What is Trauma?

What is trauma?

Trauma is a word we throw around a lot, but often struggle to understand. It is a very real experience that, if unexamined, can lead to ever-increasing pain and confusion as we attempt navigate our stories. If you remember nothing else from this article, remember that trauma not as much about what happened to you, as it’s about how an experience landed with you. 

Through examples, and a quick look at nuero-science, we will unpack the concept of trauma so and deepen our understanding of it. By digging deeper, we will cultivate the capacity to recognize the impact of trauma by identifying its those experiences and their resultant patterns in our lives. Engaging the trauma’s in our story will help us understand our stories and the deeper meaning behind them.

Understanding trauma

Trauma comes from a Greek word that literally means “wound.” In the mental health context, we understand trauma as an event (or series of events) that results in emotional or psychological wounding. Because it’s inherently painful, our tendency is to manage the pain and move away from it as quickly as possible. Often, in our scramble to dull the pain from a traumatic experience, we move on from that experience without taking the time to figure out why it was painful or what it means for our story. But doing this leaves us raw and exposed, making the wound vulnerable to unintentional irritation through otherwise perfectly normal actions.

For example, if a soldier is wounded on the battlefield, there often isn’t space to properly dress and treat the injury. A tourniquet, a compression bandage, and vitals verification is often all there is time for in the heat of a battle, and rightfully so. But in the wake of the battle, if the wound isn’t properly treated, it can lead to a faux restoration. As a result, a friendly pat on the effected shoulder can result in blinding pain, placing the wounded individual back in the traumatic experience. 

In the same way, untended traumas can leave us vulnerable to people who don’t mean to harm, but who may inadvertently ‘bump’ up against an unhealed wound. When this happens we can find ourselves ‘triggered’, or having an unexpected or disproportionate reaction to an otherwise innocuous event; but one that relates to a trauma in our story.

This is why it is so important to address trauma in our lives. It is not enough to quickly dress the wound and try to move on or forget the wounding experience ever happened; instead, we must summon the courage required to face our trauma and work towards healing.

Responding to Trauma

Our response to trauma takes us out of our normal, everyday functional cognitive capacities, making us respond in one or more different ‘triggered’ modes: fight, flight, freeze, submit or tend-and-befriend. In our triggered state, our brain registers that we are in distress and immediately responds by slowing or stopping certain autonomic processes normally associated with rest and restoration. Simultaneously, the mind and body reallocate resources to muscles (so we can either fight or run), and to more primal parts of the brain that are responsible for threat mitigation (like the amygdala, hippocampus, and medial-prefrontal cortex). This means that other lower priority signals and processes aren’t tended to in the moment. When this state of hyper-arousal is persistently maintained it can result in chronic fatigue, high blood pressure, and a host of other significant health concerns. 

The freeze response is similarly taxing. It’s an autonomically-initiated dissociative state of varying intensity designed to preserve and protect a person’s core identity from the wounds that are being inflicted on the body or self. This hypo-active response is typically initiated when the fight or flight responses are judged to be ineffective. A remaining option in this event is to posture in such a way as to freeze and endure the travail as opposed to combating or escaping it.

The submit response is an effort to move with, rather than against, whatever is perpetrating the trauma. This can often look like appeasement. The victim attempts to mitigate the damage by going along with the harmful components of a person, system, or community.

According to Teresa B. Pasquale, in her book Sacred Wounds (2012), a more recently identified defense mechanism is to tend-and-befriend. In this case, in an effort to mitigate victimization, a person will experience a powerful bonding dynamic with the perpetrator(s) creating an unhealthy alliance. The “restoration” that happens in this space is generally shallow and duplicitous, leaving the victim vulnerable to repeated perpetration in the future. This response is empowered by the natural bonding system that keeps people together in difficult times. In its more severe iterations it can present as something like Stockholm Syndrome, where a hostage identifies and aligns with their captors.

Brain Response

This is a SPECT scan of an individual’s brain recalling a traumatic event. Blood flow (depicted in red) is substantial to multiple areas of the brain. When the trauma has been addressed and resolved the same memory results in a substantially more peaceful neurological picture.

