Why is Actual Healing So Rare?

I’m writing this in 2021 from a remarkable and privileged viewpoint.  As a trauma therapist, I see people completely and profoundly heal from past experiences.  I am trained in multiple modern approaches to help clients heal and I am fortunate enough to see clients astonish themselves daily in the work that they do in sessions.  Seeing clients heal has become an incredibly normal part of my workday.  Early in my career, I had a front row seat to suffering.  Now, I have a macro view of the amazing things that happen when clients are able to rescue themselves from the past.  It strikes me that most therapists will not get to witness even once what I am privileged to see in any hour on a random Thursday morning.  Worse, throughout our long history as a species, it is probable that a shockingly-large amount of human wounding has been carried in largely unprocessed format causing endless misery throughout the lifespan ending only in life’s final somatic and synaptic unraveling.  These healing pathways that I utilize with clients have likely been with us for as long as we have been human.  Through all the wars, genocides, horrible mothers and fathers, accidents, and through a nearly infinite variety of horrible events and existentially horrible absences, our minds and bodies have known how to heal.  These healing pathways are redundantly twisted and encoded into every human cell, yet we are just now intuiting our way to some of them.  Why?  Why is actual healing so rare?

Trauma necessitates survival strategies, but what we need to survive in any given moment may not be the same things that we ultimately need to heal.  Client intuition about what we need to survive is often pretty good… at least it is sensible if we think about it.  What we actually need to heal is shockingly non-intuitive.  Absent a clear and broad understanding of how healing occurs, it is easy to mistake survival strategies for healing strategies.  Survival strategies have advantages–they allow us to survive.  Survival strategies also have costs.  Needing to numb is a cost.  Needing to prove our worth is a cost.  Needing to be needed is a cost.  Needing to stay endlessly busy and distracted is a cost.  Needing to pretend to be okay is a cost.  We should explore the advantages and costs of survival strategies.  Inside the cost is often the motivation to change or imagine the possibility of survival without having to pay a huge tax to exist.  Even therapists who are not trauma-focused can be effective at helping clients develop new survival strategies to help better manage the catastrophe of the trauma in ways that are accompanied by more manageable costs.  However, survival strategies alone rarely bring deep and lasting healing.

A Lack of Consensus about What Healing Means May Keep Us Stuck

Survival strategies are important, but they rarely allow us to completely transform our relationship with a past traumatic experience.  Survival strategies, including taking overly-cognitive approaches to wounding and healing can be helpful in managing the lasting catastrophe of trauma.  Survival strategies can help with symptom reduction or partial elimination.  They can be powerful fire extinguishers for the unpredictable cognitive, emotional, or behavioral “fires” that unprocessed trauma spawns.  Is symptom reduction alone identical to healing?  Is healing equivalent to the memory being easier to talk about?  That depends on the model we consult and many of these models confuse and conflate good resourcing with deeply transformative healing.

I’m an EMDR therapist.  What does healing look like from inside EMDR Therapy?  These criteria are broad and comprehensive and are part of how my clients and I assess whether or not an experience has been fully resolved.  When my clients fully resolve a memory, this is what has changed in nearly every case:

  • The memory content loses its distress.  The client is able to talk about the memory and explore all parts of the memory without activation on any channel (thoughts, emotions, body sensations, and memory).  The loss of distress is maintained days, weeks, months, and years later.
  • Resolving the memory automatically causes more adaptive thoughts about the self to appear and these positive thoughts related to the experience are maintained long after the resolution of the memory.
  • The memory “feels” like it happened when it did, instead of feeling fresh and vivid.  If the memory happened 20 years ago, it feels like it happened 20 years ago, instead of happening now.  The memory “behaves” and functions like an old memory.
  • The memory no longer overly defines the self or the world.
  • All parts of the self and the body realize that the memory is over and that we have survived it.
  • All parts of the self and body respond to future triggers in ways that reflect that new awareness.
  • Intrusive symptoms related to the experience largely extinguish (flashbacks and trauma-related dreams of that specific memory).
  • Fully resolving one memory may resolve many adjacent or related memories in the case of repeated traumas through the process of generalization.

The above metrics are not controversial among seasoned EMDR therapists and are part of the clinical observations and expectations.  From an EMDR Therapy perspective, wounding might affect many parts of the self.  Likewise, healing is deep, transformative, and affects many parts of the self simultaneously.

If this type of healing is possible, why has it occurred so rarely?

Vanishing the Injury

Cultures go out of their way to vanish wounding.  The same cultures that traumatize us construct obstacles to healing.  A shocking amount of wounding happens inside cultural contexts.  Families, neighborhoods, schools, churches, job sites, universities, legal system, regions, and nations are all cultures implicated in trauma visibility and invisibility. It is nearly impossible to treat things that we have strong cultural motivations to keep invisible, make irrelevant, make dispositional, or to encapsulate the experience inside a core lie about the self and the world.  When we are unable to see trauma, our tendencies are toward behaviors that are suppressive and retraumatizing.  Mental health clinics are also cultural contexts whose institutional histories of seeing and effectively treating trauma is (at best) deeply checkered and problematic.

