Bonus Episode: Lessons From Over 7,000 Trauma Therapy Sessions

Ever wondered what a trauma therapist actually learns after 7,000 sessions? Not the textbook stuff. The stuff that surprises even us.

Like the fact that 90% of what I treat isn't what you'd picture. It's not the big, stereotypical events. It's emotional neglect and emotional abuse. The quiet experiences of feeling rejected, ignored, or unimportant that shape everything, and that the research shows respond remarkably well to treatment.

I also share why the brain's capacity to heal still astonishes me after all these years, why the trauma world has an over-pathologising problem, and the most freeing lesson of all: not everything is that deep.

That's a wrap on Season 1. Thank you for being here. Genuinely.

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Follow Helen: @helenbillows

Transcript

SPEAKER_00 0:02

Hello, I'm Helen Billows, and this is the Trauma Nerd Podcast. I'm a registered psychologist, EMDR therapist, and I work exclusively with trauma. This podcast is for people who want psychologically sound explanations without pop psych shortcuts, toxic positivity, or excuses dressed up as empathy. We'll talk about trauma, responsibility, relationships, and recovery, backed by nuance, honesty, and of course, actual evidence. Let's get into it. Hello and welcome to the Trauma Nerd Podcast bonus episode. Um I think this is episode 12. I meant to only do 11, but like I mentioned last time, I get ideas and then I want to I want to follow through with them. So today is the bonus episode. Now, this one's a little different because I don't really have a script. I just kind of have a few things that I wanted to talk about because I'm just, I want to just talk about what I have learned after 7,000 trauma therapy, over 7,000 trauma therapy sessions. Um I sometimes call it, I sometimes say that I've done uh 7,000 EMDR sessions, which I technically have, or over, like I said, over 7,000. Um but I actually think to say it's only EMDR of selling myself short because the the larger umbrella has been EMDR, but um I have done other there are other therapies that have been incorporated in that. Like I've done um internal family systems, imagery rescripting with schematherapy and schematherapy concepts, ego state therapy. Um I've and the what's it called? DNMS by Shirley Schmidt Needs Meeting Protocol. I can't remember exactly what that stands for, the acronym, but anyways, um all of these different trauma therapies, healing approaches, um, but they've all been within the cot the scope of EMDR and EMDR, the EMDR protocol. Um so I'm gonna share with you today what I have learned in over 7,000 trauma therapy sessions slash EMDR sessions. I don't have a script, I'm just talking. So if it's a bit messy, I apologise. I think so. The first thing I wanted to say is one thing that has struck me through my experience and everything that I've all the people I've worked with, the hundreds of people that I've worked with, possibly approaching a thousand, just over. I don't know. There's been a lot of people. Anyways, that how much your brain wants to heal. So I've seen a lot of medical doctors, a lot of a lot of people in the health um sphere who know what they're talking about, they're qualified. They talk about how much how well our body self-heals. Um in EMDR, we sometimes use the analogy that, you know, if you cut yourself, you don't need to sit there and tell your skin cells and tell your body how to heal the cut. It just does it. Your body just knows what to do. My experience is that EMDR is exactly like that. For some people, it's a little more complicated for different reasons that are for another podcast, because that's a whole topic within itself. But it is entirely possible, and for many people, this is exactly what happens that you will attend an EMDR session to process a traumatic experience, a traumatic memory. And literally all you will do is follow well, sometimes it's fingers, sometimes you'll do tapping, sometimes you'll follow a dot on a screen, whatever your therapist uses. Um and you will follow that dot and you will go through the EMDR protocol. And with very little further intervention, your brain will process that memory. You will then think about it afterwards and go, oh, I don't like it's like it's a bad thing that happened. Like I know that it's a bad thing that happened. It's terrible. I'm I feel very sad that that happened to me, but I don't feel it in my body. I'm not distressed by it. It's it feels like the past is in the past. It will just happen. And I think throughout my career, it's actually shocked me at times. I've truly, I have sat there at times and thought, no, there's no way, no way this person is going, like I'm gonna have to pull out pull out the big guns for this. And then I don't have to do very much at all. Sometimes I do have to do a lot, but once I once we set it up, once, which requires, you know, knowledge and expertise and experience within itself, to know what to do with the MDR, to know what memory to pick, to know how to set it up effectively. And I think the better that you get at that, the more likely it is to go smoothly. So that's probably why I've seen that more as I've progressed through my career. But it truly has astonished