Retraumatization is when a client re-experiences or relives their traumatic experience. It is very possible for this to happen when treating clients with trauma. It is one of those things that cause most trauma treatment professionals a slight pause. We worry about harming clients and making things worse for them.
I think it is good to be cautious, but we should not be immobilized by fear of retraumatizing our clients. With the right skills and the right focus, we can assist clients in successfully avoiding retraumatization for the most part. Below we will discuss the three key components to helping a client avoid retraumatization. With these three things in place, you can greatly reduce a client’s chances of experiencing retraumatization.
Now before we get into the three key components, I want to ensure that you understand this is not a guarantee, but it is something that will help clients prepare for and stay stabilized in the trauma treatment process, which will greatly reduce their chances of retraumatization.
#1. Creating a Container in the Treatment Process
At some point in your trauma treatment journey, you might have heard the term container referring to the therapeutic environment/relationship that is created between client and trauma treatment professional. When I refer to a container, it is two-fold. The trauma treatment professional feels a sense of confidence and calmness within, and the client feels safe in the healing relationship.
A couple of things to consider when working on your own sense of calmness and confidence is doing your own work. We recently published a podcast on the importance of this. You can check that out here. Also it is important to track your own nervous system during the session. We also published a podcast on this topic that you can check out here. Lastly, make sure to consider getting support through consultation.
When thinking of the client’s sense of safety in the healing relationship, pacing is everything. Make sure to help clients understand that in trauma work, slower is faster. You can check out our podcast on pacing here.
#2. Tracking Your Clients Nervous System and Maintaining Their Window of Tolerance
Noting that most clients that come in are usually consistently in a hypo- or hyper-aroused state. It is important that we don’t just follow their lead because they are used to being outside of their window of tolerance. Our goal in treatment is to help them to re-establish a healthier pattern within their nervous system.
One of my favorite techniques when helping clients to become more aware of their tolerance is to gently interrupt. I usually try to tell clients in my initial consultation that one of the common things in our work together is me gently interrupting: that gives me an opportunity to provide psychoeducation to them about why this is important and how it is a part of their healing journey.
#3. Establishing and Re-Establishing Stabilization
Once we have helped clients pace themselves by gently interrupting them, we will also need to help them stabilize. I believe it is important that a majority of the time in treatment is spent on helping clients establish stabilization in their nervous system; then as the work continues to re-establish stabilization.
Another way to think about this is to help clients return to their window of tolerance repeatedly throughout the healing process. By repeatedly returning, we are helping clients repattern their nervous system in a healthier manner.
Helping clients to avoid retraumatization is vital to good trauma treatment. We don’t have to avoid the hard topics or be riddled with fear as our clients move into deeper topics in their healing journey. We can use the three components discussed in this blog to help clients move through the work in a safe manner.
6 Responses
Thank you for these keys!
Helping clients return to their window of tolerance can be challenging during session. I just had a client tell me “Nothing works” when in hyperarousal state. She began eating chocolate and picking her nails for comfort. I acknowledged the need for comfort and to take care of self. Then I invited her to talk about what is going well in her life. I saw a small shift.
Any keys when client is highly dysregulated?
Hey Debra,
Great question about highly dysregulated clients. I want to invite you to check out this podcast episode that we did a while ago on working with highly dysregulated clients. I hope it is helpful.
https://traumatreatmentcollective.com/ep-7-supporting-highly-dysregulated-trauma-clients/
I just started with this therapist and he asked me to close my eyes then brought up my most awful CSA memory. As I was in full-blown panic attack, he started acting like he was a father to me and asked if he could come to my couch to give me a hug. Obviously I said no but I was in shock. He had just retraumatized me on purpose in order to get a hug. Is this normal? I think he does CBT/schema
It sounds like you had a really intense and overwhelming experience, and it’s completely valid to feel shocked and distressed by what happened. Your feelings are important, and it’s crucial that you have a space where you feel safe and supported. It’s okay to take the time you need to process this experience and to seek additional support if you feel it would be helpful. Remember, your well-being and comfort are paramount in any therapeutic setting.
I once was practicing some technique where I had to visualize a past scenario that brought up CSA issues . I was OK at first but then the therapist asked me to lie down and if I felt comfortable, he could lie alongside me as we talked through the scene but using desensitization as a means to healing. Like yourself, I naturally said no to his lying beside me and I then started to shake and feel a lot of fear and like I need to escape. This tends to happen when I start to feel vulnerable as then I feel (Fear) that the other person will take control of me. This also can happen if someone takes a romantic interest in me as I find myself questioning their motives and feel trapped by their interest – “Why do you want to know me?” is often a thought that comes to me, “What do you want?” Maybe we should just be allowed to share what we feel comfortable sharing at that moment in time but with a little gentle encouragement to challenge ourselves so as to move slowly forward in diminishing our concerns, and without the therapist suggesting any words or insights as to how to do this, barring inviting us to ask our own questions if we seek clarification. Also, I often now strongly question the wisdom of asking a client to close their eyes and/or to hug a client (this last one I think is a no-go, though others may think otherwise). Closing one’s eyes can become very frightening as it can remind me of the past and thus retraumatize me.
Thank you for your feedback. You are correct everyones nervous system is different. And yes slow is fast in trauma treatment. We wish you well in your healing journey.