The first and most essential element in working with shock is the creation of safety. In the three-part series on Safety, I explore this issue in greater detail.

If a therapist can create a safe physical and emotional environment, it will be much easier for the client to open up to deep, painful feelings.

Another important element in working with shock is to assess the client's level of stability and strength in life. All stresses must be assessed, from work and finances to family and personal health, since any stress will tax the system and interfere with primal work. Strategy sessions are recommended so the client can gradually eliminate stresses and introduce healthy options and resources. These alternatives will act as healthy defenses within which growth can occur. Usually the task of building healthy defenses is a "piece of work" in itself, since it challenges the feelings of worthlessness that many shock/sexual abuse victims have. Feelings of this kind can be expressed in session and may lead to significant transformation.

It is essential to realize that feelings of shock, by their nature, often appear "suddenly." Less severe traumas are like a distant ravine that we prepare to descend into. Shock, on the other hand, is like a vertical chasm that appears out of nowhere. We trip over the edge and immediately hit the bottom.

People who go into a traumatic feeling are visibly upset, and they physically express their grief, fear, or rage. A person going into shock will often seem quiet, distant, or spaced out. Dissociation saves them from feeling the pain, but keeps them apart from people, life, and themselves.

When shock moments occur in session, therapists need to help clients gently "come back" into the sensations of the present moment. If dissociation is severe, asking clients to answer mundane questions (e.g. what did you eat for breakfast? what's four plus seven?) will often help them feel grounded. It is also helpful to mention that they are safe in the present and that the frightening feelings are from past experiences ("old stuff"). Waking up to this fact is an essential part of healing.

The work also involves having the clients recognize shock moments and what triggers them. This is something that they can learn by keeping a daily journal. This in itself will create a safe witnessing perspective that many shock victims have not been able to develop.

The witness perspective is a way of telling or describing a scene as if one is observing from a distance. This perspective can keep traumatic feelings in control and allow a client to slowly, over time, move toward being "in the scene" with full-body re-experiencing and emotional release.

When the therapist and client can catch shock moments as they start to happen in session, the work is not about dropping into the feeling, but about stopping at the edge of the "cliff." The very first feelings or "aura" of impending shock is often called the "near edge of shock" and is where the work needs to focus.

It is very hard not to fall off that cliff. Methods need to be developed to keep the client from dropping into the shock. Holding a client's hand (with prior approval) can be helpful. It may help for the client to sit up from a lying position, stand from a sitting position, and even walk around the room. The intention is simply to contain the shock and to witness the first signs of it in the body and feelings. If the client can learn to hold off the shock, it can create a significant feeling of power and control - something that shock victims rarely have. They are more used to feeling "blindsided," "sideswiped," or slammed "out of the blue."

If clients can keep themselves from dropping into shock, then they can report feelings, images, and body sensations in small portions - from a safe, witnessing perspective. It is essential that they are not rushed, or that they not rush themselves. They need to recognize that this is difficult work, and that it takes time to fully integrate it.

Let me use a fictional example. A client (I'll call her Alice) is a person with sexual problems and oppressive feelings of numbness and anxiety. In session, Alice notices that she gets very tense and goes into a stunned shock when the room gets quiet. Upon investigation, she discovers that the sound of the ticking clock sends her into a numb state of fear. Alice tries to feel the silence and then have the therapist "pull her out" by asking questions and getting her to talk as soon as she seems to "disappear."

After some practice, Alice is able to hover "on the edge" and report how she feels, always "pulling out" as soon as she starts to feel overwhelmed. As her confidence builds, the "narrow" edge of the shock starts to broaden - and fleeting images appear. These are in themselves shocking and have to be dealt with bit by bit.

Eventually a scene from Alice's childhood starts to emerge. First there are images of a front door. Following that are images of entering the door and noticing the decorations inside. Then there are various confusing images, and something about a small, quiet room - with a ticking grandfather clock. Alice realizes that this is the reason that a ticking clock in the present would throw her into shock.

More images appear to Alice over a number of sessions, and the feelings of fear and revulsion that accompany them are dealt with step by step. In any given session, the discovery process is stopped whenever the shock threatens to take over. If the shock ever happens to take over, Alice gently takes the time to come back to normal awareness.

Eventually Alice's memories can be processed in their entirety until the final piece appears - the first time she was sexually abused. This too is assimilated in small pieces over time, always staying on the near edge of the shock. Eventually Alice will have the strength and resilience to shift from the witness perspective into full feeling expression. By expressing the repressed fear, hurt, and anger within a safe, supportive environment, she will reclaim her body and her adult power. Alice will be more at ease with her sexuality and no longer tormented by feelings of numbness and anxiety.

This example illustrates how working with shock requires patience and gradual pacing. It helps if therapists have experienced the shock process personally and know, firsthand, the severity of this level of trauma. With this knowledge comes the compassion that protects against sudden, directive interventions.

When we are frozen by shock, we can easily crack and crumble. It is better to slowly thaw out in a warm, caring environment.

* * *

Sexual Problems - Part 1: It's a Feeling Problem
Sexual Problems - Part 2: Shock and Abuse
Sexual Problems - Part 3: Denial
Sexual Problems - Part 4: The Concepts of Working with Shock
Sexual Problems - Part 5: Working with Shock
Sexual Problems - Part 6: Remembering
Sexual Problems - Part 7: Facing and Releasing Painful Memories

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