I heard it again.
And when I heard it again, my body enflamed and my heart just about jumped out of my chest.
A member of my recovery family, an enthusiastic person with a few years in recovery, is now working at a treatment center in the role of a counselor assistant. The center runs groups that are primarily psychoeducational in nature, teaches recovery skills, and monitors residents. My friend relayed to me what the director and other members of the clinical staff instructed: “You gotta shut down trauma when it comes up.”
That’s the line that just about made me lose my lunch. Because you can’t shut down trauma when it comes up. This is simply not possible, and is part of the ignorant narrative that keeps people suffering and dying. Sure, there are measures you can take to validate people, contain affect, and help them manage the trauma reaction until it may be a more appropriate time to work on it deeply. But shutting it down? That language just makes me cringe because it conveys the fear-mongering attitude about trauma that has existed in the helping professions—specifically the addiction field—for far too long. When you shut down trauma, it will come out some other way, which more likely than not will lead people back into the addiction cycle.
The exchange with my friend gave me pause to contemplate as I spend this summer working on the second edition of Trauma and the Twelve Steps. I begin the first edition (written in 2012) with one of the formational tales of my early experience working in the field. An early clinical supervisor shut down my questions regarding trauma and our high level of recidivism by telling me that I complicated matters by looking at trauma. The thinking was that until “these people” realized that they were addicts and had a disease to be treated, looking at trauma just gives them more excuses and makes recovery impossible.
I didn’t last very long working at the treatment center, yet that exchange with the clinical director fueled the fire within me to make a difference in how we treat addiction and help people heal in a more holistic manner.
Steps forward, and back
In many ways I feel we have made strides since that formational exchange in 2005 and the publication of Trauma and the Twelve Steps in 2012. More addiction conferences are featuring sessions on trauma. Many treatment centers continue to invite my colleagues and me to train staff on trauma-informed interventions. My friend and senior faculty member in my program, Los Angeles-based Stephen Dansiger, PsyD, has even trained entire treatment center staffs in Eye Movement Desensitization and Reprocessing (EMDR) therapy as part of his paradigm-changing work.
Even in my local community, the quintessential “rust belt” town of Warren, Ohio, more folks are getting into trauma-focused interventions such as EMDR therapy earlier and are participating in groups we have set up for practices, such as trauma-focused meditation and yoga. A major publisher picked up the second edition of Trauma and the Twelve Steps (North Atlantic Books, 2020), when I struggled for anyone to take seriously the message of bridging traditional recovery and trauma-based innovation just seven to eight years before.
And then I hear stories from the trenches like the one told by my friend, and my heart sinks. I hear that where at one time Ohio had 92 specific treatment programs for women (many of them focusing on trauma), we now have just around 40, with funding crises continue to squelch what we can offer in the way of holistic, trauma-responsive care. I feel the impact of living in a country where hate crimes, mass shootings, discrimination and Twitter bullying (even by our nation’s leaders) abound. Sometimes I wonder if we’ve become so numb to harming each other and so powerless to affect any change, we just throw up our hands in frustration.
In its broadest sense, trauma means wound, a direct translation from the Greek language. Has collective numbness and sedation become the only way people can deal with such wounding, so when it shows up in others all we can manage is: “Here, take a bandage. I can’t do anything more for you”?
Part of the resistance to handle trauma narrative that I’ve heard over the years from treatment professionals is that they feel ill-equipped to handle it or there is just not the time in primary treatment. Some of the concern is that if one patient in group starts talking about trauma, it can set off a domino effect of a misery fest where one client tries to one-up another. And yes, clients can trigger one another in the group setting or in a treatment milieu when specific details of trauma start coming up. Yet this triggering of one another can be even more pervasive when it comes out in the form of people reacting to others' reactive behaviors. And guess what? Behavioral acting out is one of the many things that can happen when trauma gets shut down, invalidated, or otherwise stuffed away.
Instead of shutting people down, what if we could shift the paradigm to validating them—and then gently offering a solution or call to action? In Trauma and the Twelve Steps I cite a line I often heard when I worked in treatment—“You’re here to work on your addiction, not your trauma.” A totally absurd line that professionals often say during assessments—even in the context of asking people all of these interrogating questions about their own life. In group settings, professionals can encourage people to talk constantly, to “open up,” and to “work on their stuff.” But if that stuff includes the mention of trauma, they get shut down or redirected.
Even in the most old-school addiction counseling, there is a teaching that mixed messages are a recipe for crazy making! I can think of no worse a mixed message than, “Open up and talk. But not about trauma—not about the thing that likely led you here in the first place.”
Strategies for success
One of the misconceptions that treatment professionals still carry is that working on trauma is all about deep expressions and catharses. There are protests that people aren’t ready for such deep work until they’ve achieved some time sober. Yet the reality I witness is that people in recovery affected by all addictions may not make it long-term until they address trauma in a meaningful way that allows them to heal from the inside out. If your complaint is that people aren’t ready for the work that can save their lives, what are we as professionals doing to get them ready?
