INTRODUCTION
Early trauma often involves repeated physical or sexual abuse; the child's nervous system adapts to habituated inescapable shock. Early trauma may also includes severe neglect and early loss/abandonment. For example, a child may never have been hit or otherwise abused, but may have been seriously neglected by parents and then placed in a long series of foster homes -- most certainly traumatic for a young child. Other examples of early trauma may be repetitive surgeries or medical procedures, injury or disease which occurred over a long period of time, some physical/mental illnesses of parents, or death of a parent.

SYMPTOMS
Where traumatic events are repetitive or arise in childhood, traumatic shock occurs repeatedly and the nervous system may not settle to its pre-traumatic level of function. The "fight or flight" response may remain permanently activated, leading to unpleasant symptoms. Without intervention, trauma tends to be cumulative and non-reversing. (It's not like points on one's driver's license that diminish at a fixed rate each year as long as you don't get another speeding ticket!) Traumatic aftermath sticks around until it is resolved and the physiological mechanisms are returned to pre-trauma levels.

Individuals often experience a variety of symptoms. Some examples are:

• interpersonal. Difficulty with trust, commitment, boundaries; sometimes an inability to recognize a "healthy" relationship.

• somatic. Difficulties with gastro-intestinal, reproductive or immune systems, easily startled, sleep disturbances and nightmares, headaches, sexual dysfunction; sometime an individual feels as if he or she does not "live in the body."

• mood. Individuals may experience overwhelming bouts of sadness, teariness, fear or anxiety, anger or short-temper, or depression.

• cognitive. Cognitive difficulties may be present as memory problems, confusion, impaired self-image (low self-esteem or negative body image), or difficulty making decisions.

• cycles of numbness and activation. Traumatized nervous systems may swing between periods of over- and under-activation. When overactivated, a person may experience intrusive thoughts (="flashbacks"), high levels of emotion, or somatic memories. Alternately, there may be periods where everything feels numb or "flat." These cycles are typical of post-traumatic stress disorder, or PTSD.

TREATMENT

For long-term trauma survivors, the treatment is very often hard work over a long period of time with the expectation of an excellent outcome. Things often seem to get worse before they get better. The counselling process can be artificially divided into three phases:

• beginning. In this phase, individuals complete the "basics" of self-care. They learn to "close down" effectively and at will, including containment of strong emotion, intrusive imagery or memory, and disturbing thoughts. "Don't open what you can't close." Cognitive errors and flawed thinking are explored. Mindfulness skills are central to my work. Clients learn to tolerate strong feeling and emotion, become familiar with the felt-sense of their body, establish interpersonal boundaries, create physical safety and build support networks. For some people, fulfilling these goals completes their counselling.
• middle. This period involves actively working with traumatic memory. For many people, it is difficult work which requires solid skills that have been established during earlier counselling. It is a time of generating new meaning about old events. This is not unlike re-crafting one's "self."
• end. This phase involves integrating new meaning back into the world -- family, interpersonal relationships, work, service and spiritual practice. At this point, individuals know that they have weathered the storm, and the world looks brighter.

ABOUT MY TRAUMA WORK

I use "talk-therapy" with variations such as EMDR, art, and writing. Mindfulness is at the core of my work, especially mindfulness of body sensations. Somatic/bodily/sensory awareness is an easy way to pay attention to difficult emotional states that often occur in counselling.

I endeavour to find a balance between support and challenge, while encouraging (and demanding) that clients cultivate gentleness and compassion toward themselves! I try to help people let change emerge, rather than trying to squeeze it out like toothpaste.

Trauma work is usually long-term counselling work, although an individual may choose to do several short-term bouts of work, perhaps with different therapists. It may take from one to several years. (I use the guideline from alternate-health practitioners -- "one month of healing for every year that a condition has been in place." It helps people from struggling with impatience on top of everything else!) Individuals vary as to how they move through and between the phases.

My intention is to make the counselling process understandable over both the short and long term; it may also be understood as "nothing is hidden" or "no secrets." This transparency assists clients in making informed choices about their own lives.