About Trauma, Trauma Intervention and the Brain

TLC Guest Blogger: Lori Gill, M.A.

I recently had a client mention they were told—by a therapist—that they were not stable enough for therapy. This really shocked me and caused me to wonder: If we can’t stabilize in therapy, where can we stabilize? This paired with a psychiatrist telling a client she was not stable enough for trauma therapy really got me thinking there is still a considerable lack of awareness regarding what trauma therapy is and how it works. As a result, I thought I would focus on a few areas where there seems to be some confusion. Trauma therapy by a qualified and Certified Trauma Specialist ensures that the therapist has an understanding of trauma—how it impacts the body, the mind and behavior—and knows how to work in a safe and ethical manner to create stability.

Safety & Structure:

A qualified trauma therapist understands the key features of trauma are a sense of terror and powerlessness, occurring primarily at a sensory level. As a result, the primary focus of intervention is to instill a sense of safety, beginning with sensory interventions. A trauma therapist should be willing to slow down treatment to focus on addressing and resolving the underlying issues in a safe and secure manner to allow for externalizing, containment and reconstruction. The programs provided by TLC provide an excellent framework for safe, structured sensory interventions. I have used TLC’s various programs with children as young as two and with adults up to 65 years of age and have consistently observed great success including the reduction of trauma-related symptoms. You can review the various evidence-based trauma intervention programs at TLC’s online bookstore.

The Brain as the Master Conductor:

A trauma therapist also understands how the brain becomes hardwired and associations are formed that cause us to respond in rigid, automatic ways, rather than how we would want to respond. They understand that it is not that the brain is “not working” properly during a trauma state, rather it is actually working quite effectively, but it is operating from a place of survival due to an actual or perceived threat. This means that while we may observe behaviors that seem unusual or disproportionate, we must keep in mind that although the behaviors may not make sense to us, they are functional for the individual at some level. This may be represented through hyperarousal or dissociative continuums, which are actually protective mechanisms.

Differential Diagnosis:

Behaviors exhibited following trauma may commonly be misinterpreted by those lacking an awareness of trauma and its impact. For example when in a heightened state of arousal reactions may seem unusual to others, prompting inaccurate diagnosis, these behaviors make sense to the individual acting from a state of survival:

• Fight – We may see verbal or physical aggression or excessive reactions, which may be misinterpreted as behavioral or attention seeking. This may also be perceived as oppositional behavior, ADHD, anxious/aggressive-type behavior and may be representative of traumatized youth in conflict with the law.
• Flight – We may see individuals trying to escape or avoid circumstances, people, places and things (avoidance, kids running away, etc.) difficulty with isolation and social skills.
• Freeze – When unable to fight back or flee, we may see psychological protective responses such as trying to escape through numbing or dissociation. This may present as daydreaming behavior, inattention, inability to focus and concentrate, disorganization, etc., resulting in a diagnosis of ADD. The frozen stare of an individual immobilized by fear may also be interpreted as oppositional or passive-aggressiveness (freeze-fight).
• Surrender response – We may also observe compliance. This can be misinterpreted as agreement, when in reality it may be that they do not feel they will be heard or have expressed their feelings only to have them be ignored.

*It is crucial that we allow children to express how they feel and be heard!

*It is important to note that fight-flight-freeze behaviors are not mutually exclusive and may occur simultaneously as well.

TLC offers training providing foundational information about trauma and its impact, leading to certification as a Trauma Specialist. To learn more visit www.starrtraining.org/trauma-certification.  One of the online courses TLC offers focuses on the differential diagnosis between ADHD and PTSD.

Automatic Responses are not Willful:

A trauma therapist understands it is not that we “don’t” but rather sometimes we “can’t.” The behaviors and experiences that result are not contrived but are automatic processes governed by need for survival in the moment. During this time, higher-order brain functions not deemed necessary for survival are placed on hold to optimize those perceived vital to survival. Therefore those higher-order cognitive functions and executive control functions may not be accessible. When presenting brain function to clients, we need to do so from a space of genuineness and compassion, normalizing the way their brain and body is responding and associated symptoms as being common to trauma. Many already experience guilt and self-blame. Helping them understand these symptoms are normal and occur at an automatic and largely subconscious level helps reduce some of the associated guilt, blame and magical thinking.  TLC’s book “Brave Bart” is an excellent tool for identifying and normalizing common trauma reactions.

Compassion, education and empowerment are so important for those who have experienced trauma. TLC Certified Trauma Consultant – Supervisor Cherie Spehar nicely summarizes the needs of those who are wounded by trauma and how we can help them heal: notice me, understand me, soothe me. If we can provide this, we can help create a sense of safety, empowerment and healing.