Supporting someone after trauma

I get asked this question from time to time, often by distressed family members after something terrible has happened to someone they care about, occasionally by concerned mental health staff wanting to better support some of the people they see in their work. It’s quite heartbreaking to witness someone’s anguish in the aftermath of trauma and one of the most common responses we have is to feel terribly helpless.

That feeling is based on the reality that we cannot change that something awful has happened. We cannot reduce the losses, take away the pain, or suffer it on their behalf. We are limited in what we can do. But we are not actually helpless. Research and experience shows over and over again that many traumatised people are equally, or even more, traumatised and distressed by the way other people react to them than they are by the original trauma. One of the most powerful examples of this I’ve come across is in Victor Frankl’s Man’s Search for Meaning. People who had survived the Nazi camps and were at last free were devastated to have so many people in their community react indifferently to their suffering. Many people’s attitude was one of denial, along the lines of ‘so what, we’ve been in a war too you know’. People who had been holding on, craving freedom and ecstatic to get out of their horrific circumstances were crushed by these attitudes.

How we respond to and support someone after trauma can have a profound impact on their lives. When I have been in serious trouble, reaching someone on Lifeline who speaks kindly to me, or having someone in my life who makes time to listen compassionately to me has helped keep my heart safe. So one of the most important things you can do when supporting someone, is to make room for that feeling of helplessness. Accept it, ignore it, and don’t let it drive you into discouragement or into trying to ‘fix’ them.

What a traumatised person has lost is their control. Whatever it is that happened, they were not able to prevent it. They might have been able to escape, to fight, to react well, to protect themselves, but they couldn’t stop the situation happening in the first place -whether it was a flood, assault, or car accident. The more they were able to maintain some control in the situation, often the less challenging their recovery will be. To be made to feel utterly helpless and completely vulnerable has a profound impact on people’s sense of being in control of their own lives. Most traumatised people are very sensitive to issues around control, whether they are hypersensitive to losing it even in the smallest of ways, or whether they have collapsed into defeat and cannot summon the hope to direct any aspect of their lives.

Sensitivity to this area is really important, especially because in our zeal to help and protect someone, it is really easy to accidentally disempower them even further. We may be furious at someone who has hurt them, and insist that they take the matter to court – taking away their choice. We may start to determine what they can and can’t do, what might be too risky. It is very common for victims of sexual assault to be put under tremendous pressure to see a counsellor, by worried friends and family who do not understand that this pressure is part of the problem. Supporting the person to regain a sense of being in some control in their own lives is really important. It will help if you ask them what they want and explore options with them. It will help if you share your opinion and perspective but do not try to impose it. It will help if you continue to treat them as if they are capable of running their own life – even if you are worried about them. You cannot know the best recovery path for them. Wherever possible control should be restored to the person.

Safety is another critical area that traumatised people often struggle with. This issue is twofold – actually doing whatever needs to happen to make sure the person is safe, and also trying to support the process of regaining a sense of safety emotionally. Badly traumatised people can carry this feeling of not being safe into all areas of their lives. This can be really frustrating for you to watch, it’s easy to see how irrational some of these fears are – but the problem is that the traumatised person usually already knows this and feels stressed and humiliated by it. A good rule of thumb is that whatever can be adapted to easily, just do it. As quickly as you can support them to regain some sense of safety somewhere in their lives will help to settle the intense anxiety and the irrational fears.

It’s very important to try and be a safe person for them to be around. This doesn’t mean always getting it right – that is completely impossible. What it does mean is accepting that sometimes you will get it completely wrong – and being okay with acknowledging that. So if they say ‘It’s really not helpful when you do x’, you can go ‘sure, I’ll stop’ instead of launching into 300 brilliant reasons why you thought x was a good thing to do and why any sane person would have appreciated it. It’s also helpful to keep in mind that sometimes there is no right answer. The person is just stressed out and overwhelmed and not coping, and anything you do will be wrong. Don’t sign up for abuse about this, but don’t rake yourself over the coals for it either. As the stress and intensity settle down this should be less of an issue.

Another big part of being a safe person is not putting pressure on them to recover. Victims of assault for example, may find their partners deeply frustrated with their changed needs, feelings and behaviour, and constantly asking when they are going to be ‘back to normal’. Other people desperately need to move on and feel normal again and are under pressure from well meaning friends to open up and talk about it all. This brings me to the next critical area:

People who have been traumatised often express intense ambivalence. There are many double binds where they feel conflicting needs very strongly such as I want to talk about/I never want to talk about it. It can be very difficult to find a balance between the need to honour the events of the past, to speak about it, feel heard and validated, and have it recognised; and the need to escape it, to move on from it, to connect to the present moment and plan for the future. Different people have different needs and gravitate towards or away from their trauma at different times. Often from outside, we can perceive the lack of balance in their response. We are concerned by obsessive reliving of the event, or anxious about their intense avoidance of it. We can try to intervene and restore balance by pulling the person back in the other direction, but often this is merely perceived as an attempt to control. I would recommend instead trying to support the person and trust their own instincts about what they need and when they need it. When they have met one need, they will naturally swing towards the other. No one goes through this on some kind of ‘perfect’ arc, struggling to process trauma in an unbalanced way is the norm. Over time and with work and love, these things settle down. Be guided by their instincts, and never, ever forget, just how powerful it is to feel heard. When all else fails, or if you’re not sure what to do, your default stance is to listen compassionately. Sometimes the less you say or try to do, the less you fix, rescue, hover and fret, and the more you just hear the person, the better.

Another really important area around balance is to be aware of the changes that trauma makes to your relationship. It can temporarily shift you both into a carer/caree dynamic. This kind of dynamic is very powerful, to set aside your needs and make sacrifices to support and nurture another person is an incredible demonstration of love. But the unbalanced nature of this relationship, where you give care and they need care, can also cause problems. Healthy relationships are very fluid, there is a constant exchange of roles between who listens and talks, who sacrifices, who nurtures, who protects, who advises. This mutuality is a key to trust, respect, and mutual contentment. The carer dynamic can undermine that. I advise you to wear the roles lightly. Look for opportunities to share your vulnerabilities too, to allow them to support you as they are able to. If you can remember that the person is far more than their trauma, you will help them to remember that also. The natural response of relationships to trauma and intensity is to polarise into opposite, rigid roles. This is stifling and destructive, so be aware of it and encourage natural growth back towards mutuality.

Looking after yourself
Lastly, it is really important to recognise that when someone you care about is hurt, you are hurt too. You also need care and support and to take care of yourself. You may find yourself feeding off their anxiety and dissociation, feeling chronically irritable, frustrated, or depressed. Debriefing can be very helpful – if the person you care about is sharing deeply personal information with you, you can become very stressed by the need to keep secret things that are really upsetting you. In this instance confidential counselling of some kind can be really helpful. A sense of humor can also help to reduce the impact of trauma, breaking tension and relieving stress. Sometimes there is nothing better in the world someone can offer me than to come round and watch some Monty Python. 🙂

I hope there’s a few suggestions in there that are useful to you. In a nutshell I would suggest that you listen a lot, be guided by what they ask for and want, and hang in there. Research consistently shows that social support is one of the biggest factors in how resilient people are to the effects of trauma. Your care and sensitivity can make a tremendous difference.

To see these ideas in action in a personal case study, please read 5 hours after an an assault.

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