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Whether it’s a friend, relative, or partner, we sometimes find ourselves with someone who suddenly begins to experience the acute effects of trauma. This typically presents as sudden fear or panic, flashbacks, intrusive negative thoughts related to the trauma, or dissociative states where the person appears to “not really be there” anymore. Of course, these experiences may be frightening, confusing, and overwhelming for the person experiencing them, and they may also be for the person witnessing them as well. If you are in a relationship with someone who frequently experiences these symptoms in your presence, it may be beneficial and empowering to have a sense of what might be helpful for the person in that situation.

However, it is important to note that the purpose of this article is to highlight some quick and concrete strategies to help the person re-orient or “ground” during or after an acute trauma reaction, and it is not intended to imply that anyone in a personal relationship with another trauma survivor should take on the role of being an actual therapist. Think of the information in this article as a “first aid kit” for flashbacks – it’s to help you when you need it and should not be used in place of actual treatment from a trained professional.

What to Look For:

• Sudden difficulties communicating or responding
• Person seems disoriented
• Frozen, wide-eyed stare, clenched or fluttering eyes
• Inability to make eye contact
• Dysregulated, uncontrollable flood of emotions, such as crying, screaming, shaking (panic)
• Calling out for help, repeatedly saying “no” or trying to run away
• Curling into a fetal position or trying to hide
• Seemingly unaware of or disconnected from the present
• Making movements or gestures as if responding to something that is not really there

What to Do:

 1. DO NOT TOUCH someone (even a loved one) in an active flashback. 
This may be extremely triggering for them and the physical touch may inadvertently be experienced as part of the traumatic memory/flashback. As they are starting to come out of it and are becoming more oriented, it’s ok to ask permission to touch them (for example, placing a hand on their shoulder, a safe embrace, or using touch to guide the person to a better location). If they say “no” or appear to shutter or recoil, respect this as an indication the person does not want to be touched at that time.

2. Do not ask them to talk about the flashback details.
It’s ok to ask if they are having a bad memory or if they feel like something bad is happening to them right now. It’s important to keep in mind that if a person is having a flashback, they are overwhelmed and flooded. This is not the time to try to get them to talk about anything related to the trauma. They need help coming back to the present moment, regulating their nervous system, and feeling safe again.

3. Orient to present time and surroundings.
Identify yourself and announce where you are and say something present-oriented, such as your name and relation to the person, even if they know you well. Let them know where you are and remind them they are safe in the present moment. For example: “Laura, this is Sarah, your sister. You are here with me in your house in Florida. It’s May, 2019. It’s just me and you and nothing bad is happening to you right now. You’re safe here with me.” 

4. Use a warm, but firm voice to give instructions.

• Ask them to listen to the sound of your voice. Ask them to indicate they can hear you and know who are.
• It’s very helpful to get a person in a flashback to open their eyes and begin looking around the room. This is key in helping them gradually be able to realize they are in the present (where it’s safe), as opposed to in the past when the traumatic experience actually occurred. Repeat this in a calm, but firm voice until they are able to do so.
• Ask the person to look around the room and name as many colors as they can, name the objects they see, find something close by that makes them feel safe and comforted (e.g., a beloved pet, a favorite blanket, an article of clothing or a piece of jewelry) and ask them to hold on to it and describe it to you in as much detail as possible.
• Instruct the person to put both feet on the floor to literally “ground” them in the present moment. I like to ask people to wiggle their toes, gently press their heels into the floor, and to notice what it feels like to be supported by the ground beneath them. 
  
  

5. Repeat grounding or safety phrases as much as needed.
Again, continue to use a warm, but firm voice consistently. The person may be relying on the presence of a supportive voice to “guide” them out of the flashback experience. You can continue to say things like:

• It’s ok, you are here with me now.
• It’s all over, you have already survived this.
• He/she/they can’t hurt you anymore.
• You are safe, you aren’t in danger anymore.
• You are no longer in __________ (e.g., parent’s house, city or country of traumatic event, etc.)
• You are an adult now, which means you are safer, you have more resources, you have more choices.
  
