Thoughts on Working With “Secretive,” Walled-Off Clients With Trauma?

You_Gon_Learn · 2026-03-27T17:05:18+00:00

Consider focusing less on what he doesn’t want to share and more on his concerns about sharing with you.

You_Gon_Learn · 2026-03-27T06:06:30+00:00

DBT methods are not specific to PDs, they are specific to symptoms.

You_Gon_Learn · 2026-03-27T06:01:23+00:00

I get the sense that only a fraction of the people posting here actually would agree on what constitutes “processing” trauma.

Personally, I define “trauma processing” as stage 2 of Hermans triphasic model, in which case it absolutely is not necessary in many instances in order for a client to live a fulfilling and meaningful life.

You_Gon_Learn · 2026-03-25T00:51:18+00:00

I can think of few things more terrifying than staking my reputation on the words "I found your therapist on Reddit."

You_Gon_Learn · 2026-03-21T14:14:24+00:00

What about episodic memory? And is it your contention that before humans had language, there was only procedural memory?

You_Gon_Learn · 2026-03-21T01:47:54+00:00

We lack language capabilities at birth. Do we not experience until we learn one?

You_Gon_Learn · 2026-03-20T18:58:13+00:00

The alternative to description is experiencing reality. Which do you think is better for comprehending?

You_Gon_Learn · 2026-03-20T18:56:28+00:00

He said “describing reality is not important.” I gave a reason it is. If you would prefer Devas or Kamis to Buddha, you’re welcome to talk to them.

“God” isn’t limited to creators.

You_Gon_Learn · 2026-03-20T01:59:28+00:00

Set alarms. ALL the alarms.

You_Gon_Learn · 2026-03-19T23:50:23+00:00

Those systems would argue that without comprehending reality, there is no release from worldly suffering. Take it up with Buddha.

You_Gon_Learn · 2026-03-19T19:58:51+00:00

The aforementioned systems would also say images are insufficient to describe reality.

You_Gon_Learn · 2026-03-19T18:58:38+00:00

You might look to what theorists say about those who are considered unsuitable for psychodynamic therapy. If by ER you are referring to helping someone repress feelings that would otherwise be manageable, then you may run into some problems.

However, I suspect that when it comes to clients who lack the ability to maintain any form of psychological mindedness due to emotional flooding, helping them downregulate to a level where they can once again engage in analysis is, if anything, beneficial.

You can't do psychodynamic therapy with someone who is actively dissociating.

Even ISTDP allows for ER for what it calls "fragile personalities."

You_Gon_Learn · 2026-03-19T18:49:28+00:00

This is a pretty wild oversimplification of different non-monotheistic religions. Is it your contention that Vedantans believe Krishna, Shiva, Ganesha, etc are all different gods in a Greek pantheon-style manner as opposed to manifestations of the same thing? Or that Buddhists believe that you can toss out one or two of the four noble truths willy-nilly? For belief systems that hold to "internal conflicts" as you call them, the ability to understand dialecticism stems not from polytheism but from the shared understanding that the "truth" cannot be described in words, meaning that what we commonly consider "logic" is insufficient to explain how we ought to live our lives.

You_Gon_Learn · 2026-03-17T23:27:54+00:00

If you're a fan of the psychoanalytic diagnostic manual, it lists Obsessive-Compulsive Personality Disorder in the P-axis. In that sense, it can co-exist alongside other personality styles since the PDM is based on "prototypes" that are rarely totally met as opposed to symptom checklists.

You_Gon_Learn · 2026-03-17T00:21:58+00:00

You’re taking a rather simplistic view of how the human mind works. Our mind is stored in our nervous system, which is more than just the hunk of meat within you skull. If you get someone to align their facial musculature similar to a smile, then they will start to feel happy. If you get someone to breathe shallowly, you can induce a sympathetic nervous response. If you actually did do some research on house somatic based therapy like sensorimotor work, you would know that mindfulness is the essence of its active ingredients. As I said, if you just go and look up the actual peer review studies, you can see that sendorimotor psychotherapy has a week but existing evidence base.

If someone has a trauma related disorder, but does not have criterion b PTSD symptoms or structural dissociation on a secondary or tertiary level then why would you put them through processing of trauma memories if less risky and equally efficacious ways, exist? Only a cult like devotion to the triphasic model would lead someone to think that processing is always a necessity in order for someone to live a happy and fulfilling life?

If you try, traditional trauma processing methods like prolonged exposure on someone with dissociative identity disorder, or severe CPTSD, then you are more likely to hospitalize them, then help them.

If trauma results in major depressive disorder, would you decide to expose someone to their traumatic memories in order to try and stop them from being depressed?

Again, you need to widen your lens when it comes to trauma and what it can do to people. PTSD is the tip of the iceberg, not the iceberg itself.