Teaching them skills for managing heavy emotion and body sensation that trauma triggers will inevitably elicit must be part of treatment. These are vital skills that trauma professionals generally call containment—the art of neutralizing the impact of a trauma or addiction trigger until we have the adequate time and space to work on it.
If I was running a group where a client started talking about a traumatic experience or showed that they were being heavily impacted by someone else’s sharing, I would respond with something like, “I hear that this thing happened to you and was very difficult for you. Now, in this group, may or may not be the best place to work on it fully. So how can I as your provider and this group best support you now? We can do something as simple as taking a breath with you and then you can decide.”
If you run groups, you can use a line in your opening statement that sets some ground rules on how much detail gets shared about the specifics of traumatic experience, out of respect to others in the group who may be in a more vulnerable place in their recovery. For several years I ran a meeting based on the Trauma and the Twelve Steps content. People agreed to keep narrative details to a minimum, yet there was total openness to work on expression of feelings about how the trauma impacted them.
Additionally, you can make skill acquisition the focus of the group, especially if you as the leader or your treatment center feels inadequately trained in working with trauma. Until you get that training, you can help people work on managing what comes up as you discuss possible solutions and options for addressing the impact of trauma on a more individualized level, especially after clients leave treatment or transition to aftercare. Teaching solutions in the spirit of validation is imperative.
If you are the type of professional or recovery service provider whose tendency is to shut down trauma, I also encourage you to look at your own personal relationship with trauma, healing and recovery. Around the time that Trauma and the Twelve Steps initially released I heard the legendary Stephanie Covington, author of A Woman’s Way Through the Twelve Steps, reflect on the first time she taught about trauma at an addiction conference in 1982. Her colleagues attacked her after the presentation, saying their clients were nowhere near ready to begin working on things such as sex, violence and trauma. In their protests, she heard it very clearly—what they were really saying was we’re not ready. We’re not ready to go there with people.
Thirty-seven years later and I relate to Covington's experience more than ever. How can you know anything about trauma and be prepared to deal with it if your attitude is that you have to shut it down?
Just as I fret over hearing these horror stories, I still have reason for hope as I consider the scores of colleagues in my life and students I’ve met who are not afraid to go there with people. This courageousness usually results from a healthy dose of their own training and preparation (often self-initiated outside the context of formal schooling) combined with a willingness to do their own trauma work.
No one I’ve met in my circles who has honestly and thoroughly engaged in a trauma-focused treatment such as EMDR therapy, body-centered or somatic methods, Gestalt therapy, or even mindfulness-based cognitive interventions would ever take the attitude that trauma has to be shut down. Yes, its immediate presentation may need to be managed sensitively. The professional or other helper who has done his/her own work can generally keep a calming presence and know how to proceed.
If you’ve stuck with the article to this point and are feeling a bit conflicted or even guilty because you’ve participated in the processing of shutting down trauma on your job, please take a breath. Some of the best trauma-focused clinicians I’ve had the privilege of training began where you are. The key is willingness to learn more about trauma’s impact on the human experience, especially as it relates to addiction, and then consider how your own fear of not knowing how to handle trauma may be blocking you. Much of this fear is justified—graduate school curricula are still deficient in helping to prepare new trainees in anything other than cognitive interventions that largely scratch the surface or provide a bandage for stabilization.
In your own life experience, you may have also received messages that feelings cannot be shown to their fullest without consequence, or that you cannot trust yourself. Even if you don’t identify as being a trauma survivor in a PTSD-diagnosable sense, the presence of such blocks in your life can offer evidence that there is some deeper healing to do. There are wounds to heal. Please consider how addressing these more fully with a therapist who is not afraid to go there about trauma and adverse life experiences may help you feel less intimidated by trauma in your own work.
Jamie Marich, PhD, LPCC-S, LICDC-CS, REAT, travels internationally to teach on topics connected to trauma, EMDR therapy, mindfulness and the expressive arts. She maintains a private practice in her home base of Warren, Ohio, where she operates the Institute for Creative Mindfulness, a training program in EMDR therapy and expressive arts therapy. She is the author of six books on trauma recovery.
Visit Dr. Jamie Marich’s free resources site for hundreds of videos, articles and interviews about trauma recovery and solutions for healing. The videos offer examples of how to facilitate skills such as grounding, breathing, mindfulness meditation and simple movement/release strategies that are appropriate for group and individual work.
Visit a cutting-edge website to discover how learning from the Adverse Childhood Experiences (ACEs) study is being implemented into all styles of programming and community initiatives around the United States.
Consider educating yourself about the fundamentals of trauma neurobiology and its impact on human behavior. Psychiatrist Dan Siegel, MD, makes many accessible teachings on The Hand Model of the human brain online, including an excellent short teaching available on YouTube.
The Substance Abuse and Mental Health Services Administration (SAMHSA) makes its Treatment Improvement Protocol (TIP 57) on trauma-informed care in behavioral health services free of charge as a PDF online. Please spend some time with this document, especially if you are a clinical director, program director or other policy maker in your organization.