As we think about how our body naturally responds to trauma, let’s consider the brain as something akin to a distribution center, and our senses are the trucks that deliver the data to the appropriate docking bays (or cortices of the brain). Our senses like sight, smell, touch, etc., bring information about every single life experience for our brain to process. High-level cognitive processes get slowed and stopped so that the docking bay in your brain has to hold all of the information instead of processing it and moving it somewhere else for storage. That docking bay is suspended in time, but a memory, when mal-adaptively encoded, will be temporally bracketed. When you go to the “docking bay” to look at a memory that’s stored there, it feels like it’s happening in the present moment because it was never processed and stored. As a result, even if the memory is decades old, the experience of recall can make the event feel as if it is happening again.

When we recall an unprocessed traumatic memory, multiple areas of the brain are inundated with blood flow and the subject is typically overwhelmed and triggered. However, if treated effective trauma interventions, the memory is adaptively encoded and the subject can recall the traumatic event without significant distress. Understanding how the brain responds to trauma reveals another important aspect of trauma: because it has to do with how your brain stores the memory, it’s a primarily subjective experience issue, not an objective experience issue. 

That’s why two people can experience the same event but only one registers it as trauma. Children can grow up in the same home and be part of the same events, but one may register negative experiences as trauma and the other won’t. One isn’t right and the other wrong, that’s just the nature of trauma. It’s all about how we as individuals receive and then process the experiences in question.

Recognizing Trauma in your Story

So how do we approach trauma in our lives? If the initial trauma is subjective to each person’s experience, how can we begin to recognize when we’ve experienced trauma and learn to recognize when that trauma is impacting us down the road?

We can begin by identifying triggers. Triggers are anything that induce some variation of the aforementioned trauma responses. They can be related to feelings, fear, or energy you experienced at the initial time of the trauma. 

Perhaps, for example, your last relationship ended badly after a subtle energy shift which resulted in your fiancé leaving you. You may not have connected it at the time, but that little shift stayed with you.

Now, in your current relationship, this old trauma may play out as you noticing a similarly subtle shift in the energy of your partner. As a result of your trauma, you may find yourself hyper-aware of this shift, but may struggle to give it language. The presence of the shift increases your anxiety (triggers you) and you become hyper-vigilant to notice any relational nuance. As a result, you pull away, or hover in an effort to avoid or address the conflict. What’s really happening is you’re being triggered and probably don’t realize that it’s related to a past trauma. If left untended, this dynamic often decays into a self-fulfilling prophecy; in our effort to avoid our worst fear, we actually re-enact it.

Trauma and triggers can be very nuanced, and if you aren’t attentive to them you can find yourself in these maladaptive patterns that not only hurt you, but the people you love as well. 

Many people look at their story and think that nothing traumatic has ever happened because our understanding of trauma is often so extreme. We think if we haven’t experienced sexual abuse, combat zones, or physical injury, then we haven’t experienced any significant amount of trauma. But this unfortunate understanding keeps us from recognizing and dealing with the trauma in our own lives. Remember that trauma means “wound”, so any kind of wounding we experience carries with it the possibility of resultant trauma.

When we experience trauma as children, our natural response - because we don’t have the maturity to know how to address it - is to normalize it. That is, we assume that this is typical life; that everyone experiences something like this in their upbringing. This response serves us well as children because it allows us to live with innocence and minimize pain when we aren’t equipped to handle it. But in our adult world this avoidant tactic is neither helpful nor productive. It serves to stunt our emotional growth and our ability to live in healthy and integrated relationship with others by undermining and devaluing our emotional and relational experiences.

To respond to trauma as adults requires courage and curiosity. Allow yourself to be curious about your triggers without jumping to the “why” question. “Why?” is often a question laced with contempt and accusation resulting in a defensiveness that shuts down further exploration. Instead of asking why, be willing to step back into your story where a trauma may have occurred and see what really happened. Ask how it impacted you and how you experienced it. Explore what you felt and what was going on, and notice how you feel as you enter into the memory.

