We must tread carefully when uncovering a client’s potential hidden trauma
Millions live under the pain and terror of the past. And for most of them, the cause is more than obvious.
A rape from ten years ago writhes and squirms, wrenching at the emotions with flashbacks and nightmares. A constant, uncontrolled reliving of a horrific train wreck fractures relationships and erodes hope. A nightmarish mugging haunts and tyrannizes even decades later. Lives blighted, sometimes made even worse by therapy.
But some trauma is less easy to spot. Less obvious, but still capable of locking depression, generalized anxiety, or disturbed sleep patterns in place. Typical symptoms of flashbacks to the trauma may not have developed, making a connection with the past hard to identify.
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First, an essential caveat
Before we begin: it isn’t always trauma.
It’s important to appreciate, I think, that people fall into depressions, or addictions, or obsessive compulsions, or many other emotional problematic behaviours without having been significantly traumatized.
In these cases, looking for ‘reds under the bed’ can cause more problems. Assuming people must have been traumatized and all we need to do is dig up some memory (which might, after all, be created in therapy) is to make a dangerous assumption. As practitioners we need to be careful not to fall into the trap of confirmation bias.
So that’s a big caveat. Past trauma isn’t inevitably at the root of all, or even most, emotional problems (excepting obvious cases of PTSD). But occasionally we do find that seemingly inexplicable emotional problems have trauma at their root.
Let’s be crystal clear here. These are not traumas the client didn’t recall until going into therapy, but rather ones they may have not linked to current difficulties.1
If it is the case that a seemingly unconnected trauma is in fact driving the current problem, then we should find that effective detraumatizing of that memory ameliorates or even cures the current problem.
Here are five cases from my own records in which trauma was found to be driving the current problem despite initially not being obvious. You may have had similar experiences with your own clients.
Case one: Fainting fits – The girl who enacted death
For a fifteen year old, Emily had received a lot of therapy. But as she sat in front of me with her mother on a cold day in late October, she told me all that therapy had done nothing but made it worse. “The more I had to record my thoughts and think about it, the more I fainted”, she told me miserably.
Emily was very articulate and described in great detail how her life was blighted by continual fainting. But curiously, it only ever happened at school or on school trips. She’d nearly drowned in a lake in France, was no longer allowed on stairs at school, and had stopped going to sleepovers for fear she might faint.
All the neurological tests had come back clear. It seemed this must have a psychological basis. But Emily had had therapy. It was a mystery.
Could I help?
I asked when the fainting had started, and Emily told me it had been about two years before. Then I asked more pointedly whether anything else had happened about that time, assuming this must have already been explored. But Emily and her mother both looked pensive. This was evidently a new line of questioning.
Finally they mentioned two events that had happened while Emily had been at school.
First, Emily’s lovely neighbour Pam, a vibrant woman Emily was really close to, had unexpectedly died. Emily had been distraught when she had come home from school and heard the news from her father.
Not long after this, the family dog had been run over and killed while Emily was at school. Again, the memory of Emily’s father gravely telling her about the sudden death of her beloved pet was clearly horrible to recount.
Emily certainly seemed traumatized by these two memories. I set to work rewinding these memories in that very session.
By the end of the session, the memories were deconditioned. She could think about them as past, with calm and distance. I was intrigued to discover what, if any, effect this would have. Even I doubted that she would stop fainting. Surely it couldn’t be that simple.
But much to Emily’s and her parents’ surprise and delight, the fainting stopped. Teachers monitored her closely at first, but eventually she was allowed to resume a normal teenage life, including using the stairs!
It seems the fainting had been an unusual symptom of unresolved trauma. Perhaps a metaphorical enactment of death itself? Anyway, it didn’t matter – it was gone.
Once the trauma was gone from Emily’s brain, so too was the problematic symptom. You can read about Emily’s case in more detail here.
Case two: Hypochondria – The woman who couldn’t trust her body
Just like Emily, Shirley had been at a loss as to why her life-limiting symptoms had developed.
Wealthy and healthy of body (according to all her continually consulted medics), Shirley nevertheless believed that every twinge, ache, itch, or faint discolouration was a sure sign of unstoppable, inexorable terminal disease.
She lived in fear that she would be diagnosed with some untreatable illness that would wrench her from the children and husband she so loved.
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She constantly swept the internet searching for confirmation of her worst fears. She obsessively monitored her children’s health and felt it was just a matter of time before one or both would also be diagnosed with a debilitating condition.
“I’ve tried meditation, counselling, hypnotherapy, acupuncture and cognitive behavioural therapy, but the only thing that helps me is getting a medical check. And even then, I’m only reassured for a little while before the fear and hopelessness return.”
Shirley would stop eating, socializing, even communicating with her family if she had even the slightest ‘evidence’ that something might be wrong. She’d only want to talk about her ‘symptoms’, which never seemed to amount to anything according to those who tried to reassure her.
Had her parents or anyone close been diagnosed with a horrible illness, I wondered. “No,” she said, “all my family are perfectly healthy and actually quite long lived.”
