How To Guide The Therapy Session That Removes Trauma

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So far we have laid the groundwork for the imaginal experience that is to come. We now have

In this session, the client gets to have the imaginal experience itself.

I will show you how to facilitate this imaginal experience. I will cover the steps needed to ensure that memory reconsolidation is triggered and that trauma is overwritten for good.

There are several stages to this part of the work.

  1. The reactivation of the original event response
  2. The trying on of the reenactment scene
  3. Checking whether the new scene created the desired feelings
  4. Facilitating tweaks in order to get to a bullseye scene
  5. Repeating the bullseye scene
  6. If the work takes longer than one session

Reactivating The Old

The equation of memory reconsolidation is:

ACTIVATE + MISMATCH + REPEAT = OVERWRITE

This is true of any resource we might use. Unless there is some activation of the original learning, you will almost certainly fail to trigger memory reconsolidation.

Activating the original learning tells the brain which pathway to write onto. Without this activation, the brain would put the new responses from the new scene into a different brain pathway.

Anatomically, we would be keeping the trauma intact, yet creating some counteractive learning to compete with it. This ensures that relapse remains an option.

Only by activating the old learning (and mismatching it) do we open the trauma pathway for rewriting.

As such, I begin this session by inviting the client to very briefly reactivate the original feelings. It only needs to be a light activation so this takes just a couple of minutes. There is no need to go too deep into the original trauma response.

Therapist: So before we try out this new scene, I’d like you to briefly reconnect with the original feelings from back then. The feelings you identified at the start of this work. Is that okay with you?

The client will then place their attention – very briefly – on the original event and the feelings associated.

Therapist: Are you feeling some of that?

Client: Yes, my chest is getting that tight feeling it gets.

Therapist: Okay. So that’s enough. You can come back to me now. That’s activated and so the brain now knows where to put this new information. Good work. How are you doing?

Client: Yeah I’m good. I’m okay.

Trying on the reenactment scene

Now that the original response is activated, we are ready to help the client try on the reenactment scene that they created in the last session.

The therapist checks in with the client that they are ready to have this new experience. When they confirm that they are, it is a good idea to verbally recap the scene for them. This helps them reconnect to the scene they built and is a useful memory aid.

It also allows any last-minute tweaks.

Therapist (after recapping the new scene): So have I remembered that right?

Client: Yes.

Therapist: And that’s the new scene you’d like to experience today?

Client: Yes, except I’d like Auntie Dawn to hold my hand when we are in the car.

Therapist: Okay, lovely. So Auntie Dawn will hold your hand in the car.

Client: Yes.

Therapist: Anything else?

Client: No, everything else is good.

The client is now ready to experience the scene. The word experience is more than apt. When the client gets into it, even though it is imagined, clients can respond to the experience spontaneously. They sometimes make changes during the scene itself.

These moments feel right and so they make them happen during the imaginal experience itself. It is a testament to just how immersive these experiences are.

As I invite clients into the new scene, I let clients know that this sometimes occurs. There may be moments as they live this new, imaginal experience that they wish to respond to. I offer full permission to do so.

This is important. We don’t want clients to feel locked into the imaginal scene they drafted. We want it to be a free, spontaneous process. I remind them that the scene we created was just a draft. If it feels right to do something else in the scene, feel free to do it.

For instance, one client had the urge to stand up within the imaginal scene, give full voice to his feelings, and walk out. So he did so.

It was a key moment. It wasn’t in the scene they had originally drafted. But he gave himself the freedom to respond as needed during the experience.

It is worth restating that clients know what they need in these experiences. Offering full permission to respond in the moment within the scene is helpful.

I also remind clients that they can stop the scene at any point. They are in control and that includes opening their eyes and coming back into connection with me at any time they wish.

Of course, the new scene is one that meets their needs so this doesn’t tend to happen often, but it’s an important safety exit nonetheless.

When ready, I invite the client to close their eyes if they feel safe to do so. Closing the eyes helps them be in the imaginal scene more easily. If they don’t feel safe to do close their eyes, I guide them to find a spot to focus on instead.

I invite them to take their time, not rush, but fully have the experience. I let them know that when they are done, they can simply open their eyes again to finish.

Then, usually with eyes closed, they begin the scene. As you recall, the scene is built so it begins as it was, and then switches to fully meet the client’s needs instead.

The therapist is completely silent at this point, merely waiting for the client to have the experience of their new scene.

I notice that, on average, clients spend about six minutes within the scene. Some take longer and others do it more quickly.

Checking The Scene

The new, imagined scene is a device. Its role is to evoke the new opposite feelings from the same initial cues.

On rare occasions, a client has mentioned that they had difficulty with the imagery of the scene, and could only feel the new positive feelings. There is no need to force the imagery in such a case, as the scene is still doing its job – to evoke new feelings.

In the aftermath of their first experience of this new scene, I check in with them. Typically I will ask: “So how was that for you?”