These types of questions - “What happened?” “How did it make me feel?” “What did I believe about myself in that moment?” “What triggers that trauma today?” will help provide context for your current story allowing you to move forward in health … for yourself, and those that matter most.

How to Pick a Therapist

How to Pick a Therapist

There are several excellent reasons to see a therapist. When beginning the search, most people will ask their friend 'Google' who the best counselors are in their area. While the internet can be a great resource, your real-life friends will typically be able to connect you more effectively. Even so, if you're stuck with the internet, www.psychologytoday.com is a great place to start. Like most things, the idea of doing something is often more straightforward than actually doing it. When it comes to navigating the bevy of credentials, certifications, specializations, and licenses, finding a good counselor or therapist can be daunting. Even with all the degrees and letters aside, there are many practical, ideological, and relational dynamics that may help you narrow your search.

Why consider all of these issues? According to the Family Institute, the quality of the therapeutic relationship is one of the most reliable indicators of success in therapy. Therefore, putting in the effort to make a good therapy choice in the beginning, can pay significant dividends in the end.

Practical Questions

What can you afford?

Maybe the first and most basic question is price. What can you afford? Going into debt or taking on financial burdens will only increase the stress in your life, so it's wise to keep affordability in mind when looking for the right therapist. As a point of reference, Licensed Professional Counselors (LPC) in Colorado Springs generally charge around $125/hour.

Do you want to use insurance? If so, are they paneled with your insurance company?

You may be able to use your insurance, and if you're in crisis, don't hesitate to do so. That said, if you go the insurance route, it can introduce some limitations. Before you try to use your insurance talk to your insurance company about what kind of mental health benefits you have. You may be able to see people out of network and get reimbursed. Or an in-network provider can bill your insurance company directly and collect a copay at the point of service. If you use insurance, the therapist you work with will have to issue a diagnosis based on the information you provide. That diagnosis will then be part of your permanent medical record. If you don't meet the criteria for a diagnostic condition, later the insurance company may not pay your claim. Of course, there will be a limited number of therapists that take your insurance, thereby reducing the number of therapists to consider.

Do they offer a free consultation?

Try them out! Not every therapist is for every person; if it's not a good fit, try a different therapist. Not even a counselor will connect well with every person they see. A free consultation allows you to get a feel for the energy and approach of your prospective therapist (and occasionally a good cup of coffee). Getting a feel for different clinical methods will give you more of the information you need to find the right therapist for you in your current situation.

Can they work with your schedule, or can you work with theirs?

How soon do you want to see a therapist? The more flexible your schedule, the more choices you'll have. If you've found the therapist that you want to work with, but are struggling to find a workable time, consider taking an extended lunch break? Can you come in an hour early or leave an hour late to facilitate your meeting with a therapist during their counseling hours? We all make time for what we value, including time for our personal and emotional wellbeing . Work with your prospective therapist to find a time to connect, and if they are unavailable, wait for the time slot you'd like to open up or ask to be added to their waitlist. If the challenges abound as for anyone they would recommend that may be able to work with you within your time constraints.

These practical questions are worth considering and may limit the field considerably, making the choice more straight-forward. Many therapists will work with you to figure out timing, affordability, and other considerations, so don’t be afraid to ask.

Ideological Considerations

Are they in alignment with your values? Does that matter to you?

Values have to do with faith, worldview, politics, drugs and alcohol, sexuality, and morality. These values aren't equally relevant or prominent for everyone, and that's okay. Sometimes people are just looking for a safe place to explore their the story they find themselves in. They don't put a high premium on their therapist completely aligning with their values. After all, an ethical counselor will work diligently to avoid imposing their values on their client. For others, that question is at the top of the list. Take time to figure out how important your values are to you and use this awareness to help you narrow your options to the therapists that will be best for you. Feel free to ask your prospective therapist(s) what their orientation is regarding the values most important to you.

