edgy and defiant. That night she confessed to the group that her mother, a sex worker, had routinely allowed men to put her daughter in a corner and urinate on her for money. I was dumbfounded. I suddenly saw her as broken, tragic and lost. I remember the lump rising in my throat as I, ill-prepared and all of 22, wondered what I was going to say, what I could possibly do, and how on earth I could help this girl? I watched as the other campers recoiled at the thought of being peed on. I listened as they gave their bits of “worldly” advice. I looked up at the ember sparked night and prayed, hoping for some piece of wisdom. When it was my turn all I could say was “I’m so very sorry that happened to you.” Then I welled up and cried.
I’m So Very Sorry that Happened to You
Sadly, the answer to my question, “How on earth could I help this girl?” was that I could do very little. I could be present. I could allow her to be heard. I could lend my sympathy. But I had no real tools to make an impact. I called in the right folks and handed her case over to people more experienced than myself. Since that time (now over an 18 year journey) I have sought to help others heal in a meaningful way that would be a little less hard on my very sensitive system. I first became a massage therapist, then added yoga teacher to my resume, and now I am a certified Yoga Health Coach. My deepest desire was always to help people where they are, in whatever space and time they may show up, to remind them of their wholeness and to aid in their journey of self-healing.
Over years of practicing hands-on healing, I’ve learned that trauma comes in many different forms, severe childhood trauma, a divorce, a job loss, or the death of a loved one. Trauma can also simply stem from life circumstance, such as moving, choosing a new career, or having a child. We see evidence of trauma all around us, in our military personnel who have served in action, in women who have been sexually assaulted, in the wake of recent natural disasters, and in our neighboring countries where resources are limited. Whatever your work may be, however you express your gift or gifts for healing, and whomever you may have chosen to help, there are some basic considerations that may help you, the “Healer,” to assist your next client/patient/family/friend with their next trauma. With awareness and a plan, moving through the process with a client can be a healing experience for them and a safe, effective and wholesome experience for you.
Signs of Trauma
Clients “reveal” trauma in many ways. If we are in close relationship, we may see the situation unfold, and be witness to the ways in which our client is reacting in real time. In other situations the trauma is old and surfaces in little pieces like sand through the sieve, or manifests all at once like a landslide. If you’ve been in the healing arts for any length of time you have seen trauma- both hidden and outright. The yoga teacher may notice a student recoil from touch in an adjustment, or see her eyes wide open in savasana. The nutritionist may see someone with an eating disorder. As a bodyworker I’ve had clients begin to sob from an emerging memory due to somatic release. There are physical, emotional and cognitive signs that I’m going to list, which I believe are a gross over-simplification. In my experience any one of these things can show up differently depending on the stage of grief, the brevity of the experience, the client’s skills, resources and robustness at the time of trauma and at the time of reveal. I list them because it is a good jumping off point from which to consider that any given client may, at any given time, be in some stage of healing from some form of trauma.
Physical signs of trauma may present as chronic pain, headaches, stomach upset or muscular tension. Trouble eating or sleeping, low energy, and hypervigilance may also be present.
Emotional symptoms of trauma can look more like depression from the outside (in fact, depression and anxiety are both symptoms of trauma). These include withdrawal, anger/irritability, and feeling out of control. Cognitive signs may include distractibility, concentration issues, decision fatigue and memory loss, lapse or blocking. If you notice your clients presenting with these symptoms (whether they have spoken their experience to you or not) I encourage you to stay present in your interactions with that client and to be mindful of the following considerations. I hesitate to call these tips because, when dealing with a client who has suffered a trauma it is important to be sensitive to the nuances of the client experience and their presentation of symptoms.
In yoga we often refer to our ability to be fully present, grounded and in full awareness of others as “holding space.” Look to any teacher in any discipline you have considered great and you can see this quality. It is the way a person controls not only the energy in a room, but also the mood – which is not to say that a person who holds space is controlling another person’s experience – just that they are creating an appropriate container in which the experience can safely unfold.
Imagine if you were trying to share something deeply difficult, and your practitioner was distracted – checking his or her phone often or repeatedly leaving the room. Would this create a safe space? Imagine instead that you walk into your practitioner’s office, where he receives you with two feet on the ground, an open posture, a kind smile, and listening ears. Do you see the difference? In the second example, the practitioner is setting the tone of the entire encounter by his or her presence. This is what it means to create space. Creating and holding space is the act of creating a safe container for your client to receive healing. This allows a healing that is guided by you and interpreted by them. When a client has been through a trauma, they will present to you with varying degrees of availability. Their trust in you and their process over time will guide their openness to different degrees of healing. Hold space for their unfurling and it will directly affect the efficacy of your treatment.
