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The Sanctity of the Therapeutic Relationship

February 15, 2017

 

“Trauma therapists are exposed daily, to tales of betrayal, violence, extreme cruelty and manipulation of young children. Their craft requires them to immerse themselves empathically with the experiences that they witness. While non-therapists can listen and tune out, or find some way to emotionally remove themselves from testimony of abuse, this is obviously counterproductive for therapists working with patients who have been victimized brutally and subsequently had their suffering ignored or minimized by those closest to them.” (Benatar,)

 

Carl Rogers suggested that three critical ingredients are necessary for a positive therapeutic relationship: unconditional positive regard, genuineness, and empathy. Another way of perceiving this special relationship is through the context of trust. There are certainly other aspects of this unique inter-reaction including: balance of power issues, confidentiality factors, safety issues, etc.

 

Herein lies the conundrum: to be empathic, genuine and unconditionally positive places the therapist at risk for developing a condition we have come to call ‘Secondary PTSD.” From my perspective, there is nothing secondary about it!  As the viral infection of PTSD alters the being of the therapist, he or she (hereafter he) is transformed into a self-protective and self-defensive individual.  In the health profession, it is referred to as ‘Compassion Fatigue.’ For some, it is called: Burnout. For me, these are all variants of PTSD.

 

Let’s now take the trauma therapist and place him with a combat Veteran with multiple tours in dangerous places. Our Veteran has been previously provided with varied cocktails of medication. He has spent endless hours in group and individual therapy to no avail.  He would qualify for a myriad of diagnoses. None of the classical symptoms of his condition (Insomnia, Nightmares, Flashbacks) have been altered. He trusts no one including himself.

 

So, here’s the million-dollar question, how on earth is the trauma therapist to establish a therapeutic relationship with this individual? How many decades might it take if one were to try to approach this type of patient in a traditional manner?

 

My perspective is that one of the ways that ‘compassion fatigue’ takes place is through the therapist’s exposure to ‘raw’ limbic system expression. Because of trauma, the patient often becomes frozen in time, place and circumstance. I sincerely believe that ‘talk therapy’ cannot touch the raw material locked in perpetuity in the limbic part of the brain. It is only through altering the fixed and rigidified neuronal emotional circuitry that the humanity in the patient can truly be returned.

 

Unlike other types of exposure therapies, the therapist intentionally spares the patient from added pain, shame and humiliation, by asking that he refrain from disclosing verbally any details of the trauma. Rather, he focuses completely on the sensory aspects of the experience as if the event were occurring in the ‘here and now’ ("lighting up the target").

 

In trauma related conditions, I have found it necessary to redefine the 'empathy' aspect of being a therapist. The therapist knows implicitly that the patient alone has suffered enduring pain well beyond what mere words are able to convey. The therapist trained in RESET Therapy finds it strategic to maintain a self-protective distance from the emotionally raw material of the traumatic memory. This is done in order to preserve availability, objectivity, and effectiveness with other patients. RESET Therapy empowers the patient to choose those memories and details that he alone elects to re-experience nonverbally without the requirement of disclosure. From this perspective, RESET Therapy actually reduces the risk of unintentional harm to the patient.

 

The RESET therapist is not mechanical nor disinterested. To use the metaphor of the traumatic memory as a long burning fire, it is not necessary for the therapist to know the details of how the fire got started. Nor does one need to know how it has been fueled. Furthermore, it is unnecessary for the therapist to be so close to the fire as to get badly burned or overcome by smoke inhalation. With the resetting of the fear switch, ‘protect and defend’ transforms back to ‘curiosity and growth.’ Sleep normalizes, nightmares cease, flashbacks are gone. Trust begins and the therapeutic journey ensues. The process involved in ‘resetting the fear switch’ will be the next topic to be discussed in my following monthly blog.

 

Reference Benatar, M. 2012 How conducting trauma therapy changes the therapist. https://blogs. scientificamerican.com/guest-blog/how-conducting-trauma-therapy-changes-the-therapist/

 

 

 

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