Following the Threads — An Unexpected Journey to Better Understand Trauma

By J. Scott Janssen, MSW, LCSW

Jim fought in World War II but rarely spoke about it. When he did he was vague and quick to change the subject. As he approached the end of his life he started having nightmares about the war and was tormented by painful headaches for which no organic cause could be found and which medications could not relieve. As if overnight, a constellation of issues emerged—social anxiety, increased sensitivity to noise, an enhanced startle response, hypervigilance, panic attacks, and a sense of foreboding about the future.

Starting with the contents of his nightmares, Jim finally began talking about the war. Despite his previous silence, memories of combat had long been stabbing into his mind. The most haunting of these was the day a close friend was killed, the bullet entering the man’s head in exactly the place where Jim’s headaches were occurring. For decades Jim had kept the war’s pain and trauma hidden, but in the twilight of life he could no longer outrun his painful memories.

Trauma Resurfaces at the End of Life
I didn’t start out interested in trauma. It wasn’t long, however, before I realized how interwoven trauma and palliative care can be. Like Jim, many people at the end of their lives have long been struggling with traumas like those of war, catastrophic accidents, assault, traumatic grief, or sexual violence. As illness constricts one’s activities and independence and important roles are lost, the impact of such experiences can intensify. When these wounds have not been healed, the energy they unleash as death approaches can be formidable.

Not all traumas are as seemingly dramatic as Jim’s. Many are subtler and less apt to reveal themselves. Some go deep into the past—the grief, for example, from the sudden death of a child 50 years earlier churning up emotions as a mother faces her own death. Or maybe it’s the silent legacy of verbal and emotional abuse, or of having been neglected as a child, bringing to the surface hidden shame and questions about whether one’s life was important or really mattered to anyone.

Others are more recent. The lingering sense of vulnerability and fear left in the wake of surgery or chemotherapy, for example, or the nightmares that started after the last trip to the emergency department. It may be the shock and dread which just doesn’t seem to lift after getting a terminal diagnosis or the strange dissociative state that has persisted since hearing that a loved one may have only weeks to live.

Often these existential wounds emerge as I’m visiting with clients. Sometimes they’re triggered by physical pain or increased dependency. Other times they come up when long days in a hospital bed lead to thoughts about the life one has lived and reflections on what it’s all about.

Weaving the Threads of Healing
Whatever the catalyst, it happened so frequently early in my career I knew I needed to learn more about serving people with trauma. Even though time may be running out, the end of life can be a transformative period of growth and healing. I wanted to be in a better position to help. Over the years I’ve slowly been weaving the threads together, trying to get a better sense of how trauma survivors heal.

I guess discovering and exploring such threads is something all social workers do at one time or another. Whatever our role or practice setting, we work with human beings in intense situations that challenge us to learn new things and go in directions we didn’t expect. For me, this has meant working with trauma; for other social workers it has meant developing a specialization in pediatric care or working with teenagers. Social workers serving people with mental illness have gained extensive knowledge about substance abuse; others who started out with a focus on geriatrics have become interested in family systems, caregiver burnout, or grief counseling. Sooner or later, if you’re a social worker something will unexpectedly catch your attention and you’ll be hooked.

In an attempt to enhance my work with traumatized clients, I started simply. Paying close attention as I asked questions about the client’s life experiences, I invited them to talk about whatever was on their minds while learning to gently send the message there was nothing they could share that would shock or cause me to judge. When something traumatic came up, I invited clients to dive in. Back then I had faith that if one shared their story, unburdened themselves of unspoken thoughts, and expressed stored-up emotions, all would be well. Somehow the very process of sharing in a safe place would release one from the powerful and destructive chains of unresolved trauma.

Learning to Tread Lightly
I learned fast that it wasn’t so simple and such an approach could easily backfire. Trauma material is often so loaded with intense and potentially frightening energy, the narrative so fragmented and overwhelming, that my invitations to share often went nowhere. In some instances such invitations aroused fear, even panic. Fortunately I knew enough to not continue pushing, lest I undermine the trust I was trying to build by pushing an unwanted agenda, disrespecting someone’s defenses, or worse, risking retraumatization by calling up material before it was safe to do so.

Maybe going directly at such emotionally charged experiences wasn’t the best approach, at least in the initial stages of the relationship. I decided to back away from encouraging a dive into and release of emotions, taking a more cognitive approach. I figured thoughts would be less threatening than feelings. By focusing on unhelpful behavior patterns and unexamined cognitions and beliefs, and challenging or reframing these, I hoped to enhance patients’ awareness and control, lower the intensity of the emotions, and allow them to safely go deeper into the more charged dimensions of the experience.

To an extent this approach seemed helpful. I was glad to have found an avenue of approach that seemed less apt to overwhelm, and certainly there is good evidence that cognitive behavioral psychotherapy can be useful in trauma resolution. But although the approach seemed to work with some, for others it just didn’t resonate or seemed to only go so far without getting at those deeper layers of experience. For me, some of the threads were still missing.

