Staying Present During Trauma Therapy: Grounding Techniques

Staying Present During Trauma Therapy: Grounding Techniques

Working through trauma can be scary, painful, and potentially overwhelming. Very often people who have experienced trauma have coped at least in part through some degree of dissociation. While this was necessary for your survival then, continued dissociation (especially forms that are not within your control) is not adaptive once the abuse has stopped. Now the task of therapy is to help you stay present long enough to learn other means of establishing safety in the present. How does someone with automatic survival skills of dissociation learn to do this? Grounding is one skill that can help.

Trauma therapy does not only consist of telling your story or focusing on traumatic memories, though of course that is a crucial part of the work. Bringing trauma memories to mind, talking about them in a trusting relationship, and developing the capacities for managing them while staying present in the moment are all crucial parts of the healing process. A premature emphasis on traumatic material can in fact do more harm than good. Many trauma survivors may first need to learn and practice a variety of self-care skills that you can then employ during the memory work phase of therapy.

In the past, trauma survivors were encouraged to speak about their abuse in the belief that this catharsis would be healing. Sometimes this instead led to re-traumatization rather than mastery of the material or healing. In fact, some trauma survivors are able to tell their stories easily, but in a dissociated manner. Because of the risks involved, this healing work is best done with the help of an experienced trauma specialist who can help you learn techniques to cope with memories effectively. One goal of trauma therapy is to help you connect to the past while staying in the present.

More recent trauma therapies have focused on a stage approach, which includes early preparation, focus on developing coping skills and stabilization. Judith Herman, in Trauma and Recovery, states that the central task of the first phase of therapy must be safety. How can you experience this if you do not even feel safe within yourself, but at the risk of uncontrolled flashbacks? In fact, for many trauma survivors it may have felt that there were only two choices available to them historically: abuse or dissociation. Learning grounding skills so that you can be present enough to develop a whole range of self-care strategies is crucial.

What do therapists mean when we talk about grounding?

Grounding is about learning to stay present (or for some get present in the first place) in your body in the here and now. Basically it consists of a set of skills/tools to help you manage dissociation and the overwhelming trauma-related emotions that lead to it. Processing done from a very dissociated state is not useful in trauma work. Neither is the goal to be so overwhelmed by feelings that you feel re-traumatized. Once you are present, you also need to learn other means of managing the feelings and thoughts associated with traumatic memories.

Every one is different. Different grounding techniques will work for different people. The following are some general categories and ideas. Exploring the pros and cons of various approaches with your therapist can be useful.

-Grounding often takes the form of focusing on the present by tuning into it via all your senses. For example, one technique could involve focusing on a sound you hear right now, a physical sensation (what is the texture of the chair you are sitting on, for example?) and/or something you see. Describe each in as much detail as possible.

-Diaphragmatic or deep breathing: Trauma survivors often hold their breath or breathe very shallowly. This in turn deprives you of oxygen which can make anxiety more intense. Stopping and focusing on deepening and slowing your breathing can bring you back to the moment.

-Relaxation, guided imagery or hypnotherapy techniques- folks with dissociative disorders are engaging in a form of self-hypnosis much of the time. The trouble is, it is out of your control! Some trauma therapists are also trained in hypnosis and can help teach you how to use dissociation in a way that works for you. For example: you can develop a safe container for traumatic material between sessions, create a safe or comfortable place (“safe” may not be a concept some survivors can relate to or may be triggering to some) or learn ways to turn down the “volume” of painful feelings and memories.

Grounding and emotion management skills can help you proceed with the work of trauma therapy in a manner that feels empowering instead of re-traumatizing.

Kathleen Young Psy.D.

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35 Responses to Staying Present During Trauma Therapy: Grounding Techniques

  1. Svasti says:

    You know, when I was in the midst of dealing with daily flashbacks, the best thing I could do for myself (once the horror ride was over), was simply go out and be amongst people.

