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In the last section, we discussed techniques to help your client recall the trauma safely and accurately: memory prompts, revisiting the scene of the trauma, talking to others, and artistic outlets. Also, we will discuss self-forgiveness and its relation to the recall process.
While in the last section, we reviewed ways to help the client recall their trauma objectively, here, we’ll discuss means of helping the client recall the trauma as an emotional participant.
In this section, we will present challenges in helping clients recall their emotions during their trauma: resistant clients, risks, and unresolved grief and anger. Also in this section, we will discuss PTSD resulting from sexual abuse.
3 Challenges to Recalling Emotions
♦ #1 Resistant Clients
First, we will discuss clients who are resistant to face their emotions. Many people would stereotypically apply this characteristic of resistance to emotions to men only, but I have found that women may be just as resistant as men. Usually, this resistance stems from two fears: a fear of suffering and a fear of losing control of oneself.
The fear of suffering is understandable because many clients do not wish to relive the feelings of terror, anger, and helplessness that they experienced during the trauma. Those clients who are impaired by the fear of loss of control create this fear through a defense mechanism designed to protect them from ever feeling powerless again. The overwhelming influence of emotions can recreate the climatic helplessness they felt during the trauma.
♦ Technique: Counting Method Matt was a PTSD client of mine who had a fear of losing control if he recalled the emotions he experienced while he was being sexually abused by his uncle. Matt stated, "Look, I put all that shit into a little box and the box doesn’t need to be opened. I’m in charge of myself now, not my emotions. That little box does not need to be opened."
I asked Matt if he was scared of the potential loss of control and he said, "Yeah. Maybe. It sucks, you know? To know that someone or something else has control of you." To help introduce Matt slowly into emotional recall, I used the "Counting Method." I feel that this exercise is an excellent way to help resistant clients begin to emotionally recall their trauma because it puts a time limit on the recall.
I explained to Matt that he would get one hundred seconds, which I would count out loud, to recall a traumatic memory and emotionally immerse himself into the memory before I bring him back to reality. That way, any loss of control will last no longer than 100 seconds.
I recommend scheduling this exercise at the beginning of the session so that you have enough time to discuss the emotions and recall during the rest of the session.
I then identified which traumatic memory Matt wished to work on. He decided on one which recalled a Thanksgiving dinner, after which his uncle abused him.
I asked Matt to only recall the memory mentally and not to speak of what he was remembering.
I began counting from 1 to 100, keeping my eyes on the clock and counting off one number each second.
At 93 or 94, I said, "Back here" to assist Matt’s return to reality.
If the client appears dazed or confused, he or she has been able to recollect a trauma. Matt looked moved and upset, so I knew that he had successfully recalled the trauma.
Next, we reflected on the emotions Matt underwent and tried to end on a positive note. I stated, "You did well. You remembered and were able to turn on the emotional memory tape and turn it off."
As you can see, even resistant clients can learn to recall their emotions with the right technique. I feel that the Counting Method greatly facilitated Matt’s first emotional recall.
♦ #2 Risks
Second, we will discuss risks involved when clients reflect on their emotions. Some clients are never truly ready to confront the emotions associated with the trauma. It is up to you, the therapist, to decide if the client can truly handle the shock that could result from such a step.
You might want to consider: (1) The current emotional stability of the client; (2) Whether or not painful emotional recall will undo months of therapy; and (3) How well the client has handled the mental recall of the trauma.
I suggest using the Counting Method that we described earlier on in this section to "test the emotional waters."
However, should the client begin to react negatively, there are a few warning signs to be aware of: a. Fainting spells b. Hallucinations c. Total immobilization for more than two to three hours d. Feelings of being out of touch with reality e. Self-mutilation or the urge to harm themselves f. Suicidal or homicidal thoughts or behaviors g. Being unable to function at all for more than a day
If you notice any of these reactions in your emotional-recall client, I recommend ceasing the recall.
♦ #3 Unresolved Grief and Anger
In addition to resistant clients and risks, the third issue to keep in mind during emotional recall is the unresolved grief or anger the client is experiencing. I have found that the psychological source of PTSD is usually these two emotions. Some experts report that one is more responsible than the other. I believe that it greatly depends on the client and the nature of the trauma.
In most cases, however, anger and grief are closely related to each other. On one hand, the losses endured generate a great deal of anger while on the other the anger could be directed at the cause or causes of the personal losses. Because anger induces feelings of power, clients fighting disempowerment generally exhibit more anger and have yet to address their grief.
Conversely, those clients experiencing grief have already accepted that they are powerless in their environment and have given up any thought of regaining control. Essentially, these clients have victimized themselves. We will discuss grief and anger more thoroughly in the next section.
In this section, we discussed challenges in helping clients recall their emotions during their trauma: resistant clients, risks, and unresolved grief and anger.
PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next
- Reisman M. (2016). PTSD Treatment for Veterans: What's Working, What's New, and What's Next. P & T : a peer-reviewed journal for formulary management, 41(10), 623–634.
In the next section, we will more closely examine aspects of clients who are suffering from unresolved anger: how they deal with their anger, the targets at which they direct their anger, and forgiving their targets.
Peer-Reviewed Journal Article References:
Beck, J. G., Reich, C. M., Woodward, M. J., Olsen, S. A., Jones, J. M., & Patton, S. C. (2015). How do negative emotions relate to dysfunctional posttrauma cognitions? An examination of interpersonal trauma survivors.Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 3–10.
Lancaster, S. L., Melka, S. E., & Rodriguez, B. F. (2011). Emotional predictors of PTSD symptoms.Psychological Trauma: Theory, Research, Practice, and Policy, 3(4), 313–317.
Mott, J. M., Galovski, T. E., Walsh, R. M., & Elwood, L. S. (2015). Change in trauma narratives and perceived recall ability over a course of cognitive processing therapy for PTSD.Traumatology, 21(1), 47–54.
Online Continuing Education QUESTION
11 What are three challenges in helping clients recall their emotions during
To select and enter your answer go to CE Test.