The Importance of Safety in Working through Childhood Trauma - A Case Study

The main therapeutic ingredient for someone who is grappling with childhood trauma, whether repressed or vivid memory, is SAFETY. The safety we refer to in psychotherapy is not only physical safety but emotional and psychological safety as well. People who have been abused or traumatized in childhood were helpless victims because they were young and did not have control over their environment or the relationship with the adults around them. In essence, their nervous systems were built around the trauma and this usually means that dissociation is a central defense mechanism the child used. For some people the dissociation was so strong (a great way to protect themselves!) that the memories of the trauma get lost in very depth of the mind.

Below I share a short case study of a woman who, over the course of psychotherapy, has started to uncover the lost memories and rebuild her life. The purpose here is to give clients insight into the importance of safety in treatment and some of the ways a client can work with a therapist to create a safe container.

CASE STUDY (This is a very condensed synopsis of work that took about a year)

'Freya' was referred to therapy by a local agency and complained that she feels "like something bad happened to me but I don't know what." I explained to Freya that whether or not we find out what happened to her or not, our intention in therapy is to help her deal with the impact of her traumatic past on her present-day life. The very first step in creating safety is stepping away from the trauma and focusing on creating a supportive therapeutic relationship.

After a number of sessions, Freya and I became more and more interested in what helped her feel safe in the therapy room. We discovered that it was helpful if she took 15 minutes before the session to prepare and ground herself in the waiting area and also 15 minutes after the session to reflect and transition back into her day. Extending the session time in this way on her own helped Freya to be ready to go deeper when she was with me.

In the beginning of each session I led a grounding exercise to help Freya connect with a feeling of safety and support. Her favorite one was mindfulness of her feet on the floor and back against the couch. We sat together for about 3 minutes focusing on these sensations and arriving into the session slowly.

We also found that Freya felt more comfortable in the therapy office when after the initial exercise, she lay down on the couch. Most of the time she did not make eye contact with me. Sometimes her eyes were closed when she spoke but other times they were not. She could speak more naturally and freely this way instead of sitting up across from me. Once she began laying down during the session, each session deepened in content.

One week Freya shared that she had been consumed all week with the feeling that there was a child screaming inside her. I interpreted this as the young child self that Freya had left behind. During this session I guided her to close her eyes and encounter the child. After she spent a few moments with the child, I asked her to see herself in a safe place. For Freya the safe place was at the ocean, listening to the ocean sounds and feeling the sun and sand. In our session she alternated between being with the screaming child and returning to the safe place. Eventually without my guidance, Freya felt the urge to return to be with the little girl. The child in her mind was upset and closed off. They did not speak very much since it was hard to communicate with such a child. I asked Freya what she might do to connect and comfort the child. She found herself sitting down next to the little girl and placing a hand on her shoulder. This was all the contact necessary. The two of them sat together in silence like this for a long time. 

A few weeks went by and Freya returned to session reporting that she was having memories of her childhood trauma come to the foreground in her memory. She told me this calmly, sitting up across from me as an adult. The memories she shared were very difficult and painful. I remarked to Freya how grounded she seemed to be as she spoke. She said that she herself was surprised by how well she has been doing even as the memories surfaced. She did not expect it to be like this. I explained to Freya that she had been doing a very good job creating safety for herself while connecting with the little traumatized girl inside of her. I reminded her that she is no longer that young girl. She is an adult who is no longer going through those experiences. Her ability to reflect and support herself is a real show of her strength and growing self-acceptance and self-love as an adult.

I believe that it was Freya's willingness to let go of the expectation that the memories would come up that helped free them. She spent most of the first year of therapy focusing on resourcing herself in her day to day life by finding creative activities, support groups and a stable living environment. In therapy she focused on learning tools to use in times of high anxiety and depression. The repressed memories were not the focus of her attention yet when they began to surface, she had access to a whole new set of coping skills she had been building.

Building safety in and out of the therapy room is a very important process for clients dealing with childhood trauma. It can be a lifelong process. It is so valuable because healing can feel like a deep dive; you've gotta have that oxygen tank with you down there. But once you've been to the bottom of the ocean of your mind and come back to the surface, you can take a long walk on the beach.

---