Episode 86: What You Need in Order for Trauma Therapy to Work with Alyssa Scolari, LPC

Addressing your trauma in therapy can be one of the hardest, bravest things you’ll ever do. But before you do so, there are important safety measures that need to be put in place in order for therapy to be effective. Trying to process trauma without having safety and security in other areas of your life can lead to re-traumatization and an overall negative treatment experience. Tune into this week’s episode to learn about what you may need to make therapy as helpful as possible.  

**Every donation to Patreon for the month of March will go to Doctors Without Borders to help support those injured in Ukraine. Alyssa will personally match your donation. See the podcast Patreon and learn more about Doctors Without Borders below!**

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Transcript

Alyssa Scolari [00:23]:

Hey everybody. Welcome back to another episode of The Light After Trauma Podcast. And if you're new here, well just welcome in general. So happy to have you, happy to be here. We've got a little bit of a shorter episode coming at you today. It's been kind of a wild week for me, so please forgive me. I have had so many appointments, just like doctor's appointments after doctor's appointments and it's all good stuff, I'm doing well, things are fine. But it has just been a lot and I've been a little overwhelmed. So I actually originally wanted to talk about something else today, but I've been getting a lot of questions from you all about really the process of starting the trauma work, meaning like working through your trauma, trying to get yourself into recovery from your trauma. And this is a really important thing to talk about.

Alyssa Scolari [01:22]:

And I had a lot of questions this week in my private practice and through the podcast of just like, how do I even begin to start this? And I think that's a really important question. And I don't think that it's really talked about a whole lot. I think some people think, well, you just sign up for therapy and you go and you start talking about it, but doing that can actually be dangerous. There are certain safety measures that have to be put in place for the trauma therapy to work, the trauma recovery to be effective. So that is what we were talking about today.

Alyssa Scolari [02:03]:

So just a few housekeeping things before we get into it. Number one, I just want to remind everybody that for the month of March, we are donating to Doctors Without Borders to help the people in Ukraine right now. So you can read more about Doctors Without Borders in the show notes. And what we're doing for this month is if you become a Patreon member, which you can sign up to be a Patreon member, again go right to the show notes, whatever you decide to donate for the month of March is going to go directly to doctors without borders and to take it even one step further, I am going to personally match your donation.

Alyssa Scolari [02:46]:

So I really think this is a great way to raise some money, to be able to send over and help Ukraine, because I don't know about you all, but I have been feeling so helpless and I am just kind of looking for ways to help. So again, head right to the show notes. We are donating the month of March, whoever signs up on our Patreon, whatever you decide to donate for March is going to go to doctors without borders. And then I am also going to personally match your donation. So thank you ahead of time for that up.

Alyssa Scolari [03:19]:

And then lastly, I wanted to thank everybody. We've got another review on the podcast. Well, a few other reviews across different platforms. I know there was one that was up on Spotify and there was another one on Apple Podcasts and I'm really excited. These reviews help so much. They help move the podcast up in the rankings. And when your podcast moves up in the rankings, it then becomes more available to people. People are more likely to see it pop up on recommendations for them if they happen to be Googling something or searching for something. And the goal is really to give people the chance to have free access to some type of mental health education and support. So your reviews go such a long way in supporting this podcast even more than the Patreon. Although the Patreon is so helpful too, because this podcast does cost quite a bit of money. There's a lot of funds that go into it.

Alyssa Scolari [04:20]:

So the Patreon is so helpful as well. And I just appreciate all of the support from all of you. So if you are able to sign up to become a patron, that's fantastic. And if not, no worries. If you're able to leave a review, that is also amazing. And also remember that if you haven't given us a follow on Instagram yet, please go follow us. The Instagram handle is Light After Trauma. And I also should mention that if you do decide to become a Patreon member, you can also request specific episode topics. So if there's something that I haven't talked about yet, that you would really like me to discuss, if you're a Patreon member, you absolutely can message me through Patreon and you can request specific topics. So I think that covers it for the housekeeping things.

Alyssa Scolari [05:13]:

So without further ado, let's get into it. So as I was saying before, in order to do the trauma work, if you are considering starting therapy, or maybe you have tried to do the trauma work before, and it just hasn't worked out, it has been too painful or too overwhelming for you, or maybe that's not the case. Maybe you're like, no, I can't even think about starting the trauma work and I wouldn't even know where to begin. I think that this is going to be really helpful for you. It was really helpful for me and it continues to be helpful for me as I understand really what I need in my life to be able to process certain events, or memories, or specific traumas. So you need a certain level of safety. And when I say safety, I'm talking about really two main types of things.