This gives the client a platform to share what happened and whether it was a good experience for them.

I will ask whether anything new happened in the moment or whether it was pretty much the scene that they had designed.

Again, this allows the client to share any spontaneous moments that occur.

Therapist: So how was that for you?

Client: Yes. Good.

Therapist: And was the scene exactly as you had designed? Or did you notice other things happening too?

Client: Oh, well I did change one aspect yes.

Therapist: Ok great. What was the change?

Client: Well, you know when Mum tried to beat me, and I choose to stand up to her?

Therapist: Yes.

Client: Well, I had my brother with me in that part. Mum was always more wary of my brother.

Therapist: Ok great. So that felt safer?

Client: Yes.

Once the client has had a chance to debrief the experience, we can together check whether the scene did the job it was designed for.

In session two of this protocol, they have already described the new feelings that the scene is designed to provide. We can simply go through those feelings like a checklist to see if it did.

One of two things will happen here. Often, the scene they created hits a bullseye. As you move through the checklist of each wanted feeling, they report that the scene fully produces every one. If this occurs, there is no need for further tweaking. I call this a bullseye scene.

Alternatively, the client will notice that the scene was successful for most, but not all, of those desired feelings. When this occurs, we guide the client to tweak the scene so they do get what they need.

Here is an example of moving through the checklist of a scene that only did most of the job, and so is not yet a bullseye scene.

Therapist: Did you feel loved in this scene?

Client: Yes.

Therapist: Did you feel confident?

Client: Oh yes!

Therapist: Powerful?

Client: Yes!

Therapist: Did you feel safe?

Client: Well, yes I guess.

Therapist: Ok so there’s some doubt there?

Client: Well yes. I felt safe but also wondered if my standing up to her was storing up some trouble. Like I’d pay for it later.

Therapist: Ah yes that makes sense.

Tweaking The Scene

This check-in allows the client to share any discomfort or fears that showed up. It allows them to identify where the scene missed its target, or only scored a partial win.

When the client reports anything that is short of fully hitting its target, we can deal with it right away by verbally reconstructing the scene even more in their favour.

Ask the client how they need the scene to be different in order to fully give them that desired feeling.

Hopefully, you can see why I regard the first attempt at an imaginal scene as just a first draft. It often changes. The change occurs either spontaneously during the experience itself or as a result of noticing that there are gaps in what the scene achieved.

Let’s pick up the conversation again with the client who stood up to Mum.

Therapist: Did you feel safe?

Client: Well, yes I guess.

Therapist: Ok so there’s some doubt there?

Client: Well yes. I felt safe but also wondered if my standing up to her was storing up some trouble. Like I’d pay for it later.

Therapist: Ah yes that makes sense.

Client: It was good to stand up to her. And it helped to have my brother with me. But once I left, I still felt kind of scared for the trouble it might have gotten me into.

Therapist: Right, I get that. So it didn’t feel fully safe yet.

Client: That’s right.

Therapist: So what would you need to be different in this scene for you to feel fully safe?

The client will then come up with an answer, or share their difficulties in finding an answer. Either way, you can help the client think this through without putting your own ideas in the way.

It is a genuinely powerful experience for the client to ponder and fix the scene in their own favour, guided by their innate connection to what they most need.

Each time the client reports a shortfall in creating the desired feeling, we deal with it in the same way. In the example below, the client wants to feel loved in the new scene, but it hasn’t succeeded in creating that feeling.

Therapist: I see. So you didn’t feel loved still in this scene?

Client: No, not really.

Therapist: So what needs to happen in this scene that might give you that feeling of being loved?

Client: I think I’d just need someone to sit with me and see that I was alright.

Therapist: Yes of course. This was tough on you and you want someone to see that you’re okay.

Client: Yeah.

Therapist: And who would you like that to be?

Client: Erm. Either Mum or Ruth from next door.

Therapist: I see, so you’d like either Mum or Ruth to check in on how you are.

Client: Yes. That would help a lot.

Therapist: Who would you prefer to be doing that? Mum or Ruth?

Client: I’d prefer Mum.

Therapist: Okay yes. So in this new version of the scene, Mum is going to come and sit with you and see that you’re okay.

Client: Yes.

Therapist: And will that result in you feeling loved? Or do you need something else to happen too?

Client: Maybe a hug.

Therapist: A hug from Mum?

Client: Yeah, I’d like a hug from Mum and for her to tell me that she loves me and it’s going to be alright.

Make these tweaks in the same way for all feelings that the scene failed to fully evoke. You will have now redrafted the scene to fill these gaps.

Trying on the tweaked scene

As before, the client is invited to close their eyes or find a fixed point. They will then imaginally experience the new, tweaked version of the scene.

Again, the therapist is completely silent. The therapist simply waits for the client to open their eyes at the end of the imaginal experience.

At the end of the scene, we check in again. We ask for spontaneous changes that may have shown up. We ask how it was for the client to experience. We go through the checklist. If we need to, we tweak the scene and try it on again.

