Trauma and Self-Identity: Rebuilding Self-Esteem and Self-Worth After Trauma
By: April Lehman, LPC
EMDRIA Consultant in Training
In the current era of education, technology, and social media, “trauma” is no longer an uncommon word. In past generations, it was not uncommon for children to be taught to be seen and not heard, boys were taught crying is for girls, and families frequently turned a blind eye to abuse and “shoved problems under the rug” instead of addressing them. Today, this may still happen, but with years of research, education, and experience under our belts we have learned that these attitudes and behaviors are not helpful or healthy. As individuals we all have unique wants, needs, and experiences. As a therapist, I celebrate my client’s unique qualities and try to reinforce the positive. However, I am also there to validate and be a witness to the traumatic experiences that created emotional scars and work with my clients to promote healing. Trauma is any event experienced as disturbing or distressing or any event that has a lasting negative effect (Shapiro & Silk Forrest, p.1). Traumatic experiences can be a one-time event, such as a car crash or loss of a job, or it can be negative experiences taking place over an extended period of time. No matter the type, cause, or duration, trauma has the ability to negatively impact our sense of self and how we see ourselves in the world. Trauma, low self-esteem, and low self-worth can be a package deal.
Years ago, when I was in graduate school, I was having a conversation with a friend who asked if I believed if it was important to work through early life traumas. She wondered if 1) these early experiences really made a difference to mental health and 2) can they continue to affect us as we get older? At that time, I did not know anything about eye movement desensitization and reprocessing (EMDR), and I was very early in my counseling journey. That being said, what I did know about human growth and development was that everything we experience, from developing inside our mother’s womb to current day, affects who we are, what we think, and how we experience the world. From our experiences in utero to the first time our caregivers hold us and look into our eyes, and everything beyond, our brains are making new connections based on those experiences. So, my answer to my friend was unreservedly, “Yes.” I do believe it is important to address early traumatic experiences, especially when it is causing a problem in our lives. Interestingly, many times clients present for therapy and do not realize that past experiences of trauma are connected to their current symptoms. They may not be consciously aware of the effect these lifelong connections in their brain have on the way they think, feel, and behave. And, for many, it is these unresolved traumatic memories that contribute to feelings of low self-esteem or self-worth. In some instances, clients may even be unaware that what they experienced in the past was “trauma” because they view it as normal.
Whether a client comes in wanting to work on “trauma,” anxiety, depression, or any issue, frankly, I know that every concern was laid in the groundwork of past experiences. And these past experiences have shaped the way the clients see themselves and the world around them. It is common for clients to grapple with self-esteem due to the negative cognitions formed during traumas. Like many therapists, I have seen countless clients over the years recount their traumatic experiences, leaving us to process the emotional wreckage left behind. Common themes among these clients are beliefs that “there’s something wrong with me,” “it was my fault,” “I’m bad,” “I’m a failure” or “I’m just crazy.” Other remarks such as “I’m the black sheep of the family” or “I don’t deserve to be happy” are often heard in my office. These narratives contribute to poor self-esteem and low self-worth. In the book EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma, Francine Shapiro, PhD and Margot Silk Forrest posit that “earlier life experiences, many of which took place in childhood, long before we had any choice, appear clinically to be one of the primary reasons for certain kinds of depression, phobias, anxiety, stress, low self-esteem, relationship difficulties, and addictions” (2016) .
So, how do we go about addressing the aftershocks of trauma and rebuilding self-esteem and self-worth? Well, there is no short answer to this question. As a newer therapist years ago, I would have jumped to cognitive behavioral therapy (CBT), my handy go-to first line of defense. We would identify, challenge, and counter maladaptive thinking contributing to low self-esteem or low self-worth. We would also focus on realistic positive self-talk to increase positive feelings about the self. However, in using this modality over the first few years of my career, I realized something was missing. Clients were able to rationally identify, challenge, and counter maladaptive thinking. They were able to practice positive self-talk. The problem was that, in certain cases, they did not believe it. For example, they might rationally know “I’m not bad,” but part of them still believes they are, no matter how much evidence there is to the contrary.
