“Yes, yes, I want to continue… and yes, I know I have to talk about it… it’s just that… not today… no, please. Today I don’t feel able to talk about any of that.” Does that sound familiar? Today we want to tell you about a therapeutic tool for treating trauma.
How to treat trauma?
Those of us who work with severely traumatized patients often hear phrases like that. They are common when they have to face again that abuse, physical or emotional, that abandonment or neglect, that situation of mistreatment from which they saw no way out. Sometimes when they have to talk about situations in their life that caused them a feeling of unmet need that now manifests emotionally. Sadly, we often hear these types of phrases from young people who come to the session almost by force, brought by family members, usually parents, who only see symptoms of anxiety or depression but their loved ones cannot express what they feel.
Reliving traumas with the psychologist
The way we psychologists listen is never passive or indifferent. I love the phrase from Doctor Augusto Pérez Gómez, when he says “a therapist commits to accompanying their client on a path that is never strewn with rose petals. Nor with petals of any other kind.” The definition is truly brilliant, as in the cases we indicated above, as a therapist you become the reference who must help the patient see the traumas of their life from a new perspective. And it’s true, you are there to accompany them. But it’s also true that this will make them relive that trauma, and although the idea is for it to stop hurting, first you have to face it, that open wound. And the first encounter will be painful. As therapists, we have to prepare ourselves to listen to the patient as they explain a traumatic event in their life, with the pain of that moment and the updated emotional “interests” of all those years. And, many times, with a deep feeling of shame, guilt, dirtiness. If the bond of trust has not yet been established, our patient has to tell a complete stranger something that hurts and shames them, with the fear of being judged. If the bond has already been established, they have to tell it with the fear of losing the support they receive, with fear of an even deeper judgment. When guilt is an important part of trauma, the patient fears rejection and contempt. And yes, guilt is always an important part of trauma.
There are no mild or severe traumas
And does this happen even in traumas that are not severe, when what happened is actually something of little importance, something normal in everyday life? Don’t answer, it’s a trick question! By definition, even by etymology, a trauma is such because the effect is traumatic. It cannot be regulated as more or less severe. The person suffered it and it caused an emotional wound that is still bleeding, and our job is not to downplay it. Our job is to help them heal that wound. A girl asked for water and they wouldn’t give it to her. And another girl had to let the other girls steal her toys so they would play with her, and the rest of the time she had to play completely alone. And seriously, as an adult, does she have severe trauma because of that? Of course! And no, it’s not a symbol that she’s weak nor is she a weirdo because of it. Well, okay… it’s not the only trauma nor is it in itself what made it traumatic…
Talking about traumas in therapy
In one way or another, when the patient faces the situation of talking about their trauma, they will feel exposed and vulnerable. If the trauma is sexual in nature, add a feeling of nakedness in front of the therapist, and all the emotional burden of sexual traumas: shame, guilt, helplessness, dirtiness.
Forcing the patient to talk about a trauma will have such a negative effect that we will surely be reinforcing the resistance factor we are trying to break down. The patient should speak when they feel ready and when they are able to face what they have to tell us about their experiences from a current perspective, remembering but not reliving. In certain borderline cases, forcing the patient to face a trauma when they are not ready can push them from neurosis to psychosis. If our patient doesn’t have the strength to speak, we must inspire them, but never force them. Making them feel that they have control of the session, that they set the pace, will help them to create the therapeutic bond and, from that moment on, to talk about their traumas.
The patient controls the pace in the session
This is known as the symbol of control. It is at this point that the possibility arises of agreeing on a symbol in accordance with the patient, something that grants them the guarantee that they control the pace of the session, that their needs and emotions are what matter. In short, that even if the environment is clinical-therapeutic, their well-being is paramount. With this premise, the “Isabella Butterfly” is born.
Real example of trauma treatment
Isabella is a patient with a resistance index close to 100%. Brought to the session by force by her mother, had it not been evident that that resistance hid deep traumas and was actually a cry for help, at first it was easy to think of oppositional defiant disorder. It was very difficult for her to open up emotionally, to the point that when she was finally able to establish a bond with her psychologist, the instinct to escape therapy intensified instead of disappearing. Being able to talk about her traumas required her to feel that she could control the session, interrupt it at any time, and that she was never forced to speak. And, of course, that they didn’t judge or blame her for her experiences and emotions. Let’s not forget that to judge and condemn them, they don’t need us; their own minds and the society we live in already do it continuously.
