Trauma and life balance (Part 1): A critical part of therapy that can't be done in the office!
I attended a lecture last year, a great psychologist who spoke about the treatment of anxiety and depression. Trauma disorders of course involve both. Trauma can be seen as a phobia of traumatic memories, and phobia of course is an anxiety disorder. Extended struggles with trauma certainly leads to periods of hopelessness, which is characteristic of depression. So I paid very close attention to what he had to say. He spoke about assisting clients in balancing their lives.
So, while the following represents only a small part of how I treat trauma (this is part of Phase One of a classic phase-based treatment of trauma involving three phases), I have found that it is absolutely critical, even if I only spend the first five minutes of each session keeping up with it.
This psychologist listed seven life areas which he felt covered every area of life. He noted that a core element of his treatment was assisting clients in balancing their lives, so that they could achieve their goals. That is, without a decent effort at self-improvement outside the session, one hour of therapy per week is unlikely to produce any change at all.
Balance is intended to be within each life area, and among all life areas. This can't be done all at once. Organizing the effort to do this is exactly where part of the therapy session comes in! Even if it is five minutes. And it reduces symptoms, increasingly giving clients a sense of control.
The idea is not to have a client lead a perfectly balanced life before therapy begins--then there would be no need for therapy. Simply a "good enough effort" is needed, and furthermore, this happens at the same time as therapy, assisted by therapy, with planning, problem-solving, and discussion in the context of the presenting disorder.
"Good enough effort" means that, however small some sustained attempts at self-care are made--so that things are "on the upswing, even if still very far from happiness. It might start with doing some laundry that has been sitting around for three weeks. And these effort need to be in various areas of life, not just focusing on one at a time, and being sure to keep it simple. Here are the areas, and I added two of my own, as I did not feel that committed romantic relationships should be lumped in with family experience, and I felt that spirituality is separate from social engagement in society.
So, the areas of life to be balanced (taking personality type into account) are:
Committed romantic relationship (or views about this if this is not present)
What I find, through observation and actually tracking this on a spreadsheet, is remarkable:
Clients who arrive with more balance within and among these areas are far less symptomatic from the start, even if their trauma is VERY severe. 6/9 areas appears to be "good enough."
Trauma clients who engage in bettering each area, and who are able to make consistent progress, become less symptomatic, even before the treatment of traumatic memories, and the treatment of traumatic memories becomes far easier.
Bettering health and self-care produces the fastest improvement (most importantly breakfast, sleep, rest, and water intake).
Clients who are part of a healthy, encouraging, non-judgmental religious community, even with extreme childhood traumatic experience, are far less symptomatic than they "ought to be." I am not attempting to "sell religion" here (simply being religious doesn't seem to have much effect on symptoms, by the way), but I can't help but observe this amazing phenomenon. Understandably, this is a very small minority of my clients. Trauma not only makes people wonder why any loving god would let terrible things happen to children, but childhood trauma also physically affects the sections of the brain involved in the ability to process religious ideas on a meaningful level.
The best interventions are those that integrate multiple areas at the same time. For instance, social involvement with friends in an educational community.
Again, it seems that the goal is "good enough" in 6/9 areas, such that things aren't necessarily "good," but are on the upswing, which is how I define "good enough." Hopefulness comes from the journey, rather than the destination.
Think about it--in "trauma time," where parts of the self are stuck in an endless nightmare, there is no hope because there is no progress, only an expectation of the worst. But, when traumatized parts can see that life actually can improve, and when the present is different from the past--not stuck, but improving--phobia decreases dramatically, and real treatment is possible.
When I integrate trauma treatment in session with the work people have done on bettering one of these areas in the past week, I have come to call this a "good time session"! Through this, clients have had the most incredibly encouraging experiences. Who knew that treating trauma could be so encouraging? Well, if trauma treatment is a "downer" all the time, what good is that? And that would wear me out too. It was, before I started doing this!
I will post two other entries that explain why I think this method works both as part of the first phase of a three-phase trauma treatment (the best plan for complex trauma), which uses my metaphor of the "Maasai Warrior." Fun stuff--clients love it.
And these principles are effective as part of any therapy. In fact, the most successful and fun marriage therapy I have ever learned (and I learned the 12 top ones in grad school), Gottman Method, incorporates couples doing this very thing together as an integral part of its model--balancing life together and apart, within life areas and among life areas.