How Therapy Unlocked the Past for a Client with Trauma
Jenny came to see me after she was mugged. Her company organised it - in fact someone from her office brought her to me. She felt too vulnerable on her own. But she was a middle-aged professional woman, used to making decisions and taking charge. So even before we started, I expected an element of resistance here. Strong, independent bosses can, in my experience, be difficult to engage with in therapy - they see it as a sign of weakness.
Even though she was suffering from fear, headaches, lack of sleep, nausea, and panic attacks, and had a stutter so bad that I could barely hear her talk, she clearly didn’t want to be there. Her body language was defensive, she perched on edge of her seat, she barely looked at me, and her body was turned away. Everything about her was telling me to back off. For this lady, I don’t know which was worse: the trauma and the idea of having therapy.
Talking to her during the initial session I started to feel that the incident and her resulting reaction to it didn’t quite match up. Obviously it was hideous to be mugged, but I strongly felt that there was something deeper here. But I did also think, I’ll have to be careful - she’s not come to me for psychotherapy, but been sent by her organisation so she can go back to work.
For first time I saw not trauma tears but life tears
To deal with a trauma like the mugging, the National Institute for Clinical Excellence gold standard is CBT, but I’ve never been a big fan. It might work for some people, but I knew it was never going to work for Jenny. She knows all those things - that she’s going to feel better if she gets up instead of lying in bed, and that she’ll feel worse if she eats a burger, and better if she calls a friend. It would have been dumbing down, even insulting to deal with her that way.
Instead I decided to share with her some of the theory about Transactional Analysis, a type of psychotherapy that evolved in the 1950s. Its basic theory is that we have one of three ego-states Parent, Adult, Child, and that we are all largely shaped by our childhood experiences. I felt that with an intelligent person like her, knowing something about how I worked would help her see that her response to the recent trauma was being underpinned by what had happened before in her life.
Then I had to challenge her with that thought.
Thinking back on it I remember how worried I was about raising the question of her early childhood. She could have stormed out of the room - people have! But I truly believe it’s my job to risk it. Jenny turned and locked onto me, and for a few seconds I thought, I’m done for. But then her whole body softened and for first time I saw not trauma tears but life tears.
We all have dos and don’ts that our parents have handed down to us, and for her it was you get up and get on with it, the women in this family, we cope. Jenny, her mother and her grandmother had struggled, but Jenny had gone to university, got a really good job, married, had two children, divorced, and was now independent. She had not just literally been knocked to floor, but emotionally she couldn't pick herself up in the way she had before. That trauma felt like failure and shame to her.
She had been trapped, helpless - all the things she was feeling now
You don’t always have an a-ha moment, but this was one. I saw this strong determined woman slip through time to a small child. I told her it made me feel sad to see her. Then she told me a memory of being four - a terrifying story, from within her family. She had been trapped, helpless - all the things she was feeling now. In surviving that incident as a young girl, she had made a decision that if you can’t run or fight then you shut down. That’s what was happening again.
It was a gateway to showing her she could be ok with this feeling. She then went from strength to strength and, over the remaining sessions we could talk about her adult life. She started to realise that she didn’t let people get too close; that over the years, she had stopped caring for herself and her appearance. That changed too. She lost weight, brought new clothes, treated herself.
Jenny had learned from the women she’d grown up with that if you’re down you get kicked, if you stay up you stay strong. Understanding the effects of that on her as an adult, that gave her back her confidence. She was the kind of person who would never have had therapy without this trauma to deal with, but the rapport that we built up made it a life-changing experience for her. She told me that it brought her back to herself.
A version of this interview was originally published in Psychologies magazine