  

6. If necessary, continue with more structured breathing or grounding exercises.

• If the person is hyperventilating or appears to be panicking, you can ask them to take some slow, deep breaths with you. It can help to mirror this for them and do it along with them. Ask them to notice what their breath feels like as they breath in and then to notice what it feels like to breathe out. See if they can take a deep breath in for the count of 4 and then breath out for a count of 4. Repeat until breathing has stabilized.
• For further grounding strategies, continue to ask the person to look around the room as much as possible. You can transition to using all 5 senses (sight, sound, smell, taste, and touch) if something “stronger” is needed. Ask the person to name 5 things they see, 4 things they touch, 3 things they hear, 2 things they smell, and 1 thing they taste. Feel free to offer assistance by giving access to scented candles or lotions, mints or chewing gum, or anything else that would likely be soothing.

 
Key Points to Keep in Mind:

• Be warm, firm, and consistent
• Be calm and patient and don’t give up
• Do not push and try not to get scared or frustrated yourself
• Repeat as much as necessary and don’t worry about sounding like a “broken record”

• Once the person is fully out of the experience, you can ask the person for feedback about what was helpful and what wasn’t. Make a plan for next time and please follow up with professional help if needed. 

 

1. Hold assumptions at the door
It can be very easy (and understandable!) to assume that the struggles you faced in middle school are the same ones your child will experience: mean girls, peer pressure, opening lockers—you name it. And while some of those fears seem to stand the test of time (have they changed those dang padlock lockers?!), others will change based on both new forms of communication (like social media) as well as your child’s individual strengths and challenges.  If we assume that children are concerned about peer pressure and talk with them all about how to “say no to drugs” when what they are actually concerned about is where they will sit at the lunch table, they may end up feeling unsupported and be less likely to disclose about the things that are actually stressing them out.  A couple of helpful questions to ask are: “What are you most excited about?” and “What are you most nervous about?”.  Asking those questions not only normalizes the feelings of excitement and nervousness, but it also gives them the opportunity to express what they need from you.  That support may be similar or different from what was originally imagined.

2. Provide opportunities to practice 
Often the fears a child holds can be minimized by knowing what to expect.  The fear of being late to class because they weren’t able to open their locker can be greatly decreased by becoming an expert at opening a padlock at home.  The fear of getting lost in the hallways can be solved by walking from class to class before the first day of school. The fear of knowing how to say no to a party while saving face can be decreased by creating a plan or code word to use if they need you to assert that they’re not allowed to go out.  While many schools offer the option of a tour for incoming students, if your child seems particularly anxious about starting somewhere new, it might be worth asking for a private tour of the space to assuage those fears.  Again, it is important to attend to your child’s individual needs, as practicing or rehearsing something unnecessarily can unintentionally send the message that you doubt their ability to manage new situations.

3. Take care of yourself!
Having a child transition to a new phase of life can bring up feelings of joy, grief, and uncertainty.  Fears can easily arise such as: “Will my child be okay?” “Have I prepared them well enough?” and “What can I do to make sure my child doesn’t have to go through what I did?”.  To avoid the trap of projecting anxiety onto your child, it’s a good idea to be curious about and validate any challenges during transitions that come up for you.  This way you can accompany your child on their own journey in a way that’s healthy for them.  Some of the challenges they will face will mirror your own, and some will be different.  Knowing you believe in their capacity to manage stress and navigate this new time in life is the most effective way to help them have that same confidence in themselves!

​Guest Blogger: Alisa Stamps, MSS, LCSW ​

Who do you see when you look in the mirror?  Do you see your smile, your shining eyes, the incredible qualities that you bring to your life?  Or do you see the “bad” traits?  Maybe even the traits that were projected there by someone else.  That you are lazy, stupid, too heavy, or maybe even not good enough?  How do you feel about the face looking back at you?  Do you feel pride?  Or do you feel full of shame?  Who do you see when you look in that mirror?   Is it you?  Or is it someone else entirely? 