Alyssa Scolari [06:13]:

You need emotional safety, but you also need physical safety. And I'm going to talk a little bit more about each of those. So let's start with physical safety. I learned, and I'm sure anybody who has ever studied any kind of psychology, has learned about something called Maslow's Hierarchy of Needs. And one thing at the top of this pyramid, basically what Maslow's Hierarchy of Needs is, and don't quote me on this directly because it's been a little bit of time since undergrad. But basically it is this hierarchy of needs, it's this pyramid of things that you need in your life in order to have a sense of safety and in order to reach a sense of happiness and contentment in your life.

Alyssa Scolari [07:03]:

And one of the first things is physical safety and a sense of security. And I'm talking like you're very, very basic stuff. So like all the way at the bottom of Maslow's pyramid is like, you're psychological needs. We're talking food, we are talking water, we are talking shelter, things like that. We need those things in order to do anything in life.

Alyssa Scolari [07:33]:

If you are struggling with what you are going to eat, if you don't have enough money to pay for food, if you can't pay your bills, if you have credit card debt, if you are about to be kicked out, if you're about to be evicted from your home, you can't do the trauma work safely when your physical needs aren't being met. And so many people, millions of people around this world can't do the trauma work because that is the type of environment that they are living in. They are living paycheck to paycheck, if that, they are barely able to make ends meet, every single minute is a struggle or a stressor of thinking, what am I going to do next? What are we going to eat tonight? How am I going to feed, I don't know myself, my kids? And it's how am I going to pay for the doctors? Things like that.

Alyssa Scolari [08:36]:

I can't go to the doctors because I don't have insurance because I can't afford insurance. I can't go get my cavity taken care of. So I am in constant pain all of the time, because I can't afford a dentist. It's really bad in the United States when it comes to healthcare. Really bad. I know like in Germany, Germany and other countries, it's a lot easier to have affordable healthcare. In the United States, it is nearly impossible unless you have a job where you are given good insurance. And even then, it can be expensive depending on your deductibles and things like that. But when people are struggling just to live, just to breathe and feed themselves, when people don't have access to clean water, they can't do the trauma work. When people can't get to a doctor, but are experiencing excruciating pain, they can't do the trauma work. Not because there's anything wrong with them. God, no, that's not it at all, but because it's not safe.

Alyssa Scolari [09:57]:

And why is it not safe? Well, because trauma work takes so much of you and it requires you to live in your body, to work towards living in your body when the trauma that we've experienced causes us to want to disassociate and leave our bodies. It's really, really hard to just live in a body and to revisit all of our past memories and to try to integrate them with who we are now, when we don't really have a ton of protective factors. It's not like we can say, well, I was really traumatized back then, but right now, I'm safe because you're not. If you're somebody who's struggling and living paycheck to paycheck, that's not a sense of safety and security.

Alyssa Scolari [10:55]:

So you're already in a state where you are being traumatized by your situation in the present, or what's happening to you is re-traumatizing you from things you dealt with in the past. So if you're already in a state of not feeling safe to then go back and rehash all those memories and to ask you to be present and not dissociate would be a complete override of your system. It would just be so ... It wouldn't be right. It wouldn't be fair for anybody to ask you to do that, but it also just wouldn't be safe for people to do that.

Alyssa Scolari [11:36]:

I also see this a lot in people who repress their trauma and who don't ... They really don't remember their trauma. They don't remember what happened to them. I am one of those people for those of you who are new and don't really know my story. I am somebody who has repressed my trauma. I did not know anything for years. If you had asked me 10 years ago, if I thought that I had trauma, I would've been like, absolutely not. I don't really even know what that is. Are you out of your mind? And then what happened is I got married and this event happened and it was a horrible event. And I don't think I've talked about it on the podcast. And I will talk about it one day soon. I've just honestly still been processing the fallout from it myself. So I will talk about it soon, but this horrible event happened that started to trigger all of these memories in me.

