Last week the therapists in my local Ellie sat together to listen to the latest case consultations on our caseloads when an interesting and unique situation came up for discussion. One of my co-workers was describing her patient’s extensive trauma history and all the things she had tried in talk therapy that seemed to miss the mark when it dawned on me: Nothing was working because we were all advising our co-worker to use words, talking, and active cognition to speak to a traumatized brain that did not have this available at the time of trauma or now.
Why Traditional Talk Therapy Isn’t Always Effective for Trauma
In the experience of something traumatic, our thinking brain and active cognition shuts off. Hormones flood the system like a big red flashing stoplight in the brain to protect us and the mid brain takes over. This is where our fight/flight/freeze is activated.
This is a good thing. If our thinking brain had to be present in trauma, we would have to analyze and plan next steps which would be really slow. Our bodies shut that process down to make it quick. We move to fight or run or get ready to fight or run. It’s fast and that is how we survive.
When I’m in therapy with my patients I explain it like this: Imagine you see a bear. If you had to think and plan your next steps it would go something like this. “Should I go left? Should I go right? Perhaps I should get out a spreadsheet and analyze which way I should go.” And that just doesn’t work! By the time our thinking brain has analyzed the situation, the bear has victoriously declared us as their prized dinner. So, our bodies do it for us. The thinking brain shuts off and we just act. We either fight the bear, we run from the bear, or we freeze and get ready to fight/flight. Whatever we do, we just act.
However, this means when we are healing traumatized brains in talk therapy, sometimes we miss the mark because we are talking to a brain that was not present or active in the experience at all. Talk therapy engages a thinking, planning, cognitive brain that was not even there in the traumatic event. So, what do we do?
How to Engage the Midbrain in Trauma Healing
We talk to the mid brain; the brain that was present in trauma. But we do not talk to that brain with words or language or anything connected to planning, analyzing, thinking, or anything rational that we are accustomed to using in talk therapy.
How do we talk to the mid brain, you ask? There are so many ways you can talk to the midbrain from somatic therapy, bottom-up therapy, and so many other ways. But this happens to be a favorite of mine.
1. Use Images Instead of Words
In my experience, I talk to the midbrain in images. If my patient is struggling with finding safety and remembering what safety is, I have them draw me a picture of a safe place. Even if that place does not actually exist in reality. If my patient is wrestling with grief after loss, I might have them draw me their idea of what loss feels like to them. If my patient can’t tell me what anger feels like or what they think about anger, I have them draw it. You get the point. I always have an accessible art supply in my office for anyone who might be trying to communicate with me but can’t because of a block in words due to trauma. Once we have images sometimes the person can tell me what they just drew and there’s the language.
2. Introduce Writing Before Verbal Processing
But often when we tap into those images, we can’t find words. I may have them do some writing exercises to get the words out in writing before they become verbal. Sometimes we can access language from the brain to the pen before we can access it from the brain to the mouth.
3. Gradually Assign Language to the Experience
After engaging the midbrain through imagery and writing, I work to help the person assign language and meaning with me to the experience.
Creativity in Therapy
The point is, we have to be creative as therapists to know when our patients are coming to us with experiences that are outside of verbal language. They may really want to tell us but be entirely incapable because words were outside of their traumatic experience. So, it is our job to gently help that along.
Another creative idea: Giving someone art supplies with the assignment “Let’s give voice to what hasn’t had a voice yet.” Because sometimes even the trauma therapist can’t get it all, even when they are tuned in and watching all body language, what’s said and what’s not said, and reading between the lines. Sometimes what hasn’t had a voice yet needs to speak through the images.
The Importance of Consent in Trauma Therapy
Since this process can be deeply vulnerable. Before introducing any of these exercises, I always ask something like:
- “Would it be okay if we tried an activity today?”
- “What do you think about doing a writing exercise to see what comes up?”
My patients deserve to give their consent before we touch their emotional moment. By honoring their consent, I honor their agency and choice where it was often disregarded in trauma—which can be a deeply empowering experience in and of itself.
Conclusion
Trauma is violating but the tools of therapy can be empowering. Trauma is often the thing that takes away voice and choice, but therapy itself can be the thing that gives that back.
Try it out. You might be surprised by what comes up! Find an Ellie location near you to get started.