me how easily your brain will heal in the right circumstances, given the right conditions. Your brain doesn't need to be told how to heal, it knows what to do. Um, I think it's it's been quite astonishing, quite remarkable at times, and has actually um made me view humanity and the human spirit and our makeup very differently to before I started EMDR. Um because it feels, yeah, I won't go into it too much because it's it that's a little beyond the scope of a psychology podcast, but it kind of makes you think about the bigger picture and why our brains can heal it themselves, especially like when it comes to memory. Um but, anyways, your brain wants to heal. So the next thing that has become very uh actually, and another note there, I love to use the analogy of labor when it comes to EMDR. When I was pregnant with my son, um, I was, I think I can't quite remember. It's funny because when it's happening, you think, how could I forget this? This is gonna be burned in my memory forever. And now it's he's two and I can't remember anything that happened. Um But when I was pregnant, I think I was like 41 and something, 41 weeks and a few days. Like I was approaching, it might have been 40 and something. I don't know, something like that. Um, but it was approaching the point at which I wouldn't be able to give birth at the hospital that I wanted to give birth at because it was, he was gonna be too overdue. They were gonna make me go to the more public hospital in the city, and I just didn't want to go that far from home. So I got induced. Now, I think induction of labor is a really good analogy for how EMDR works because you don't need to tell your body how to have a baby. Your body knows what to do when it comes to growing babies and having babies. Sure, things go wrong, but for the most part, your body knows what to do. Um, when I got induced, my body just needs a little kick start to be able to get things going. But then from there, it knew what to do and it just did it. EMDR, that's an excellent analogy for EMDR. Where something's gone a bit wrong and your body just needs a jump start. We create the conditions, we get it started, but then it knows what to do. We don't need to, once we get it going, it will do it itself. Okay. I really think that is a better analogy than the cut because it implies that we've had some interventions be required, but from there, your body knew what to do. Uh, so the second point I probably should have written more notes about because I might fumble this a bit, but anyways. So I think society's general idea of what is trauma and what isn't trauma is wrong. I would say, so many people are surprised by this, right? I would say 90% of the trauma that I work with and what I help people with is emotional neglect and emotional abuse. Now, people are expecting, I think, that someone like me would predominantly be working with the more obvious character, stereotypical traumatic events: sexual violence, physical abuse, sexual abuse, um, being a victim of a crime, being attacked, having like a horrific accident or something. Those things do come up, absolutely. Um, but it's maybe 15% of what I work with. Overwhelming majority is emotional neglect and emotional abuse. Now, it's really interesting because this people will often come to trauma therapy with a suspicion that their past is involved. And usually they're right. It's not always that deep, but usually if people have a history and they're having trouble now, there's something related there. There's something we can do. So it's often the case, though, that people will come and they'll have some kind of problem. So maybe they have difficulty with people pleasing, maybe they have a they're really mean to themselves in their heads. They're very critical, they're very judging of themselves and they don't know why. Um, maybe they feel very anxious in different situations, maybe they've got a lot of social anxiety or they just really feel not very confident in themselves. There is just so many things that it that can come up that people come help with um that they think is connected to their past. And so much of the time people will go, I like it must be this. It like, and and they'll pick out, pick out things, cherry-pick things from their history um that look bad, but then when we actually investigate, sometimes it has nothing to do with it. So, like, for example, maybe they um their mum forgot to pick them up from school, and they're like, well, I got abandoned. So maybe, but it's the logical brain, right? It's the logical brain trying to create cause and effect intellectual links between the past and the present. It's often incorrect. In EMDR, when we are developing the links, we use the body. We we detect where is the body taking us. Because the mind, the the logical mind doesn't think the same way as the emotional brain does. They operate differently. So, what is a link logically often is not accurate. So when people come in and they they've got these preconceived ideas because they're they're thinking logically and they're using their stereotypes and their prior knowledge to what they think is likely the problem, sometimes they're right, but I find most of the time it's either wrong or not the full story and kind of half right. Um, but we me doing my job