Trauma therapy is difficult and complex. Generally, trauma therapy takes place in 3 stages—stabilization and resourcing, memory work, and grief work coupled with the practice of new behaviors. Each stage likely involves multiple interventions and approaches. It is not fast work. When I talk to people about trauma work, they often have some awareness of the process of memory work but neglect dedication to stabilization and processing grief. This blog will address the importance of the latter.
Processing and managing trauma-related grief is often an overlooked or underscored part of trauma therapy. Trauma related grief is the sense of loss that comes as a result of the trauma itself—lost time, lost opportunity, and lost sense of self or safety. This is not necessarily a linear process. Grief may be interwoven into all stages of therapy as the trauma surfaces and is processed.
Before we grieve
A few therapeutic tasks will precede trauma related grief. The individual must be able to distinguish past from present—what was true then is not true now. This is not always cognitive. For example, I might know in my head that the trauma is over but when triggered, my body physiologically reacts as though threat is still present. The parts of me that are triggered live in what can be dubbed “trauma time”. Stabilization will help the individual manage these responses and memory work or trauma processing (perhaps through EMDR) will help to disarm or disengage the threat response. Once the nervous system returns to a normal baseline the individual can now be oriented in the present, no longer assuming threat each time they are triggered. Grief comes once we recognize it is over.
The second task that must take place is the development of self-compassion toward all parts of self. This is the shift in the relationship with the wounded self. This is far more complex than I can do justice in this blog. Simply put, it is common to exile or shame parts of ourselves that live in “trauma time”. We may even align with perpetrators in our treatment of these parts by blaming ourselves for our pain and banishing hurt parts from our daily lives, assuming these parts are the problem. Aligning with perpetrators serves as an adaptive survival response under threat but once the threat has passed it is retraumatizing. For example, I might tell myself “get over it” or “you deserved this”. How can we truly heal if we treat or view ourselves the same as those who hurt us or neglected to care for us? The very act of responding to our pain differently helps us to distinguish between past and present.
What gets in the way
This is HARD! Distinguishing between past and present and responding to the self with compassion comes at a cost. A secondary gain is the benefit of staying stuck. Addressing secondary gains is a normal part of trauma therapy. There are benefits to staying stuck in trauma time. One benefit might be a desire for a “re-do”. Those with attachment wounding, who never received appropriate or healthy caregiving from a parent, may hold out hope that a rescuer will arrive and re-parent them. This may be expressed in dependency toward a friend or partner. However, no friend or partner can live up to this task. The expectation that another meet unmet childhood needs will often lead to resentment or further feelings of rejection and abandonment. Unmet childhood needs cannot be reasonably met; they must be grieved. This is where trauma-related grief comes into treatment.
Another barrier to grief is the temptation to stay in shame (read about the benefits of shame here). Shame toward the wounded self stunts our healing. Compassion identifies boundaries and appropriately places responsibility.
With the knowledge that the past is over (both cognitively and physically) and the work of compassion toward self, the traumatized individual begins to grieve all the things lost through trauma. It hurts to realize that one cannot get a “re-do”. It hurts to realize that there are wounds that impact relationships and the ability to love or attach. It hurts to acknowledge you did the best you could and evil still exists. In fact, it is devastating.
The work of grief
Grief is not a linear process. Trauma-related grief feels like anger at the injustice, why questions and “what ifs?”. It results in deep sadness. Self-compassion is a good place to start. The adult individual becomes the primary caregiver of wounded parts as opposed to holding out for a rescuer. For specific exercises on self-compassion Kristin Neff’s website is a good place to start. You can even direct these exercises specifically to part of you that feels hurt or is grieving.
Grief–whether complex, trauma related, or “uncomplicated”–is not something we fix. It is a human experience that we move through with care and compassion. It is allowed to hurt, and you do not have to make it go away. Care for yourself through it. Grief comes in waves and eventually the waves are less intense and further apart. It is tempting to assume you can find a solution (or the right words) but this often leads to shame when the solution doesn’t work.
Trauma is hard. Grief is hard. But trauma-related grief means you survived. Kubler-Ross and Kessler identified the five stages of grief–denial, anger, bargaining, depression, and acceptance–in their book On grief and grieving in 2005. In 2019 Kessler published Finding Meaning to include a 6th stage–meaning. This is the ongoing work of grief. Seek the meaning. Take care of you. This is hard. You are enough. You are worth caring for.