We keep going through this redrafting process until we end up with a bullseye scene that provides everything they needed.

A bullseye scene produces all of the desired opposite feelings that they previously identified.

A bullseye scene provides a mismatch that breaks the brain’s prediction. The scene initially looks exactly as it did back then. The brain predicts the same threats and dangers so expects the client to feel just as bad.

Yet instead, the same beginning leads to the total satisfaction of the client’s needs. Rather than the predicted danger and helplessness, there is a mismatch experience of safety and empowerment.

Repeating The Bullseye Scene

A mismatch experience is essential, but it is not enough to replace the old trauma with the new feelings.

A mismatch makes the brain pathway writable again. But does no more than that. It is the metaphorical equivalent of unlocking the combination to a safe.

The safe is open but nothing has yet happened to the contents.

To overwrite a trauma response, the brain needs a mismatch experience to be repeated. Remember the formula:

ACTIVATE + MISMATCH + REPEAT = OVERWRITE.

We must repeat that clash of prediction and prediction error. We need to activate the old expectation yet deliver the mismatch scene instead.

Think of the metaphor of the conker fight. One conker is the original learning (the prediction). The other conker is the mismatch experience that produces a prediction error.

A conker fight involves these two conkers bumping against each other, and to keep doing so. Memory reconsolidation works the same way.

The simple way to do this is to repeat having the experience of the new bullseye scene.

Repeating the good experience works well for this particular approach. But it is worth noting that we can’t always just repeat the good experience.

Repeating a good experience on its own is just one conker. Memory reconsolidation demands both: the original learning that forms the basis of the prediction AND the new mismatching experience.

It just so happens that the bullseye scene inherently contains both. Not all approaches do.

Remember that there are 3 parts to any scene:

A) Before the triggering event when all is well
B) The triggering event that made the safe unsafe
C) Everything after that

Our bullseye scene keeps parts A and B. When the client reimagines the new scene, they re-experience A and B as it originally was.

The brain takes that cue and expects the original part C as it happened back then. Yet what occurs instead is a new outcome that meets all of the client’s needs. Prediction and prediction error.

Every time the client experiences the bullseye scene, they activate that old prediction while disconfirming it. As such, each bullseye scene experience is a fresh round of conkers.

We ask the client to go back into the bullseye scene, fall silent and wait.

Then do it again.

I typically ensure that the client has experienced the bullseye version of the scene three times. This means we satisfy the equation of:

ACTIVATE + MISMATCH + REPEAT.

It ensures that they don’t just have the mismatch, but they have the repetition as well.

The brain has now received what it needs to overwrite the old trauma response. That old set of cues now triggers a new prediction of safety. The trauma response is gone.

If This Work Goes Beyond One Session

Sometimes this part of the work takes more than one session. This needs to be managed to ensure that the mismatch and the repeat part happen together.

Once a mismatch experience has occurred, the brain gives you 4 to 5 hours to repeat the experience. In other words, the brain pathway stays open for rewrite for 4 to 5 hours. It then automatically locks itself again.

As such, it may be helpful to think of this part of the work as split into two parts:

A) Redrafting: getting to the bullseye
B) Experiencing and repeating the bullseye

The redrafting part of the work involves the client experiencing, evaluating and then tweaking the scene. This can sometimes take a while. At other times, the bullseye is in place from the outset, or at least very quickly.

If you notice that some redrafting is needed, keep an eye on the time. Once you hit the point where there would be no time to repeat any bullseye scenes, you may decide to wind up the work and agree to return to it next session.

You can spend the rest of the session reflecting on what has occurred so far, without working any more on the scene.

You will begin the next session from where you left off. Therapists can sometimes wonder what aspects need to be repeated when there is a split session like this. To clarify, in the next session you won’t need to repeat everything again. The brain needs to repeat only the mismatch experiences.

It doesn’t care how you get to the mismatch experience so it doesn’t need you to repeat your whole process. If you had wound up the redrafting before reaching the bullseye scene, you don’t yet have that mismatch experience. So you can happily build from the previous session.

I often like to make room for runovers when I know a reimagining session is scheduled. This gives me the option to run over time in order to complete the repetition.

If the bullseye scene emerges late on, I can invite the client to repeat it two more times before the session completes, even if that means the session runs a little over time.

SUMMARY

We have covered the steps of how to facilitate an imaginal experience (sometimes referred to as an imaginal reenactment).

As well as identifying the steps needed for each part of the work, we looked specifically at the steps needed to ensure that memory reconsolidation is triggered. It is only by the triggering of memory reconsolidation that the unwanted trauma response is overwritten for good.

We looked at six different stages of the work.

  1. The reactivation of the original event response
  2. The trying on of the reenactment scene
  3. Checking whether the new scene created the desired feelings
  4. Facilitating tweaks in order to get to a bullseye scene
  5. Repeating the bullseye scene
  6. If the work takes longer than one session

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