How to Bring Up Trauma With My Therapist: Live Q&A

How to bring up trauma with my therapist: I'm answering a couple of questions about trauma and trauma therapy. The first question is about how to bring up trauma to your therapist. The second question is about how to identify triggers at the moment and how to set boundaries around triggers. I'm a provisionally licensed mental health practitioner and certified trauma professional (CTP) in Grand Island, NE.

I go live on Fridays on my Instagram and Facebook page to answer your questions anonymously. You can ask your questions under any post. If you don't want to post your question publicly, you can just message me on my Facebook page.

Question #1: How To Bring Up Trauma With My Therapist

“I have a question about working with a therapist. As the patient, should I tell my therapist I want to sort out how I am processing trauma or just talk about the trauma and wait for suggestions? Both approaches seem awkward.” 

Most people are nervous about bringing up their trauma or bringing up something they went through that was difficult. And that is completely understandable. Hopefully, every therapist’s office is a safe place. But not every space is safe or has ever been safe for talking about what you've gone through.

That being said, therapists are very used to trauma coming up at all different stages of the therapy process. 

We have people who come to therapy and that's their main goal. They're like, I went through this, this was my childhood, or this is the thing that I experienced. This was the traumatic relationship that I was in or all of the above. And they know that's why they're in therapy. They want to work through that. 

Others, they're coming to therapy for something else first, and they either know they have trauma and they just haven't brought it up with a therapist yet or it comes out later on in therapy. 

Or through the process of therapy, they realize that certain things in their life were very traumatic. They may realize they have trauma that they didn't necessarily know was trauma. 

I'm going to say, it doesn't matter how you bring it up. It's way more awkward in your head than it is to your therapist because your therapist is used to that. Most therapists are not going to be super surprised if you suddenly bring something up. Anytime you bring it up, it's going to be okay. 

Try to bring it up more towards the beginning or the middle of your session. It's kind of difficult for your therapist when you're bringing up a trauma at the end of the session. They're like, oh, I'm sorry, I want to talk about this with you, but we're gonna have to wait. 

And that can also be difficult for you, especially if it's a trauma that you haven't processed or that could bring up some really difficult feelings for you. It might not be in your best interest to bring that up at the end of the session, and then go home and be thinking about it. Now you're thinking about how awkward it was to bring up to your therapist and you're ruminating on it until your next session. 

The Trauma Therapy Process

However you bring it up, each, every therapist is going to be a little bit different in how they approach trauma work. Or depending on what their specialty is, they may think it's best to refer you out to someone who specializes in trauma.

Most therapists are equipped to work with someone who has trauma, but if you’re wanting to do deep trauma work, I suggest seeking out someone who specializes in trauma work. Lastly, makes sure you’re working with a therapist whom you feel comfortable expressing when you need to slow down or ease into talking about trauma. 

Trauma therapy should be, and usually is, one of the slower therapy processes. It’s usually long-term work. Especially when we're talking about something like complex trauma, where you had repeated traumas throughout childhood or throughout relationships, or very deep attachment wounds.

Processing the trauma, working through things, and building skills should be a process. It may be something that you do some work on, take a break, and come back a year or two later. I'm not saying you have to be in therapy for the rest of your life. But I think that for people who have trauma, that should always be a tool that's available to them because things are going to come up. 

If you have any follow-up questions, just let me know. I can add them to the next q&a.! 

Question #2: How to Notice Trauma Triggers in the Moment

“Not sure how to phrase it, but when you notice being around toxic behaviors, In hindsight, how to notice them at the moment and draw boundaries around that.”

I love this question. This is a great question because it has to do with some of the core of trauma work and working through how trauma comes up in your current life.

It takes time to learn how to identify your triggers. And it takes even more time to be able to recognize them at the moment. Do not feel like you should just be able to get this and understand this. Identifying triggers is usually a long process for people, especially for people with complex trauma. 

If you grew up in an abusive or neglectful household, experienced deep traumas as a young child, or were in abusive relationships for many years, you have a lot of triggers.

We have trauma neural networks, which are networks of neurons in our brains where we store traumatic events. These neural networks store things like sensations, people, sounds, memories, feelings, situations, relationships patterns, etc. Relational triggers in particular are prevalent in complex trauma. 