    Its not like I ever really wanted to. In fact, I would’ve rather just stayed at home. And it wasn’t easy to force myself out of the house. But just seeing that the world was going on like normal, despite what I was experiencing… somehow that really helped.

    • Thanks for sharing this strategy, Svasti. It truly is about figuring out what works for you as an individual.

      Sometimes I brainstorm a whole list with clients, so they can run through them as needed til something works.

      I am glad you figured out something that worked for you!

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  3. Dr. Young, thanks for your website. I found you via “invisible illness”..I am Type 1 Diabetic, but also live, not so well, with ptsd. The PTSD has dug itself so completely in my nervous system that hypoglycemia is perceived as a threat and sends me to the floor. Life is difficult lately. It’s nice to find more literature, although I have a great understanding of the process…reading more is promising.
    Thanks for the work!

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  6. onesurvivor says:

    I really appreciate your thoughts here.

    I read the first part of this article at the Survivor Manual. The thing that really stuck out to me is where you talk about survivors being able to talk about what happened to them easily because they are in a dissociated state. That triggered a whole train of thought because of my own experience.

    You have definitely given me some things to chew on for awhile to help me keep working on my own healing.

    Thank you.

    • Hi onesurvivor-

      I am glad you found my post over there and followed it here! One of the things I like best about blogging is the way we can spark each other to think further on these issues.

      I hope you keep reading and look forward to hearing more from you!

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  10. Staying grounded and aware is something that I had to learn to do on my own. No one taught it to me. Thanks for sharing this information.

  11. Jeanette L says:

    One problem that I have is that I don’t always know when I am dissociative. I am just now becoming co-conscious during some of my dissociative times but not all of them, and even the ones I am, I’m not really the one in the drivers seat, so I don’t have the control to try to ground. I have only had maybe a handful of times in the last couple of years where I have been able to try a grounding technique when triggered into an anxiety attack, most often I dissociate too quickly though.

    It’s hard when you know that you should be able to do these things, but haven’t had the ability to catch it before the chance has slipped away. I will say that when having flashbacks and memories emerge at this stage, I am able to ride the wave easier and not get pulled down for days at a time, I’m usually past the hardest parts much quicker than I used to be. These things don’t seem to have as much of a hold on me as they did at first.

    I still don’t like it though! I can’t wait until all this is over with! It’s the hardest thing I have ever done, maybe even harder than the original abuse, because then I was fully dissociated and now I’m living through some of this stuff, the feelings of it, even the body memories are being released. Very hard.

    • Amy Greenlaw says:

      yes.. very hard to be here and not there as Van der Kolk says.. keep yours patients here not there…. in real time…can be disorienting.. I have experienced it and just tried to let my body try to run it’s course, with the knowledge and awareness that that’s what was happening…I think it may be part of the integration process between body and mind.

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  16. My therapist and I have found a few ways to get me present so I can work on grounding – lavender oil. The smell of that brings me back from where ever I’ve gone to within seconds. Another I’ve recently discovered is an ice pack under my feet.

    Once I’m present I can work on grounding and staying present.

  17. Cassie says:

    This article isn’t listed on the right under recent posts, or anywhere on this site (that I can find).
    Where are all your posts listed?
    Thank you.

    • Hi Cassie-

      There is a tab on the top task bar “Article List” that has my posts listed in chronological order, but it is not completely up to date. There is also a search box on the side bar that allows you to search the blog by topics.

      I hope that helps!

  18. Cherlheen says:

    Hi… I was sexually abused when I was young and I just learned because of your article that I have dissociation. I usually talk to them, and I really don’t what to do with them. Sometimes i can’t control them especially when there’s a situation which is difficult for me to handle. I really don’t know what to do. I experienced severe depression last month and I heard several voices. Based from my research that was brief psychotic depression. I am truly confused right now, i hope you could help me somehow. Thanks and more power.

