Reflection

The Hole Where the Story Should Be: Trauma, EMDR and the Gentler Door

Beneath most of what I treat, there is a trauma. I have written about the executive who drinks, the successful man who cannot stop the cocaine, the woman who binges in secret, the person whose relationships keep ending in the same place. Spend long enough with any of them and you arrive at the same floor underneath: something, once, that could not be felt, and a whole life quietly built to keep it that way. Addiction and alcoholism are, so often, built on trauma. The drink, the drug, the food, the work: these are ways of managing a wound that was never processed. Treat the behaviour and leave the wound, and the person relapses, or the wound simply finds another door.

What trauma actually is

Trauma is not simply a terrible event. It is an experience that overwhelmed the psyche’s capacity to metabolise it. What remains afterwards is not a memory in the ordinary sense, not a story with a beginning and an end, filed in the past. It is a sensory imprint, raw and present: a flash, a smell, a tightening of the body, a hole where the story should be. The event is over, but the nervous system does not know it. The memory stays live, triggerable by anything that resembles the original, and the person says the thing I hear so often: I do not recognise myself. I do not understand why I react this way.

Big T and small t trauma: the difference

Sometimes there is one identifiable event, an assault, an accident, a loss: what we call big T trauma. But much of what I treat is what we call small t trauma: repeated messages, non-stop, over many years. The chronic criticism, the emotional absence, the steady drip of being told you are not enough. No single moment to point to, and a nervous system shaped just as profoundly. In my experience the small t is often the harder of the two to treat, precisely because there is no story to tell, only a self that was formed inside it.

EMDR: helping the brain finish what it started

For over twenty years, my main tool for processing trauma has been EMDR, the method Francine Shapiro developed after her now-famous observation in a California park in 1987: that as her eyes moved rapidly, the disturbing thoughts she was carrying lost their charge. From that accidental discovery came a structured therapy with one elegant idea at its centre: the brain knows how to process experience, it does it every night in REM sleep, and trauma is what happens when that processing is overwhelmed and freezes. The bilateral stimulation of EMDR, the eye movements, the taps, appears to restart what froze. The memory is not erased. It shifts: it stays accessible but loses its power to intrude, to flood, to run the person’s life from underneath.

It works, and the evidence base is among the strongest in psychotherapy. But its limits and dangers matter here, because the most important clinical fact about EMDR is this: reprocessing asks a great deal of the person. You are taking someone directly toward the very material their whole system is organised to avoid. Done before the person is ready, that is not treatment; it is re-exposure. The preparation is not a formality before the work. It is the work.

The gentler door: why I often begin with art

This is where a less expected part of my training earns its place. I am also an art psychotherapist, and with people who are still fragile, when the trauma is causing real problems in their life right now but the psyche is not yet stable enough for direct reprocessing, I will often begin not with EMDR but with art therapy. Not as something softer in the dismissive sense. Softer in a precise, clinical sense, for two reasons.

The first is distance. In art therapy, what is traumatic is on the paper. It is in the sandbox. There is a space between the patient and the image: the person looks at the trauma rather than being, once again, the place where it is all happening. In verbal work, and in reprocessing, the patient is the theatre of the event. On the paper, the paper is. That distance is what makes the material approachable for someone who cannot yet survive meeting it directly.

The second is containment. On the page, the trauma has edges. In the box, it has walls. The frame of the paper and the borders of the sandbox do, physically, what the fragile psyche cannot yet do internally: they hold the thing. When the trauma is only inside the person, and only spoken, it is uncontained, and it spills. The art contains it first, outside, so that the person can slowly build the capacity to contain it within. I have written elsewhere about the temenos, the protected space in which difficult experience can be held; the paper and the sandbox are small temenoi inside the larger one of the consulting room.

So the sequence, as a rule of thumb, is this: the gentler door first, art, image, stabilisation, the building of resources, and EMDR later, when the person is stable enough to walk through the harder one.

The territory is bigger than the map

But I want to be honest, because this is where clinical reality parts company with protocol. Sometimes I work on the trauma even though the person is not the most stable, because the trauma is too triggering to wait: it is flooding them anyway, and delay protects nothing. The rule of thumb is wait if you can. The truth is that it is a clinical judgment, made in the room, with this person, on this day. The territory is always bigger than the map. Twenty years with a method teaches you, above all, when not to follow it.

The keystone

This, finally, is why trauma is the keystone of everything else I have described. The functioning alcoholic medicating the gap between his image and his inner life; the cocaine that counterfeits power; the binge that floods an unbearable feeling; the thirst for a oneness that was lost too early and too brutally: beneath each of them, so often, is the unprocessed thing, the hole where the story should be. Process it, and the behaviours built on top of it lose their reason to exist. Witness it first, contain it, approach it at the pace the person can survive, and finish, at last, what the psyche could not finish at the time. That is the work. The tools matter, EMDR, art, the analytic relationship, but they serve something simpler and older: a person becoming able to say, this happened to me, it is part of my story, and I am still here.

One of trauma’s most common inheritances is the terror of being left: read The Fear of Abandonment.

Where addiction and trauma meet: addiction therapist in London.