HEAING BEGINS WITH KNOWING SOMEONE WILL STAY

When people with complex PTSD (CPTSD) Begin therapy, they often arrive with a lot of pain.

They may come in because they are overwhelmed by anxiety, depression, anger, shame, relationship difficulties, emotional triggers, dissociation, panit, or a persistent feeling what something is wrong with them.  They may have spent years trying to understand why they react they way they do.

On the surface, it can seem obvious what therapy should focus on: Let’s work on the symptoms. Let’s stop that intrusive thoughts.  Let’s stop that nightmares. Let’s help you feel better.  

And sometimes that is exactly what is needed.

But with complex trauma, there can be another process happening underneath the symptoms.  

The client may also be quietly asking:

Can I trust you?

Are you doing to rush me?

What happens if I should you something really painful?

What happens when I should the side of me haven’t been accepted by others?

Will you still be here if I become overwhelmed?

Can you sit with what I am experiencing without trying to immediately make it go away?

These questions may not be spoken out loud.  Sometimes the client may not even consciously realize they are asking them.  But their nervous system are defiantly paying very close attention.

The Work of Building Trust

For someone with complex trauma, beginning therapy is definately more than telling their sotry and learning coping skills.  They are learning what it feels like to be iwth another person while vulerable.  They are watching how the therapist reponds when they become emotional.  What happens when they disagree? What happens when they are confused, angry, quiet, numb, or unsure?

Does the therapist become uncomfortable? 

Does the therapist push?

Does the therapist become overly eager to fix things?

Or can the thearpist remain grounded and curious?

For some clients, these experiences become an important part of establishing safety.  

This can be challenging for therpaists, particularly when we know how powerful trauma therapies can be.

When you are trained in EMDR, for example, you know that powerful tools are available to help clients process traumatic experiences.  When a client is suffering, it can be tempting to think, I know something that could help.  Why aren’t we doing it yet?

But sometimes the most important clinical quesiton is not:
“What intervention can I use right now?”

It is

“What does this client need from me right now?”

Those are not always the same thing.

Are We Holding an Agenda?

One question I frequently ask myself is 

Am I holding an agenda for this clien? Is this agenda helping client’s nervous system or actually going against it?

As thearpists, we have our traiing, our treatment plans, protocols, interventions, and our ideas about what might be helpful. 

Those things matter.

But our expertise can also make it easy to move into doing before there has been enough space for being.

We might assume that becaue a client is taling about a painful memory, they are ready to process it.

We might assume that becaue they want their anxiety to go away, they are ready to do EMDR. 

We might assume that beause they have been in thearpy before, they already know how to trust a therapist.

CPTSD can make those assumptions particularly important to examine. 

Sometimes the client is not yet asking us to proces the trauma.

Sometimes they are asking us, in ways they may not have words for yet, whether we can stay with them while they experience it.

What Happens When a Client Isn’t Happy with Me? 

There have also been times in my own work as a therapist when clients have not been hapy with me.

Earlier in my career, my instict have been to become defensive—to explain what I meant, clarify why I made a particular decision, or try to help the client understand my perspective. (I know, I was such a jerk!)

I have learned that sometimes, that is not what the client needs.  

Now, when a client tells me they are unhappy, I try to slow down and genuinely listen.

What are they experiencing?

What did they need from me that they didn’t receive?

What did I miss?

What is important for me to understand about their perspective?

This does not mean that I automatically agree with everything a client says.  For me, at this point, agreeing is not important.  Holding a safe space for the client to feel validated is more important.  It means I want to understand their experiences.

I can actually hear the client more clearly.

I may learn something about what they need from therapy.  I may recognize that I moved too quickly, misunderstood something, or made an assumption that did not fit their experiences. Or what I did, no matter how good of my intention, it did hurt them, and I need to apologize.

I also deeply appreciate when a client has enough trust in me to tell me that something isn’t working.  I know that can take a tremendous amount of energy and courage, especially for someone whose history may have taught tgem that speaking up is unsafe, pointless, or likely to lead to rejection.

When a client can say, “I am not happy with how this is goin,” and we can stay in the conversation, something important can happen.

We can have a problem.

We can talk about it.

We can come to a better understanding of each other.

And we can continue working together.

I am still here.

A Story about a Pillow

During a training with Kathy Kain, she shared a story that has stayed with me.

She described a client who repeately complained that the pillow in her office was uncomfortable.

Rahter than dismissing the complaint or telling the client to simply tolerate it, Kathy kept looking for another pillow.

She spent weekends shopping for different pillows!

This continue for a long time.

Eventually, after about a year, the client found a pillow that felt comfortable.

(And honestly, when I heard the story, one of my first thoughts was: Where did all those other pillows go?)

But the pillow wasn’t really just about the pillow.

The pillow became part of the relationship.

It communicated something important to the client:

I hear you.  Your needs matter. I am not going to disappear because the intervention (the pillow for example) is not working or because something is difficult.

The pillow became an intervention—not because the right pillow was going to cure trauma, but because of what the therpaist’s response communicated.

For someone whose history may include abandonment, neglect, unpredictability, betrayal, or reltionships in which their needs were repeatedly dismissed, and experience of someone staying present can be deeply meaningful.

Sometimes safety is built through these seemingly small moments.

Not every therapeutic intervention look like an intenvention.

Staying Does Not Mean Doing Nothing

There is an important distinction here.

Slowing down does not mean avoiding trauma work forever.

It does not meant that a therapist should never challenge a client, never introduce EMDR, or never move toward difficult material.

And it certainly does not mean that therapy should become a place where the client remains stuck indefinitely.

Rather, it means paying attention to timing.

Trauma therpy is not simply about what we do.

It is also about when we do it, how we do it, and whether the client has enough internal and relational safety to engage with the work.

This means we continue to help clients build nervous system regulations skills, be able to track what safety feels like, all while building trust and rapport.

Healing Can Begin with Staying

Sometimes the most important part of trauma therapyis the experiencce of being heard, undertood, and met with curiosity—even when things are difficult. 

We can have diificult moment.  We can repair.  And I am still here.  

“Jane” I-Chen Liu, MA. LMHC. SEP™, owner of KareKounseling PLLC, is a licensed trauma therapist in Lynnwood, WA who specialize in CPTSD, sexual abuse, medical trauma, and complex issues clients have with their family of origin. Jane is passionate to work with people who had been carrying too much on their own. Learn more about Jane here.