I watched this video about an amazing rescue of an impala, and cannot help but feel a tremendous sense of wonder for the nature of the nervous system.
This video shows us an animal’s natural response to a traumatic event, being stuck in a situation which is life threatening. Then it comes across rescuers who saved its life.
How is this connected to trauma treatment?
Well, if we observe carefully the behavior of the impala, we may be able to learn something very valuable about treating post-traumatic stress disorder and complex trauma in humans. Let’s take this video as a metaphor: the impala as the client who seeks the help of a professional, the rescuers. The impala is not aware of its traumatic situation. It only knows that it wants to get out of being trapped. Clients too come to therapy seeking help to get out of a “stuck” situation. They have often little awareness of the big picture. In therapy, the therapist and client find out together what the big picture looks like.
When clients come to therapy, there is anxiety. Just like in the video, as the rescuers approach the impala. It becomes more afraid. Client’s wonder, “Can he/she help me?”,” Will I be hurt by this person?”,”Is therapy a waste of my resources?” “What is he/she doing?” “Is he/she judging me?” etc.
The therapist is there for the client exclusively. In the video, the rescuers genuinely wants to save the impala. Hence, it is really important that the therapist is there, in the session, only for the client. Realistically, this can only be possible with therapists who genuinely love the work and who are adequately remunerated for it. Reasons why professionals in the helping professions burn out and become ineffective can be attributed to this point: giving is a two-way process, and overt charity is neither kind nor sustainable.
The therapist’s empathy. A genuinely present therapist, will put in the effort and strength to be with the client, just like the man who would put his body in the mud for the impala. The therapist would, experience what the client is going through. This is what we call empathy.
Therapists also need other therapists to support them. That is why we attend workshops, therapy, supervision and inter-vision. In the video, the rescuer does not work alone. When he is stuck in the mud with the animal, his friends help to pull him out.
A part of therapeutic treatment is about doing nothing together. This is a recovery phase for both therapist and client. When the rescuers finally managed to pull the impala onto safe ground, they take time to be with the animal and to give it some comfort by washing it. We can see in the video that the impala is really still at this point.
This is the trauma treatment work in psychotherapy. The stillness seen in the animal’s body is not calmness. It is a somatic response to a highly frightening situation. The body shuts down, and fatigues. The work is far from over. Trauma-focussed therapist will not overlook this. Clients in this state have the symptom of being depressed, get panic attacks, lack focus, forget things, feel the need to throw up or cut themselves, feel like they are dying, lose their sense of reality (…the list goes on). The client needs to physically recover. For this to happen, he/she needs the support of the therapist. In the video, this process seems natural and smooth. The rescuers pat the animal on the back, pulls it up and encourages it to get up and go. The animal gets on its feet, trembles, pants and bolts.
In human beings, this is far from the case. Steven Porges explains why this is so with the polyvagal theory.
Treating clients at this phase involves a sometimes a long-drawn and difficult process of working through the client’s very difficult feelings despair, fear, guilt, grief plus the bodily reactions accompanying it. Such reactions may include screaming, hitting or pushing, bolting, crying, and sometimes throwing up. We try, most of the time, to allow this energy to come out in tiny steps. Peter Levine calls it “titration”.
Therapists would also encourage clients to do body-focussed activities like yoga, weight-training, dancing or tai-chi.
Trauma-focussed therapy, for whom?
The animal, stuck, finds itself in a panicked state. It’s muscles tense and it tries to fight its way out of the situation. Being really stuck in the mud, all its efforts fail. Its body fatigues. Looking at us human beings, when we find ourselves in a threatening situation, our first impulse is to flee or fight back. In events that cause trauma, this instinct to fight or flee does not lead us anywhere. These traumatic events trap its victims. Such events often occur in childhood, when victims of child abuse and neglect are trapped in a life of a child, helpless, vulnerable and dependent on its caregivers. This can go on for years.
Many clients come for therapy without the awareness that they are survivors of trauma. As adults, they come to therapy because they encounter symptoms like, depression, suicidality, anxiety, compulsive behavior, rages, emotional dysregulation, feeling numb, fatigued, loss of memory, relationship problems, eating disorders (…the list goes on). These symptoms are now known to be likely somatic reactions to past trauma. Trauma-orientated therapists will pick up on this.
Medication to treat trauma?
Medication stabilizes the body, but it unfortunately does not help the client work through the source of the problem. Medicine does not empower the client with awareness of the self. It does not lead the client towards self-agency. Meds lose their effectiveness with time. Imagine the rescuers in the video giving the animal meds, and not doing anything else. The animal will no longer be in distress. It would simply live trapped until it dies.
I hope this article enlightens you the reader on what psychotherapy can look like, and how your symptoms can be perceived and treated.
Psychotherapy is a great profession because it opens doors for the possibility of healing from the otherwise life-sentence of trauma.