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On the last track, 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 on the last track 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.
this track, we will present challenges in helping clients recall their emotions
during their trauma: resistant clients, risks, and unresolved grief
and anger. Also
in this track, 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
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
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
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
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
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.
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
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 track to "test the emotional waters".
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.
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 on the next track.
On this track, 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.
On the next track, 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.
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.