One of the most important sessions you can have with a child, teen, or really any human entering the therapy process is the intake session. It is during this session you get to know each other, know a bit more about the process, but most importantly begin to get curious about early life, situations, circumstances, and trauma that could have an impact on the presenting problem.
For kids and teens the presenting problem is typically big behaviors, tantrums, panic, difficulty detaching from a parent's leg to go to soccer practice, decreasing academic performance, difficulty sleeping, never coming out of their room… you know - the usual.
Now, I’ve said it before and I’ll say it a million times again -almost every difficulty that comes into a therapy office is a difficulty with regulation, or more specifically - dysregulation. I honestly can’t think of a client that has presented in my office since my first session as a newbie therapist that didn’t involve regulation in some way.
Now here’s where it gets complicated.
Two kids that throw epic tantrums may have a significantly different path in therapy. And we know this inherently as therapists (I hope) but I wanted to talk more about some specific reasons why this may be true.
Okay, more like one reason. Trauma.
Trauma changes everything.
One of my most favorite ways to explain trauma is with Adaptive Information Processing developed by Francine Shapiro, Ph.D.. You could spend days deep diving into Adaptive Information Processing (AIP) Theory BUT the very short overview of the model is that our mind is made up of associated memory networks that serve as the basis of perceptions, attitudes, and behaviors. All new experiences are assimilated into already existing memory networks, which helps us make sense of our experiences and update our knowledge.
When someone has a traumatic experience, the traumatic memory is stuck in time in its own isolated neural network in raw unprocessed form with all of the details from the trauma including all the sounds, sights, smells, tastes, textures, etc. Because of this the memory is frozen and is unable to connect with other memory networks that hold adaptive information.
And these memories don’t just hang out without ever being seen again. This is not a case of “time heals” or “out of sight out of mind”.
They get triggered All. The. Time. And this isolated memory network continues to be triggered by anything that remotely resembles the trauma.
So what does this mean?
Well, the human brain can process 11 million bits of information every second, and some would argue significantly more. But our conscious minds can handle only 40 to 50 bits of information a second.
Okay - so for a traumatic experience that lasted only 5 minutes that would be 55 million bits of data that could potentially be a trauma trigger at some point of anything about the environment (you know - any of sights, sounds, tastes, smells, or tactile stimulation) was similar in the future.
And if I’m completely honest most of the clients that come into my office have chronic trauma, preverbal trauma prior to age 3, and multiple trauma experiences.
In short trauma memories continue to be triggered by a variety of internal and external stimuli, resulting in emotional, cognitive, and behavioral reactions that made sense in the context of the trauma but do not make sense in the here and now.
And these dysfunctionally stored memories lay the foundation for future responses of dysregulation and trauma symptoms like anxiety, anger, risky behavior, etc.
So here is what all therapists that work with trauma need to know.
We might not ever know what the trauma trigger is.
And often as therapists we want to know exactly what the trigger is or why the behavior occurred AND being a detective and looking for the exact trauma trigger in the exact moment isn't necessary for healing.
It can be helpful to identify specific triggers to make sure clients can cope ahead and be aware of what is most triggering for them. It can also be helpful as a topic for therapy to dive deeper and create healing around the trigger.
One of the things I LOVE about EMDR and other trauma modalities is that true healing comes not from avoiding all trauma triggers, but being able to update our neural network of memories to help our brains and bodies understand that the trauma is over.
It’s not happening anymore, and that it is okay to feel safe and regulated when we are safe.
Check back for Part Two where we will dive deeper into how trauma affects emotional regulation and the Polyvagal Theory.
Want more information on how emotional regulation is impacted by trauma? Check out my course Keep Calm and Regulate On: Play Therapy and the Neuroscience of Emotional Regulation!
I'm Ann Meehan, an LPCC,