 Moral injury is rooted in a violation of personal values. It’s an important concept but it is one that many people haven’t heard of. It refers to the extremely distressing psychological, behavioural, cognitive, and spiritual aftermath of exposure to events that violate our sense of ‘what’s right’. Regardless of if these morally injurious events were through commission, omission, or betrayal, the lingering consequences on a person’s sense of self are tremendous. Main Points
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 There are many therapeutic approaches in counselling psychology. This handout is intended to describe Eye Movement Desensitization and Reprocessing (EMDR). Originally developed by Francine Shapiro for use with post-traumatic stress, EMDR is also used with fears, phobias, addiction, and anxiety. It also works to strengthen feelings of calm and confidence. Disclaimer: Please know that no therapy is one size fits all. There are many layers and approaches in counselling psychology and to the complex experiences people have. This information is intended to introduce you to EMDR therapy to inform your expectations prior to starting counselling.  Trauma Therapy ExplainedPeople tend to consider attending counselling for a long time before they reach out to start it up. Making that initial phone call can stir up fear and uncertainty. And once an appointment is scheduled, actually attending it can stir up anxiety and doubt. I believe it does take a tremendous amount of courage to start up counselling: to entrust your story to a stranger invites vulnerability. Yet for each courageous soul that takes the first step, there is hope. Hope says “This will help”, and “I can get through this”. To anyone reading this who has been considering starting up counselling but has been apprehensive, I’d like to demystify the counselling process. When it comes to working with trauma, I use the Three Stage Trauma Recovery Model, which was developed by Judith Herman in the 1980’s. I use the model as a framework within which all therapeutic interventions launch from. Please Note: Each client is unique, and therefore counselling is not a one-size-fits-all service. While you read the following information, please know that it might look a little different for each person. Also, rarely do we move through the model in a fully linear manner, (stage 3 often initiates during stage 2 work). Stage 1 – Safety and StabilizationCounselling often begins with history taking. I typically ask about what brings a person in for counselling, and gain an idea of their history in a “newspaper headline” manner. I use the newspaper headline approach because at this point, I am still a stranger to the client, and he or she may not yet feel comfortable sharing a detailed portrait of their life. Then, we collaboratively develop treatment goals. Within the first stage, the focus is on safety and stabilization. That refers to external (living environment) and internal (emotional safety). Elements in this stage may include:
According to Judith Herman (1982) the goal of stage 1 trauma work is to create a safe and stable life-in-the-here-and-now, which can enable folks to safely remember the trauma, and not continue to re-live it. You might feel as though you want to start working on the tough stuff right away, perhaps feeling a sense of urgency to “feel better” or to “heal this right now”. However, there is great importance of stage 1 work, and we can not skip over it. Think of it this way: If you had a car with shoty brakes, no seatbelts or airbags, no horn, bald tires, and a foggy windshield – you could still get from point A to point B. However, you would likely feel terrified the entire way. The resourcing and affect regulation strategies of stage 1 are like the safety features in a car: they enable you to get from point A to point B without full-blown panic and emotional overwhelm. Stage 2 – Coming to Terms with TraumaOnce an individual has developed the ability to regulate emotion and achieve a level of internal emotional safety, trauma processing can begin. As we work through a trauma, I keep a keen eye on resourcing to ensure a client isn’t become too flooded with emotion. Techniques are used to modulate this process, and I employ several end-of-session strategies to assist folks in stabilizing emotion prior to leaving the office. Here are some elements stage 2 may include:
Stage 3 – Integration and Moving onAs we work through trauma processing, elements of the third stage begin to show up. Some of these elements include:
As a result of doing the work of trauma therapy, the trauma starts to feel farther away, as something that happened but that is no longer a daily focus disrupting life. If you are thinking of starting up therapy, and have some questions, please feel free to reach out and ask. The decision to move towards self-growth and healing can be empowering and freeing. I hope you give it a go! If you’d like to learn more about the Three Stage Trauma Recovery Model by Judith Herman, check out these resources:
All too often we get caught up in trying to be someone or something we’re not. That is why when I was watching the new Avengers movie recently, this quote really jumped out at me: “Everyone fails at becoming who they’re suppose to be Thor. A measure of a person is how well they succeed at becoming who they are”. There are many reasons different reasons why each of us might become caught up in someone else’s expectation of us. But take a few moments to think about your expectations for yourself. Yes- you are going to have to quiet that inner critic for this exercise! Take some time to ponder the following questions, as a way to truly get to know you and the driving forces in your life that originate from your own heart:
Living in the shadow of who you think you’re supposed to be can be a big source of stress. I hope you take the time to explore and discover and accept the wonderful person that is you. Remember, we are all works in progress, so go slow, and go with intent. 
