Re-traumatising clients

Many clinicians express concern about re-traumatising their clients. A simple google search recently produced 516,000 results with the term present. Some of the headlines appear below, but they seem to suggest that re-traumatising clients is something clinicians can and ought to avoid.

7 Ways to Avoid Re-Traumatizing A Trauma Victim

How to Avoid Re-traumatisation and Re-victimisation

If your client is suffering from PTSD, they are by definition re-experiencing a traumatic event that has occurred in their life. Reminders of the event, talking about it, even seeing a therapist may trigger distress associated with re-experiencing. Similarly, clients often have a strong desire to avoid this distress, as they want to avoid any reminders of the trauma. Both these symptoms are important criteria for a diagnosis of PTSD. It is also important to be aware that avoidance symptoms are the significant driver of PTSD, and the best, evidence-based treatments for PTSD are focused upon reducing avoidance.

Assisting clients to manage their distress and remain motivated to engage in therapy are also important in the treatment of PTSD and successful psychotherapy.

It can be difficult to sit for an extended period of time with a client who is very distressed. Clinicians must make a judgement about whether to directly pursue distressing lines of questioning, or to step back. The clinician must also remain aware of not colluding with avoidance by not asking the difficult questions. However, if the client’s arousal peaks too high, this may be frightening for the client and bring on re-experiencing or dissociation. Both avoidance and hyper arousal have the capacity to compromise the client’s ability to remain present and engaged in the therapy. Yet they can be managed, and clients can and do refocus.

The term “re-traumatising clients” is unhelpful. It implies that a clinician can do damage and places responsibility for managing this dynamic solely with the clinician. Psychologists are ethically and morally bound to practice professionally and safely. However, within each moment in the therapy room, the decision about how far to pursue a line of questioning in the face of discomfort is complicated. It ought to be based upon direct feedback from the client as well as observations of the client by the trained clinician. However, in order to be effective, treatment must produce discomfort. This challenges clinicians to therefore be aware of their own feelings of discomfort during treatment, and to remain aware of what that means in any particular interaction. The capacity to reflect upon one’s own discomfort (countertransference in psychodynmiac language) is an essential skill in psychotherapy.