Welcome the client when you meet them. Saying “Hello”, talking about the weather etc is a normal thing for people to do. The most important part of your client is the person, not the trauma.
Turn your phone off. Ensure that you will not be interrupted throughout the session. Arrange the next few sessions in advance, so that the client does not spend time with you wondering if you will see them again.
Ask the client where they want to sit, how they want you to sit – sometimes directly opposite can be tricky. This may change over time.
Guided imagery – e.g. finding/re-visiting/inventing a safe place – check first that the place is not scary! Many traumatised people struggle with finding their creativity, so a led visualisation can be helpful. Allow plenty of time for them to move along each part of the visualisation. (When my counsellor asked me where my safe place was in 2015, I couldn’t tell her because I had never felt safe anywhere. Creating a haven helped me to find safety in my house).
Box of thoughts – my counsellor gave me an empty shoe box sized box. When I woke in the middle of the night/couldn’t get to sleep for the thoughts whirling around, I would put the light on and write them briefly on a page of the notebook I keep by my bed. I’d then tear the page out and put it in the box. Light off again. If the thoughts return, they do not need any brain space as they are “in the box”.
Doing some breathing/relaxation/visualisation of a safe place can help the person relax enough to get back to sleep. Sometimes I would take the pages to my next counselling session, sometimes talking about the topics I’d written down.
Gentle reinforcement/repetition of being believed and not being to blame, being innocent. Changing beliefs/introducing new beliefs – I was not an object, I was a person. These took about two years of repetition for it to start making sense. It is Ok to tell your client that you believe them. They may be struggling with believing themselves and hearing that from someone they trust can be very helpful.
5,6,7 breathing – first aid/grounding exercise. Breathe in through the nose for 5, hold it for 6, breathe out gently through the mouth for 7. Repeat. (Best not tried while driving!)
Use, “Where are you now?” if the client has “Disappeared”. It is not always necessary for them to describe the memory, which may re-traumatise them. Simply note, or acknowledge that it is a memory. Re-establish that they are in the therapy room with you and not in that scary place of long ago. Use all the senses to bring them back to the room – see below.
To bring a client who is in a flashback back to the present, use their five senses. Ask them to tell you five things they can see; four things they can hear; three things they can feel; two things they can smell (having some pleasant smells such as lavender or other essential oils handy can be useful. As always, check with the client that the smell is not in itself triggering before you need to use it to ground someone); one thing they can taste. This exercise should bring the person back to the room and can be used by them when not in a session too.
Use physical objects to solidify thoughts and feelings. It can be helpful to have a bag of things to use, such as pebbles, though again, it’s important to check that the objects are not triggering in themselves.
Inner child/littles. This approach has been weird but very helpful. I now have a whole family of young me s that I take to most counselling sessions. Sometimes they come out, sometimes they don’t. They have just begun to speak. When they come out, they now have a garden that I have drawn on a sheet of A3 paper, which includes lots of places they like and things they enjoy. It also has all the dogs I’ve known through my life; my grandad, who was a good man, and Professor McGonagall who maintains the force field of safetyness over the garden.
Have a glass of water available – moving can break the chains of being unable to articulate. It also replaces some of the tears!
Having an imaginary skip/waste paper bin/incinerator in the room can provide a place to leave unwanted stuff behind.
Ask the client “If you were an animal, what would you be?” Resist the temptation to put your own interpretation on the choice of animal – offer options if the person is unable to express anything about their choice. Writing/drawing can be helpful.
Try also not to finish phrases/sentences for the client. Being abused leaves a feeling of powerlessness and it can be difficult to go against what is suggested. Maybe offer some alternatives if the person is stuck, check which may fit.
Encourage the person to be gentle with themselves, take care of themselves, this is a message which is not always one they are familiar with and gives a sense of value.
Allow the person all the time they need to speak if they want to /are able to. Live imaging has shown that when a traumatised person is having a flashback, Broca’s area – the part of the brain that generates speech – is disabled. They may well be literally “speechless”. Writing/drawing can bypass the stuckness.
Books written with distressed children in mind can be helpful to read during a session. I guess the littles recognise themselves and it can be a launch point for developing understanding.
Always have a supply of paper, pens, crayons/felt-tips and tissues!
The most useful and effective resource is you. You cannot do/say anything worse than what has already happened to the person opposite you to bring them to you. It’s OK to make a mistake and say/do something that is upsetting, the important part is to help the person work out what the link was to the past and to bring them back to the present.
Take care of yourself.
Thank you for embarking on the journey with us.