From Stuck to Breakthrough: Supporting Patients with Trauma
Often, we encounter situations where clients say they want to make changes and will follow recommendations, and then they do not …This understandably frustrates many clinicians.
We think about compliance and commitment and link those with being able to implement or stick to a therapeutic plan. We ask questions about internal locus of control and willingness to change. However, sometimes the client is lacking the capacity to apply your recommendations because their nervous systems are overwhelmed.
Consider this idea of perceived versus actual capacity to change and how it relates to a person’s allostatic burden. I like the analogy of a bucket of water. The bucket is the person’s allostatic capacity, and the water represents the stressors or burdens. The bucket fills based on the constant input of stress and empties due to the activities, beliefs, and exposures that help clear the burden and drain the bucket.
When someone has significant trauma history, the bucket often can be mostly full when they come to see you. That often translates to a mental and physical experience of fullness and reduced capacity. In the presence of this fullness, it is hard to breathe, hard to find rest, and there may be very little room for creative energy.
Clinically, these folks look like they are not compliant when you actually may just be setting the goals too high based on their available resources. Address this by breaking down your short-term goals into tiny incremental steps. There is no limit to how small those steps can be. Find a pace that works for your clients' personal goals, time, and resources, including capacity of their nervous systems. Instead of suggesting three dietary and lifestyle changes, suggest one. You may even break down the steps of that one recommendation to meet your client’s allostatic capacity. My goal would be to just to find something that can break through and become a habit, with no shame or fear of failure to further complicate things. Then we can build on that success.
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