    • Hi Cherlheen-

      I strongly encourage you to seek help from a therapist with expertise in trauma and dissociation. There are links to resources on the sidebar to help with that. Trying to diagnose yourself can only go so far and it does nothing to help with the healing. Good luck to you!

  19. ella says:

    I have just been diagnosed with PTSD. I have had a couple of experiences in my life where I have come out of my body and watched myself from the ceiling. I am now aware that at times I begin to space out and then feel almost hypnotised. I get a noise in my ears, things become distant. It happened once in a therapy session. I went ‘away’ – briefly, I think and then remember the therapist asking if I was ok. I said yes. We didnt speak about it further. There was another time where I was unable to drive as I coudn’t move my arms, I was frozen and another where I stopped walking and coudn’t move. Does this sound like dissociation??

    • Hi ella-

      What you describe does sound like dissociation to me, but I am in no position to say for certain based on a comment on the internet. 🙂
      I encourage you to talk about this with your therapist. You may also find post I have written about dissociation helpful.

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  21. Moveforward says:

    Couldn’t it be possible to recover by moving forward, persisting, practicing? Do you believe that one MUST address the trauma? In my case it is very old, and I am wanting to address the “bad habits,” such as involuntary dissociation, panic, etc. thanks for your insight.

    • My perhaps not so useful answer is “it depends”. Everyone is different and some people do find benefit in learning new coping skills without processing past trauma. I also am curious about what you mean by addressing the trauma. To resolve things like dissociation (depending on the degree) it may be important to acknowledge that the traumatic events DID happen to you, as well as to understand their impact on your sense of self and the world. That is not the same thing as reliving/re-experiencing every traumatic event. Often it is hard to truly move forward without accepting the past.

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  25. Great post! I’ve been working a lot on grounding techniques, specifically for the purpose of staying present during therapy. I’ve often been told I talk about my life as if it happened to someone else. So I can SAY it, but I’m not connected to it at all. It’s incredibly scary to think about connecting the words with emotion, but I know it will be the key to healing from this trauma.

  26. djmendyblog says:

    I appreciate your dedication to the trauma community. I was hoping for some further information specifically on the therapy for my childhood chronic trauma from my 2 caregivers both physical and emotional. However, i have issues with my psychologist because she has explained in the past about the possibility of retraumatization. I have a good honest relationship with her that goes back 16 years. I was never tapped into my emotions regarding the trauma and abuse. After 2 years of consistent abstinence from drugs and alcohol. I felt we were at an impass because i did not get any kind of support from here regarding this issue. I found a new therapist with emdr therapy and we started the journey. Unfortunately, she had me role play standing within inches of her and it not only shocked me but in conjunction with all areas of my life giving me stress, anxiety, problems . I looked to self medicate and in 2002 found crystal meth. And the ADD i was born with due to a birth defect of crossed eyes and testing while i was sober. My ADD is off the charts. So recovery has been very difficult. Today i am in a dual diagnosis intensive outpatient program in pasadena and finally i have the feelings, thoughts and details of my traumas. That include my peers at school that would hunt me down just to attack me after school. My point of all this is i dont believe this therapist has the knowledge or experience to help a patient process and guide them through the process. But being on medicare with Medical therapists are extremely difficult if not impossible to find. For now i need her to continue my abstinence from meth but my psychiatrist will handle the ADD. But the trauma must be handled processed and guided with a trauma therapist. I have been sad for fleeting moments but my character default is optimistic, enthusiastic, and a sound set of support to my small group of friends i have known each for more than 10 years. I have printed up the initial documents for grounding techniques to show my psychologist and would like to think we can do this but i can’t ignore our past. Hopefully your community can help with any advice. And i will ask for referrals from the mental hospital in pasadena i attend for group therapy. God bless and good thoughts for all that read this. PS i have never should any signs of retraumatization. I just want to be heard and have a voice for this never before addressed problem that has manifested into some psychological cognitive distortions. Forever grateful, David

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