‘Don’t make me vomit slowly’ – my experience of phase two work
THE THREE PHASE APPROACH
When I first started therapy in 2006, I didn’t know much about trauma and nothing about ‘the three phase approach’. My counsellor didn’t know much more. So although I’d like to say that we started by carefully doing the Phase 1 work of safety and stabilisation, the reality was a great deal messier than that. It took a few years for us to settle into a pattern of work that I can now look back and identify as ‘Phase 2’ and to some extent—although dramatically less so—that work is still ongoing. Nowadays we dip into Phase 2 for a while, for a specific purpose, and then return again to our ongoing Phase 3 work. But for several years I hopped from week to week, like a bear on hot coals, backwards and forwards between Phases 1 and 2. It certainly wasn’t textbook, but somehow it has been effective.
One of the things that surprised me most about processing trauma was not the feelings of dread, terror, hopelessness, horror, grief and despair that swirled around like a Canadian snowstorm. It was the more unexpected feelings—specifically the aloneness. It washed up over me and drenched me through. Back then, when I was a child, I evidently felt so alone in it all. There was no one—literally no one—to reach out to for comfort, for support, for protection, for love. Those memories would wash back over me in intense spasms of aloneness in the here-
The backdrop to much of my therapeutic work in Phase 2 was my therapists helping me to learn to contain my feelings. I grew up believing that feelings were wrong, shameful, and weak. I stuffed them down, or I dissociated from them. But then, in this therapy room, they were allowed to be. They could come, we could notice them, they could rise, we could notice them, they could form into a fist wanting to hit or tears wanting to fall, we could notice them, and let them be. I learned gradually to let feelings come, to notice them, to tolerate them: and all the time in the presence of another person—without shame taking over. That was a long, hard process. It felt so shameful to be feeling feelings, let alone expressing them. I was stuck for a long time in procedurally-
MINOR ISSUE FOCUS VS. MAJOR ISSUE FOCUS
Even after many years’ work, I still felt by default that I couldn’t ‘go there’. I automatically avoided it all. I got busy with work, I let minor issues be the focus of my session, I scurried from the therapeutic relationship, I argued theory or danced around the issue—anything other than ‘going there’. The instinct to avoid was burned deep in me. And then at other times—usually with other parts of me—the trauma was imminent and we were in it, steeped thick up to our necks in it, and we couldn’t hold back, couldn’t avoid, couldn’t think about anything else, couldn’t do anything other than explode it all out of our heads in a frantic, desperate collapse of defences. We wanted to get it all out, and we wanted to get it all out, now. ‘Don’t make me vomit slowly,’ is what I would say when we were in this state of mind. ‘Let’s just do it—I don’t care—I can’t stand this—I need to get it out.’ And so I would proceed to vomit this trauma out of my deep unconscious, and by the end of the session not only was I retraumatised by the reliving, but my therapist very probably was too. It took me a long time to accept that slow is fast, and that being destabilised by the telling achieves nothing at all. It was always a difficult balance to attain: too much avoidance versus too much flooding. I’m not sure anyone gets that balance right all the time—perhaps not even most of the time. All I know is that when I blurted out too much stuff too fast, I achieved nothing, because I just switched and dealt with it by dissociating—so none of it was integrated, none of it was done in a ‘window of tolerance’ where I could still think and feel. It was wild catharsis without any form of resolution.
I eventually learned that this stuff would only shift—the trauma would only be processed and metabolised—if at least to some extent I was able to own it as mine, rather than disowning it into the various traumatised parts of me. I had to work at integrating, at making associations, rather than dissociating—‘This is me, and this is my trauma; these things happened to me; I am me; I am still me now remembering what happened to me.’ Owning it, accepting it, was (still is) hard—I’ve had a lifetime of coping with it by disowning it, by disremembering it, so it’s a new way to live, a new way to think and to be.
Shame kept me away from a lot of it for a long time—a desperate, overwhelming shame that said, ‘That can’t have happened to me, it can’t have’ because I felt so horrifically tainted and contaminated by what I was remembering. But shame eventually gave way to anger, once I felt safe enough to feel it: ‘That’s so wrong that that happened to me!’ Only once I had sufficient physical and emotional distance from the people who abused me could I begin to touch the edges of that anger. Previously I had avoided my anger through the shame that says, ‘I don’t deserve to be angry, because I deserved the bad things that happened to me’. That had kept me safe from them as a child—anger would have been met with the most severe punishment! But it was unhelpful now as an adult, where I continued to pay the price of shame rather than being able to straighten my spine and lift my eyes and walk purposefully into life. I had to feel safe enough to feel that anger towards them rather than directing it instead towards me. So physical safety and emotional distance from them was important before I could even begin to ‘go there’ with much of this stuff.