properly, right? I will always confirm those links. I will make space for the, you know, because often, you know, people are quite um invested in the link they've established and they're like, they're like, I think this is it. Um we'll check, but I also don't want to waste people's time and go, okay, you figured it out, right? Let's process this memory. Because what if it's wrong? What if it's not the actual problem? So those stereotypical traumas, we call them the capital T traumas. Um, that's sort of it's not non-official language, but it's what the trauma world often used to categorize the more like stereotypical trauma events, the PTSD, the ones we think about when we think PTSD, natural disasters, victim of a crime, like I said before, the big events, the stereotypically big events. Um but like I said, more often than not, it's actually the lowercase T traumas that are a bit quieter, they're smaller, but they're meaningful. They are so, so meaningful. Um I've actually just I've got a study here that I think is really interesting. So that it was um so a hospital, a facility in the Netherlands called CyTrek. Um has they have the group of researchers there, the clinicians that work there and work with that facility have been extremely influential in the trauma world and particularly in the EMDR world. They have just done incredible research that has helped us learn so much. We the MDR community have a lot, um, a lot to be grateful for with this group. They've just done amazing work. So in 2020, they did a study on 97 people who had a diagnosis, a primary diagnosis that they may have had other diagnoses, but their primary diagnosis, like the one that was causing them the most trouble, the most impairing one, was a personality disorder. And about a quarter of those people had been diagnosed with borderline personality disorder. So they were really struggling, suffering. Um, but they excluded anybody who met criteria for PTSD. So these people had personality disorders and like were very unwell, but they did not have PTSD. So they did not, they either didn't have the capital T trauma experiences, or they just they they did not meet criteria for PTSD. So those experiences were not a problem for them, according to this study. After just five sessions of EMDR targeting memories of things like emotional neglect and emotional abuse, so these are the experiences that do not tick the boxes of a formal PTSD diagnosis, they do not fit that characteristic capital T trauma idea. After five sessions of EMDR targeting emotional neglect and emotional abuse, and like I said, with the people I work with, emotional neglect and emotional abuse is the vast majority of what I work on. By far, it's not even close. The therapy worked for this group and their symptoms significantly improved. Okay. So this is a really good illustration that what we often think about as the problem and with the way we stereotypically think about trauma, I think is is not quite right. We underemphasize the the uh incredible importance of emotional neglect and emotional abuse. Um, and we overemphasize other things. Obviously, uh PTSD level events are always bad, but I think we uh I think people look for a problem that isn't there because they're expecting it to be a big event, but more likely it's the smaller ones. So, and just to clarify, those smaller events, just to give some examples, emotional neglect and emotional abuse, this really fits experiences like feeling rejected as a child, feeling ignored, feeling abandoned, being treated in ways that leave you feeling unimportant and worthless. So I think those are that we do not give enough attention to those things. The next point that I've come to learn is that the trauma world, how I would say it, chronically overpathologizes. Now, I am a big like trauma is my world. It is all I do. I'm a trauma therapist, I do trauma therapy, I mostly do EMDR therapy, but I don't like to burrow myself into a hole with that because it doesn't work for everybody, right? Nothing does. EMDR is a fabulous therapy, and I love it. I'm very, very passionate about it. I've really made my career about it, actually. Um, but I'm also realistic and acknowledging it, not not everybody is a good candidate for anything, right? So it's you don't want to hole yourself into one thing. Um, but the trauma world, I think I got to a point in my career where I was looking for trauma to the point where I was creating it in some cases, where I would meet a client and I'd be going, Well, I've got my my binoculars on. Where's the trauma? Let's find it. Let's make it up if it's not there. You know, it's I think I had been trained in a way that everything means something. Everything, you know, oh, you've overreacted. What's it linked to? What happened in your past? The biggest thing I've learned is it's not always that deep. Not everything means something, not everything is about your past. And to assume that everything that's abnormal or everything that you notice and feel and think is related to something in your past is just blatantly incorrect. Um, and gonna drive you crazy because you're gonna start digging into your past and trying to create a problem where there might not be one. Um, not to say that there's not a problem, but it might not be your past that's