A couple years ago, I went scuba diving for the first time. Before I was permitted to dive, I first had to sit in a classroom and learn how to use the equipment, how to communicate with my companions, and how to respond to potential challenges. Many people could probably be given scuba gear, sent into the water, and they could manage safely. But while scuba diving is relatively intuitive, it is wise to respect the powerful potential of the ocean and be well-prepared to leave the surface.
I am a trauma therapist, not a scuba instructor. But I also prepare clients to traverse deep waters of emotional pain in pursuit of new experiences. A typical trauma recovery treatment plan begins with a period of skill-building and stabilization, followed by trauma processing. When I explain these phases to my clients, one of the questions most frequently asked is: How will we know when to move into trauma processing?
This is a vitally important consideration in the treatment of trauma. Initiated too early, trauma processing can be retraumatizing. But successful trauma processing is what leads to transformative change and relief. Part of my role is to assess my client’s readiness and ability to uncover and withstand the painful emotions and sensations they may experience. We don’t want to go too fast, but we also don’t want to unnecessarily delay. And unlike a scuba instructor, I can’t just give clients a multiple choice quiz to determine their readiness.
In conceptualizing whether a client is prepared to begin trauma processing, here are some of the factors I consider:
The quality of the therapeutic relationship.
Trauma therapy involves confronting painful feelings, deep fears, and distressing sensations. Many of my clients are survivors of abuse or violence, and the inherrent power differential created in trauma processing – the client’s intense emotional vulnerability and the therapist’s lack of emotional vulnerability – can be highly triggering. It can take time for the relational security to develop such that the client feels emotionally safe enough and trusts the therapist competency to guide them through distress. And the therapist’s trust in the client’s willingness to be honest about their internal experience is equally essential.
Ability to moderate emotional intensity.
As noted above, trauma processing involves allowing oneself to feel intense emotions. We hold space for sorrow, rage, powerlessness, terror, shame. In order to do so, we need mechanisms for intentionally reducing the intensity of or refocusing away from these feelings if they approach overwhelming intensity. I often spend time working with clients on techniques related to self-soothing, grounding, and regulation. Intentional and compassionate engagement with strategies that result in successful moderation of emotional flooding is a good indicator of readiness for trauma processing.
Ability to feel.
Many clients have developed patterns of disconnecting from emotions in order to cope with traumatic stress. If a client experiences emotional numbness, apathy, poor memory, derealization or depersonalization, somatic distress, or detachment on a chronic basis, we spend time learning strategies to reconnect and ground the nervous system. It is likely that clients with these patterns will experience emotional disconnection during trauma processing because their nervous system has adapted as such. Having reliable tools that assist with regulating the dissociation response ensures we are prepared to navigate this inevitability.
Personal and environmental stability.
Addiction, self-harm, serious suicidal ideation, significant patterns of disordered eating, and panic attacks should be relatively stabilized prior to initiating any trauma processing. Similar caution should be applied if there are anticipated family-, financial-, vocation-, or health-related major transitions/stressors. How a client responds to trauma processing is highly variable, and some clients feel worse prior to feeling better. Full stability and remission from symptoms, patterns, or stressors is not necessary – otherwise the client probably wouldn’t be seeking help – but it would be a disservice to my client to initiate reprocessing if increasing their emotional load is likely to cause crisis, relapse, or significant disruption to daily functioning.
After we are able to sufficiently prepare, resolving the emotions and sensations resulting from experiences of trauma leads to profound transformation and healing. It is both a challenging and worthwhile process – one that is deeply rewarding to witness. It is my job to work together with my client to set a pace appropriate to their unique circumstances and needs. A solid therapeutic relationship, practiced strategies for nervous system regulation, creating a stable environment, and intentional timing pave the way for successful processing and long-lasting relief.