Getting Started:
Will the Counsellor be a Fit For You?Once you have a couple candidates for whom you think you might like to work with, consider asking these additional questions to help you firm up your decision.
What is Your Gut Feeling?Let’s not underestimate the importance of hearing your intuition. When you meet with the Counsellor you have selected, do you feel comfortable in their counselling space and in their presence? When you talk with the Counsellor, does it feel collaborative, like you will have an equal role in the therapeutic relationship, goal setting, and direction of the work? Do you feel heard, respected? It can be intimidating to start up counselling, and some nervousness is to be expected. But overall, for counselling to be successful you need to feel safe, heard, and relatively at ease in the counselling room.
Take your time in finding the right fit for you, so that you get the most out of your counselling experience. If you have found a Counsellor and asked some questions in your selection process that I didn’t list, please add them to the comments. Grief does not have a definitive ending. There is no moment in time you arrive at with a sigh of relief and a renewed bounce in your step. Instead, grief sets us upon an atelic journey through emotion, winding us along a new path of life where we have memories instead of phone calls, and pictures instead of hugs. One of the tasks of grieving is certainly to discover new ways to hold the memory of the person you have lost so as to appreciate the continuity of your relationship with them. I think of grieving as a dance between sorrow and longing, love and remembering. Feeling the gift of a memory and allowing the accompanying music of emotions to wash over you – letting your heart fill with love, allowing a threshold of pain, a tear of sadness – all the while keeping your feet on the dance floor of the present moment. Do not walk backwards through time and live in the pain of loss. Step forward bravely, holding the memories in your heart, and finding a new way to honour your loved one. There are lessons to be learned in grief, if we tune in and allow the process to unfold: that loving means we will one day experience loss, and that living means we will feel both joy and sorrow. That each bittersweet memory is like a gentle kiss, lingering and leaving you wanting another. And as each memory brings with it sadness, or anger, or regret, so too can it bring joy and laughter. We all have the capacity to stay grounded in the present moment, to love those that are still with us, and to learn and accept our shortcomings and try differently. Grief demands that when we turn to the past to mourn, that we also remember to return to the present moment – because we are here, living this life. By living it fully and honouring memories as they arise, we honour the ones we have lost. If one of your loved ones has died, and you are touching into the profound pain of loss, I’d like to share a strategy that can help you navigate through those strong waves of emotion. The following questions can be used for reflection in whatever means works for you (such as journaling prompts, a point to reflect, or a story to share with a trusting friend or family member). Take your time with your responses, reflect on them, and allow them to grow as you need. The inner reflection prompted by these questions aids in grieving as they are designed to spark remembering, a continuity of your relationship with the person you have lost, and a bringing of your story forward in order to transfuse it with new meaning. Personal Reflection Questions:
 The amazing and capable women in my life: my Zia Tina, my Mom, and my Nonna This article is written in honour of my Nonna, who was always wise, strong, and beautiful Giuseppina “Nella” Di Staulo, Oct 12 1928-Jan 28 2019  To write in a journal or not to write in a journal, that is the question. Do you dread writing down your deepest thoughts for fear someone might find your journal and read it? If so, you are exactly like most people! I’d like to share a strategy that will respect your privacy while also facilitating the hugely therapeutic process of journaling. I recognize that writing isn’t for everyone, and that it’s important to find what works for you. The Reason to Write: Emotional CopingThe bubbling up of strong emotions tends to leave people feeling out of control, over-whelmed, and flooded. During these moments, one’s immediate reaction may be to shut down the emotions causing them to feel that way. We do this in all kinds of ways – some healthy and some super unhealthy. Coping well, and healing from trauma, is about being with the emotions and the message those emotions are providing in a more conscious and titrated way. Writing those heavy thoughts down is one way to get them out of your head, see them more objectively, and process some of the emotion connected to them. Always use Two JournalsJournal 1 – The Dumping Journal Your dumping journal can be any notepad or piece of paper. What you write on isn’t important, because once you dump the thoughts, you will be destroying the page. A dumping journal can be used to work through strong emotions, such as anxiety, anger, and grief. When you feel the pull of strong emotions, write about it. Literally dump it from your head onto the page – write it, draw it, scribble it, paint it. Write about the situation and about what’s stirring up for you. Tip: If you sit down to journal and no words are coming – keep writing. Put your pen to