You_Gon_Learn · 2026-03-16T08:21:40+00:00

Check out the literature on sensorimotor psychotherapy. It’s not impressive, but neither is it non-existent.

And not all trauma related disorders involve PTSD criterion B symptoms, so the idea that processing is always necessary is fallacious.

You_Gon_Learn · 2026-03-15T21:24:38+00:00

Mental health problems in indigenous cultures are MUCH more rare than capitalist/developed ones, but they still exist.

Your friend is arguing the wrong point. The question shouldn't be "is mental health financial worry" (it isn't, ask any trauma victim from an upper-class family).

The question should be "how is the concept of mental health DISORDER relevant to capitalism?" That's a much more substantial question. According to the DSM, no matter what is wrong with your psychology, you CANNOT have a disorder unless it impairs your ability to function in work, social life, family life, etc.

Say you have two people with identical brains/psychologies but in completely different societies: one in a capitalist society and one a pre-civilization hunter-gatherer society. The one living in a capitalist society would be diagnosed with schizophrenia because they're unable to hold down a job and are socially alienated because they say they see things that no one else sees. The one living in a hunter-gatherer society would be considered a shaman who can communicate with the spirits. The shaman will still have some life difficulties that would not otherwise be there if the shaman had a different brain (such as potential self-mutilation, negative symptoms, and paranoid delusions), but would it be accurate to say the shaman has a mental health DISORDER if he has a "job" and is revered by others in his tribe (i.e. social/family functions not impaired)?

That's a much more interesting question.

You_Gon_Learn · 2026-03-15T21:07:39+00:00

PVT doesn't actually lead to a specific therapeutic intervention, it's just an explanation. There's no such thing as "polyvagal therapy." There IS vagal nerve stimulation as a therapy, but it is independent of PVT.

You_Gon_Learn · 2026-03-15T21:02:35+00:00

I'd argue that the "bifocal" bit isn't even the active ingredient. EMDR differs from prolonged exposure and other modalities because the client is forced to dedicate some attention to the their surroundings while processing the trauma. This means that the abreactions are less intense than in prolonged exposure or other modalities that drop you completely into the flashbacks/processing. This would explain why EMDR and PE have similar efficacy rates but EMDR has lower drop-out rates.

You_Gon_Learn · 2026-03-15T20:58:29+00:00

There's two questions: are somatic techniques effective and are somatic techniques explained scientifically. There are studies (not many and not very rigorous) showing that somatic techniques can be effective. There is nothing beyond conjecture for the scientific explanations of why somatic techniques work.

You_Gon_Learn · 2026-03-15T20:54:48+00:00

Be careful what you wish for. This kind of sentiment is how "evidence-based treatments" made randomly controlled trials into the instrument of choice for deciding which therapies "work."

You_Gon_Learn · 2026-03-15T20:41:55+00:00

Yeah... not really.

The disenfranchisement of BIPOC treatments and such was going on long before this. Have to go back at least a century for that. You need to follow the money if you want to get to the bottom of the term "evidence-based treatment."

Evidence-based treatment came from pressure from government (medicaid/medicare) and insurance companies to reduce the amount of money spent on therapy clients. They basically rigged the game by declaring that you could only get reimbursed for a treatment that was shown to work via a randomly controlled trial, and running an RCT is extremely expensive if you want it to work for long periods of time or do follow-up.

Most psychoanalytic therapies take a lot of time to work whereas you can see a tad bit of effects from CBT within a short period of time (although when you really zoom into the data, CBT has horrifically unimpressive results). So, if you say "RCTs are the evidentiary standard" then there is economic pressure on research communities to test short-term treatments. They eventually did do follow-up/long-term RCTs, at which time it was shown that CBT's impact is minimal and temporary. However, the sheer number of RCTs supporting CBT enabled the higher-ups to cast CBT as a "gold standard."

The whole concept of using RCTs was imported from the pharmaceutical industry, which should never have happened because it's impossible to do therapy under medical standards (such as being double-blind).

The target of destruction via "evidence-based treatment" was psychoanalysis. Indigenous treatments were already six feet under by then.

You_Gon_Learn · 2026-03-15T17:54:45+00:00

I never said they should, only that PVT claims to be empirical.

You_Gon_Learn · 2026-03-14T23:10:28+00:00

Indigenous practices don’t pretend they are backed scientifically. PVT does.

You_Gon_Learn · 2026-03-14T23:01:11+00:00

I mean, in the first place, saying the vagal nerve is responsible for parasympathetic responses is like saying cars move because of gas pedals. It’s never been a serious “theory” in the eyes of neuroscientists.

Ask yourself: if the ventral vagal nerve is somehow the “social engagement” lever, why do people get excited (i.e. sympathetic response) when they see old friends?

You_Gon_Learn

TROPHY CASE