This is going to take some thought to answer. I've found myself wondering what to say in response to this question, and I'm finding myself a bit lost on it. I have some thoughts that may come out a bit haphazardly as a result. I don't have a clear answer.
One thing I agree with is what Whobuddy says:
"What I mean is that some quickly give a cut and dry diagnosis and prescription for treatment such as EMDR, meds, or similar and others go to the other extreme of "client-led" therapy and they do little other than listen. They need to find the middle ground. We are all so very different in our unfortunate experiences, how we responded, how we coped, and where we are presently. "
In my experience, most therapists do not understand trauma. They have no idea how it affects a person and what it means in terms of attachment in the case of childhood trauma. I have felt many times misunderstood. In some cases I felt judged for the anxiety I experience, and like I was a crazy person. What was I getting so worked up about, after all?
I feel like all the mental health professionals that I have seen over the years have all been absolutely clueless about what a person with complex trauma experiences. Some made me feel judged, some were arrogant and thought they knew everything about me after only 10 minutes of talking to me, some were very rude and asked invasive questions. Those were the bad ones, and clearly had their own issues. I spent most of my time educating my long-term therapist. I was doing all the research and reading, and spent a lot of time catching her up on stuff. I was too afraid, for many years, to admit to myself that maybe she didn't know what she was doing when it came to the trauma. The idea that she didn't know how to help me until recently was just too frightening and overwhelming. So I ended up staying with her far longer than I should have. She was very well meaning, and I think she believed she could help by just listening and offering feedback. But meaning well isn't enough to help someone.
Unless you have experienced complex trauma yourself, it feels like nobody can possibly understand or relate. Mental health professionals don't seem to get any training in trauma. I was looking at some university curriculums to see what people becoming psychologists would be learning and not a single course on trauma. I think this is a huge problem. I think trauma is an epidemic in our society and it's just not recognized at all. It baffles me that it is ignored in the basic education.
I think every single mental health professional needs to be schooled in complex trauma. They need to understand the impact on a person. They need to understand the impact of growing up in a home with emotional neglect. Everyone can intuitively understand physical or sexual abuse would be damaging, but emotional neglect? It is an invisible beast that people do not understand whatsoever. It is something that can happen in homes with even well-meaning parents and the damage is huge. They need to learn enough to at the very least be able to diagnose it in a person, and if they feel like this is not the population they want to work with, they need to refer the person on to someone who does and who has gotten an extensive education in complex trauma.
I think trauma is something that people instinctively avoid and run from. I think mental health professionals are not immune to this. I think way more of us have been affected than people would care to admit or want to look at.
In summary
All mental health professionals need to be trained and educated on the basics of complex trauma
They need to know enough to refer a person to someone else if they don't pursue advanced complex trauma training
They need to have empathy and be compassionate, rather than judge the clients they see and make snap judgments about them/ask invasive and insensitive questions
Those who do wish to work with trauma must understand it is a very delicate issue. Attachment trauma is excruciatingly painful and getting things wrong in this area is very bad. Not knowing enough about it or how to work with it/treat it can cause some very serious damage and distress.
Why do we need a seat at the table?
- We need to be seen and heard. We are still too invisible by the very people who are supposed to help us. Far too few clinicians understand what it means to have a complex trauma history. It is very hard to understand what a person with complex trauma deals with and experiences on a day to day basis, and without having our input, it would be impossible to know what it means and to develop appropriate treatments.
What treatment, services and support do we need and how might we work together to get these in place?
- It would be helpful if there were a directory of some kind for therapists treating complex trauma. I find that the really good ones seem to be unlisted and it takes a lot of work to find a person. (This is actually a complaint I have regardless of what issue you are trying to get support with - not just trauma)
- Treatment right now seems to be focused on the individual. If a person has managed to have a partner and/or children, the family as a whole needs to have counseling available. Don't treat the person in isolation.
- Talk therapy can only go so far. CBT can only go so far. No single approach is going to be enough. Trauma treatment requires multiple components. I haven't tried much of this on my own just yet but from my own research, it seems trauma is stored in the body, so the body needs to be involved in the treatment. I'm not sure what that looks like. I know that my body never truly relaxes, and I'm always tense. I don't know how to learn to relax and I startle easily. Any good trauma treatment needs to involve bringing the body out of the hyper-alert state it's in (assuming the person is now safe and not being abused by anyone).
- Have a plan in place to treat the trauma. Open-ended therapy where the client is just listened to and validated isn't enough to heal them.
- Grounding techniques, such as counting items you see, aren't enough. These really are just a means to manage symptoms, but they do not solve the root of the problem. I have refused to use these grounding approaches because the message to me is "the real problem isn't important, I just want you to calm down so things are easier for me", or "I don't know how to fix the real problem so just do this instead"
- Breathing as a means of handling anxiety often does not work because this is threatening. It brings us back into our bodies and opens up feelings we are desperately trying to keep at bay. Jumping into breathing right away might not be the best way. I'm not sure yet what one does instead, I am sure a good trauma therapist would know how to work with this to get someone to a place to start to be able to breathe gradually.
- We need help coming out of the social isolation that comes with complex trauma. We need help getting connected to other people. We need help with developmental milestones we may have missed, such as how to make friends. I think this is a really important and critical part of treatment.
- availability of crisis support between regular appointments is a must. I have not found the regular mental health crisis hotlines helpful the few times that I called, and they ended up making me feel worse. An emergency counselling session was more what I needed when in crisis, rather than being given platitudes, grounding techniques that didn't work for me, and feeling like I was taking up too much time.
- Treatment needs to be accessible, We need a lot more therapists trained in complex trauma. There are too few available for treating this condition.
- Cost of treatment is a barrier to treatment. Complex trauma requires long-term treatment.
What can they need to learn about us that therapy sessions or research studies haven't revealed?
- how excruciating this condition is
- how it takes over your life and how much of it is driven by pure fear
- how pervasive the feeling of not being safe is
- how socially isolating it is
- if an approach is not working for a client, then look at it as not the client being the problem, but rather, the approach doesn't fit, so be willing to look at something different.
- that even though we may possibly look like functioning adults, on the inside we are terrified. We need to be treated with care and compassion.
All of this is coloured by my personal situation and experience, I can only speak from that place. I may have more thoughts as I think about this more.
