Exploring the Effects of Trauma

Beth M. Broom, LPC-S, CCTP-II

As I supervise new counselors, I am often asked what they need to learn early in the counseling process in order to set goals that fit the needs of the counselee. Whether you are a formal counselor or a pastor or mentor, it’s a good idea to have good questions on hand to help you learn important information. While we can’t know everything, knowing too little can hinder the counselee’s growth process. 

Let’s say you’re sitting in a counseling session with a new counselee (we’ll call him James) who comes to you because he is experiencing anxiety. Maybe he has completed an intake form, so you may have learned certain things about his struggle and history. But at the beginning, you know very little about his life and what has shaped him. You don’t know how he copes or what he believes about himself, God, and other people. 

You don’t expect him to share everything in the beginning, but there are some key things you want to uncover. First, has James ever experienced anything terrifying, overwhelming, or life-altering? If he has, you will want to explore whether his symptoms of anxiety arose after that event or season. Keep in mind that you don’t need (or want) James to tell you everything about the event that was terrifying. You don’t know yet whether he has the skills and self-awareness to stay regulated in his emotions and body while telling a distressing story. Instead, you ask him to give you a ‘bird’s eye view’ of the situation that occurred. 

Some counselors wonder if they need to try to verify whether James’ experience was actually traumatic. I don’t feel very concerned about this, especially not in the first session. I just want to understand the source or sources of his pain. I don’t want to assess or evaluate him. I want him to leave that first session believing that I care about him as a person, and that his problems are only a piece of who he is. 

After we get a bird’s eye view of James’ history with possible traumatic events, we want to know how he is currently being affected by suffering. There are a lot of questions we can ask about the various aspects of suffering, but I want to make sure to ask one or two questions related to each of these types of struggle:

• Avoidance of:
  • Memories, thoughts, feelings and situations associated with a traumatic event (although he may not be aware of the association)
  • External or internal reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts or feelings
• Intrusions:
  • Recurrent, involuntary and distressing memories
  • Recurrent and distressing dreams related to a traumatic event
  • Flashbacks, in which the person senses a traumatic event is recurring
• Overwhelm:
  • Feelings of panic or rage that cause a quick bodily and behavioral reaction
  • Thoughts and beliefs related to being out of control or unable to make decisions
• Shut-Down:
  • Feeling numb, losing track of time, or feeling as if you are standing outside yourself 
  • Difficulty with concentration and verbalization
• Thoughts and Beliefs that are Absolute:
  • Polarization of ideas (such as “everyone is out to get me,” or “no one cares”)
  • Difficulty seeing the nuance related to self or others (such as “people can love you but also say mean things”)
• Difficulty with Relationships:
  • Struggles with big emotions that can cause tension in relationships
  • Insecurity about relationships that lead to avoidance or dependency
  • Struggles with rational communication during conflict
• Struggles with Daily Functioning:
  • Difficulty doing regular required or socially expected activities
  • Loss of motivation or pleasure in activities and relationships
  • Loss of hope
• Spiritual Struggles:
  • Difficulty interacting with God on a personal and corporate level
  • Doubts about God’s character and promises
  • Lack of trust in God’s goodness

I probably won’t have time to ask questions about all eight areas of struggle in the first session. In fact, it might take three or more sessions to really learn about all these things. But when we ask good questions, we invite the counselee to explore his suffering with someone who will listen and bear witness. Our goal is not to diagnose or assess pathology. Our goal is to honor his life, his story, and his experience of pain. When we do this well, we will create fertile ground in which to do the work of counseling. And we will be mirroring the heart of Jesus, who entered fully into people’s suffering and offered hope and wisdom.

We have created a resource that includes specific questions to ask in each of these eight areas of struggle. This resource is available to all CTHN Members by clicking HERE. To learn about becoming a CTHN Member and accessing all our resources, click HERE.