Vanishing the Body

Show me someone with extensive trauma that doesn’t have a problematic relationship with the body. Fleeing the wisdom and distress of the body is a survival strategy that comes at a high cost.  Distress sits in the body, but so does the experience of peace, love, and grace.  Many effective trauma treatments move through the canvas of the body.  Much of what makes EMDR Therapy highly effective is creating enough safety and opportunity for the body to experience and digest what it was too overwhelmed or shut down to experience at the time of the wounding.  Much of what makes EMDR seem “weird” is its centeredness on embodied experience.

Bodies are culturally shaped and culturally defined objects.  Families instruct us on which emotions our bodies are allowed to feel.  Churches vary in how “bad” and untrustworthy our bodies are from the moment of our birth.  School systems are designed to teach stationary heads during the day and celebrate moving strength and endurance in the evenings.  If we manage to grow up with the ability to experience, tolerate, and process our own emotions, then we have done something remarkable in our cultures.  When we teach someone how to do this, we are undoing some of the primary and purposeful cultural obstacles to healing. 

Making Ourselves Acceptable, Real, Relevant, or Invisible Can Shape Identity

Trauma creates deficits and our attempts to fill those deficits can highly inform identity.  In high school I realized I was smart, but I became smart because it was the only territory of identity that I could master.  I learned how to extinguish the body.  I learned long before how to appear to be okay.  I learned how to disappear and unname things.  I found a mystical spirituality that leveraged my strengths and deficits.  I was smart and Teflon and things did not really affect me.  Until they did.  A lot of what made getting therapy difficult in my adult years is that I had to get that therapy in ways that aligned with my highly trauma-informed identity.  I was balancing things I did not know where unsteady inside me.

When we are children and are born into contexts where we can’t get our needs met, we have two broad and bad choices.  We can do things to try to get our needs met.  We can become a problem, which can make us relevant.  Or, on the other extreme, we can become exactly what our attachment figures say that they need us to be.  When becoming a problem or trying to become lovable don’t work, we may experiment with the second option: figuring out how to not need or expect things from people.  When we vanish need, we often vanish parts of ourselves that we need to live fully and intentionally.  All of these attempts to get our needs met have important survival advantages, but they come with significant costs.  Many of those advantages and many of those costs intersect with many of the things that we assume makes us remarkable, acceptable, real, or relevant.

Deep healing requires some identity reformation.  Parts of us probably know this and are terrified.

Promoting Healing on the Least Effective Channels

Since young Freud of the 1890s, we have assumed that trauma recovery requires narration.  We have since learned that trauma is stored in parts of the brain without time and without language.  Talking about trauma makes it easier to talk about, it rarely transforms where it is stored.  Deep and astonishing healing involves moving memories and fully transforming memories rarely involves much talking.  Many of my clients are not confused about what they should think about a bad memory.  Part of the problem with trauma is how our defenses against it so quickly take offline our capacity to think our way through it.

When deep and astonishing healing comes, it comes to you.  It happens in the present.  In EMDR Therapy it comes largely as a function of noticing internal experiences.  Other highly effective therapies engage the body directly or disrupt working memory.  I have seen many, many, memories completely resolve without the client describing the memory at all.  The idea that trauma can be resolved largely through language was invented by big men with big fragile identities who never once saw the kind of healing that I see in a random hour in a random week… sitting mostly in complete silence and with me doing remarkably little other than attuning and accompanying.

I’m writing this in 2021 to let you know that we know some ways that trauma heals quickly, deeply, and in non-intuitive ways.  We have been trying to process our own traumas for as long as we have been human using mostly highly ineffective strategies.  The mind and body know how to heal and there is compelling evidence that the greatest obstacles to that healing are cultural misdirection.

If you are a therapist, find a therapy that lets you see what I see.  You will never burnout.  Seeing clients astonish themselves is a great way to spend a career.

If you are a client, find a therapist who understands healing.  Ask them to talk about what healing looks like from their perspective.  If what they describe sounds like coping, move on.  Your mind already knows how to heal.  It just needs someone to help you remove some of the obstacles.

2 thoughts on “Why is Actual Healing So Rare?

  1. Thomas, Thank you for writing this. It is brilliant and just what I needed to hear this morning. I am a therapist and have been for a very long time. I rarely saw deep healing before my intro to EMDR …and still sometimes struggle to help my clients find it today. I have transformed how I work with clients over the past 6 years. I use ego state work and EMDR now and it resonates with me and my clients deeply. However, I know that I still bring blocks to the work. Your descriptions in your writing of how we can focus on building up better survival strategies, …. or help our clients transform their relationship with the past, is such a helpful concept for me to take in. A bit of history, I first started following your writing (blog posts) when I was new to emdr. I printed out many of your articles and carried them around with me for confidence when building up the courage to trust emdr. This summer I found your podcast and listed to them all. I’m so thankful that you work the way you do and that you capture and share your findings and discoveries in writing for us to learn from. Thank you!

    Kate Osborne

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