Courageous Conversations

Time to heal

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The last two columns courageously addressed trauma resulting from deeply distressing adverse childhood experiences.

An ongoing discussion about trauma is extremely important because, if childhood trauma is not addressed, an emotional toll will follow the victim into adulthood. This may manifest as alcohol abuse, abuse of illegal drugs or prescribed medications, anxiety, depression, mania, or anger associated with explosive and oppositional defiant disorders, to name just a few outcomes. These behaviors disrupt a person’s intimate, personal, social and professional relationships.

Because of the often egregious behavior associated with childhood trauma, some people find it difficult to get over. Very often, people enter into adulthood with an unanswered question: Why did the person responsible for conceiving and caring for me, neglect their responsibility or, worse, abuse me? Having to ask that question in adulthood could be considered yet another adverse experience.

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Therapy is an effective way to get that question answered in a nonthreatening and confidential way. But clinicians sometimes find it difficult to get clients to confront the issue of past abuse. Therapists call this “resistance.” The American Psychological Dictionary defines resistance in psychotherapy as “obstruction, through the client’s words or behavior, of the therapist’s methods of eliciting or interpreting psychic material brought forth in therapy.”

Some people are not willing to be psychoanalyzed or let a stranger “get into their heads.” Although it may appear clear to outsiders that a person is in need of therapy, refusing to enter therapy is a natural response for someone who had a chaotic childhood. In most cases, resistance shows itself as a passive or assertive refusal to attend even one therapy session. Resistance is an attempt to protect oneself from harm, and in the case of survivors of childhood trauma, self-preservation becomes a necessary priority.

For therapy to work, people must be emotionally ready to change their behavior. The first step to behavior change is the recognition that there is a problem that is interfering with something important in one’s life (relationship, health, career, etc.)

The transtheoretical model of behavior change developed by James O. Prochaska and his colleagues involves six stages of change: precontemplation, contemplation, preparation, action, maintenance and termination. It is not until the precontemplation stage that a person may begin to recognize that a problem exists. A person in this stage is mostly focused on the cons of changing (I will no longer have a social outlet, I will have to feel uncomfortable, I will have to recall troubling events, an important person may not like me anymore).

Once a person enters into the contemplation phase, they are willing to focus more on the benefits of change and begin the change process in the foreseeable future. However, it is not until they move into the preparation phase that they are ready to take action and may take small steps toward the desired behavior. What is important about the preparation stage of change is that, at this point, a person believes that some areas of their life will actually improve with change. From there, they proceed to current action, maintenance for 6 months or more, and ultimately termination, at which point they are sure they will not go back to their old ways.

Lisa Hill

Lisa Hill

As a clinician, I offer a four-stage intervention model with clients who have been the victims of trauma — the vast majority of people I work with. My model is called “metamorphosis” (copyright pending).

Clients who authentically want to consider changing their behavior — they don’t have to be initially committed to change — will begin the first stage of therapy, the “explorer” stage. As explorers, they will critically evaluate the past. I am very interested in what life was like for them BEFORE they were able to navigate their own lives. We stay in the explorer phase as long as they want to because, as with most explorations, we discover many secret treasures of information.

During the next stage, the “learner” stage, they learn to define their past appropriately; very often, they learn that they were actually victims during their childhood. This is a huge step for some clients as it changes their perspective. According to the California Penal Code section 679.01(b), a victim is someone against whom a crime has been committed. Learning that your behavior stems from being victimized does not justify or excuse the behavior, but it may offer validation that makes it possible to enter the next stage of therapy.

The third stage is “metamorphosis.” This is usually the most challenging stage of therapy because it is the work stage. Just as a caterpillar must work very hard in the cocoon to develop strong wings to fly, clients must labor against the desire to resort back to their default behavior. For anyone who has tried to give up preferred but unhealthy foods, you know how difficult it is to do the right thing.

The final stage of the metamorphosis model is “maturation.” This stage is similar to the maintenance stage of the transtheoretical model because, at this stage, the new behavior has been tried, established and practiced for some time and the client is actively working on not returning to the old behavior. The person in maturation is happy with the change and reaping the benefits of their new persona.

People who have had traumatic childhoods deserve therapy and they owe it to themselves. Remember, people do the best they can at any given time with the resources they have. Therapy is a resource that helps people to do better.

Is it time for you to heal?

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