From the time I first see a client for an intake session, I am listening for these negative cognitions. As their life experiences are being shared with me, I am making note of how they describe their perceptions of themselves and how this relates to their presenting problem. Coming from an eclectic approach, as we proceed with future sessions, I am working in the early phases of EMDR and assessing appropriateness to move forward with this modality. In phase 1, I am addressing client readiness and safety factors for moving forward with EMDR and using floatback technique to determine what distressing memories we will be targeting. In Phase 2, I am providing psychoeducation regarding this modality, assessing affect tolerance, addressing client questions or concerns, and introducing them to Safe/Calm Place and Container, as well as other positive resources. Expectations for what comes next in EMDR is discussed. This is also where I might be doing some cognitive behavioral therapy and using other modalities to prepare for a smooth transition to the following phases. In phase 3, we are setting up the target and identifying associated negative cognitions and body sensations. In this phase we are also identifying the positive cognition the client would like to believe about themselves when they think about this memory. We then rate the subjective units of disturbance (SUDs) while holding the the most disturbing part of the negative memory, along with the negative cognition and associated body sensations.
Phase 4 is where the magic happens. Desensitization begins and the brain moves toward adaptive information processing (AIP). Shapiro explains that the body has a way of naturally addressing or resolving upsetting instances we experience. She likens this process to digestion and states that just as our bodies extract nutrients from our food to nourish our bodies, “so the mind’s information processing system, when functioning properly, extracts useful information from our experiences. When the memories of upsetting experiences are processed, the related emotions, beliefs, body responses, and thoughts are transformed, becoming healthy and adaptive” (Shapiro & Silk Forrest, 2016, p.2). It is when traumatic experiences are not able to process normally and become stuck in the nervous system that we begin to see associated maladaptive thoughts and behaviors. That is where we as trauma therapists bring in EMDR. In Phase 4, we are helping clients to become “unstuck” by accessing the distressing memory and associated thoughts and body sensations. By adding dual attention stimuli (DAS) the brain unlocks and processes this memory eventually moving toward a state of “adaptive resolution and functional integration” (Shapiro, 2018, p. 28). Shapiro describes the model of AIP as the brain’s tendency to self-heal. She compares this to the body’s natural tendency to heal itself. For example, if you sustain a minor cut you will notice over time your body will begin to heal this injury without any outside intervention. However, if something were to block healing, for example, you had a splinter in your hand, you would need to remove that block or splinter, in order for the body to resume self-healing. This concept is similar to how EMDR operates – we are helping clients to remove the block with EMDR so the brain can do it’s thing and move toward self-healing and positive mental health.
In phase 5 of EMDR we are installing the positive cognition the client wants to think when they bring up the desensitized target. So effectively we have desensitized the distressing target and the negative cognition contributing to low self-esteem and low self-worth and installed a positive cognition associated with a healthy sense of self. We then continue with phases 6 through 8 before moving to the next target on our target diagram. Once we work through the entire chain of memories identified in floatback, past to present, we use those positive cognitions installed to create our future template. Essentially, we are helping to rewire the brain and prepare for future success by addressing possible future scenarios that would normally be triggering for clients and reinforcing positive adaptive cognitions. Frequently, in doing future template or mental rehearsal, clients will comment that they feel more confident in themselves and more confident in addressing challenging scenarios practiced with these protocols.
To conclude, it is inevitable to the human experience that each of us will endure emotional wounds to some degree. Depending on the circumstances, if not properly processed they have the potential to negatively affect our sense of self-esteem and self-worth. The great news is that EMDR can help heal these wounds and foster resilience in our lives. I cannot count the amount of times a client has come into a session following a previous EMDR session and stated, “I feel confident” or “I know I’m good enough.” Low self-esteem and self-worth can go hand-in-hand with trauma. By desensitizing past trauma and installing positive cognitions we are helping clients get “unstuck” and let go of old maladaptive cognitions effecting their sense of self and allowing their brains to self-heal and integrate adaptive information. As a result, this will naturally lead to an increased sense of self-worth and more positive self-esteem.
References:
Shapiro, F . (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.) New York, NY: The Guilford Press.
Shapiro, F . & Silk Forrest, M. (2016). EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma (Updated ed.) New York, NY: Basic Books.
About the Author
April Lehman, LPC completed an EMDRIA Approved EMDR Basic Training in 2016. This training completely changed the way she conceptualizes treatment with clients and started her on the path to becoming a trauma therapist. She maintains a solo private practice in Kearneysville, WV as a therapist and EMDR Consultant in Training and is currently working toward becoming an EMDR Consultant for EMDRIA.
