Why talk therapy doesn't always work.

Brain imaging has shown us that trauma is encoded in the right brain.

How do we tell a therapist about a trauma that is encoded in a way that seems to evade language, to defy how we traditionally understand memory?

It is believed that memories related to traumatic experiences are stored separately from other memories in the right hemisphere of the brain. This right hemisphere, or right brain, stores information differently than the left brain.

Unlike the left side, which relies on language and linear thinking, the right brain processes information more holistically without words or a timeline.

Memories encoded in this right-brain region can be expressed through sensations and emotions instead of verbal descriptions. As such, these trauma-related memories may remain inaccessible to conscious thought even though they still exist in our minds.

Talk therapy can work with trauma symptoms, but it won’t resolve the underlying traumatic memory. To understand why this is, we first need to be clear on a few facts.

1.Talk therapy is an umbrella term used to describe a series of different approaches (CBT, REBT, DBT, ACT, psychoanalysis, etc.) that are based on the assumption that talking about something is needed in order to process and heal.

2.Talk therapy works primarily by activating the Prefrontal Cortex (PFC) which is responsible for logic, spatial recognition, problem solving, and consequential reasoning. This is why it focuses on reasoning, observing, and thinking through problems.

3.Traumatic memories directly impact the midbrain which is responsible for everything to do with survival: risk sensing, emotion, reaction (fight, flight, freeze, appease). The midbrain’s mission is to end pain quickly and increase relief as quickly as possible, and if it is heavily activated, it will shut down the PFC which has the side effect of stopping or slowing speech.

4.The midbrain is activated by connection with emotions, body, and movement. So approaches such as Depth Hypnosis that allows you to reenter the experience and provide healing directly to the situation tends to be more effective at activating the midbrain.

In order to effectively treat trauma, a therapist MUST address the trauma where it lives; the midbrain. You can think and logic all you want, but you are just going to activate the PFC. This split between logic and emotion is why someone with trauma can logically KNOW they are safe, but still not FEEL safe.

Don’t get me wrong, talk therapy builds the therapeutic relationship brilliantly and it provides fantastic tools that can be used to knock you out of the beginning of a panic attack or flashback. This said though, talk-based approaches don’t have a great track record for coping with trauma symptoms when you’re in the middle of them. If you want more than just staving off symptoms and you want to heal their cause, you gotta use a more holistic approach.

ISSUES THAT CAN CAUSE THERAPY NOT TO WORK?

When it comes to therapy, there are a number of ingredients to consider. There is you, the therapist, the relationship between you, the type of therapy, your different issues, and the length and format of your sessions (online therapy, in person, blended). So what can go wrong with this combination of things that can mean therapy doesn’t work?

1. You are doing a type of therapy that doesn’t suit your personality. Your personality can affect what therapy works best. For example, if you are naturally an over analyser, psychoanalysis could just keep you trapped in overthinking. A therapy that pulls you more into your feelings and body might be more effective, such as compassion-focussed therapy (CFT) or mindfulness-based CBT. If you are too emotional, on the other hand, a very structured therapy might be best, such as CBT or dialectical behavior therapy.
2. Your issues aren’t suited to the therapy you are doing. Unstable due to past trauma? Have c-PTSD? In some cases a therapy that immediately jumps into talking about your past, such as psychodynamic therapy, can leave you constantly triggered. If you have emotional dysregulation and impulsivity from trauma it can be a good idea to first do a therapy that helps you stabilize and get your stress response under control.
3. You don’t stick out therapy long enough or properly commit to the process. Therapy does not provide instant results and it is not easy. It requires commitment and hard work. If you keep hopping from one therapist to the next the second they say something you don’t like?

You’ll never see results. And if you are showing up at therapy and being half-hearted, not in the present moment and not caring about the process? You are likely wasting your time. Therapy is best seen like a journey, not a destination. And you have to commit to being on that journey.

4. Therapy doesn’t work because you and your therapist are not a good match. Therapy is like dating. It can take several tries to get that ‘click’ and the first time might not work out. (But, again like dating, it can take a couple of sessions to be sure, don’t be too hasty). And don’t expect to immediately like and trust a therapist. It’s a working relationship, not a friendship. And most people who come to therapy have trust issues, which isn’t going to magically change with a therapist. Look for someone who you respect and feel you can grow to trust over time, and feel comfortable around.
5. There are boundary issues between you and your therapist. Again, the therapy-client relationship is a working relationship. A good therapist should have clear working boundaries with you, and not bring their own life to the therapy room or contact you outside of therapy. As for your side, if you can’t help but think your therapist is a friend, or that you are in love with them? Then you really need to talk to your therapist about this. ‘Transference’ means we move feelings for other people in our past or present onto our therapist, and talking about it can lead to breakthroughs. Note that schema therapy has a different client therapist relationship than other talk therapies, and practices what is called ‘reparenting’. But even here the therapist works as a trusting parental figure, not a friend. And boundaries should be constantly discussed.
6. You have a treatment resistant issue or personality disorder that needs a specialized type of therapy. Some of us have deeply entrenched trauma or what are rather horribly called ‘personality disorders’. A better way to put it would be ‘personality differences’.

Our thinking and emotional responses can be very different or more extreme. So we can need a specialized therapy that suits us and creates a safe, strong container for us to grow within. Schema therapy, for example, is created for treatment resistant issues and personality disorders. And dialectical behavior therapy (DBT) was created to help those with borderline personality disorder (by someone who suffered with BPD herself).

7. Your expectations are unrealistic. Sometimes, therapy is working. It’s just not working as well as we want it to. We want to be ‘perfect’ or some version of ‘normal’ we have decided exists (it doesn’t). The therapy industry could be held partially accountable here. Recent research does show, for example, that literature around how effective therapy is for depression was found to sometimes exaggerate the results. A good therapist is honest with you about results you can expect. And also will help you to recognise how things are improving and where you are comparing yourself to unrealistic ideals.
8. Your therapist is simply not a good therapist. Not all therapists are created equal. Like in any profession, there are uncommitted sorts, those who are in it for wrong reasons, people just aren’t cut out for the job, and the occasional bad egg who crosses ethical boundaries. It’s very important to educate yourself on what to look for in a therapist, and to assert your rights if any therapist is crossing professional boundaries, such as by calling the registrar they work under.

THE GOOD NEWS!

The good news is that there is an effective process to deal with trauma and great distress. The model of Depth Hypnosis developed by Isa Gucciardi, Ph. D. is a very effective process to heal these issues at the root of the issues. By using Depth Hypnosis we are able to reenter the traumatic experience in a safe and therapeutic way and deliver healing right where it is needed. Alleviating the issue in this way allows for healing on many levels.