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Self-Secondary Wounding – Part 2

March 13, 2012

TLC GUEST BLOGGER: Cherie L. Spehar, LCSW, CTS, CTC

Last month, we introduced you to the new concept of Self-Secondary Wounding – an intense variation of secondary wounding that is self-inflicted. Informing our trauma work with this concept is proving to be essential for true healing to occur. This month, we’d like expand on this component of post-traumatic pain by offering some information on its impact on the Trauma Recovery process and some practical approaches that can be integrated into the Trauma Intervention Program.

Impacts

When Self-Secondary Wounding is present, or Secondary Wounding, it interrupts the structured component of the Trauma Intervention Program. When we reach this point in treatment, you may see a person begin to absorb themselves in thoughts and feelings of worthlessness, intense feelings of self-hatred, shame and self-disappointment. Temporarily, the wounding becomes the trauma source, and therefore needs a specialized kind of attention.

Some Helpful Steps

The first thing I have recognized is that this is where we might integrate a “Planned Pause” in the structured sessions of the Trauma Intervention Program. The depth of pain caused by Self Secondary Wounding is intense and also traumatic. With that in mind, when I see this emerge, there are several steps I have incorporated into this Planned Pause in treatment. Here are some of the few practical and gentle approaches I have used:

  • Mindful Self-Compassion – We know that mindfulness is a very useful component for sensory regulation and awareness. An approach called Mindful Self-Compassion is particularly helpful in assisting adults to be lovingly aware of these feelings and sensations, while responding to them with gentleness, kindness and understanding. If you are not familiar with this specialized mindfulness approach, there are several resources available to help inform your practice. I would, however, add the important caution that when using any form of mindfulness in trauma work, we must be very certain that the person is ready to be fully present with those feelings. Mindfulness should usually be introduced only in the latter part of trauma work and only when other healing conditions and readiness have been met. This is no exception.
  • Drawing – Continuing with the important art and drawing component of the Trauma Intervention Program, I have had great success with asking adults to draw pictures specifically related to Self-Secondary Wounding.  I usually integrate a series of drawings that include a self-portrait, a picture of “Now Self” saying the wounding elements to “Then Self”, or a picture of what the secondary self-wounding looks like. It will be important to choose what drawing is most appropriate for which client at what time. You would then witness this in exactly the same way as the Trauma Intervention Program instructs but with questions relevant to Self Secondary Wounding.
  • Internal Family Systems Therapy – I have also seen positive outcomes by creating some adaptations to this gentle and strength-based approach. Simplified, this is a form of therapy that helps a person make “friends” with all their “parts.” It helps a person recognize that, not only are they made of these various parts, but that each part serves to protect them in some way.  Internal Family Systems Therapy is a wonderful therapeutic approach for promoting balance and internal harmony.

It is clear that there are some parts of trauma recovery that are creating new learning for us as practitioners. We certainly know that many individuals report feeling worse about Secondary Wounding than the trauma itself. Self-Secondary Wounding is no exception, and it calls for the integration of some additional therapeutic approaches. While our main role with the Trauma Intervention Program is to be a witness, if Self Secondary Wounding is present, it seems essential to blend roles of clinician and witness to maximize healing outcomes.

Cherie L. Spehar

http://www.facebook.com/smilingspiritpathways

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