Alyssa Scolari [12:36]:

And it wasn't just that event that caused me to remember. It wasn't just that horrible event. But I also had established a sense of safety. Before I had gotten married, I was so, so stressed out. I was in grad school. I was making such little money. I was in a job that was extremely dangerous. I was not well taken care of by my supervisors at all. They did not care. They were asking me to go into people's homes, to deal people who were very dangerous. They were asking me to go in completely alone. I was working all the time and I also was really, really sick physically. I was very sick physically. I had absolutely no space to do the trauma work.

Alyssa Scolari [13:32]:

And really my whole life, I was so sick with my eating disorder. Plus I also had been around people who were extremely unsafe for me. So I was not going to be able to remember what happened to me. I wasn't going to be able to process my trauma. If you are a child and you are living with a household member who is abusive, it's going to be really hard for you to acknowledge that that person is abusive because you still have to live with them. So it's not like you can go to a therapist and say, "Hey, I think I'm being abused." I mean, listen, you can. There people who do, I certainly have had plenty of children in my office who have said, "I think I'm being abused."

Alyssa Scolari [14:23]:

But sometimes our brains repress, our brains push things down and don't let us even know or acknowledge that we are being abused because it wouldn't be safe for us. In order to really do the trauma work, it's really important for you to be in an environment in which you are not having to stress about your physical needs, meaning you're not having to worry about somebody abusing you, you're not having to worry about how you're going to get your next meal, or you're not worried about the quality of your water, things like that. Not worried about being kicked out of your home. Those are things that are essential.

Alyssa Scolari [15:07]:

So here's the other thing that's needed, and that's emotional safety. And that can be kind of tricky because this isn't to say that all of your emotional problems need to go away before you do the trauma work. That would be absolutely ridiculous. But what this really means is that it's very hard to do deep trauma work if you are battling with an addiction that is hindering your ability to function in life. It's very hard to do the trauma work if you are struggling with an eating disorder. If you are malnourished, or if you are binge eating, or purging to the point where it's consuming your life, you're not going to have space to do the trauma work. If you are self-harming, it's going to be really hard to do the trauma work because ... In a sense of safety, but it's more of an emotional sense of safety.

Alyssa Scolari [16:09]:

It will be really hard to keep yourself safe if you are harming yourself or you are sick with an eating disorder. We can't expect that you're then going to walk into a therapist's office while you're sick with, let's say, an eating disorder and then start talking about your deepest traumatic memories. Or start processing all the emotions that have come up through your childhood trauma. It just wouldn't be safe because so many of our addictions and our self-harm strategies, including eating disorders are designed to sort of keep that trauma suppressed. So what tends to happen if we are trying to work through trauma before getting any kind of grip on self-harm, suicidality, eating disorders, addiction is that we talk about our trauma and then that causes our self-harm or our eating disorders to increase. And we tend to turn to these things even more because don't have the proper tools that we need to learn what to do with the feelings that come up when we're doing the trauma work.

Alyssa Scolari [17:21]:

So again, it's not realistic to expect that if you're struggling with an eating disorder, or if you struggle with self-harm, it's not realistic to expect that you are never going to have urges to self-harm. No, there were plenty of times that I had urges to self-harm and times where I even did self-harm throughout my trauma recovery. But I do know that there was a time in my therapy process where I was pushed very inappropriately so to dive into memories that I should not have been diving into because A, you really don't need to rehash the details of your trauma in order to heal. And that's a topic for another episode. But B, I was not safe enough. I was self-harming a lot. And I was essentially persuaded or coerced into going through the intimate details of many of my traumatic memories during this time. And it landed me in the hospital ultimately.

Alyssa Scolari [18:44]:

It was horrible and I became worse and worse and worse. And I realize now how damaging that was for me, because I didn't have the tools to be able to take good care of myself. What I needed was help on the self-harm first. And once I got help with that, and once I stopped doing that, I was able to then go back and work through a lot of my old trauma in a much safer setting. Again, that is not to say that the urges to self-harm didn't come up. Same thing with my eating disorder. I really needed to take care of my eating disorder, which I did. I, first was in treatment for an eating disorder before I knew anything about trauma. So I was taking care of that and I continued to take care of that even once I knew I had trauma.

Alyssa Scolari [19:43]:

That way, while I was working through the trauma, I didn't dive right back into my eating disorder to the point where I got so sick that it nearly killed me. Of course there were times where I would have a really rough day at therapy and I would binge, and it was a learning experience. But it wasn't something that was happening all the time. And my symptoms continued to improve instead of worsen. Let's say that you get your eating disorder under control or the self-harm under control, and you start the trauma therapy process. And then all of a sudden, you find yourself right back into your eating disorder in the same severity as before, or maybe even worse. That might be a sign that you might not be ready to address this part of your recovery, or maybe this specific memory, or maybe you just need a little bit more work in terms of your eating disorder.

