Dr. Kathleen Young: Treating Trauma in Tucson

Talking vs. Processing in Trauma Therapy


This post was inspired by a Twitter conversation I had with the illustrious cartoonist of all things therapy related, @TherapyTales, about this Tweet:

There us a difference between “telling” the story of trauma and “processing” through the trauma. One brings more pain-the other relief. –@zebraspolkadots

When @TherapyTales offered to draw an accompanying ‘toon if I wrote a post on the subject, how could I refuse?  The Tweet resonated with me as I do see this difference in my work with trauma survivors. What is the difference? What do trauma therapists mean when we talk about “processing” trauma? How is this different from talking about it?

Some trauma survivors come into therapy unable to share their stories. Others may recount their traumatic experiences freely, but in a manner that appears disconnected. It seems as if they are talking about someone else (and in the case of dissociative identity disorder, they may really experience it that way).  In these instances the facts are relayed without accompanying emotion and out of context.  This kind of talking about trauma does not promote healing and in some cases may even be retraumatizing. The goal of processing trauma by any form of therapy is to be able to decrease the high intensity emotional charge while creating meaning.

I touched on some of this previously when I wrote:

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.

To me, processing requires first having established a therapeutic alliance, meaning you feel connected and reasonably trusting. This allows for a corrective emotional experience: when connected you are open to noticing the therapist’s reaction to what you share and how it differs from your fears or the reactions of those in the past.

Processing also requires the capacity to be and stay present in the moment. Talking while dissociated prevents you from experiencing something new. Those with dissociative disorders have survived by keeping the traumatic knowledge, emotion and bodily sensations separate. You may even experience traumatic events as having happened to someone else, not you! Processing your trauma means experiencing it as yours. It involves holding all these aspects of the experience together.

Thirdly, processing involves an integration of experience that is a step towards creating meaning (a goal of the third phase of trauma treatment). For example, in EMDR, we talk about processing as holding an image of a traumatic experience, the associated feelings and bodily sensations together with the core negative belief about yourself created by this experience. The idea is that this can change the brain, the stuckness of the traumatic material, allowing for new learning to take place.

Creating meaning is key. Trauma disrupts so many things: the child’s developing sense of self, the ability to find  security in relationship, and the belief in a safe and just world. Creating new meaning means moving beyond trauma-based beliefs such as “I am bad” and “I deserved it”. Sharing your traumatic experiences with a trusted other, such as your therapist, is a step towards creating a different experience of relationships. Connecting with a larger, supportive, and validating community (such as a survivor therapy group or online survivor communities) can also be powerfully healing. As Judith Herman writes in Trauma and Recovery:

In the task of healing, therefore, each survivor must find her own way to restore her sense of connection with the wider community. We do not know how many succeed in this task. But we do know that the women who recover most successfully are those who discover some meaning in their experience that transcends the limits of personal tragedy. Most commonly, women find this meaning by joining with others in social action. In their follow-up study of rape survivors, Burgess and Holmstrom discovered that the women who had made the best recoveries were those who had become active in the anti rape movement. They became volunteer counselors at rape crisis centers, victim advocates in court, lobbyists for legislative reform. One woman traveled to another country to speak on rape and organize a rape crisis center. In refusing to hide or be silenced, in insisting that rape is a public matter, and in demanding social change, survivors create their own living monument.

Making meaning through activism can take many forms. It can be speaking up about daily experiences of rape culture. It can be writing a blog. It can be art. It can be breaking the cycle of abuse in your own life, with your own children. It is as individual as you are. And please remember: this is the final stage of healing for a reason. Many survivors would rather care for others than themselves. You need to do your own healing first to most effectively help others. Plus, you deserve to be the focus of your time and attention!

Kathleen Young, Psy.D.

If you are not already a fan, you can check out more Therapy Tales here.