Pandemic-Related Trauma: Helping Clients Feel Safe
How can we support clients who are struggling with trauma, whether new or historic, during the coronavirus crisis? Schema therapist Dan Roberts discusses threat-system activation, nervous-system dysregulation and maladaptive schemas, and shares his favourite technique for helping clients to create a felt sense of safety.
In my practice, as well as helping people with the kind of grief and trauma that are directly related to the pandemic, I find that many of my clients with trauma histories are struggling, often in more subtle, less-obvious ways.
There are a number of reasons for this. First, their Window of Tolerance is narrower than those without a trauma history. This, sadly, makes them less able to cope with stressful situations like the pandemic, regulate their nervous systems, or cope with threat-focused emotions such as anger or anxiety.
As I explain to these clients, much of the pandemic’s impact on our health is outside our consciousness. We are bombarded daily with words and images in the media that are highly activating for our threat systems, especially if they are pre-sensitised by a trauma history. So there is a constant, background hum of threat-system activation and nervous-system dysregulation, which makes us more prone to chronic stress, anxiety disorders, depression – and what Janina Fisher calls ‘quick and dirty’ means of coping, such as alcohol or substance abuse, disordered eating, self-harm and dissociative detachment.
How might the pandemic be triggering maladaptive schemas?
Jeffrey Young, the founder of schema therapy, also made the key discovery that we all have one or more maladaptive ‘schemas’ – neural networks that get triggered by stressful events that remind us of similarly threatening events from childhood. For example, the Vulnerability to Harm or Illness schema is clearly highly active for many of my clients right now. Some of this is logical and proportionate – it’s a scary time to be human. Infection and mortality rates are still very high, and just leaving your house can be highly stressful, with every person you meet potentially carrying a deadly virus.
But for clients with a history of health anxiety, or a trauma history in which they were made to feel vulnerable, helpless or afraid, the Vulnerability schema will be triggered often, causing high levels of stress, anxiety and upset, distorted beliefs and cognitions, worry and rumination, as well as physiological symptoms such as headaches / migraines, skin complaints and digestive problems like IBS.
Creating a felt sense of safety: the Safe Place technique
Of paramount importance for our clients, whether they are experiencing present-day or reactivated historical trauma, is to create a sense of safety. One of the most helpful techniques is the Safe Place imagery, developed by compassion-focused therapy founder Paul Gilbert, but also a key intervention in schema therapy. When using this technique with clients, I find it helpful to record it on my phone, then send them the recording to use as a guided meditation for homework.
Start by discussing the imagery with your client, telling them that they need to imagine a safe place. This might be somewhere they have visited, such as a beautiful beach, forest or mountain meadow. It could also be somewhere that feels safe and comfortable for them, such as a cosy room in their house, or place they walk their dog. Sometimes, especially with trauma survivors, they can’t think of anywhere that feels safe – in that case, create an imaginary place together.
They will need to be alone, with no potentially triggering people visiting; and it should be warm, as warmth is soothing for the brain. Get them to close their eyes and ‘be there’ as vividly as possible. Help them explore their Safe Place, using their senses – what do they see, hear, feel, smell and taste? If it’s a beach get them to visualise the beautiful turquoise sea, golden sands and blue skies, hear the gulls and breeze rustling palm fronds, feel the sand between their toes… The more sensory information the better, as this convinces the brain that they are actually on that beach.
Keep repeating that this is their Safe Place, using words like ‘calm’ and ‘peaceful’. Help them mindfully focus on the somatic sensations of calmness, peacefulness and safety in their body. Also, say that this place itself takes pleasure in them being there (many trauma survivors were never cherished or shown love, so this often feels very good). End the imagery by saying that this place is always here for them, just waiting for them to visit. Then say, ‘The image is fading, fading and it’s gone. Now take a deep breath and open your eyes.’
Then send them the recording, as well as reminding them that they can visit their Safe Place whenever they need a break from daily life. If they close their eyes they can be there, even for a few seconds, when they feel stressed, anxious or overwhelmed – then rejoin the world feeling a little calmer or safer.
Also, remember that this is a stressful time for therapists too! So by all means create your own Safe Place and use it to keep you calm and grounded as we all navigate this highly challenging situation.