paper and just write anything that comes to you. Within a few minutes the flow of thought will start to pour out onto the page. This journal is called a dumping journal because we dump out the nagging emotions and thoughts onto page. Once complete, feel free to review what you have written, and then destroy the page. Shred it, burn it (safely) – ensure there is no record. The therapy isn’t in keeping what you write down, it’s about getting it out of your head and onto paper so you can work through it. The dumping journal isn’t to be kept because it’s not a reflection of who you truly are – it’s the angry, sad, traumatized, frightened, disorganized, annoyed, and vulnerable parts of you that are simply finding a voice. Each page gets destroyed after it’s been created in order to maintain the privacy of your healing process. Journal 2 – The Healing Journal The healing journal is the one that you will keep, so take some time to find a beautiful book to use. On any given day you may want to look back through this journal for strength, motivation, and a reminder of what sustains you. The healing journal is the one that you will to use to document all the good stuff. Some examples include:
Here is how it works:Whenever you have finished writing in your dumping journal, turn to the healing journal and write something positive. Turn towards gratitude, acknowledge your worth, connect with your peaceful place. Perhaps what you want to do differently tomorrow, or something that sustains you, or motivates you, or all the examples from your past that have demonstrated your ability to persist. If you have written or processed something pretty heavy in the dumping journal, you may want to do something symbolic that represents a clear division between processing hurts and daily life. Taking a shower or washing your hands can be symbolic of washing it away, have a cup of tea do 10 burpees – whatever works to better enable your brain to recognize the dumping is complete and you are now letting go and returning to the present moment. Tip: If you journal at bedtime, and then have difficulty settling the thoughts as you try to fall asleep, gently remind yourself that you have already “done the work” for the day and that it’s now your ‘time off’. Pull your peaceful place image back in as often as needed, or use a bedtime story app such as Insight Timer or Calm.com to settle in for sleep. Additional Resources to Inspire Journaling
Rhonda Brynes talks about writing 10 things for which you feel grateful for each day, in her book titled “The Magic” Kristen Neff talks about journalling to build self-compassion  On the darkest of nights, when there seem to be no options – no solutions to the despair you feel, how will you find your way? When it seems like there is no hope left, will you hold out hope for your own fire?
I’d like to write about suicide, and the option that takes just the tiniest spark of hope: living. Ask 10 people for their thoughts on suicide, and chances are you will receive 10 completely different responses. Suicide is a word packed with 100 times more emotion than syllables. And even in sitting down to write about it today, I had to wait for the whirl of emotions to slow before I could hear the one constant resounding thought: I value life. I value life. I didn’t always though. I was once an impulsive and shy kid with few friends, the target of ridicule by classmates – once or twice even by teachers. I knew rejection. I knew loneliness. I even knew the pain of grief when cancer claimed my mother . I knew feeling directionless. Feeling unsure of myself. Of having no one to turn to who would truly have my back. One day, during my Masters degree training, I took a class on suicide risk and intervention. After learning crisis intervention and theory, we were required to demonstrate our suicide intervention abilities by role playing client and clinician. When it was my turn to play the role of the ‘client’, I harnessed those many years past from my youth, when living another day felt unbearable. And while I could still acknowledge the pain of those days, I could barely get the words out in order to “act” suicidal in the moment. And that was when it dawned on me: I value life. I could not even pretend for one moment that I didn’t want to be alive. I have bad days and sad days. I have lonely days and grumpy days. But I also have good days and joy-filled days. I have peacefully quiet days and blissfully calm days. I have days when I feel invisible but I have so many more days when I love and value myself. The thoughts and emotions that awaken thoughts of suicide are a signal that you are in pain. That you are hurting and feel powerless to create change yet that you desperately need to create that change in order to be ok. Sometimes it might feel as though that change is impossible. Sometimes it might feel as though the energy required to act on creating that change is just too much. So what can you do? We need to get out of our own heads. The view one takes of the world when feeling depressed or anxiety-ridden can become a habit and can breed more thoughts that are characteristic of depression or anxiety. We need to really look at the people in our life and ask the tough questions. We need to turn towards the people who care and we need to let them care. We need to be kind – even to ourselves. We need to listen. We need to be present. And in doing so, we can ignite the tiniest spark of hope to keep going, to find your fire – because this life really can be good. If you are