But at the same time, what added complication to her case was the learned difficulty in saying what she felt, in being able to speak openly about her emotions, in being able to say “I don’t want to talk about that topic, at least not now.” Saying that phrase at a moment when she felt overwhelmed by the conversation cost her such emotional overexertion that it left her physically exhausted for days. Her case is what leads to seeking a way for the patient to say that on that day they don’t feel strong enough to talk about their trauma without it causing such difficulty, which will take its toll later. A piece of clothing? A keyword? Finally, the idea of a butterfly-shaped brooch is born, allowing the patient to decide whether or not they want to talk about deep traumas that day.
Signals in session to delve into or not into trauma
If the patient wears the brooch that day, the therapist will know that they can delve into those painful memories, that they have emotional authorization to accompany the patient to talk about the bleeding wounds that torment them and that they feel strong enough to face it. In an elegant and discreet way, the patient is offered an additional form of communication, a way to indicate, without words, their state of strength at that moment. The most immediate additional effect is that a weapon is offered to combat the fear of the session, since simply by wearing the brooch, the patient is allowed to request a more manageable therapeutic contact from the beginning, with the assurance that it will be respected. Absenteeism and premature abandonment of therapy are drastically reduced with a simple brooch. And the patient knows that they are not going to a place where they are forced to do something they don’t have the strength for, but to one where they will receive respect that, at times, even their own mind doesn’t offer them.
Tools to combat the fear of the psychologist’s session
Furthermore, the skilled therapist will know, by seeing the brooch or not seeing it and the patient’s attitude about it, if during the time elapsed since the last session that trauma has been present in their daily life and if the wound has “bled” a lot or a little. Secondary uses can also occur, such as in patients who self-harm. A butterfly if they have spent all those days without self-harming? Butterflies of different colors depending on how they have faced the problem, yielding, resisting, or not thinking about it? A butterfly if they feel they have advanced and a little worm if they feel they have regressed? The possibilities are wide, and each therapist who adopts this method can adapt it to their specialty and their patient: depression, eating disorders, self-harm, addictions… The idea is not copyrighted; each professional can adapt and develop it as they wish.
Why a butterfly for the psychologist’s session?
Evidently, it can be replaced by anything else the patient prefers. A small car, a flower, even a button. The butterfly emerges when, inspired by the patient Isabella, the Sevillian artist Mamen Sánchez (Instagram: byebye_fiona) draws the work called “Blue Butterflies,” symbolizing those traumas that devour from within like worms, and which, through appropriate therapy, should transform into butterflies that can simply fly away from those who are suffering them. Faced with the beauty of the butterfly, we forget that it is a metamorphosed worm. A butterfly can be allowed to fly, and generally it will not be something that causes us fear or rejection. Furthermore, the patient can wear it at any time from leaving home until just before entering the session. No one will be surprised to see someone with a butterfly brooch.
And this detail of being able to walk down the street with the brooch on the lapel will in itself be a positive reinforcement, one that the patient themselves will often refer to upon arriving at the session. Sometimes they will do so with tears in their eyes, feeling a liberation they hadn’t felt for years, perhaps never. The brooch ends up being related to the trauma itself, being a way to control or hide it, to decide whether to talk about it or to act as if no one knew about the trauma that day. For many years, trauma has been something that made the patient think that everyone looked at them on the street with contempt and rejection, that they were a nuisance to others, that they should stay away from a society that judged and despised them. Now the patient walks down the street with “their trauma on their lapel,” so to speak, and no one is surprised, no one looks at them with contempt or judges them, most people don’t even notice or at most give them a fleeting indifferent glance. Suddenly, that trauma becomes something only theirs and, therefore, they control it. Little by little, and if the therapist knows how to skillfully guide them, the trauma and associated emotions go from being a suffocating secret that conditions them and distances them from others to something to carry naturally, something that is only theirs, that others will not look at with contempt or know just by looking at them. Something that others, in fact, simply neither know nor care about. They no longer feel that in every glance and every comment there is contempt or judgment because, after all, they wear their trauma on their lapel, and no one judges them for it. Although symbolically and within limits, trauma becomes something that can be seen as physical, facilitating its focus and confrontation.
And in the end, little by little, as in Mamen Sánchez’s painting, we will help those traumas stop consuming the patient and let them fly away…