Trauma and therapy and triggers
February 15, 2018 4:00 AM   Subscribe

I went to see a therapist for the first time yesterday for help with coping skills and the conversation ended up focusing on childhood trauma and it was immensely triggering. I'd like help with figuring out some immediate coping skills/if I should see this therapist again?

So I went to see someone yesterday for help with mood swings/anxiety and depression that I've been experiencing. I told her that I was interested in therapy for help with learning better coping skills and she wanted to talk about my childhood/background and when I told her about some childhood abuse, she wanted to go into that more. And it was just... very triggering. I literally slept two hours last night and have been dealing with this all over body panic/fear... which I haven't experienced in almost two years.

I don't have the sense of mind right now to figure out if this means that this therapist is a bad fit for me or if this is a sign that I *really* need to sort this stuff out.

Also, I would really appreciate any resources that anyone might be able to share in terms of better coping with these intense emotions. I'd like to feel like I have a toolkit at hand that I can use when I experience overwhelming panic like this.
posted by twill to Human Relations (14 answers total) 4 users marked this as a favorite
You should tell the therapist before you go to your next session what happened. I would expect her to scale back or eliminate that topic for now given it's effect on you. Also, ask her what coping skills you can start to practice in the event you start feeling triggered. If she can't comply with these requests, definitely look for another and let them know what happened before you start therapy with them and see what they say about how their therapy will be different and effective for you.
posted by waving at 4:59 AM on February 15, 2018 [3 favorites]

Seconding tell your therapist what happened – you could call her now to do that. If she's busy and has good time management skills, she'll let you know when a good time is.

Also, if she's a good therapist, she could probably answer your question about how to handle the panic. For me, sitting with my eyes closed and focusing on breathing helps. Let thoughts come and go; don't hold on to them. But I also remember a time when I wasn't able to do that; it was just too overwhelming.
posted by fraula at 5:16 AM on February 15, 2018

For me, doing cognitive behavioural therapy was a great thing to do before talking therapy which will be more likely to trigger you. CBT (especially in a group) will explicitly give you those coping skills without the background, then you can go more prepared. YMMV I found the coping strategies fairly useful, although not addressing the underlying issues - I could tell it wasn't going to BE the fix, but it could HELP with the fix. Good luck!
posted by london explorer girl at 5:27 AM on February 15, 2018 [1 favorite]

I can't speak for you, but shit that triggers me is exactly what I need to work on. That which I resist, persists.

You might consider "the body keeps the score" as a resource. It's quite good at helping to understand patterns/reactions to trauma.
posted by Gorgik at 6:47 AM on February 15, 2018 [6 favorites]

Are you in a place where you have time and energy to work on the past? Gorgik is correct--these types of trauma persist and need worked on. But. If you went to therapist for coping skills because of immediate pressing issues, maybe you need triage strategies to deal with current problems. It's not wrong to shelve the past to deal with the present, as long as you eventually are able to find time and space to do that, also.

You need to talk with your therapist about priorities and making a safe place for you to work on issues. If she continues to push you too far, too fast, then she's not a good fit for you. A good therapist will let you unpack at your own speed.
posted by BlueHorse at 7:23 AM on February 15, 2018 [9 favorites]

Some immediate strategies:

Do the "5 senses" check in - stop in one place, try to name 5 things you hear, 5 things you see, 5 things you feel, 5 things you smell, if you taste anything.

Vigorous exercise, from 3 minutes of jumping jacks to a good strong run or workout.

Deep breathing, meditation, a yoga class.

A writing or other art exercise - get it out of your head and on paper.

Throw or smash things (safely) like old plates out in the backyard.

Call a trusted friend or family member and have a chat.

Something you love to do in the present like work at a hobby, knead bread, etc.
posted by warriorqueen at 7:40 AM on February 15, 2018 [3 favorites]

And if you do continue with this kind of therapy, your therapist should help, but a "killer hack" is to schedule an exercise class right after therapy. It makes a great transition.
posted by warriorqueen at 7:41 AM on February 15, 2018 [4 favorites]

My advice is based on struggling with PTSD (childhood trauma + adult trauma combo) for over 20 years.

I've been through therapists like yours and it resulted in me being in a dissociative state for pretty much all of those 20 years. I didn't even know better until my last therapist of 5 years who was finally able to help me in the following ways:
- he never needed to hear my life story or dig into all the painful moments the way others did
- if a general trauma was relevant to our session, it was ok to just give the highlights so I didn't have to be brought back to those times
- at the end of every session we did a grounding exercise so I wouldn't leave triggered/dissociated
- I learned and practiced distress tolerance that I could use when I was dissociated
- my therapist engaged me in a combination of DBT and ACT - this worked much better for me than CBT
(DBT = Dialectical Behavioural Therapy; ACT = Acceptance and Commitment Therapy)

There's no need for you to be a story-teller in your sessions and it's ok if your current therapist isn't a good fit. Find someone else who will be more interested in helping you thrive right now vs someone who is fascinated by your past experiences and pain.

