‘Reaching in’ as a therapeutic imperative for complex health patients with origins of trauma

For many of my patients, their story of trauma is buried so deep inside them that it has never seen the light of day.

These patients present to me at our integrated health clinic. Many of them have a complex health or syndromic presentation. And many of them have been doing the rounds of doctors, bodyworkers and therapists for years. Symptoms typically range from fibromyalgia, chronic fatigue, thyroid issues, digestive issues, migraines, brain fog, neurological symptoms including twitches, burning or loss of feeling, insomnia, anxiety, depression and OCD…among others.

Usually by the time they reach me, they are at a crisis point and verging on drowning in their own hopelessness and frustration with their condition.

This is not the kind of client that is walking around aware of their trauma; reading blogs and Instagram posts about trauma, attachment, nervous system and spirituality. There is little to no awareness available.

This is the kind of client for which the trauma experience runs so deep that it is either completely unconscious, or the level of fragmentation is so great, that there is no voice that is permitted to share the unspeakable past experiences. In a way, these clients are trapped inside their own living nightmare… an internal prison where mind and body are completely split and where the mind has become so fragmented that there is no access to one clear voice — there are either many internal voices warring against each other, or the voices themselves have been taken hostage and gagged… and there is nothing but a foggy drone available. Many of these clients are in a state of deep dissociation; however, some are so high-functioning that even their medical professionals and closest friends and family have no idea.

Typically, this kind of client may be written off by western medicine as difficult, hypochondriac, hysterical, crazy or the worst — a lost cause. Or, they have learned to shut up about their problems because no one can help them. (In these cases, the fragmentation becomes deeper because they develop another layer of ‘coping’ a that masks it all). They are often sent from doctor to doctor, to therapist to therapist with little or no change. Many are doped up on all kinds of medication. This experience does nothing other than foster feelings of abandonment and betrayal for the medical system, all of which end up being ‘acted in’ to self. Interestingly, the experience of the medical system is often a parody of their attachment experience.

When a patient stops believing in their own story; when they accept that there is something innately wrong and broken within them, this leads to a shut down so deep that their will (or some may say, their spirit) becomes eroded. The loss of will or impulse to share one’s deep truth is the ultimate sign of powerlessness. This is the result of ‘acting in’ abandonment and betrayal.

We leave ourselves.

A reidentification of self occurs where the true self is lost and the ‘sick-self’ becomes the new paradigm for existence.

When we betray and abandon our own spirit, we disrupt the connection to our innate flow of life force. This directly effects our capacity for movement and regeneration which are the fundamental principles of aliveness.

The neurophysiology of these clients is commonly a co-activation; both a sympathetic and parasympathetic activation. They are trapped in two concurrent danger responses. I connect to this as an internal neurological tug of war — fight/flight at one end and shut/down freeze at the other end. There is often a period of tension where both responses are maintaining tension, but ultimately there will be some tipping point to one extreme; either as a result of an external stressor or simply from time itself. We cannot remain in a war forever. There is always a winner and a loser. When fight/flight is winning, typical symptoms may include pain, insomnia, rage, anxiety, inability to gain weight. When shut down/freeze is winning, typical symptoms may include fatigue, depression, thyroid issues, weight gain and muscle loss.

Being able to assess a client’s neurophysiology serves as a great diagnostic tool that, as therapists, clues us in to the best approach for treatment.

But before we can even consider working with the nervous system and all our modern trauma tools, we need to ‘reach in’.

These clients, who mostly have severe experiences of developmental trauma, high levels of dissociation and loss of self, are not primed for typical trauma work. Their nervous systems aren’t ready to play ball and their spirits are not present. Their experiences are so trapped and buried and there is no authentic expression available; which is paramount to recovery. For many of them, there is a silent voice screaming ‘Something is wrong. I am not safe. Not with you. Not with anyone. Not with myself. And I don’t know why. But please, please help me if you can. I’m in here; waiting for you.’

It is our role, as therapists, to learn to hear that silent voice; to ‘reach in’ and say ‘I hear you in there. And I’m coming in to hang out with you. And when you are ready, we will find a way out of this hellhole together.’

By ‘reaching in’, we are sharing our own capacity for movement and expression — something that these clients have lost at some point in their journey. We are letting our spirit and life force be a model for them to learn from, to resonate with. And when there is enough resonance, they will gain enough capacity to start moving on their own.

How do we ‘reach in’?

Before we reach in, we must first be able to listen. To what is not verbalised. Rather than listening to the tale that is told (which is often a regurgitated spiel that has been told many times), we have to inquire. Find the gaps in the story and bring the unsaid into the room. Notice the parts that are rushed over and avoided and come back to gently explore them. We have to know our stuff as therapists and have great psychoeducation skills. We need to be able to track a narrative (both verbal and somatic), intuit the blind spots and draw possible conclusions from joining the dots. We need to be brave enough to ask the right questions that illicit specks of truth and hold space for just enough narrative to emerge that the patient knows ‘hey you can hear me. Thank you for coming to find me’, and takes an internal exhale. It is this silent exhale that is the reignition of movement.

Once there is movement, recovery can begin.