I decided to try an affect bridge with Shirley. I asked her to focus on that horrible feeling of being certain she or her children would be stricken with some horrible illness, and suggested that maybe a memory might come to mind of a time she’d had similar feelings.
She immediately felt a little tearful, and I reassured her we wouldn’t dwell long on the feelings involved. After a minute or so she suddenly opened her eyes and told me:
“Wow, I’ve just had a memory come to mind. I was six or seven. There was this girl I knew at school. She wasn’t really a friend, but I liked her. She got sick, leukaemia I think. I never thought she would die.” Shirley sniffed, and a solitary tear began to glide down her cheek.
“We were in assembly. The head teacher, Mrs Jenkins, asked her to come to the front to receive a reward for bravery and we all clapped. She looked so thin and frail, but I still thought she’d be okay. Then another girl I knew sitting next to me whispered to me that her mother had said this girl only had a month to live. Those words really struck me. Only a month to live! A month!”
Now Shirley’s breath was coming like a speeding metronome. She looked pained, a frozen look of fear from a frozen point in time. She hadn’t thought about that time in years, but realized she’d often felt that time.
I asked her to tell me, on a scale of 1 to 10, what level of fear she felt now when she recalled that time. She instantly told me it was off the scale. She felt really scared recalling that time. The first time she realized that little girl would die. The first time she really felt she herself could die – and those she loved.
We used the Rewind Technique to bring that fear score down from a 10 to a 2. In deep relaxation I had her envisage “forgetting to think about” health or illness for long periods, and having faith in her body and her children’s capacity to be healthy.
In the end, she told me her hypochondria improved by around 90%. She could finally live more fully without a preoccupation with death or dying.
Case three: Panic attacks – The man who called the police
With Dan it was different. He suffered panic attacks: a condition in which the quite-common PTSD element is so often missed.
Dan, a computer analyst for a large corporation, was as sharp as a razor. He seemed to know what I was trying to say before I knew myself. (Disconcerting when you’re the therapist!) But he had a problem.
Rising stress had crept up on him without him really noticing. It had culminated one sickening day in an explosive way, though he didn’t mention that at first.
“I was working longer hours. My marriage was suffering. I was surviving on coffee and cigarettes. And then it happened. I started having panic attacks.
“I’m off work now with the stress of it. I tried tranquillizers, but they stopped me from focusing on the work I was doing at home. Work paid for me to have Cognitive Behavioural Therapy, but it was too analytical and complicated even for me! And it didn’t seem to deal with my feelings, just my thoughts.
“What worries me now is that I will always suffer with these attacks!”
Now I knew that often people are traumatized by a particularly bad, perhaps the very first, panic attack. Subsequent panic attacks may sometimes be a kind of flashback to the first or worst one. I asked Dan: “Thinking back now, what would you say was the very worst panic attack?”
Without hesitation, Dan said: “The first one! It was horrific! Like a waking nightmare. And the reason it was so bad was because I didn’t know it was a panic attack. I thought I was dying or going completely mad!”
Dan described how he’d been driving to work during rush hour. He was late and getting increasingly stressed. Suddenly he felt dizzy. He was hyperventilating, drowning in sweat and felt his hands tingling.
“I couldn’t think straight… it was terrifying! I was certain I must be dying! I stopped on the hard shoulder of the road with trucks whizzing by, and I called the police, of all people! I was so crazed with fear I didn’t even realize I’d called them. When the police arrived they seemed angry, and they called an ambulance.
“At the hospital, after having my heart checked, I was told that it was ‘just’ a panic attack and to get counselling. But since then I keep having them, and I can’t even think about driving my car. If I try to drive anywhere I get flashbacks to that time.”
Dan told me that the memory made him feel panicky just to recall; a sure sign of trauma. Once we had deconditioned the traumatic memory, I then gave him strategies to control and prevent future panic attacks. Just like that, the panic attacks stopped. Dan found he could drive again and was no longer haunted by memories of that first panic attack.
Panic attacks are terrifying and so can be traumatizing. When people are traumatized by an initial panic attack, no amount of breathing or cognitive techniques will help until the post-traumatic effects of that time are comfortably dealt with.
Case four: Obsessive compulsive disorder – The woman who hated nursing homes
Frieda was in her seventies. A neat-featured, neatly dressed woman, she was plagued by an extreme case of chronic obsessive compulsive disorder (OCD). To the exclusion of her husband, family, and friends, germs had become her major focus.
But not any old germs.
“I only really care about stuff that has been infected by a nursing home”, she told me. I noticed the words ‘nursing home’ took on their own special tone. She felt the nursing home would get “onto” her.
If Frieda went outside (which she seldom did now), every time she passed someone in the street, she couldn’t help but wonder if they worked in or had visited a nursing home. She would worry for days. She would boil her clothes and spend hours cleansing and re-cleansing her home.
