Frozen Personalities: Why Talk Therapy Needs More Than Talk

The time-honored treatment for psychological trauma is to uncover the wound, then gently expose it to the light. The “infection” must be drained, ever so slowly. Healing should follow.

Perhaps. Yet this method is rather like digging a hole, uncovering a buried skeleton, and raising it to earth. No revival is guaranteed. The bones still need to be fleshed out. The heart must beat. The creature needs to walk — away. Otherwise, the perimeter of the territory around the hole circumscribes the rest of his life. As the blunt, sometimes too impatient saying goes, you must “move on” — away from the place you’ve been stuck.

Movement is the key.

The patient will survive, but must live for the first time. Psychiatrist Bessel van der Kolk describes the brain dysfunction produced by trauma: the victim is both more prone to agitation and less able to distinguish what is happening in the moment. Despite the chronological distance from injury, one’s life remains organized as if the danger were still present. Imagine an army after the war is over, forever in “stress mobilization” mode, ready for the next onslaught. The brain and body sense the world through the old, cracked lens of an ancient injury. Thus, rewiring the brain is now thought to be an essential treatment element for Post Traumatic Stress Disorder (PTSD).

The patient must become alive to the present. A number of methods might accomplish this, though research on how best to produce brain changes is in its infancy. Among the approaches suggested are neurofeedback, mindfulness meditation, yoga, and group theatrical or musical performance. These techniques engage the body, where so much of the damage is “felt,” almost as if it were written on the skin. Little is proven, but the field of recovery from trauma is buzzing with discussion.

In my own practice I treated those who took flight once the hurt wing was mended — and those for whom there was no bottom to the hole they had fallen into — pushed by an unkind hand.

For the latter group, the therapist’s office sometimes serves as both a refuge and a prison. One sees the dual function of the doctor’s consulting room for patients still afraid, wary, and worried. They continue to scan the environment for signs of the next disaster. Their lives are fraught with endless repetitions and imaginings of future grotesque events. The counselor can be like a magnet for them, offering a sometimes too tight embrace. The therapist becomes a metaphorical talisman in such cases, a rabbit’s foot one cannot do without. In effect, the therapy appointment itself is the only safe time in the only safe place; the shrink, the only safe person.

This is not enough. Both the doctor and the patient must recognize the goal is not only to grieve the trauma, but to reclaim a life; or to learn how to live for the first time. The participants in the therapy hour should leave rabbits’ feet to rabbits. They must recognize that, however lifelike, the client has not been living. He has been trapped in self-defeating routines. His life consists of traveling at considerable speed in a circle, always returning to the same place. Adventure, imagination, and joyful relationships are absent. The patient lives in his traumatized past or a fearful future, but not in the moment. Lacking the resilience to take on an imperfect world, he ventures nowhere.

Yes, you must talk about what happened. Yes, you must understand what happened. Yes, you must grieve what happened. But life, not an imitation, requires movement, change, and repeated abandonment of old ways for new ones. The therapist and her office, taken together, are like a stepping stone on your trip into the rough stream of remembrance: a place to land, but not a stopping place.

Nor is the shore the goal. The truth is, one never lands in a completely safe spot. Good therapy simply helps one become a better navigator in today’s waters, not yesterday’s or tomorrow’s.

You are safer not because of the place or the doctor, but because of yourself: newly designed, rewired, and outfitted, ready for the wind to catch your sails — ready for adventure even without the wind.

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The top image is called, Mr. Seafall’s Talk Button, by Mr. Seafall. The second photo is a Naval Ship of Brazil by the Brazilian Navy. Both are sourced from Wikimedia Commons.