How to care for trauma survivors Q&A

Unfortunately, in our very broken world, we all too frequently hear about tragedies at home and abroad. These events can have significant impact on the mental and emotional health and well-being of those involved and, in fact, have an impact on you and me. To help us all better understand trauma, I reached out to one of our network counselors, Brady Robinson, LPC-S, who specializes in coping with trauma for a brief Q & A session.

1.  How do I know if I have experienced trauma?

Trauma in a traditional sense of the word implies that one has experienced a real or perceived threat to their life or physical integrity. This can also include witnessing or even sympathizing deeply with trauma that happened to someone else near you, a close loved one, family member, or a friend. In the wake of our nation’s most recent violent and traumatic events, it would not be uncommon for many that were not directly exposed to traumatic scenes to also experience elements of traumatization or acute stress. Individuals that have been through terrible tragedies and experiences will often turn to ministers, church staff, or fellow congregates for comfort.  

It’s important that caregivers are aware that they can experience the negative effects of trauma simply by their exposure to the pain, emotions, and vivid recollections of the people they serve and care for. As a mental health counselor, I can attest to the difficulty of being exposed to my client's traumatic and vivid recollections of their trauma. In a way, caregivers can be vicariously exposed to trauma and still experience distress of the trauma themselves as a result of their deep care and empathy towards the people they serve. We pray with our people, cry with our people, and grieve with our friends and loved ones. Anyone exposed to traumatic experiences, directly or indirectly, is susceptible to the negative effects of trauma.

2.  Are there different types of trauma?

Trauma comes in many shapes and sizes. When we think of trauma we often think of wars, natural disasters, accidents, and acts of violence (to name a few). These types of traumas might be considered "Big T" traumas. Individuals that experience Big T traumas would generally meet the appropriate diagnosing criteria for Post Traumatic Stress Disorder (PTSD), and Acute Stress Disorder found within the The Diagnostic and Statistical Manual of Mental Disorders (aka the DSM). 

However, more common and least talked about might be the other massive category of trauma often referred to as "little t"  traumas. Little "t" traumas are experiences that can hurt and/or damage greatly but did not threaten the life, limb, or physical integrity of self or others close to us.

Have you ever worked with an individual that was deeply hurt and pained by careless words that were said to them or about them? Think of the trauma that a child may face when a parent says such things as "I wish I never had you," or "You're such as disappointment." These are technically "little t" traumas but anyone in our profession will tell you that emotional abuse and damaging words can be just as traumatic as "Big T" traumas. Very often my clients will tell me they would have preferred to have experienced a Big T any day compared to the pain of repeated "little t's" throughout their life. 

Pastors, counselors, and caregivers of trauma survivors may also need to understand the difference between "single-incident"  and "multi-incident" traumas. Single-incident refers to a trauma that was experienced at one particular point in time and was not repeated. These could be both "T" and "t" traumas, but occurred just once. Though not always the case, single-incident traumas may be easier to overcome and treat because there is less material to have to process and deal with. Multi-incident traumas are traumas that repeat or their traumatic themes re-occur. Themes of the trauma become a repeating story for the survivor and deeper underlying beliefs about oneself may begin to form and become pervasive in the survivor's thoughts and day-to-day functioning.  

For example, there's a different path to recovery for a survivor of one near-fatal auto accident versus someone that has been through five separate near fatal accidents. The single incident survivor may feel like they are "to blame" or they "should have done something different." The multi-incident survivor may begin to adapt a belief about themselves that "I'm a failure. I'm a bad person. I deserve bad things." This is why it is very important for caregivers to take the time to listen to the full story (sometimes very long back-stories). The process of working with multi-incident survivors may take weeks, months, or even years, depending on the frequency of the individual's trauma history. 

3.  What type of treatment is available and most effective for dealing with trauma? How can I be supportive of someone that is dealing with trauma?

In the hours immediately following a trauma, caregivers of survivors may simply just need to assist with basic, first-order needs and concerns such as; water, food, shelter, first-aid, family arrangements, and assisting with making contact with the survivor's friends and family. This stage has been called  "Psychological First Aid." Often during this initial stage of care-giving, we would attend to these first-order needs before exploring the emotional aspects of the trauma. It may be appropriate at this stage for a survivor to visit with a physician about short-term medication treatments to assist with anxiety reduction. 

Water is surprisingly, one of the best medicines in the immediate moments and hours after a trauma. Hydration with water following a recent incident trauma can help to reduce the body's accumulation of the stress hormone, cortisol. Reduction of cortisol results in a reduction in anxiety, which in turn may lead to better sleep and recovery. 

In the days and weeks following a trauma, it may be necessary and important for a survivor to engage in conversation about the trauma. Some of the most helpful caregivers do nothing more than listen. There's a tendency for pastors, counselors, and other professional caregivers to feel the need to have answers. I encourage caregivers to resist that urge to impart meaning, interpretation, or reasoning for the "why." Just being present is sometimes all someone needs.  Well intending statements such as, "God is going to use this for good" or "You have to forgive right now or you'll never get over this,” can be emotionally challenging or even damaging to the survivor. 

There may be times when it becomes clear that more intense clinical treatment is required in order to overcome the effects of trauma. There are many treatment approaches that are effective and produce tangible results. To discuss all of the trauma treatment options is simply outside of the scope of this article. 

Some individuals might benefit greatly from pharmaceutical interventions such as anti-anxiety meds, sleep meds, anti-depression medications, and even some heart medications (beta blockers). Talk therapy options are also plentiful. Trauma survivors report that support groups help because they can talk specifically about their struggles and memories to a group of peers that "get it" and understand what they're going through.

In addition to group therapy, there are many effective evidence-based methods of individual talk therapy. A short list of these therapies include: Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged-exposure therapy, Stress-inoculation training, and my personal favorite, Eye Movement Desensitization and Reprocessing therapy (EMDR). Readers can visit the video section of my website to see a list of informative videos discussing EMDR therapy.

4. Can a person ever recover from trauma?

The short answer is yes. Absolutely, yes you can recover. However, it is important to understand that our brain does not keep track of time. So, to say "time heals all wounds" is simply not true. Someone can suffer and carry the pain of a trauma with them for years, if not life, if the trauma is never dealt with properly. The unfortunate aspect of trauma recovery is that many survivors do not seek help due to stigma, embarrassment, shame, and fear. Others may stop seeking help because the help they initially received was ineffective or possibly even damaging.  

I've worked with Vietnam veterans that have been on and off medications and in and out of ineffective treatments for 40 years, but experienced little-to-no psychological relief. However, after receiving the right kind of therapy and treatment they were finally able to experience lasting and permanent recovery after only a few sessions. If it is determined that professional trauma treatment is needed, I highly advice caregivers and survivors do their research and locate a provider that has been trained, credentialed, and works specifically in the areas of trauma recovery. I'll often tell clergy that "not every counselor is a pastor and not every pastor is a counselor." In short, caregivers may sometimes need to provide a listening ear but sometimes they may need to provide a referral to a trauma specialist.

In light of the tragedy at First Baptist Church of Sutherland Springs, Texas Baptists have added an additional workshop at the 2017 Annual Meeting entitled “Church Security Basics: Preparing for the Unexpected.” The workshop, which is free and open to church leaders, will be held on Tuesday, November 14, at 8:30 a.m. at the Waco Convention Center. For more information, visit texasbaptists.org/annualmeeting.

Brady Robinson holds a master's degree in counseling and is a Licensed Professional Counselor Supervisor (LPC-S). His wife is also a licensed therapist and together they own Hope For Texoma a Christ-Centered counseling center in Sherman, TX.