MEMORIES AND AMNESIA
Working through the amnesia was not what I expected. I don’t really know what I expected—I suppose I imagined that a ‘memory’ would just pop back into my head and that I’d say, ‘Oh I remember now…this happened.’ But it wasn’t like that at all. It was a gradual seeping, through every medium in my brain, with the ‘visual’ memory last, if it came at all. It would be dreams and nightmares that hinted. It would be body memories that built to a crescendo over a period of weeks—pain in my shoulders, pain in my pelvis, pain in my genitals; strange feelings of suffocation or tightness or not being able to run. It would be sudden, out-
Much of that ‘facing’ was done in therapy, with the gentle prompts, the and-
‘Processing’ doesn’t happen with flashing blue lights and a two-
I know I have more work to do when the tell-
But I have learned, gradually, that it’s only by thinking and feeling, only by bringing those two aspects together, that this stuff can shift. But I’ve also learned that it does shift, and the process, painful though it is, is worth it.
WHAT HELPED—WAYS WE ‘PROCESSED’ TRAUMA
How do you process trauma when you can’t even remember it? That was the struggle I faced, like so many other survivors. But what I eventually realised was that it was not a case of ‘all or nothing’—that I either remembered it or I didn’t. Usually the bigger problem was that I couldn’t face recalling it, at least not all in one go, and what I did remember was not ‘integrated’: it was not joined up. There was a fragment here, a visual image there, a feeling here, an automatic flinching there. The hard work of Phase 2 was actually bringing all of those things into consciousness and then starting to join them together. There were a few different ‘techniques’ that we used to do this:
INSTALLING A ‘RESOURCE’
A typical traumatic memory for me usually involved some horrific act of abuse, and me feeling overpowered, helpless, stuck and frozen. And that is exactly what it was like for me as a child. But as we worked it through, we started to look for ‘resources’ that we had at the time too. How had I survived? Some horrendous things were done to me, things that were unbelievable and unthinkable, and yet I survived them. How? What had I done? Usually my survival had been achieved by things that I had always considered shameful—not fighting back, not running, not screaming for help, not doing anything at all. But then I began to understand: that way I shrunk myself down and became small and subservient and didn’t move—that wasn’t pathetic. It was smart. It meant that I didn’t ignite their wrath. It meant that the abuse was over and done with more quickly. I had always seen it as weakness and my compliance as consent. But I began to be able to reframe it as my best attempt to survive.
So in re-
We ‘installed’ this resource by pausing the narrative, and noticing how different I might feel in my body if I had a meat cleaver, or the police had arrived. We paused on that, let the feeling of power and freedom nestle down into my guts and inflate every muscle, and then ‘practised’ that mental state for the next few days and weeks until every time we thought of that particular incident, instead of the terror and humiliation, the competing emotions of strength, anger and righteous revenge came through instead.
CHANGING THE IMAGE
Borrowing techniques from Neuro-
ENGAGING THE BODY
Much of the Sensorimotor Psychotherapy that I went through focused relentlessly on the body: ‘Just notice where you’re feeling that in your body’; ‘What does your body want to do?’; ‘Let’s just notice what your breathing is doing now.’ The focus was on learning to take mastery over traumatic responses by calming the body, by switching attention away from the left-
You can feel really daft, pushing against a wall and focusing on how strong you feel, but it does work. It was about not trying to change the mind until we’ve changed the body. Let the body feel strong and powerful and then we will have a different relationship with ourselves, instead of feeling, eternally, that we need to make ourselves small and submit.
I learned to stand up—to really stand up. To feel strong and powerful and competent and brave standing up, rather than the automatic weakness and impulse to collapse that I had at first. We identified that being told to stand up was often a prelude for me of abuse, hence my automatic reaction of crumpling and terror. But when I learned, slowly, to stand up and notice that nothing bad happened—to pause and think and reflect and feel it in my body that nothing bad was happening—it began to transform my bodily reactions.
Sometimes the trauma narrative, especially when I switched to a ‘younger’ part of me, came tumbling out all breathless and disjointed and full of stammering terror. So we invented ‘chronicling’—a term we used to describe something that we tried just once as an experiment and which was so effective that it became the go-
Even though a lot of the time it was all feeling and no thinking, it did get it out. And then the next session, or in the second half of the same session, back it would come to me as thinking, reflecting, adult-
In mentalising it, I tried then to develop some self-