Is there a time frame for successful trauma work?

A common question that arises with trauma work relates to the timeframe of the work itself. Neuroscience lays out what the brain needs to trigger the brain mechanism that overwrites trauma responses. But given that the brain needs a specific set of steps, is there a timeframe that we need to follow as therapists?

In this article, I will cover:

  • The three stages of memory reconsolidation
  • The timeframe of the preparation stage
  • The rewrite time window

By the end of the article, you will have a clear sense of the timeframes that the brain needs in order for you to effectively do this work.

The three stages of memory reconsolidation

Memory reconsolidation is the only known brain mechanism that can literally erase trauma response. There are many ways to trigger this mechanism. Yet, whatever approach you choose, there must be a mismatch experience for the client.

Neuroscience lays out the roadmap. But it is up to us how we travel. How do we set up that mismatch experience? What do we need to know beforehand?

There are 3 stages of memory reconsolidation.

  • Preparation
  • Implementation
  • Verification

A nice metaphor is baking. We prepare, we bake, we eat to test.

The preparation part is where we are engaged in discovery. We want to find out the problem that the client is struggling with and what they want instead. We want to find out the target learning that keeps reproducing that problem.

Depending on our method, we may want to discover some mismatch information too. For instance, if a client has a sense that they never stand up for themselves, we may notice those times in life when they did.

Once we have this information, we can then set up a mismatch experience for the client. There are so many ways this can be done, from conversational to imaginal. But the brain needs the surprise of a mismatch experience, and for that mismatch to be repeatedly held in mind.

Once the work is done, we then verify that it worked. A good way to check is to notice if the autonomic nervous system responses are no longer present. A good working knowledge of polyvagal theory is useful here.

But what are the timeframes involved for each of the active stages of preparation and implementation?

The timeframe of preparation and discovery

The point of preparation and discovery work is to be able to create a mismatch. We need to find the correct target. Our assumption here is that the client’s problem makes sense. That involves acknowledging its dual nature.

In some ways, it is a problem and they want rid of it. In another way, it is the solution to another problem, so getting rid of it is scary. We want to discover how and why it makes sense for them to keep their problem.

Another way to think of it is: “It is better for me to have THIS problem than THAT one – because ANYTHING is better than that.”

I sometimes refer to this as The Monster In The Corridor problem.

So in this phase of the work, we are not triggering memory reconsolidation. Instead, we are doing what is needed to find the right key for this particular lock. The mismatch experience needs to target the right learning.

In terms of timeframes, this takes as long as it takes. The brain mechanism is not yet being triggered so the brain has no demands on you at this point. You are simply exploring the territory.

If you don’t know

  • the problem they want rid of
  • the target learning that keeps the problem alive
  • the mismatch information that you might use to counter the target learning

then you are not in a position to deliberately trigger memory reconsolidation and so overwrite the trauma response.

(That is not to say that memory reconsolidation is impossible of course. This mechanism can be triggered inadvertently. Think of the mismatches inherently involved in the therapeutic relationship itself – even when therapists are not consciously following these steps.)

This process of discovery and preparation takes as long as it needs. Sometimes it can take place quickly. For instance, there is a technique I often use with clients that gets to the target learning often within one session. But at other times, it takes longer.

Knowledge of neuroscience doesn’t mean we stop being attuned to the client and the pace and sensitivity they need. So we go gently, at the client’s pace and readiness. There is no time-related deadline that the brain demands that justifies rushing the client.

The Rewrite time window

When it comes to implementing memory reconsolidation, two things need to happen:

  • unlock the brain pathway
  • rewrite the contents of the brain pathway

First, we have to unlock the brain pathway so it becomes writable. Think of a safe. It’s hard to get into. But with the right combination the safe will open.

Yet merely opening the safe makes no changes to its contents. So the final step is to perform the rewrite itself.

We open the brain pathway through a mismatch experience. We change the contents by repeating the mismatch. The client holds both parts of the mismatch at the same time. As both can’t be true, the brain is invited to update its learning and its response.

Repetition is a key component of memory reconsolidation. But notice that only the mismatch experience is repeated. There is no need to repeat the discovery work too.

For instance, in this example of 4 sessions that result in imaginal work, it is only the imaginal scene in session 4 that is repeated.

Only the reimagining provides the mismatch. The rest is discovery work. The imaginal experience of the new scene is the only aspect that is repeated. This is achieved as the client reimagines the new scene a number of times.

(Note that these 4 sessions will have typically followed some earlier conversational discovery work to identify the problem and the target learning. These are not the only 4 sessions with the client.)

Of course, imaginal work is only one approach. A conversational opportunity may arise to set up a mismatch experience. This may involve joining the dots between a current belief or fear and some other information that counters it.

If it lands there is an “aha!” moment of realisation. The repetition then comes from staying with the contradiction and to keep inviting the client to reflect upon holding both in mind at the same time.

So is there a time period for this?

The mismatch experience opens the brain pathway. We then have a window of opportunity for rewriting. This lasts 4 to 5 hours. There is some dispute as to how long exactly, but the dispute doesn’t really impact our work.

As therapists, we need to know that

  • The brain pathway won’t close again before your session ends.
  • It won’t still be open next session.

This means that the mismatch and the repeat need to happen within the same session.

As Ecker describes it, the steps of implementation are:

  • activate the target learning
  • activate the mismatch
  • repeat

These must occur together. If you only activate the mismatch but don’t repeat, it is akin to opening the safe and walking away. Assume that the safe self locks in a few hours. If you come back to the safe next week, it won’t still be open.

So what do we do if we didn’t have time to complete the mismatch for some reason? The same as we would do with the safe. If the safe has auto-locked, we open it again.

In our work, we would need to once again set up a mismatch experience for the client.

This is another reason why I incorporate imaginal work. It is a little easier to restart if the process is interrupted for any reason.

Conclusion

Memory reconsolidation is triggered by a combination of a mismatch experience followed by repetition. Neuroscience tells us that this is what the brain needs to trigger an overwrite of trauma response.

As therapists, we split our work into stages of discovery and implementation.

Discovery work is the preparation stage. It aims to find out what the problem is and why it makes sense. It also harvests the raw material for setting up a mismatch experience.

There is no time limit for this work, and many approaches can be used. The brain is setting no deadline for discovery. You will get there when you get there.

Once the mismatch experience occurs, the proverbial safe is opened. Yet here there is a time limit. It will auto-lock in a few hours. If you want to change the contents you’ll need to do it within the current session.

If you can’t, then you need to recreate a mismatch experience to open the safe afresh next time.

Note that the repeat part of memory reconsolidation only relates to the mismatch experience, not the discovery phase. Everything else simply gives you the information needed to reliably trigger that mismatch. But only the mismatch needs repeating.

To sum up, the discovery phrase has no deadline and can take as long as it takes. Yet the mismatch and its repetition need to happen within the 4 to 5 hour window, so will need to happen in the same therapy session.

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