To answer these questions we must begin with the Greek myth of Narcissus.  Narcissus was a hunter who was known for his beauty and love of all things beautiful.  One day as he was walking in the woods a mountain nymph named Echo saw Narcissus and fell completely in love with him.  Sensing he was being followed, Narcissus cried out, “Who’s there?” and Echo repeated, “Who’s there?” and tried to embrace him.  Disgusted, Narcissus stepped away and asked her to leave him alone.  Echo was heartbroken and spent the rest of her days alone until nothing but an echo sound remained of her.  Nemesis, the goddess of revenge, caught wind of this story and decided to punish Narcissus.  One hot summer’s day, after many hours of hunting, the goddess Nemesis lured Narcissus to a pool of water deep in the forest.  As Narcissus bent to drink, he gazed upon his own reflection and saw himself staring back in the prime and bloom of his youth.  However, he did not recognize it as his own reflection, and so he fell in love with it as if it were someone else.  Narcissus was unable to tear himself away from his own gaze, and after some time realized that his love could not be reciprocated.  He eventually withered away from the passion burning inside of him and thus turned into a gold and white flower. 

​What does the myth of Narcissus have to do with what we know today as narcissism?  The DSM V defines narcissism, or narcissistic personality, as a, “fixation with oneself and one’s physical appearance or public perception”.  It also goes on to say that someone with narcissistic tendencies will have a need for admiration, will have a pervasive pattern of grandiosity, and will possess a lack of empathy.   The terms manipulation and domination also come to mind when defining a narcissist.  In order to succeed, the narcissist has to make the target (spouse, child, etc.) into an extension of themselves.  This extension can pertain to both the emotional and the physical.  The narcissist needs their target to believe that they are nothing without the approval of the narcissist.  The narcissist will also, as is the case with many personality disorders, project parts of themself on to their target, and then attack those parts. 

Does any of this sound familiar?  Are you wondering if you’ve been in a relationship with a narcissist in the past?  Was that person your partner?  Or maybe even your parent?  What happens now that you’re aware of this?  How do we get to the point when we can look in the mirror and see ourselves and not the narcissist?  How do we recover from perhaps a lifetime of narcissistic, emotional abuse?  Stay tuned as this and much more will be addressed in future blog posts.  And be on the lookout for information about a new outpatient group starting in the fall, Shattering the Mirror—Support and Recovery for Adult Children of Narcissists.  

​“Children are not meant to provide the emotional or psychological needs of parents.” – Sheila Darling

In a “good enough” home environment, children have mostly consistent, predictable, and nurturing responsiveness from an attuned parent or caregiver. There is an internal experience of being taken care of that comes from healthy boundaries between the parent and the child. The child understands and knows on a deep level the adult is there and “has got this” while also not feeling overly controlled and smothered. There is a balance between dependence and independence, structure and freedom, love and discipline.

In family environments that aren’t so ideal, as in cases where a parent experiences ongoing emotional difficulties, this balance is not achieved on a consistent basis. The child intuits, or “picks up,” that something is not emotionally (or sometimes physically) safe and takes on a sense of responsibility for taking care of the parent in a variety of ways, typically by providing emotional or physical caregiving to the disturbed parent. Life in this kind of dysfunctional family environment pulls the child into a role reversal with the disturbed parent. The result for the child is often a pervasive sense of worry or anxiety about the feelings and needs of the adult, feelings of depression or sadness, low self-esteem, withdrawal from developmentally appropriate activities and engagement with peers, and an exaggerated sense of being mature or “wise beyond your years” that equates with a lost childhood.

Taking on these feelings and the overwhelming sense of responsibility for a parent is often referred to as being a “parentified child.” The costs to these children are tremendous. First, the child often learns that his or her needs are not wanted, acceptable, nor likely to be met. These needs are either ignored, neglected, or perhaps even worse, the child is actively punished, criticized, shamed, or rejected when expressing his or her own desires or wishes. As a result, the child learns how to “cut off,” bury, or deny his or her needs in order to take care of the parent’s and to prevent further disappointment or harm.