Come from your own experience
Many of us who have chosen healing professions are survivors of trauma ourselves. I have been through many traumatic experiences which have shifted my course in my career and in life. Because of this, I am able to experience deep empathy. I am also able to share my truth.
Sharing my story, the lessons I have learned, the growth I have encountered, and the miracles of my own healing, has proven to be a highly effective tool in gaining trust and credibility as a professional healer. When you share your story you are saying, “you are not alone. I truly understand you.” Imagine what this does for a person who is guarded or feeling shame. It allows them to drop the heavy burden of pretense, if only for a period of time, and provides an inlet for healing and growth.
If you are new to the game, you may not be comfortable with your own story yet. Similarly, when a personal trauma is fresh and not yet integrated it may not be appropriate to yet tell your story. You may in this case choose to tell the story of an anonymous previous client (without telling details, of course.) Sharing story is an important part of establishing connection and rapport, even if you have known the client for a period of time, to show some vulnerability and create some common ground.
Be Aware of Triggers
We can’t control our client’s response to everything, but we can have awareness and sensitivity to actions and words that may trigger a trauma response. While we want the client to be safe to express their story, their current emotions, and their physical observations, we don’t want to be the source of trauma activation. A trigger can elicit an unwanted response that puts both you and the client in a compromised position. For example, an emotional release is welcome (a client starts crying in yoga class as they move through a painful memory) but a panic attack brought on by an unexpected physical adjustment (the teacher comes from behind the student, or the massage therapist goes too deep in a sensitive spot) could compromise client and practitioner safety.
- Practice simple habits like using the word “and” instead of “but” to avoid the sound of judgement or contradiction.
- Always explain procedure before moving forward, asking permission before applying the next method.
- Be careful of your own assumptions, particularly those colored by your own experience, which may mischaracterize the client’s experience.
- Do reiterate what your client has said to ensure that you understand them completely and to validate that the client has been heard. You can utilize “I hear” statements – like “I hear you saying ___, is that correct?” One of my favorite validations can be offered in three simple words: “I believe you.”
Identity Evolution Resolves the Trauma Experience
A client may not want to recognize an experience as traumatic because the word itself carries a great deal of weight. It is difficult, however, to resolve trauma without first recognizing the effects the experience of trauma has had on their mind/body/spirit. In my opinion, this is the first stage of healing. A client may be gently guided to their own discovery by using the techniques we have already discussed – repeated their own words back to them, observing the signs and symptoms, and simply holding space for their revelation.
Once trauma is recognized and the client begins their process of healing, they can move into a very important stage of healing, which is to recognize that “I am not this/defined by this.” This is the stage of self-empowerment! Encouraging your client to identify with who they are becoming instead of identifying with the old trauma changes interaction, outlook and response. When “I am a victim” changes to “I am courageous,” the traumatic experience may be integrated and the client can move onward.
Consider Your Scope
It’s important to say this, for benefit of all the licensed professionals out there who are legally bound and limited (or supported by) the parameters and ethics of their legal professions. You must consider your scope of practice! I, for one, am a Licensed Massage and Bodywork Therapist in the state of North Carolina. In my case, I look for the ways in which trauma shows up in the body. I work (in that scope) with the physical hurts, whether they be somatic, stress induced, or physical in origin. If you are a psychologist you may be looking for signs of trauma in the mind. If you are a Pastor you may be looking for signs of trauma in the spirit. We all have a lens through which we consider our clients experience.
As a coach you might take this consideration one step farther: what is my scope, and within that, what is my zone of genius? No matter your profession, you must approach a client’s trauma from a place of authenticity. After all, the person sought you out and stays with you because of your connection. Your expertise may have brought them through the door, but it is the spoken and unspoken language you have developed that entrusts them to stay with you. Stick to who you are and work within your scope and you will profoundly help your client with your presence and consistency alone.
Finally, don’t forget the old adage “when in doubt, refer out.” If that which a client reveals to you surpasses your scope, have an open and honest discussion with your client about it. It is imperative to have an established network of referral partners on hand to whom you can entrust your client’s care. If the needs of your client would be better served by someone else (or perhaps by another modality in addition to your own) be prepared to refer out, keeping the fiduciary nature of your client/practitioner relationship intact.