feeling suicidal, please reach out for help. Call, text, email, talk. You have more worth than you know. If there isn’t someone you can talk to, or a Crisis Line in your area, check out The LifeLine App in the App Store. One key way we build self-esteem is by accomplishing the goals we set for ourselves. Every accomplished goal trickles into our sense self: it feeds our personal integrity, that sense of trust we have in ourselves that we will do what we set out to do. Our proven ability, even though only proven to ourselves, contributes to feeling good about ourselves. But what happens when a negative core belief such as “I’m not good enough” has a stronghold over our thoughts? Negative core beliefs are false self-referencing beliefs, and they pack a pretty heavy punch. When a negative belief screams out in our brain, a powerful emotional response reverberates throughout our memory network and our body responds with much the same level of activation as when the negative belief was created – even though in the present moment we are safe. Experiences from childhood may have planted the seeds of the negative belief, and then additional life experiences may have strengthened them. Because these negative beliefs have been reinforced over and over again, they feel very true. “Negative beliefs come to create a perpetual filter through which we view ourselves and our world” (Parnell, 2007). Negative core beliefs feel true but they are not true. Because these beliefs are capable of infiltrating all of our daily activities, social interactions, and inner dialogue, we need an equally powerful method for countering them. Counselling is an excellent way to heal early wounds and develop coping strategies for the present. There are also techniques we can focus on between sessions to practice being present with new, positive belief systems.  Three Little Things:
For this journaling activity, you are going to want to use a beautiful book: one that makes you smile when you look at. You won’t be journaling in the traditional style: this will be more of a ‘healing journal’, one that you are going to want to flip through often, to remind yourself of what you have written. Each evening before you get ready for bed, take 10 minutes to sit down and reflect on 3 things you did well that day. These are the little things that we often over-look, that there are no accolades for. When we take the time to notice, we develop compassion for our selves. We start to see the evidence that yes, we are human and we make mistakes, but also that we are also inherently good and worthwhile beings. If you find that you are having trouble getting started, try reflecting on the list of prompts below. Writing Prompts for Reflection:
For more strategies on journaling to build self-compassion (and a really good read…) check out Dr. Kristin Neff’s website: self-compassion.org. Resources: Parnell, L. (2007). A Therapist’s Guide to EMDR: Tools and Techniques for Successful Treatment. New York NY: W.W. Norton & Company. When I first told my Nonna that I was going to be a Counsellor, I was 20 years old and had just switched out of an orientation to teaching stream in university to a Psychology major. With an appalled look on her face and an emphatic inhale, she stated in her thick Italian accent “Why you wanna sit and listen to peoples’ problems?” It wasn’t a question, but rather a statement laced with judgment and condescension. My response was something along the lines of “I can’t explain it”. I suppressed my headstrong must-fight-for-what-I-believe-in feisty inner warrior and simply hugged her.  But her statement sat with me. Not because I doubted my career choice, but rather because it gave me insight into how little my Nonna understood about asking for and receiving help. Raised in a farming family by parents who lived through the depression in southern Italy, then witnessing first-hand the impacts of the second world war, asking for emotional support had never become her go-to coping strategy. For every loss she experienced, (and there were many), she donned her symbolic black clothing and shut off the hurting part of herself. It wasn’t my place to fight with her. I could only love her fully, for she was coping in the only way she knew how.
Yes, the job of a Counsellor is to listen – but it is also so much more. It is about motivating and inspiring people to be the best versions of themselves, to learn how to invite in the change they are so desperately seeking. It is about helping people reconnect with hope after life experience has rattled it. It is about discovering the strength and courage they forgot they had. It is about cultivating resilience. It is about discovering how to be kind to one’s self, in a life where that was potentially never taught or even discouraged. The safety of the counselling office becomes a place to practice holding positive beliefs that just aren’t rooting due to the busy-ness of life. It’s a place to deconstruct shame, to grieve losses, to breathe deeply and fully, and to acknowledge ones’ worth. Every single counselling interaction is a chance to let someone know that they matter, that they are not struggling alone, and to foster hope. That is why I choose this career, and that is why I love what I do. |
AuthorSusan Guttridge is a trauma-informed Master level Counsellor with the clinical designation of Canadian Certified Counsellor (CCPA). She has 20+ years experience providing individual and group therapy. Archives
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