Psychotherapy was invented as a treatment for trauma. That is where Freud, the inventor of psychoanalysis (the progenitor of psychotherapy) began. He formulated that the patients he was seeing with illnesses not related to an organic cause were the victims of some sort of trauma. He believed their symptoms were responses to these traumas. And in fact, in the Victorian. days of the late 19th century Vienna, there was a great deal of sexual abuse in the form of incest. Many of his patients had experienced such abuse.
Freud went on to broaden his views of the origins of psychological conditions to include non-traumatic experiences, and psychotherapy has broadened its scope as well. However, it still remains a treatment for trauma, both in the sense of large (capital T) and small (lower-case t) traumas. By that I mean that some patients have experienced, particularly in their early years, horrific traumas caused by sexual and physical abuse, as well as neglect. Others come to psychotherapy treatment with traumas less acute but still powerfully influencing their lives.
Traumas in both senses of the term share one particular characteristic: the experience has not been processed and worked through. Why one experience, even a horrific one, becomes more of a bad, very unfortunate experience rather than traumatic has to do in large part to the ability to process it. If an experience remains traumatic, it has not been processed. It has not been experienced emotionally to the fullest extent. To do that, to heal, always requires another person. Healing is always accomplished in an interpersonal context. Often in cases of trauma, perhaps the emotions were too extreme, so overwhelming, to be fully felt and processed. Or perhaps there was not a sufficient environment, the presence of another, in which to experience and work through the terrible circumstances.
When I’m working with people who have experienced either form of trauma, the focus of psychotherapy remains the same. Through the process of talking with me about these past experiences, the client is going back to the early injuries. The client talks about the experience (often more than once, sometimes over some time), and in so doing re-experiences (relives) the event and the associated feelings. It is particularly important in the healing process that the person experience all the associated feelings. Now accompanied by the therapist, in the presence of someone who is truly interested and provides a safe environment, the person can set out a new course. This work is, of course, often painful. But accompanied by the therapist, there is the chance for real healing to take place.
All too often a person has developed the best possible coping skills he or she could at the time to manage the traumatic event. Perhaps the person has learned to shut off emotions because they became too overpowering and overwhelming. Perhaps the person has developed certain attitudes and beliefs (such as that other people can’t be trusted) so as to protect himself. One particular coping strategy that often results from traumatic experience is the development of a hyper self-critical part of the person. If what has occurred is one’s own fault, then the internal fantasy is that one can control it, that one is not helpless. However, the development of this type of coping strategy means a life of eviscerating self-criticism. In the therapeutic work, in moving through the traumatic experiences from the past, options that were never available to the person originally emerge. One can set out on a new course: To feel those feelings in a safe and contained environment and not rely on coping strategies which also hamper and constrict one’s life.
This is essentially the work of psychotherapy. As I said above, this is true when dealing with the most horrific of experiences as well as those on a smaller scale which have still had a long-term effect. It is not easy work. It is not particularly fun. Nor is it an overnight process. And while the events of the past can never be changed, their impact on one’s life, particularly in the present, can. The aim of psychotherapy is to transform the trauma back to a very unfortunate experience. One that no longer exerts such influence and control on a life.