I read books, took training, talked with people in the field, and watched clinical sessions of experts working with trauma survivors. Along the way I studied treatment models as diverse as hypnosis and poetry therapy. I learned the importance of establishing safety, helping clients ground themselves, activate their strengths, and better pace such explorations. As I got better at these things my ability to stay connected with clients without being distracted by my own fears increased and the power of relationship in trauma healing became apparent.

One of the things I came to understand is the insidious and potentially crippling way trauma can shatter or alter one’s sense of identity—one’s very sense of self. Paradoxically, as I got better at having these conversations I started getting glimpses of a client’s deeper, inward-dwelling self: a self that had not been shattered and was able to step back and assess an experience without escalating toward fear or anger, and without shutting down or dissociating. It goes by many names in the psychological literature: core self, deep self, wise mind, inner self. If you’re a Jungian maybe you call it the individuated self; if you’re an existentialist maybe it’s the authentic self. If you use internal family systems you may simply capitalize the “s” and call it the Self.

Whatever you call it, tracking and communicating with this inner self and connecting people with this place of strength and its capacity for wisdom, curiosity, and personal and spiritual growth became a central pillar of the work I was doing whenever trauma issues emerged. Taking this thread and weaving it with others, I thought I’d finally formulated an approach upon which I could stand pat.

But like many complex fabrics—and trauma is one of the most mysterious—threads were missing. Even when the conversations were going well and people were processing the story, gaining insight into triggers, and becoming aware of negative thoughts and beliefs, something was missing. Even when the relationship was solid and as searing memories, emotions, and beliefs were being unpacked in a context undergirded by personal strengths, compassion, and a safe, well-regulated pace, sometimes things just didn’t seem to add up.

There was often so much bristling energy that seemed to be sustaining trauma’s disruption of client’s lives and relationships. Sometimes it made my head spin. For a long time I thought the energy was coming from thoughts and emotions spiraling and looping through one’s life creating viscous circles of inner turmoil, but the more I worked with clients and their loved ones the more I began suspecting there was another energy source I hadn’t yet discovered.

Somatic Experiencing
That’s when I started exploring somatic approaches to trauma like somatic experiencing. Once safety and trust have been established these approaches start not with cognition or affect or memory or the trauma narrative; they start with the human body and the here-and-now exploration of sensation and all its subtle and not-so-subtle energies.

In somatic experiencing, the energy I was picking up on is viewed as embedded in one’s central nervous system, arising from the charge trauma transmits deep into our physical being. As Peter Levine puts it in his book Waking the Tiger: Healing Trauma, “Traumatic symptoms are not caused by the ‘triggering’ event itself. They stem from the frozen residue of energy that has not resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits.”

Is it possible that this stored body-memory, the energy it imparts, and the ways it can change the very circuitry of our brains is what I’d been picking up on for these last years? I’ve recently begun practicing a more refined attention to the messages of the body and developing my ability to track and decipher these messages. I’m slowly gaining skill helping clients increase their sensate awareness. How do unnoticed physical sensations, holding patterns, and currents of nervous energy sustain painful defensive and social patterns as well as personal narratives related to unresolved trauma? And how can they be used as portals into transformation and healing?

These are some of the questions currently rattling around in my head and informing my work as it develops. I feel like I still have a lot to learn. I’m not claiming I’ve discovered the psychotherapeutic Holy Grail in taking a more somatic approach but it has become an indispensable thread in the larger fabric of trauma healing.

At times I wish I could go back and have another talk with Jim, taking with me what I’ve learned these last years. Exploring what his body might have been telling him, discovering what might happen if he were to bring a new, subtler attention to physical and energetic sensations arising in his nervous system. Back then it didn’t occur to me to try helping him connect with an inner self beneath the surface with its painful intrusive memories, grief, and survivor guilt. Truth be told, I didn’t know much back then about pacing tricky conversations like the ones we had or how to help people stay grounded when things start to get overwhelming. Still, I look back on our talks knowing I did my best.

That’s another thing about these unexpected dimensions of human life we social workers sometimes find ourselves exploring—learning takes time and we deepen our knowledge and skills as we go. No one starts out with the whole picture. I’m not sure anyone ever really sees the big picture even after a lifetime. But we gather threads of whatever experiential fabric has caught our attention. I have no illusions that placing my newfound fascination with somatic awareness into the larger context will complete the picture once and for all. When dealing with human things it doesn’t seem to work like that. There will always be new areas to discover and explore. But every new thread helps.

— J. Scott Janssen, MSW, LCSW, had been a hospice social worker for
20 years but is currently a private practice social worker in Hillsborough, NC. He authored the book The Dawn Is Never Far Away: Stories of Loss, Resilience, and the Human Journey. He is currently being trained as a somatic experiencing practitioner.