When an avoidant trauma patient shows up to a session but refuses to speak, it can be challenging for the psychotherapist. However, there are several approaches and strategies that the therapist can employ to address this situation:
Validate their feelings: It's essential for the therapist to validate the patient's emotions and acknowledge that it might be difficult for them to speak at the moment. Let the patient know that their feelings are understood and accepted, and there is no pressure to talk if they're not ready.
Create a safe environment: Reinforce the safety of the therapeutic space. Remind the patient that the therapy room is a place where they can take their time, and there is no judgment or rush to disclose information before they feel ready.
Non-verbal communication: Encourage the patient to communicate in non-verbal ways if they find it easier. This can include using gestures, drawing, writing, or even pointing to words or images in books or handouts. Non-verbal communication can be a starting point for expressing emotions and experiences.
Use expressive therapies: Introduce expressive therapies like art therapy, play therapy, or movement therapy. These approaches can help the patient access and express their emotions without relying on verbal communication.
Explore the resistance: Gently explore the reasons behind the patient's reluctance to speak. Trauma patients might fear being overwhelmed by their emotions or re-experiencing traumatic events by speaking about them. Understanding these concerns can inform the therapeutic approach and build trust.
Focus on grounding and stabilization: If the patient is particularly distressed or overwhelmed, the therapist can shift the focus of the session towards grounding and stabilization techniques. These techniques can help the patient manage their emotions and stay present in the session.
Use writing or journaling: Suggest that the patient writes down their thoughts, feelings, or experiences during the session. This can serve as a form of self-expression and might eventually lead to verbal communication.
Explore alternative communication styles: If the patient finds it challenging to speak directly to the therapist, explore alternative communication methods, such as email exchanges or using a communication app between sessions. This can provide the patient with a sense of safety and control over the process.
Patience and pacing: Be patient and allow the therapeutic process to unfold at the patient's pace. Healing from trauma takes time, and the therapist should respect the individual's unique journey.
Consult with colleagues: If the therapist finds the situation particularly complex or challenging, seeking supervision or consultation with colleagues can provide valuable insights and support.
Remember, working with avoidant trauma patients requires sensitivity, empathy, and flexibility. Building trust and rapport is a gradual process, and the therapist should be prepared to navigate setbacks and progress at the patient's pace.