The beginning to understanding our triggers and how they happen in the moment starts with body awareness. Every therapist will say it a million times: trauma is stored in the body. If you are someone with complex trauma, or you grew up in a difficult household, you have body cues for your triggers, even if you don’t recognize them yet. 

You can work with a therapist to figure out your body cues. But if you know what the trigger is, you can start by paying attention to what things happen when you’re triggered. For example, when someone is disrespecting your boundaries, how does it feel in your body? Are you in pain? Do you get a stomach ache? Do you get headaches? Perhaps you get really bad anxiety. Or maybe you go into a shutdown state, where you feel tired and aloof or disconnected from everyone. You could feel like you’re somewhere else all day. This is a form of dissociation. These symptoms could be in the hours or days after the trigger.

It also starts with understanding the nervous system and building body awareness into times when you’re not triggered: Mindfulness, breathing, meditation, etc. 

Boundaries are very important. Especially if you're dealing with triggers that are shutting you down and making your mental health worse, it's good to set some firm boundaries and put some distance between you and that person or situation. But not all trauma triggers should necessarily be avoided. 

The Window of Tolerance in Trauma Therapy

If you were working with a therapist, you’d likely be working to identify triggers and establish your window of tolerance. You can kind of do this on your own, but it’s helpful to work with a therapist to facilitate your understanding of this process. Your therapist can help you choose certain triggers or situations to work on. 

The window of tolerance is the window in which you can experience life events or talk about life events without going into fight or flight, fawn, or freeze. For people who don’t have trauma or mental health issues, their window of tolerance is usually larger. When we have trauma, our window of tolerance is usually much smaller. Especially if we're also a highly sensitive person.

The upper end of the window of tolerance is the point at which you reach fight or flight. This is when your anxiety is at it’s max. If we’re talking about anxiety, the top is like a panic attack. The same goes for trauma triggers. The upper limit of your window of tolerance could be when you have a panic attack, you hyperventilate. Dissociation and detachment can also be at the top. 

The bottom of the window of tolerance would be fawning or freezing. This is when you shut down or completely dissociate. You can’t talk about it. You cant’ deal with it. 

The goal in working with our triggers is to expand our window of tolerance. This can be quite a process in complex trauma. 

To give an example of relational triggers, let’s pretend that interactions with your mother-in-law are the trigger. Your window of tolerance may be such with this trigger that you need to take a break from your mother-in-law because you can’t even have a conversation with that person without hitting the upper or lower limits of your window of tolerance. 

To expand this window of tolerance, you’d be doing something like trying to expose yourself to the trigger in a controlled way. This might be a phone call to mother in law that is scripted. This is where we’re looking to use body awareness in order to stay within the window of tolerance. This is what we call titrating. This is likely something you’d be working on with a therapist who specialized in trauma. 

A therapist may also do this during a therapy session. If you’re talking about a traumatic experience that you had in the past, the therapist may use titration to expand your window of tolerance in talking about the trauma. For some people, they come into therapy and they can’t even talk bout or say what happened to them. Therapy can help to expand the window of tolerance and build up to talking about the experience without hitting the top or bottom points of the window of tolerance. 

During this process, your therapist may use something called the SUDS scale. I try to teach clients how to use this scale in everyday life. The SUDS scale is basically a scale of 0 to 100. Say we're talking about an anxiety-provoking event. I’d ask, where are you on the SUDS scale when you think bout going into that anxiety-provoking situation? 100 is the point at which you cannot tolerate it, you’d have a panic attack, or you’d feel like you would die. Zero would be completely fine, zero anxiety. 

When we’re talking about the window of tolerance, we’re wanting to stay within approximately the 50-70 range in a controlled exposure. You want to learn how to experience a situation without going past the point where you can’t control your reactions any more or you can’t turn back. 

Noticing your triggers at the moment is a very helpful part of trauma work. However, by doing deep trauma work with a trauma therapist, you’ll also be working to down-regulate your nervous system so that triggers are not as bad. We shouldn’t necessarily avoid all triggers. This is an unsustainable way of looking at trauma recovery. Our goal in the big picture is to lessen your reactions overall so that things are not as triggering as they have been in the past. 

For those who live in Nebraska, I work out of Clearwater Counseling in Grand Island Nebraska. You can call the phone number on their website to reach the appointment line if you'd like to book an appointment with me.


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How to Bring Up Trauma With My Therapist: Live Q&A

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