Secondly, as an adult, there is often a deeply profound sense of shame that comes from having a personal need emerge. Throughout childhood, there was a complete orientation towards taking care of the parent, often at the exclusion of being aware of one’s own sense of self and healthy entitlement to personal needs and interpersonal boundaries. After growing up always being oriented toward “the other,” adults from this type of family environment often have a hard time developing certain abilities, such feeling entitled to saying “no” to others, expressing anger, getting close and developing deeper levels of intimacy, and feeling whole and worthwhile as an individual.
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If you recognize yourself in these descriptions, it is possible you grew up with a parent or caregiver that relied too heavily on you to meet his or her emotional and/or physical needs. Individual psychotherapy with a relational or attachment-focused approach can provide a certain kind of space and therapeutic relationship where you can be free to explore the effects of your unique childhood experiences on your development and ability to connect in healthy ways with others. Although this will inevitably require a certain amount of courage and willingness on your part, parentified children are undoubtedly strong and resilient by nature and healing and growth are certainly possible if given the right opportunity. 

Traumatic experiences profoundly affect us in deeply personal ways, in part, because they make us feel out of control in this world, feel unsafe with others, and even unsafe with ourselves. We start to feel unsafe with ourselves, for example, when we question our own judgments, lose trust in ourselves, or carry a sense of inner badness, defectiveness, or self-disgust. We may find ourselves asking questions like, “Why did this happen to me?” or “What did I do to deserve this?” Sometimes, this inner sense of being to blame or of having some kind of inner “badness” is so significant, it makes us question or lose faith in our spiritual belief system. For example, we may say “I’m so awful, not even God could love me.”
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Inevitably, those who have experienced trauma find themselves trying to sit with and make sense of a tangled knot of intense emotions. These can include feeling anxious, frightened, alone, angry, sad, depressed, guilty, and ashamed. When these emotions are accompanied by thoughts of self-blame or self-hatred, it’s like pouring gasoline on a blazing fire. For example, when we are already feeling sad and alone, to think thoughts like, “It’s all my fault” or “I should have done something different” only makes us feel more depressed and isolated from others. So, in this way, a vicious cycle of negative, intense emotions and social isolation is perpetuated.

Why is blaming oneself for traumatic experiences so common even though it can make us feel so much worse? To outsiders, it may seem obvious it is not our fault or even absurd that these kinds of thoughts could be believable to us. But, the truth is, there are many understandable reasons why we can tend to blame ourselves. These reasons often center around themes of either 1) Needing to have a sense of control or 2) Needing to have a sense of meaning. Following is a list of some examples of underlying (or unconscious) reasons why we can hold on to self-blame after traumatic experiences:

• It feels better to believe we either did have control (e.g., I caused this because I am bad) or that we could have had control (e.g., if I didn’t make him angry with me, he wouldn’t have hurt me). Essentially, if we feel like we have control then it can feel like we can prevent future traumas from happening and we will ultimately be safer.

 

• If we were raised in families where, as children, we were blamed when bad things happened, this may feel like a natural “role” we readily take upon ourselves.

 

• It can feel easier to blame ourselves than to ponder philosophical or spiritual questions about why bad things happen to good people. We can preserve our spiritual beliefs or our framework for how we make meaning out of life that way.

 

• It can feel safer to be angry at ourselves than others that we love or even at God or the world.

