Constructing a Trauma Account

Sometimes it takes a while to figure out if what has happened to you counts as trauma. Not all trauma is capital-T Trauma, and not all trauma causes PTSD. PTSD at its core is a disorder of processing; the brain gets stuck processing the traumatic event(s), and those memories remain active but fragmented. Not everyone who experiences traumatic events gets fully stuck, but processing may be slow and interrupted.

After I experienced huge consequences from workplace bullying, I was slow to realize that what happened was actually bullying. It took even longer to recognize that "counted" as trauma.

As part of my regular continuing education as a mental health nurse, I had learned about a form of trauma therapy called cognitive processing therapy (CPT), which is a form of cognitive behavioural therapy. One of elements that may be used in CPT is creating a trauma account. This has similarities with narrative exposure therapy, and involves writing out an account of the trauma in order to consolidate and complete processing of the memories. Repeatedly going through the account is a form of exposure, which helps to address the avoidance that gets in the way of processing.

Because I've experienced trauma but not PTSD, and because it was little-t trauma, I felt like this was a process that would be safe for me to do on my own without the support of a therapist.

Constructing a trauma account is actually more than just one account. The first account consists of all the memories and sensory details that can be pulled up. A second account is created by rewriting the first account, adding in any extra sensory details that come up, and making note of thoughts and feelings that arise during the rewriting. CPT would involve looking for "stuck points," which are thoughts and beliefs that are holding you back from processing the memories.

I created a routine and a safe zone that helped me to contain whatever came up. I scheduled time for each writing session, much like schedule therapy appointments. I had soothing aromatherapy going, a cup of tea, a cozy blanket, and a fur-baby at my side. I aimed to spend 45-60 minutes on each session and do two sessions a week.

It took me about 7 hours to write out my initial trauma account incorporating as many relevant memories as I could come up with. Each writing session was exhausting. I would begin with a few sentences capturing what was happening at that moment with my thoughts, emotions, and body, and then I would take up where I left off at the end of the last session. At the end of a session I'd write a few sentences saying where I was at, and in particular what my body was doing.

More recent memories were harder to work through, which is likely because the older memories I'd had a longer amount of time to at least partially process. It was also more difficult to remember details from a period of time when my depression was quite bad.

Especially once I made it to the second account, I noticed that I started to be able to tease apart individual emotions that had been too tangled up in the big picture before to separate out. One that really stood out was a feeling of worthlessness. Once I realized that, I was able to begin working on that belief.

Staring my trauma directly in the face was hard, because of course the natural inclination is to run the other way. However, going through that really difficult process helped me to take a huge step forward in my own healing. The memories are still unpleasant, but there's not the sense of immediacy and pain that had previously been associated with them.

I don't think doing a trauma account alone would be a good match for someone with PTSD, but in my cause of trauma without PTSD it was a really powerful experience.

Additional Resources

American Psychological Association: Cognitive Processing Therapy

American Psychological Association: Narrative Exposure Therapy

Vivo International/Psychology Tools: Narrative Exposure Therapy