Tips for Working with Trauma from Sandy Hume

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The November 1, 2013, edition of Clinical Connections at the Irvine Graduate Campus featured Sandy Hume, LMFT’s presentation on working with adults with complex trauma.

In her presentation to an audience of students and practitioners, Sandy explored the attachment research that is the underpinning of the contemporary understanding of complex trauma. Secure infants/children learn to trust how they feel and the world, to understand feelings, make decisions and take action. They develop a complex vocabulary to describe their emotions: “I can regulate myself, make good decisions, take action, communicate what I need and get help.” When this security is undermined by a chronic experience of physical, emotional, or educational neglect or abuse, however, complex trauma can result.

Developmental/chronic trauma interferes with neurobiological development, specifically the capacity to integrate sensory, emotional, and cognitive information into a coherent whole. Adults with developmental trauma often:

  • Desire safety — they do not feel safe, so they engage in behaviors that create a perception of safety. For example, perfectionists order every detail of their lives down to the most minute aspect in order to feel safe.
  • Feel overwhelmed and experience affect regulation issues.
  • Have issues with trust and discernment,
  • Have learned to be overly pleasing and/or rejecting when it comes to people. For clinicians, notice someone’s interpersonal intensity reaches inappropriate levels. Were they left alone early on to deal with their experiences?
  • Are hypervigalent.
  • Self-blame in order to continue loving someone who should have been protective. When you organize your world around someone who is abusive to you, you feel like you have to make it your fault in order to survive.

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Developmental trauma coping mechanisms that you may find in a client with complex trauma include:

  • Fight/flight/freeze responses
  • What is a freeze response? In wild, it’s playing dead in the face of a predator. In people it often takes the form of dissociation.
  • ADHD from trauma? “You’re not living up to your potential” is a common misunderstanding of the situation.
  • Repression of terror are helplessness.
  • Amazing resilience, resourcefulness, and talent.

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Regardless of theoretical orientation or technique (CBT, psychodynamic, and EMDR are all common and empirically supported), the goals of working with complex trauma clients are similar. They include helping clients to:

  • Learn how to respond effectively in the here and now.
  • Regain control of their emotional responses
  • Integrate traumatic memories into the larger perspective as historical rather than current or future.
  • Feel in charge of their lives.
  • Reduce feelings of shame.
  • Set better boundaries.
  • Choose mutual relationships in their lives, rather than relationships that are a one way street.
  • Express their feelings and needs and ask for help.
  • Deal with the disappointment that comes from understanding that no one is coming to be the perfect parent or other person that they never had (thinking this is how people get into bad relationships).
  • Learn how to modulate feelings and responses.
  • Build their ability to self soothe and experience containment – for example, through journaling, exercising, tolerating unpleasant emotion until it passes, reaching out for support, etc.
  • Understand emotions as cues rather than defaulting to fight/flight/freeze instincts.
  • Utilize breathing techniques to bring the calming parasympathetic nervous system online.
  • Verbalize feelings and associated meanings to create context.
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