Feel free to memeail me if you happen to live in Toronto - I'm happy to recommend my therapist because for the first time in my life I'm thriving.
posted by A hidden well at 8:55 AM on February 15, 2018 [13 favorites]

I don't have good advice on the therapist front. I just wanted to add when you're triggered a lot of these suggestions can feel like too much. They can be overwhelming. My husband has severe anxiety and he says it's easy to talk about self care when you're in a good place, but in the moment when you're triggered it feels like you're drowning and people are telling you to remember to breathe. It comes from a good place but it's not practical or helpful. So I recommend when you're in a decent place, make a list on your phone or on a note card of easy things you can do when you're panicked to make you feel better. You want something you can just grab. Make it as easy as possible. He recommends what his therapist calls "shelter in the storm". So your mind is racing and you can't breathe. You're afraid the attack is never going to end. Take some big belly breaths and just focus on reminding yourself that it's bad now, but it will be okay later. Accept that you're freaking out. All you have to do is ride it out because eventually IT WILL END. If there's something easy and mindless you can do to distract yourself, do that. Maybe a phone game or practice your handwriting or something. The goal is to convince your brain and body that you're not under attack. I like to stretch or take a shower. Maybe take a walk. For me, changing my physical condition helps draw me out. My husband likes to just like flat and focus on his breath. I'm so sorry you're going through this, good luck.
posted by Bistyfrass at 9:37 AM on February 15, 2018 [3 favorites]

My (trauma) therapist will do a container exercise with me before I leave if something particularly triggering has come up. Basically, it involves imagining a strong container with a lid in which to put the distressing "stuff" until you can deal with it safely. Explanation better than mine here. (It's the second suggestion in the list, though I've found the body scan and movement suggestions useful, as well.) The lid is important, because you're not "stuffing" the emotions but putting them away until another time.

In your first session with a therapist there obviously hasn't been time to build a safe space or relationship with them, so _of course_ you would be triggered by discussing your childhood abuse. Definitely tell the therapist that you were triggered by what you talked about -- I think their response will help you decide if this person and/or their style is just not a good fit for you. Therapists should be responsive when you tell them something doesn't work; at the same time, I expect my therapist to have some sense of what isn't going to work/will be triggering without my having to have the wherewithal to explain it in the middle of being triggered.

And this is anecdata, but I did DBT for nearly a year and found it _enormously_ retraumatizing for my C-PTSD. CBT/DBT are very trendy right now but they are not for everyone, so do your research on the modality and the way the therapist you're considering implements them first.
posted by camyram at 9:58 AM on February 15, 2018

I keep tetris, two dot and some Zen matching games on my phone for this. Civilization iPad for extreme bad times. Any kind of clicking immersive video game plus headphones with a heavy beat no lyrics music played loudly to sink back into. I like EDM in foreign languages or brown static noise tracks. Exercise helps but my brain keeps whirring so drowning in relentless noise and games while walking helps. And i try to sleep as soon as possible to reset the day.
posted by dorothyisunderwood at 9:05 PM on February 15, 2018 [1 favorite]

My therapist has told me that directing exessive focus on one's trauma history before one is ready, feels trust for the therapist, and has developed some coping mechanisms can be re-traumatizing.

I would definitely tell my therapist that I emphatically did not want to delve into details about my trauma history yet and wanted to focus on X. If they do not respect that choice I would seek a different therapist. If they thought it was very important I would possibly be open to creating a plan to slowly and cautiously approach my trauma history, however, I don't personally find this avenue useful.

As for learning to cope with the intense emotions... Developing that toolkit has been the main work I have been doing in therapy. So that's something you might want to bring up with your therapist.
posted by windykites at 10:15 PM on February 15, 2018

Oh but also trigger your relaxation response with stuff like a warm bath, soothing music, warm tea, a weighted blanket, turkey and carbs (or liquid food if you feel too scared to eat), blanket forts.
posted by windykites at 10:18 PM on February 15, 2018

Thank you everyone for your replies.

I had a tough couple of days immediately following the appointment. I ended up e-mailing the therapist I had seen, and she actually called me and walked me through a couple of basic breathing exercises to manage the panic that I was feeling.

I am still on the fence about whether I will see this therapist again.

But in the mean time, what has helped has been being as gentle with myself as I can be. At the worst of it, it meant that I called a close friend, cried a lot, slowed down my breathing by counting slow inhales and slow exhales, wrote down positive/caring/loving affirmation to myself and I also took a couple of over the counter sleeping pills to help me sleep. In the couple of days since this has meant going to bed early, going to a gentle yoga class, reaching out to a close friend to let her know what I've been going through, taking out children's fiction from the library, and allowing myself to be exactly as lazy as I want/need to be right now.
posted by twill at 9:10 AM on February 17, 2018 [2 favorites]

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