Emotional Regulation in Working with Trauma by Gregory Hasek MA/MFT LPC
Last month I wrote about the importance of assessing for PTSD with clients who present with trauma in their past, including abortion related trauma. This month I want to talk about the importance of screening for a client's ability to regulate their emotions. In my opinion this is a critical thing to know in the beginning of counseling. You may be wondering what that screening process might look like. During the intake process, you will be asking questions such as, addiction history, impulse control problems, relationship history and conflict etc. The answers to these questions might give you an idea or a clue about that client's ability to regulate their emotions. It will also give you a clue about their developmental history regarding attachment security etc. For example if a client has an addiction history they are likely to have problems with regulating their emotional states and this often points to attachment difficulties as a child. I want to expand further on the importance of knowing your client's ability to regulate emotions when working with those that present with a trauma in their recent or past history.
Once you make a hypothesis about the ability of your client to regulate emotions, you can begin to use this information in the next steps of treatment planning. If a client has a history of not being able to regulate emotions in a healthy way, then this may very well be a first goal in providing treatment. It would make no sense to begin to work on trauma issues if the client has trouble with self regulation. This may just cause more problems and possibly cause regression in behaviors such as self medicating through addictions etc. In addition, if you are working with a couple and have identified that the couple is in a cycle of trauma, in order to help that couple interrupt that cycle, each individual will need to know some healthy forms of self soothing in order to regulate.
An obvious first step might include teaching some deep breathing exercises in the beginning of session so that your client or client's body is able to be in a relaxed state prior to discussing some potentially difficult topics. When I work with couples with trauma, I always teach them deep breathing and how to prepare for the session because many times clients will come to the session already ramped up from conflict many times on the way to the session in the car. As therapists we need to be able to anticipate this especially when couples present with trauma in their history whether separately or together.
A next step may include teaching our clients the technique of mindfulness. Mindfulness can be defined as the capacity to maintain awareness of and openness to current experience, including internal mental states and impinging aspects of the external world, without judgment and with acceptance (D. J. Siegel, 2007). I often will teach couples to externalize their reactions by verbalizing what they are noticing about what their mind is telling them versus just believing it right off. This also helps decrease the conditioning of the trigger rooted in trauma rather than reinforcing the trigger by an immediate escalation. We also know through research that mindfulness is effective for trauma recovery. A recent study from the University of Michigan Health System discovered that mindfulness based treatment was more effective that standard treatment for PTSD such as exposure therapy and EMDR (King, Thane M. Erickson, Nicholas D. Giardino, Todd Favorite, Sheila A.M. Rauch, Elizabeth Robinson, Madhur Kulkarni, Israel Liberzon).
One of the most basic tools to use with clients is to teach them how to identify and label emotions. One thing to remember when working with clients that have a history of problems with regulation, is that most likely they never really learned the ability to identify their emotions as a child due to attachment difficulties and family systems that did not encourage or model this. Teaching basic skills may look like handing out a feelings chart and having the client begin to identify what they are either feeling in session or out of session through journaling for example.
In summary, when working with clients who present with trauma in their history, including abortion related trauma, it is important to first screen for signs of problems with emotional regulation. The next step should include building into your treatment plan the teaching of emotional regulation techniques at the beginning of the counseling process. If this is done in an effective way, this may prevent any regression the client or couple may experiencing in their level of functioning.
References
King, Thane M. Erickson, Nicholas D. Giardino, Todd Favorite, Sheila A.M. Rauch, Elizabeth Robinson, Madhur Kulkarni, Israel Liberzon. A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 2013
Siegal, D. (2007). The mindful brain: Reflection and attunement in the cultivation of wellbeing. W. W. Norton & Company
Last month I wrote about the importance of assessing for PTSD with clients who present with trauma in their past, including abortion related trauma. This month I want to talk about the importance of screening for a client's ability to regulate their emotions. In my opinion this is a critical thing to know in the beginning of counseling. You may be wondering what that screening process might look like. During the intake process, you will be asking questions such as, addiction history, impulse control problems, relationship history and conflict etc. The answers to these questions might give you an idea or a clue about that client's ability to regulate their emotions. It will also give you a clue about their developmental history regarding attachment security etc. For example if a client has an addiction history they are likely to have problems with regulating their emotional states and this often points to attachment difficulties as a child. I want to expand further on the importance of knowing your client's ability to regulate emotions when working with those that present with a trauma in their recent or past history.
Once you make a hypothesis about the ability of your client to regulate emotions, you can begin to use this information in the next steps of treatment planning. If a client has a history of not being able to regulate emotions in a healthy way, then this may very well be a first goal in providing treatment. It would make no sense to begin to work on trauma issues if the client has trouble with self regulation. This may just cause more problems and possibly cause regression in behaviors such as self medicating through addictions etc. In addition, if you are working with a couple and have identified that the couple is in a cycle of trauma, in order to help that couple interrupt that cycle, each individual will need to know some healthy forms of self soothing in order to regulate.
An obvious first step might include teaching some deep breathing exercises in the beginning of session so that your client or client's body is able to be in a relaxed state prior to discussing some potentially difficult topics. When I work with couples with trauma, I always teach them deep breathing and how to prepare for the session because many times clients will come to the session already ramped up from conflict many times on the way to the session in the car. As therapists we need to be able to anticipate this especially when couples present with trauma in their history whether separately or together.
A next step may include teaching our clients the technique of mindfulness. Mindfulness can be defined as the capacity to maintain awareness of and openness to current experience, including internal mental states and impinging aspects of the external world, without judgment and with acceptance (D. J. Siegel, 2007). I often will teach couples to externalize their reactions by verbalizing what they are noticing about what their mind is telling them versus just believing it right off. This also helps decrease the conditioning of the trigger rooted in trauma rather than reinforcing the trigger by an immediate escalation. We also know through research that mindfulness is effective for trauma recovery. A recent study from the University of Michigan Health System discovered that mindfulness based treatment was more effective that standard treatment for PTSD such as exposure therapy and EMDR (King, Thane M. Erickson, Nicholas D. Giardino, Todd Favorite, Sheila A.M. Rauch, Elizabeth Robinson, Madhur Kulkarni, Israel Liberzon).
One of the most basic tools to use with clients is to teach them how to identify and label emotions. One thing to remember when working with clients that have a history of problems with regulation, is that most likely they never really learned the ability to identify their emotions as a child due to attachment difficulties and family systems that did not encourage or model this. Teaching basic skills may look like handing out a feelings chart and having the client begin to identify what they are either feeling in session or out of session through journaling for example.
In summary, when working with clients who present with trauma in their history, including abortion related trauma, it is important to first screen for signs of problems with emotional regulation. The next step should include building into your treatment plan the teaching of emotional regulation techniques at the beginning of the counseling process. If this is done in an effective way, this may prevent any regression the client or couple may experiencing in their level of functioning.
References
King, Thane M. Erickson, Nicholas D. Giardino, Todd Favorite, Sheila A.M. Rauch, Elizabeth Robinson, Madhur Kulkarni, Israel Liberzon. A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 2013
Siegal, D. (2007). The mindful brain: Reflection and attunement in the cultivation of wellbeing. W. W. Norton & Company