With this being said, it makes perfect sense to me why some end up carrying around this sense of self-blame despite how much worse it can make things feel. On the other hand, it has been my experience that those who carry these feelings around the most are also the ones who carry a tremendous amount of shame and who are the most likely to be suffering from other serious symptoms of Post-Traumatic Stress Disorder (PTSD). This may be because the shame is so powerfully painful, it can keep us from talking about or coping with the traumatic experiences in ways that could ultimately be healing and freeing. The shame keeps us wanting to avoid the trauma-based thoughts, feelings, and memories and from sharing these with potentially helpful others because it can be so frightening and painful. However, the avoidance only ends up keeping us trapped inside ourselves, without being able to get the support needed to face, process, and ultimately resolve the feelings of shame or guilt and to heal from the traumatic experiences themselves.

If you find yourself relating to these experiences of self-blame, I encourage you to find someone you can trust (even just a little bit at first), whether that is a friend, a relative, a spiritual or religious leader, or a licensed therapist and start to take the healthy risk of sharing your story with someone. Its going to feel very scary and painful at first, but over time, having someone hear your story and accept it without judgement can help you start to resolve these feelings of shame, self-blame, and self-hatred and to move forward in your life. 

Beginning therapy for the first time or with a new therapist can be a scary, terrifying situation. This can be true for anyone, but especially for people who have experienced any kind of abuse or trauma. There may be a part of you that acknowledges you need help, but another part (or parts) of you that are afraid to seek help or believe that it is pointless. Having the ability to trust another person with these deepest, darkest aspects of yourself or your history may seem impossible. Still, it may be terrifying to even think about talking about the trauma or abuse, and you may believe this is what will be required of you in order to be in therapy.  Additionally, many people with trauma or abuse histories have, unfortunately, had bad or traumatizing experiences with therapists or other mental health professionals. Of course, if this has happened to you, it understandably makes it even more difficult and scary to make the decision to try therapy again.   

These are just a few of the things that can make it difficult and scary to seek help from a therapist. Still, therapy has the potential to offer a healing relationship, increased stability, and hope for the future. Although it may feel like a risk, seeking help from a healthcare professional is a healthy risk.

​Here are 5 steps you can take to make finding a new therapist a little less scary.

1. Do Your Research
Chances are, if you are reading this post, you are really good at finding information on the internet. Many people find their therapists online, and are used to reading therapist profiles, websites, blog posts, etc. While this is a great place to start, it doesn’t have to stop there. Feel free to look up the school and program where the therapist graduated from and any trainings attended. If a therapist reports using a specific therapeutic approach or technique that you are not familiar with, take the time to look into it. Make sure it looks like the therapist’s background, training, and approach are consistent with your thoughts and the direction you want to go in therapy. Although this does not ensure a good fit, it can help give you some peace of mind, knowing as much as possible about the potential new therapist.
 
For people with a history of severe or prolonged childhood abuse, dissociative symptoms, and/or self-injurious or suicidal thoughts/feelings, I highly recommend finding someone who specializes in these problems.

2.  Ask for an Initial Consultation
Many people do not realize you can “therapist shop” or meet with multiple therapists to interview them before actually starting therapy. This can help take some of the pressure off and give you some space to get a sense of what might be the most helpful for you and to reflect on your feelings without feeling “trapped” or “obligated” to return. Therapy works best when there is a good fit between the therapist and the client. There is no point in trying to force a good fit, when there is likely a better fit out there.
 
As a psychologist, if I am aware someone is interested in interviewing me prior to beginning therapy, I often offer a free initial consultation. It is perfectly ok to ask for this option when making the initial contact with a potential new therapist.   

3. Listen to Yourself
We often have a little voice inside or a feeling telling us information about what we may need. If you are like me, it is sometimes difficult to trust that voice or that feeling. It is much easier to minimize that, brush it off, or even criticize it. But actually, there is a lot of wisdom in what these experiences tell us and it’s important to not only listen to that, but to also trust it. If there is a part of you saying you don’t want to see a particular kind of therapist or participate in a particular kind of therapy, honor that part of you and try to find a therapist that does not contradict what that important part of you is saying. Also, try not to “should” yourself, (i.e., I should see a male therapist because that will help me get over my past), or follow someone else’s advice at your own expense. Listening deep down and following your own instincts or intuition will help you feel more in control of this process.