Alyssa Scolari [20:46]:

I can't say for sure, obviously. I'm not you. But I am just trying to give examples of the different ways in which safety, both physical and emotional, can be really important in this role. I make sure to ask all of my clients about their safety habits. I make sure before we do any kind of trauma processing that I know that they have a sense of safety, both physical and emotional. I would never, in a million years ask somebody who has come to me, who has been self-harming to relive traumatic memories. It would be a horrible thing to do, and it was done to me, and it is a horrible, horrible feeling.

Alyssa Scolari [21:38]:

So I hope that this is helpful because a lot of you really have asked me a lot about this. And I also just want to say that when it comes to treatment, one size doesn't fit all. Some people can do both. Some people certainly can. I think it's rarer, but I'm a never say never kind of woman. So I do think that perhaps it can be done, but I also think that I have talked with so many people who have tried to do the trauma work, but then have said things like it was just too bad and I almost lost my life. And I tried to commit suicide or complete suicide, I should say. Just as a little FYI and the reason I'm not taking this out in editing is because I think that language is really important when we talk about suicide. And when we use the word commit, it makes it sound like people did something horrible, like they committed a crime. But when we say complete suicide, I think it takes a lot of the stigma away from it. So that's why I corrected myself there.

Alyssa Scolari [22:47]:

So anyway, I've had people say, "I tried to complete suicide when I started to go through the trauma work." And I think one of the first questions that I always ask people when they tell me that is like, well, tell me about your environment. Tell me about your sense of safety. Are you doing okay? Are you well fed? Are you well nourished? Are you living in a safe home? Do you have good shelter? Do you have people in your life who you can talk to? Who can support you? Who are safe people that you can trust? Do you have some sort of financial stability? Are you struggling with an eating disorder, with self-harm, with addiction? Because these are all things that need to be worked on in order for the safety to be there in trauma work.

Alyssa Scolari [23:40]:

And sometimes this is why people go up to inpatient. People feel like they can't keep themselves safe and they go up to inpatient and they help get themselves stabilized. And then they come back out to outpatient and then they do the trauma work. Again, not a one size fits all, but I do think it's really important to know that there are huge steps to try to take before you do the trauma work, and it can potentially be unsafe to just dive right in. With that being said, I want you all to dive in. This is what we do here. These are the things we talk about. So take those steps, do what you have to do. Not to say that everything is in your control. Financial stability is really hard to come by in this country right now. And the prices just keep rising and rising and rising. And my heart is shattered for all of us.

Alyssa Scolari [24:41]:

So it is not the easiest thing to do and it is not always in our control. And I do want to acknowledge that. But these ultimately are the important things to be able to start doing some sort of trauma work. And at the end of the day, if you're hearing this and you're feeling like something resonates with you and you're like, oh, maybe I'm not quite ready. If you have a therapist, please talk to your therapist about it because your therapist is going to know way better than I do. I'm not your therapist. I'm a therapist. I've got a good bit of knowledge on this subject, but ultimately nobody knows you better than you. And if you have a great therapist and you've been with your therapist for a while, there's a good chance that you're a therapist is going to know too.

Alyssa Scolari [25:29]:

So don't be afraid to start asking questions about this kind of stuff and make sure that you're keeping it in the back of your mind, because this work is really hard. It's some of the hardest work that you'll ever do. It's, of course, the most rewarding work that you'll ever do, but safety is so important. So with that being said, I hope that this has helped you today. I like this. I think it's a really interesting topic to talk about. And I know a lot of you have been asking about it. So I hope that this is helpful and I wish everybody a fantastic week. I am over here on the East Coast in the United States. And we got slammed with snow today, which was a little ridiculous in my opinion. But hey, it is what it is. So I hope that you all are enjoying warmer weather than what I'm having. And I am holding you all in the light. Talk to you next week.

Alyssa Scolari [26:28]:

Thanks for listening everyone. For more information, please head over to lightaftertrauma.com or you can also follow us on social media. On Instagram, we are at lightaftertrauma and on Twitter, it is at lightafterpod. Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over. Again, that's patreon.com/lightaftertrauma. Thank you and we appreciate your support. [singing]