PTSD Professional Perspective: Grounding Techniques

Tweet

A guest post today by Dr. Kathleen Young, a licensed clinical psychologist with over 20 years of experience. She has been in private practice in Chicago, Illinois, since 1992. She incorporates aspects of psychodynamic, relational therapy and dialectical behavior therapy into her approach to psychotherapy. Her career focus has been on treating trauma and its aftermath. You can read more about her approach to treating trauma at: http://drkathleenyoung.wordpress.com/. You can follow her on Twitter @DrKathleenYoung.

Grounding Techniques in Trauma Therapy

Working through trauma can be scary, painful, and potentially re-traumatizing. Very often people who have experienced trauma have coped at least in part through some degree of dissociation. While this was necessary for your survival then, continued dissociation (especially forms that are not within your control) is not adaptive once the abuse has stopped. Now the task of therapy is to help you stay present long enough to learn other means of establishing safety in the present. How does someone with automatic survival skills of dissociation learn to do this? Grounding is one skill that can help.

Trauma therapy does not only consist of telling your story or focusing on traumatic memories, though of course that is a crucial part of the work. Bringing trauma memories to mind, talking about them in a trusting relationship, and developing the capacities for managing them while staying present in the moment are all crucial parts of the healing process. A premature emphasis on traumatic material can in fact do more harm than good.

In the past, trauma survivors were encouraged to speak about their abuse in the belief that this catharsis would be healing. Sometimes this instead led to re-traumatization rather than mastery of the material or healing. In fact, some trauma survivors are able to tell their stories easily, but in a dissociated manner. Because of the risks involved, this healing work is best done with the help of an experienced trauma specialist who can help you learn techniques to cope with memories effectively. One goal of trauma therapy is to help you connect to the past while staying in the present. How does someone with automatic survival skills of dissociation accomplish such a task?

More recent trauma therapies have focused on a stage approach, which includes early preparation, focus on developing coping skills and stabilization. Judith Herman, in Trauma and Recovery, states that the central task of the first phase of therapy must be safety. How can you experience this if you do not even feel safe within yourself, but at the risk of uncontrolled flashbacks? In fact, for many trauma survivors it may have felt that there were only two choices available to them historically: abuse or dissociation.

What do therapists mean when we talk about grounding?

Grounding is about learning to stay present ( or for some get present in the first place) in your body in the here and now. Basically it consists of a set of skills/tools to help you manage dissociation and the overwhelming trauma-related emotions that lead to it. Processing done from a very dissociated state is not useful in trauma work. Neither is the goal to be so overwhelmed by feelings that you feel re-traumatized. Once you are present, you also need to learn other means of managing the feelings and thoughts asst with traumatic memories.

Every one is different. Different grounding techniques will work for different people. The following are some general categories and ideas. Exploring the pros and cons of various approaches with your therapist can be useful in determining which will be the best fit for you.

-Grounding often takes the form of focusing on the present by tuning into it via all your senses. For example, one technique could involve focusing on a sound you hear right now, a physical sensation (what is the texture of the chair you are sitting on, for example?) and/or something you see. Describe each in as much detail as possible.

-Diaphragmatic or deep breathing: Trauma survivors often hold their breath or breathe very shallowly. This in turn deprives you of oxygen which can make anxiety more intense. Stopping and focusing on deepening and slowing your breathing can bring you back to the moment.

-Relaxation, guided imagery or hypnosis- folks with dissociative disorders are engaging in a form of self-hypnosis much of the time. The trouble is, it is out of your control! Some trauma therapists are also trained in hypnosis and can help teach you how to use dissociation in a way that works for you. For example: you can develop a safe container for traumatic material between sessions, create a safe or comfortable place (“safe” may not be a concept some survivors can relate to or may be triggering to some) 0r learn ways to turn down the “volume” of painful feelings and memories.

Grounding and emotion management skills can help you proceed with the work of trauma therapy in a manner that feels empowering instead of re-traumatizing.

‘PTSD Professional Perspective’ is a weekly feature. If you would like to contribute please Contact Michele.

Tags: dissociation, grounding technique, guided imagery, hypnosis, Kathleen Young, relaxation, therapy, trauma