If having your therapist align with your values is important to you, there are other questions to consider along those lines. Will they support your faith system, for example, while also calling out its failures or harm? Will the therapist be affirming of your sexuality? Will they help you navigate the complex spaces that have emerged between sexuality and faith. A good therapist is there to help you, so be honest and transparent regarding your values and goals. This posture will bring clarity and direction to the work you embark on together.

What's their specialty?

Some therapists are trained specially to work with people that have specific issues or challenges. Some counselors specialize in trauma, sexuality, faith, addiction, couples, testing and assessments, and medication. If you're navigating a specific kind of challenge, there are certainly therapists that have dedicated their practice and career to someone like you. If you're having a hard time finding the right practitioner, tap into your network. You'd be surprised by how many of your friends and acquaintances know someone who may be well suited to your needs and preference. Some people want to journey with people who have been there. Despite their experiences, some therapists can still help get to the root issues you wish to address without having similar experiences as you. Do that free consult, or sit with a potential therapist for a few sessions to see where it goes. Again, the quality of the therapeutic relationship is one of the most reliable indicators of success, so if the chemistry is there, you may not need the specialty.

Relational Questions

Does gender matter?

The vast majority of the mental health field is female, so if you’re looking for a female therapist you’re in luck. However, it is important to be openminded; different genders can help you work through distinctive parts of your story. If you’re not sure, taking therapists up on their offer of a free consultation can be valuable. Also, take into consideration the critical parts of your story. If you're often triggered by one gender more than the other, that can inform the therapist you choose. If you're new to therapy, it may be wise to work with whichever gender you find safest. If you've done some work, and you're looking to venture into uncharted territory, it may be time to work with a more challenging therapist.

How do you receive feedback?

Regardless of who you choose to work with, know that a good therapist will give honest and insightful feedback. If you are struggling to find the right therapist, you may want to consider if you are willing to contend with the issues that therapy is exposing in your story. If you've struggled to connect with several therapists, it may be that something continually resurfaces that you're unwilling to address. Take note of this; it may be your invitation to go deeper into your personal narrative.

Navigating Credentials

One of the most overt considerations, even if it's not the most important, is to evaluate your prospective therapists' qualifications. Different licenses allow therapists to do different things and knowing this can help you choose the right one. Keep in mind, if a therapist has more education, experience, and demand, it is likely they will have a higher price-point. Here is a list of the various types for reference:

• RP – A Registered Psychotherapist is unique to the state of Colorado. This practitioner is not required to have any additional training or credentials and only needs to pass a state test to earn their title and practice.

• LPC – A Licensed Professional Counselor (LPC) has a masters degree (but can have a doctorate as well), has passed the Colorado Jurisprudence Exam, logged 2,000 hours of post-degree of supervised experience, and can specialize in a variety of arenas.

  • CAC I, II, III – A Certified Addictions Counselor (Level I, II, or III) is a title that identifies clinicians specially certified to work with substance abuse and addiction.

• LAC – A Licensed Addiction Counselor has completed all the training of the CAC and has received sufficient addictions-specific supervision to carry an Addictions License with the state.

• LCSW – A Licensed Clinical Social Worker (LCSW) typically has a masters degree and usually works at providing and identifying relevant community resources. In a more clinical setting; their focus is often, though not exclusively, related to resourcing clients with various community-based interventions and programs.

• LMFT – A Licensed Marriage and Family Therapist has a masters degree and two years of post-masters supervised practice. As their title indicates, they specialize in marriage and family dynamics. If you're interested in couple therapy, or if you're dealing with a difficult family situation, the LMFT could be the right pick for you.

• A Psychologist holds a non-medical degree and cannot prescribe medication. In the state of Colorado, they have at least one year of supervised post-doctoral work. Psychologists can offer high-level assessments and then interpret and deliver the results. They are often trained in research and have deeply specialized experience in their given areas of clinical practice. They are frequently on the leading edge of new clinical explorations.

• A Psychiatrist holds a medical doctoral (MD) degree with specializations in psychiatry and psychiatric medicine; this means they can prescribe medication. They're required to practice for four years under supervision, typically in a residency program. They often, though not exclusively, do a lot of work with medication management. In other words, you're likely to get an initial consultation, followed by appointments every few months to ensure that your medication levels are adequate and effective. It is not unusual to see Psychiatric Nurse Practitioners functioning in the similar spaces as psychiatrists.

