A Novel Approach in Understanding Trauma Treatment

By Leslie Gura, LCMHC, NCC

In summer 2021, two years into my late-in-life swerve to a clinical mental health counseling career, I found myself at a crossroads.

My head was crammed with ideas after three years of school, two years of an intense residency program and a year of fellowship and continuing education focused on trauma. The problem?

I didn’t know how to conceptualize everything in my head for the many clients coming to see me with trauma or attachment issues, or in the case of most, both.

From Journalist to Counselor

I came to counseling late in life, having spent nearly three decades in journalism as a writer and editor, with a specialty in narrative storytelling. When journalism left me behind in 2011, I drifted into marketing and communications but did not find it spiritually satisfying, so I began to explore other career options. My years of experience in a 12-step program, including multifaceted service work, led me toward counseling. And in my very first course, Theories of Counseling, I learned about the narrative orientation, a natural link to my life as a writer and editor.

As a lifelong writer, I was used to asking questions and getting people to open up to tell stories on a macro level for the public. In the counseling room, I put many of my narrative writing techniques to use in a new way — by discerning a story on a micro level, I could help clients grow.

Identifying a person’s dominant narrative — the issue that brings them into therapy — is a key step in narrative therapy espoused by founder Michael White. The goal, once identified, is working with clients to recognize alternative, or preferred, narratives in their lives. Once the preferred narrative has been identified, the client begins learning ways to move away from the dominant narrative and toward the preferred. The work can be slow and incremental, but many clients instinctively see the preferred narrative as something to strive for. It offers them hope.

Trauma treatment was different, though. Trauma and deep-seated attachment issues, often the result of adverse childhood experiences, result in the type of negative self-beliefs that make for a formidable roadblock to change.

The Difficulties of Trauma Treatment

All the training I’d received in trauma, in particular Dr. Bessel van der Kolk’s work about the brain-body connection discussed in his seminal book, The Body Keeps the Score, resonated deeply for me.

I could see immediate small improvements in clients who used simple resiliency techniques when they were able to notice signs of sensorimotor signals of anxiety in their body. Similarly, I found eye movement desensitization and reprocessing therapy was an effective tool for some clients with trauma, depression or anxiety.

But as a narrative therapist, I felt disconnected from clients. I felt like I was trying various unconnected strategies with clients who had deep, painful traumas.

One day, as I pondered this potential flaw in my work — an inability to help ease the present-day symptoms of people with such trauma — I imagined a client who might be filled with multiple traumas and attachment issues. I did what my lifelong instincts told me to do.

I started to write.

Using the Written Word to Conceptualize Treatment

Nine months later, I’d finished Unwrapping: A Novel About Generational Trauma. While writing the book, I learned I could combine different therapeutic techniques — narrative, sensorimotor psychotherapy and cognitive behavioral — in working with clients.

The novel reflects a type of cat-and-mouse interplay over the course of eight therapy sessions between a troubled young woman and a baseball player-turned-counselor. There is not a single element in Unwrapping that steals from or mimics any client I’ve seen. There are, however, several therapeutic interventions in Unwrapping that mirror my work with clients. For example, the book includes narrative questioning techniques, resiliency methodologies and trauma-based treatments to restore power and connection in the present day.

Much as in a therapy room in real life, I let the fictional counselor and client play out their work and discover dominant and preferred narratives and a desire for change.

I had reasons for writing Unwrapping besides my own need to conceptualize trauma treatment. I wanted the book to be a window into the world of therapy, to help destigmatize a profession that many people don’t understand or, even worse, fear. And I wanted to demonstrate the hope that talk therapy can represent — at its core, counseling is about the connection people often don’t have or don’t realize is available to them.

Ultimately, I succeeded in meeting my own need to conceptualize trauma treatment because writing Unwrapping showed me this work is truly integrative in nature, rather than resolvable with one approach. And maybe that was the key to my struggles at the start with trauma treatment. As a therapist, I needed to open my mind to integrating different therapeutic approaches for clients with complex problems.

In the end, regardless of the techniques used, new narratives are always possible.

Note: Opinions expressed and statements made in this blog do not necessarily represent the policies or opinions of ACA and its editors.