Some Traumas Are Forever

Saying so is part of the treatment.

This is Part 1 of a 12-Part Series: The Hardest Things in Psychotherapy

I hear clinicians tell this story about trauma treatment.

It goes like this:

Something terrible happens; It creates the trauma (i.e. “the wound”), and with the right treatment — EMDR, cognitive processing, prolonged exposure, trauma-focused CBT, even psychodynamic psychotherapy — healing is possible.

Recovery is the promise, but some traumas are forever.

Recovery may be possible, but often times an entire treatment is built around placing too much hope on the promise of recovery.

Recovery is the promise, but some traumas are forever.

When trauma recovery becomes the unspoken expectation, something goes wrong. Patient who aren’t recovering may feel like they’re disappointing their therapist.

Also, clinicians who expect recovery may feel like their treatment has failed. Both may struggle to acknowledges that the goal might need to change.

The Key Difference Between Recovery as a Treatment and Goals Aimed at Livability

There’s a key difference between recovery as a treatment and goals aimed at livability.

• Recovery suggests the wound closes.
• Livability asks: given what’s happened, how can my patient build a meaningful life?

For many trauma survivors, only livability is truly possible.

From the Frontlines

I’ve sat with Holocaust survivors, patients who have lost family members to gun violence, patient’s traumatized by war, patients experiencing the long persistent trauma of some natural disaster. These are often patients who live, and love, and have meaningful relationships. Yet, they carried their trauma as an unrelenting permanent weight, forever influencing their lives. This is a weight that never leaves. It’s a deeply embedded view of the world that no amount of processing can relieve.

What I’ve learned—slowly, and sometimes reluctantly—is that the best thing a clinician can do for a patient whose trauma can’t resolve is to stop needing it to.

We should communicate—through witnessing and words—that the work of trauma therapy is not dependent on recovery. The therapist should stay with a patient no matter the path. The suffering is real. It’s not a problem to fix, and it should not make the therapist look away.

What I’ve learned—slowly, and sometimes reluctantly—is that the best thing a clinician can do for a patient whose trauma can’t resolve is to stop needing it to.

Our ability to bear becoming a permanent witness—to absorb, week after week, the weight of unrelenting suffering—is one of the toughest demands of this work. It’s also one of the most vital.

If my readers could take away one thing from this piece, I’d like it to be this: Mental health practitioners need to be able to accept this uncomfortable truth: some traumas are forever.

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Robert E. Feinstein, MD

Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell

Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com

Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com

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