the problem. And to reduce, it's a very reductionist approach that everything is trauma. It's not true. It's just not true. I've learned that very clearly through my work. Some people come for trauma therapy because they've they've had this narrative that everything means something and everything is about your past and everything is about trauma. It's not true. Some of the things that go wrong for you, some of your symptoms, some of your problems, the things that you've had difficulty with, the things that you want to be different, they they're problems, but they're not necessarily about trauma. They can be about, well, there are so many things that can cause a problem. So I think this is something that the wellness space, social media is terrible. Everything means something. What does it mean? Let's find the problem. Um, it's just not always that deep. Sometimes it is, of course. I would not have a job if it wasn't sometimes. But I don't make assumptions. I want the truth. I want to find the truth. Because if we assume that your past is the problem and we are, we have an agenda and we're fixated on that as our as our target and it's not there, what a waste of your time and what a what a spirally kind of thought process we're engaging in there, where we're trying to force a problem where there isn't one and actually ignoring and not even looking elsewhere to actually try to solve the problem. So, trauma world over pathologizes. Um the last point that I have here is the limited number of ways. Another thing that I've learned, the limited number of ways that things can go wrong, I find this fascinating. When it comes to trauma, it's it's it's sort of it's so fascinating because it's this um dialectic, like we say in dialectical behavior therapy, which has a really bad reputation, but I don't mind it. Um there's this dialectic, this irony about trauma that it is both exceptionally complex but also astonishingly simple. Um it's hard to explain, but there are a limited number of ways that things can go wrong in your brain, which I find really fascinating. There's a pattern to it. There are there's pattern to it, there is a structure to how your brain how things get stark. And that's why we are able in trauma-focused therapies, and you know, I'm speaking, I'm gonna speak to EMDR specifically because it's where most of my education experiences. Um, in EMDR, when I'm when I'm assessing somebody, because of the structure and because of what we understand and the way we've been able to organize the patterns and the nature in which trauma occurs in people, when someone tells me their story, I can figure out where things have gone wrong within an hour or two. And to a pretty for not everybody, obviously, if somebody's got a super complex story and it's really convoluted and low everywhere, um, it might take longer, but I think the average, I can figure it out pretty quickly. And it's not because I'm a genius, it's because there is a pattern to things and there's a pattern to how things go wrong. There is a structure, there is an architecture to how trauma occurs and how it's healed. It's predictable, it occurs in the same way every time. Every single time, there is a general structure to the way that your brain processes a memory to the point where it is highly predictable and to the point where I can detect a problem with processing within a minute of it happening because it's not following the structure that it should. So make of that what you will, but I'm sure you'll understand now why I'm a bit like, what does this mean? I don't know. I I get a little bit bigger picture about it almost because I'm like, this is quite remarkable that our brain is so highly structured and can do this. The problem occurs in a structured way, and the healing occurs in a structured way, and it's all malleable and workable. It's quite incredible. So I'm humbled. I'm constantly humbled. Every session I have of EMDR, I sit there like this is just this feels like a miracle every time, every time I do it. Um, it's not though, it's scientific, it's all in the research. I'm not doing anything that the research haven't found, researchers haven't found, but it's just, it feels it's sort of like witnessing childbirth. It happens every second of every day. Babies are born, but it never ceases to be less miraculous and less incredible when you witness it. You feel humbled witnessing it. I feel like that a little bit in my EMDR sessions, you know, that you're witnessing this amazing thing that the body can do very naturally. So I think that's it for my bonus episode. I hope, hope you found it interesting. Um, this is the end of my first season. Thank you so much if you've listened. It just means so much to me. Um, I've got some really exciting stuff coming. I've got some other projects uh in tow. So uh subscribe, subscribe to the mailing list so you get updates. And I think I'll leave you there. And I will talk to you soon. That's it for today's episode of the Trauma Nerd Podcast. If you felt validated, yay! If you felt challenged, double yay. If you found this useful, you can follow or subscribe wherever you listen to podcasts. If you're interested in trauma focused therapy or resources, you can find more information at my website. Thanks for listening and bye for now.