Finally, there are community mental health centers. I've saved this for last because you will likely find all of the above categories in these organizations. They can be useful, but often practitioners are overworked, seeing as many as 40 clients a week. If you're on Medicaid* or other government-mandated or managed care, this can be a great place to start, though many clinicians in private practice also accept Medicaid..

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*Medicaid recipients may not pay out-of-pocket for covered services. Charging a Medicaid client for such services is considered fraud.

Even if your search for the right therapist takes time, keep your long-term goal in mind: emotional and relational wellbeing. The value of exploring your story is staggering; it's worth it to take the time to find the right person to help you get there.

Why do we have Emotions?

Why Emotions?

"What would it look like for you to invite sadness in as a friend?" I looked at my counselor with shock and disbelief. I immediately blurted out, "Why would I do that?!" I honestly don't remember the remainder of that session. My mind immediately descended into a frenzy. Who on earth would ever want sadness as a friend? I have worked most of my life to avoid, eliminate, squelch, and or ignore my sadness along with every other "bad" emotion.

Like the stereotypical man, I worked to rise above my emotions and make "rational" decisions. Feelings were supposed to get in line with my other, more “reasonable faculties”. And when those pesky little buggers raised their heads, I would smash them down to make sure they didn't influence things too significantly. Emotions, especially the negative ones, were a nuisance that needed to be kept in line.

What use are Emotions?

But what if there is more to our affective experience than that? If they serve a purpose, what purpose would emotions serve? Perhaps they tell me what I like to do and things I don't much like to do. Or maybe they help me figure out my temperament and what kinds of work I should be pursuing. Or possibly they are a result of human brokenness, and if we lived in a perfect world, there would be little more than pleasant serenity. If it were only that simple…

In subsequent sessions with my counselor, as well as in my time studying to be a counselor myself, I realized that the purpose emotions served was far more profound than I had initially considered. As far as I can tell emotions serve at least these three purposes:

Three Purposes of Emotions

1. Emotions allow me to know and respond to the state of my internal world. Like the indicators on a dashboard, or the instruments of an airplane cockpit, I can understand the running condition of my inner world through the information provided in and through my emotions.

2. Emotions allow me to connect with others in the context of their emotional experiences. I cannot attend well to my wife if I remain wholly oblivious or contemptuous of her emotional state; the same holds with my children, not to mention the clients that I serve within my clinical practice.

3. Fundamentally emotions give me data regarding the quality, nature, and impact of the relationships and conditions I am currently navigating.

Working Against Myself

So here is the ironic thing: In my effort to be logical and rational, I tried to eliminate emotional data from my evaluation, hobbling myself in the very goal (being rational) I intended to pursue. I will never be logical if I eradicate relevant data, even emotional data, from my calculus. It turns out that by diminishing, ignoring and downplaying my emotional experience, I was becoming less rational.

When we shun our emotional experience, we end up numb to our world. As with numbness in the dentist chair, we don't feel pain; we don’t feel anything. We can't taste our food; we can't report if our toothache is better or worse; we don’t have enough data. Likewise, if we live a life void of emotion, we can't live a life informed by the experience of either joy or sadness.

Welcome to the Human Race

So when my therapist asked me to, "invite sadness in as a friend," he was asking me to be more integrated. He was inviting me to be more rational and logical; more wholehearted; and fundamentally more fully human. We are not (nor were we ever intended to be) cold, calculating machines. In fact, when we integrate our emotions more fully into our lives, we don’t only live more rationally, but we also find a bedrock of meaning and purpose.

However, living a more fully integrated life is costly. Integrating our emotional lives into our story opens us to hurt and sadness, but it can also bring great joy. The invitation is to acknowledge your heart with all of its pain, sadness, grief, distress, anger, fear, gratitude and joy. It is an invitation to live a life fully integrated, and fully human.