4. Ask Questions
You absolutely have the right to interview or question your therapist. It is important you have the opportunity to understand the therapist’s education, level of training, and background. You can ask how many of years of experience he or she has in treating a particular problem or using a particular approach. Questions regarding the therapist’s philosophy or approach to therapy, boundaries, and ways he or she would handle particular problems are completely appropriate. If you struggle with things like self-injury or suicidality, definitely ask up front for the policies and procedures for making crisis calls during times of emergencies. If something is bothering you, making you afraid, or if you have specific needs, ask, ask, ask.

5. Go slow and take control
Therapy is for you, and it is beyond important that you feel as safe and comfortable as possible. I strongly believe that your history belongs to you and you should be in complete control over how and when you share this information, if you chose. As a trauma therapist, I do not believe I need to know the details of anyone’s trauma history at the onset of therapy in order to help them. Although I believe having this information is helpful and being able to tell one’s story is an important part of the therapeutic process, I think it is more important for the person to be in complete control of what information is shared and when. It’s ok to take your time, and you can decide when it feels safe to start talking about your trauma or abuse history. 
 
You do not have to feel pressured by a therapist to talk about it before you are ready and its ok to say you do not want to talk about it. Therapy can focus on managing and coping with trauma symptoms, promoting safety and stabilization, improving quality of life, and building a solid therapeutic relationship without the demand to talk about trauma or abuse details. 

These days it seems there is a misconception, or even a “watering down” of what the word trauma actually means. In everyday conversations, the word “traumatic” can be used in the same way as words like “stressful” or “upsetting.” For example, we have all seen the dramatized, reality tv-show star say something to the effect of, “Finding out my wrinkle cream has been discontinued has been really traumatic for me.” But, if you have lived through a traumatic experience, you know on a deep level that trauma and stress are not the same thing.

​On the other hand, when most people think about trauma, they often think about those who have survived a natural disaster, been physically or sexually assaulted, or been exposed to war or combat. Understandably, these kinds of experiences can be extremely traumatic for a lot of people who go through them. However, a person does not have to have undergone an experience as obviously profound as these for it to cause a traumatic reaction or response. ​

Some trauma experts like to distinguish between “big-T” traumas and “little-t” traumas. Big-T traumas are what most people typically think of, as I just described. They create a terrifying sense of being completely overwhelmed, are often sudden, and leave the person’s life or sense of well-being feeling physically threatened.  

​Little-t traumas, on the other hand, may not be life threatening or as horrifying or terrifying as the typical list of qualifying traumatic events. Nevertheless, many kinds of events or experiences can be traumatic even if there was no threat of physical injury or death. These types of traumas include experiences that threatened the person’s sense of psychological integrity or well-being.

​Of course, neither of these lists are exhaustive and represent only a small fraction of life events or experiences that a person can experience as being potentially traumatic. Big-T traumas, by nature, are very severe. Yet, it also makes sense to me that these less obvious forms of trauma (i.e., little-t traumas) can have a profoundly traumatizing effect on people and can create many of the same post-traumatic responses as the Big-T traumas. This becomes more and more true with experiences that are chronic, repetitive, or having survived multiple types of traumas, as this tends to have a “cumulative” traumatizing effect.

Even if what you have experienced has not been mentioned in this blog, it does not mean you have not suffered a trauma or that what you have experienced did not result in post-traumatic reactions. What these different types of trauma have in common is the lasting impact they can have on people, which includes experiences such as being emotionally, physically, and mentally overwhelmed and feeling shocked, horrified, helpless, damaged, or fractured in some deeply profound way.
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The important thing is not to focus on what type(s) of trauma(s) you have survived and to try to quantify it in some way, but to recognize the ways you have been affected and what all of this means to you. There is hope for recovery, and it begins with recognizing and coming to terms with what has occurred and the many ways it has impacted your sense of self, your experience of the world, your perspectives, your ability to connect with others, and to engage in a quality of life that feels personally meaningful.