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How can I update trauma memories when the worst did happen?

Understanding the very personal meanings of trauma memories, and trying to update any misappraisals, can help ameliorate strong negative beliefs about traumatic events.

However, in many cases, something really awful did happen, and it would be inauthentic and unhelpful to pretend otherwise. For example, a loved one may have died or a client’s worst fear may have come true e.g. “They are going to rape me” or “I’m going to lose my legs”.

With these examples, we cannot always update a trauma with ‘the worst didn’t happen’, so instead we explore the different layers of meaning associated both with the event, and with the fact that the worst did actually happen.

For example, it may be true that a loved one has died. Yet, the most painful underlying meaning may be something different e.g. “I’m to blame for their death” or “they died in pain”. These additional meanings may be inaccurate and, as they are contributing to someone’s distress, we can still update them.

If the distressing meaning associated with a memory appears accurate, it’s still always worth asking ‘and what’s the worst thing about that for you?’ to explore any additional layers of meaning. And, in almost all cases, meanings can be updated by including the information that the trauma is now in the past, and the danger or suffering is over.

Sometimes, we need to help our clients accept the implications of a terrible event or the uncertainty of not knowing an outcome. For example, Gunam’s brother went missing, presumably captured by the authorities because he had protested for Tamil rights in Sri Lanka. Gunam was similarly at risk and managed to escape but frequently had nightmares where he was in his brother’s situation, either dead or being held in prison, where he was likely to be tortured.

Gunam never found out what had actually happened to his brother, so the focus in treatment became how he could move forward with his life, while living with this uncertainty. He found it helpful to put himself in his brother’s shoes – if he was in prison or had been killed, what would he want for Gunam? He realised he would want him to take the opportunity of freedom to have a good life.

We also worked on the guilt that Gunam felt about leaving Sri Lanka, helped him to stop dwelling on or imagining what might be happening to his brother (on the basis that it didn’t help his brother, and only made Gunam feel worse), and supported him to build a life in the UK.

We then worked on the memories of his own escape, ‘tagging’ the constructed images of being tortured himself as having their source in his fears and things he’d seen in the news. We updated them with the information that they hadn’t happened to him, then using imagery manipulation techniques to ‘shatter’ the images into tiny pieces as a way of taking away their power.

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