Baker’s Dozen of Things Not to Do with Traumatized Clients

Your clients with trauma have likely been told throughout their lives that their traumatic experiences did not happen, that their emotional responses are dramatic and unfounded, that the problem is how they are thinking about what happened to them, and that their misery comes from their inability to forget and move along.  It is easy to lose track of the important role that therapeutic validation can serve in the healing process.  You may be the only person who has ever heard the client.

You should avoid using your relationship equity with your clients in ways that force them into a double bind.   A double bind is any situation where clients feel cornered and lose regardless of the choice that they make.  Before you do or say anything, you should always go out of your way to align on the side of your client.  Make sure that comments like these never come out of your mouth in session (my clients have reported that previous therapists have said many of these):

• “Well, what you have told me isn’t really that bad… I hear much worse all the time.” [This is incredibly dismissive of your client’s experience.  Trauma is relative.  Listen to the client, don’t overlay your judgments about what types of trauma are legitimate and which are not.]
• “You should not feel that way.”  [Never tell a client how he should feel. Accept the legitimacy of how your traumatized clients feel in response to the things that have happened.]
• Issuing ultimatums related to maladaptive coping mechanisms, such as: “If you cut yourself again, I’m going to discharge you;” “I can’t keep seeing you if you keep sleeping with men you hardly know;” “I can’t work with you if you continue to melt down so loudly in my office.” [Yes, you may need to refer clients with severe alcohol or drug problems to treatment and offer to resume therapy after or concurrently.  In general, you should go out of your way to avoid threats of abandonment.  Threatening abandonment is what abusers do and is inherently a double bind.]
• “What’s in the past is in the past, there is nothing you can do now to change it, except to accept it and move on.” [This is incredibly dismissive of their experience. They are experiencing the problem in the present.  It’s not a problem of simple acceptance.]
• Anything related to “forgiveness” of the abuser. [Align with the client, not the abuser. Don’t promote spiritual bypass.]
• “Well, I know that you have faith and at least you can know that your [mother/child/grandparent] is in heaven looking down on you.” [Don’t promote spiritual bypass. Grief is a process that we walk through.]
• “I cannot help you if you do not tell me what happened to you.” [Do not force clients to disclose anything traumatic to you.  You can address progress in therapy in other ways.  Good therapists do not put clients in that type of double bind.]
• “He probably hurt you because someone hurt him.” [Do not try to promote understanding trauma from the perspective of the abuser. This minimizes and discounts the client’s experience.  Don’t attempt to explain or contextualize away the horror of what happened.]
• “Anyone who hurts a child is a monster and deserves to be shot.” [Just don’t… even if it is what you strongly believe morally and politically. You can think it, but do not say it.  If the client says this, fine.  And, of course, you should find ways to align with your client that do not actively promote slaughter.]
• “Your mom did the best she could. I’m sure if she had known for certain what your father was doing to you, she would have left him.”  [You are aligning against the client’s experience.  Do not tell the client how she should feel about her mother or anyone else.]
• “I don’t know how you can have a relationship with your mother now, because of all the pain she caused you in your childhood.” [Do not tell the client how she should feel about her mother or anyone else.  Do not promote estrangement from the client’s support system or family.]
• “That’s the most horrible and disgusting thing I have ever, ever, heard. I feel sick.”  [Do not reflect your somatic revulsions back onto the client.  It is fine to show your client that his experiences have triggered emotions inside you.  Just make sure that what you are communicating to the client is promoting empathy, closeness, understanding… not distance and disgust.]
• “I believe that everything happens for a reason.” [Are you sure?  Childhood sexual trauma happens for a reason?  Believe this on your own time.  Instead, listen to your client.  Don’t moralize, dismiss, bypass, or minimize the experience of your clients.]