Frieda hadn’t sought therapy until now, but a new and depressing development had finally convinced her something needed to change. Her husband was considering leaving her. He just couldn’t stand it anymore.
She constantly pleaded with him not to go out, but when he did, she would insist he strip naked on the porch before she would let him back in the house. Wearing disposable gloves, she would collect his clothes to boil. She’d then make him shower, take a bath, and take another shower. She’d encourage him to turn up the water temperature as high as he could stand.
So what was all this about? Frieda had hated nursing homes ever since she was a little girl, when she had visited her grandmother in one. (“It smelt of death!”) But more recently, her own mother had gone downhill fast while living in one.
When I asked Frieda about this she admitted she had horrific memories of going to visit her mother for her birthday and finding her close to death. “I could see my mum was dying, but no matter how much I shouted or pressed the button, no staff came! She died, and no one did anything! And I couldn’t do anything!”
As Frieda recounted this time she trembled and wept. But this was nothing new. She told me she actually felt like that “most of the time”.
Naturally I wondered if Frieda’s marriage-destroying, life-shrinking OCD might have had its genesis during her mother’s final moments.
I used Rewind to take the sting out of those memories (and, just for good measure, her memories of her visits to her grandmother’s nursing home as well). We found that her symptoms ameliorated, and eventually began to fade. She no longer thought much or felt much about nursing homes. And she was able to enjoy her twilight years with her husband.
OCD doesn’t always have a clear-cut traumatic root, but it may.
Case five: Depression – Jealous of a phantom
This next case is pretty unusual, but certainly not unique. Keith was traumatized not by an experience, but simply by hearing about something and then imagining it.
When I first saw Keith, he was forlorn. I got the sense he didn’t hold out much hope that I could help him. In fact, his wife was much more hopeful than he was that I could lift him from the depression that sapped the energy, hope, and fun from every waking moment.
Depressed people, really depressed people, don’t tend to hope much. But they do tend to ruminate, mull, and imagine bad stuff. We as practitioners need to help our depressed clients develop a little hope, because hope is a major antidepressant even in those prone to mulling.
In fact, the depressive effects of rumination actually seem to be negated if a person mulls while retaining some hope.2 Hope is kryptonite to depression.
Anyway, Keith had little hope at first. He felt like a victim. Like things happened to him, not because of him. He was angry at his wife all the time. I asked him what he worried about the most. Why he felt so angry.
He couldn’t explain it at first, but after some more careful questioning he came out with “My wife’s sex life with another man!”
Nonplussed, I asked what he meant.
Keith and his wife and been married for thirty-five years. About ten years into their marriage, she had told him about the one other boyfriend she’d had before meeting Keith.
For some reason, she had gone into explicit detail about her sexual experiences with this other man. In his mind’s eye, Keith had ‘seen’ his wife having all kinds of sex with this other man.
As far as he was concerned, he had seen it all happen during their marriage, and felt like she’d been unfaithful to him even though cognitively he knew it had happened long before he had even met her.
Keith had traumatized himself through his own imaginings.
These self-generated images often came back to Keith. Every day he seemed to see his wife with this “better” man. A man whose appearance Keith himself had created. I asked Keith what he imagined this man looked like – “very handsome” came the answer, though his wife had never described him as such.
I suggested this ‘phantom man’ would have aged by now. I pointed out that every cell in his wife’s body would have been replaced many times since she had known that other man (or, actually, teenage boy – this really had been a long time ago).
But I also helped Keith process the (imagined) memory so that it no longer troubled him. Actually, because Keith had never spoken about this before (not even to his wife), he found just by talking calmly with me about it the memory already felt better. But for good measure I rewound the imagined scenario in Keith’s mind to the point that it no longer made him feel anything at all.
Amazingly, Keith began to feel more loving toward his wife, more in control, and better about himself. He began to enjoy his marriage and his life. He reclaimed his fun, humour, love, and hope. He was still prone to some depressive thinking, partly through force of habit, but we were now able to work on that.
This imagined man, the phantom, no longer haunted Keith.
The missing piece that completes the puzzle
These were not your typical cases of post-traumatic stress disorder, but for these clients trauma played a big part – a part that had been missed. Once we had dealt with the traumatic element of their difficulties it became much, much easier to help them develop healthier lives.
So how do we discover whether a previously unconsidered trauma might be driving current difficulties? Sometimes it’s enough just to ask questions like: “Was anything going on around the time this (emotional difficulty) started happening?” Or sometimes we can use the Affect Bridge.
Half-submerged logs might be just logs. But sometimes, just sometimes, they might be angry, biting crocodiles.
The Rewind Technique provides a way of treating the destructive force of hidden trauma. Read about it here and sign up to be notified when the course is open for booking.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
Find out more about my trauma treatment course hereYou can also get my articles on YouTube, find me on Instagram, Amazon, Twitter, and Facebook.
Notes:
- See my father’s interview with Mark Pendergrast: http://blog.humangivens.com/2012/06/hg-library-shattered-lives-interview.html
- https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-8-53
