You have done great work with your trauma clients. Their lives improved and they no longer need your help. For each client that moved on, it was a joyous day. Clients no longer needing you is your goal and you felt satisfied with a job well done. You didn’t expect to see them again. Your work together was complete. And then – covid.
One by one, these trauma clients that you thought were healed came back. It feels dispiriting. You really wanted the changes to last for them. Yet here they are. Why is this happening?
In this post, I want to look at 3 big questions that will help you understand what is going on here:
- Is this inevitable?
- Why is it happening?
- How do I prevent relapse?
Is this inevitable?
Covid is stressful. There is great uncertainty. Connections to social resources are limited. There is less control and often less freedom. So isn’t it inevitable that old traumas will show up again?
The truth is that old traumas need not show up again in stressful times. Even without covid, our clients will face stressful times in life. If old traumas show up again and the client relapses, it is a sign that the work we did was counteractive.
But what do we mean by counteractive?
What is really happening?
Counteractive work brings great benefit to the lives of our clients, but it is prone to relapse during times of stress and crisis. Covid is currently that crisis. But soon enough it would be something else.
When we suffer trauma, the associated trauma responses are stored within a particular part of the brain within the limbic system.
Therapists can do great work by building a competing set of brain responses. Now our client has options. They now have a choice not to follow the old trauma responses but choose something new instead. Our work has them standing at a crossroads, where before they had only one path.
This is what is meant by counteractive change. The new pathways counteract the old.
The problem is that the old path is still there. The bigger the stressor, the more likely they will take the old path that still remains. This is the core reason why relapse happens for your clients at times like this.
It’s not that your work together wasn’t powerful. It was. But it left the trauma response intact. If you don’t want old trauma to be triggered in times of fresh crisis, those old trauma responses have to be erased. Literally erased.
How do i prevent relapse?
When the old path remains intact, relapse is likely. The answer is to overwrite it. When these brain pathways are overwritten, the old trauma responses are gone. The result is that change is transformative, not temporary. The healing is lasting and effortless.
Think of an old cassette tape. When it is overwritten, you don’t hear the old song anymore. Likewise, the old trauma responses do not replay when we overwrite them rather than merely build another option.
It was once thought that erasing these responses was impossible. But neuroscience now knows differently. A brain mechanism called memory reconsolidation results in old trauma responses being literally replaced.
The result is that clients are no longer triggered by stressors or crises that resemble their old trauma. When their environment offers cues that seem similar to their old trauma, a different song plays instead.
They still remember what happened of course. The biographical memories are stored separately. But the autonomic nervous system responses to those memories are changed – for good.
When clients relapse it tells us that memory reconsolidation did not take place. It tells us that change, while useful, was only counteractive. The original trauma response is still there, waiting to be triggered.
Counteractive change means relapse is very possible. It is a constant battle between the original trauma response and the new pathways you worked together to build.
When your clients return with the same issue, it indicates the need to switch to a way of healing that will not relapse. Just as your old cassette tape will not play that erased song.
It tells us that our work must trigger memory reconsolidation so that, this time, the healing is permanent. Does this mean changing your whole model? Happily not. Memory reconsolidation is a brain mechanism, not a model, so can be incorporated into how you already work.
Memory reconsolidation is the only known mechanism that the brain has for creating transformational change. It is no longer inevitable that trauma clients need to return at times of stress. Therapists now have an answer to that problem.
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