Responding Functionally To Emotional Flashbacks
~ Pete Walker
Emotional flashbacks strand clients in the cognitions and feelings of danger, helplessness and hopelessness that characterized their original abandonment, when there was no safe parental figure to go to for comfort and support. Hence, Complex PTSD is now accurately being identified by some traumatologists as an attachment disorder. Emotional flashback management, therefore, needs to be taught in the context of a safe relationship. Clients need to feel safe enough with the therapist to describe their humiliation and overwhelm, and the therapist needs to feel comfortable enough to provide the empathy and calm support that was missing in the client's early experience.
Because most emotional flashbacks do not have a visual or memory component to them, the triggered individual rarely realizes that she is re-experiencing a traumatic time from childhood. Psychoeducation is therefore a fundamental first step in the process of helping clients understand and manage their flashbacks. Most of my clients experience noticeable relief when I explain Complex PTSD to them. The diagnosis resonates deeply with their intuitive understanding of their suffering. When they recognize that their sense of overwhelm initially arose as a normal instinctual response to their traumatic circumstances, they begin to shed the belief that they are crazy, hopelessly oversensitive, and/or incurably defective.
Without help in the midst of an emotional flashback, clients typically find no recourse but their own particular array of primitive, self-injuring defenses to their unmanageable feelings. These dysfunctional responses generally manifest in four ways:
 FIGHT Fighting or over-asserting oneself in narcissistic ways such as misusing power or promoting excessive self-interest;
 FLIGHT Fleeing obsessive-compulsively into activities such as work addiction, sex and love addiction, or substance abuse ("uppers");
 FREEZE Freezing in numbing, dissociative ways such as sleeping excessively, over-fantasizing, or tuning out with TV or medications ("downers");
 FAWN Fawning codependently in self-abandoning ways such as putting up with narcissistic bosses or abusive partners.
I find that most clients can be guided to see the harmfulness of their previously necessary, but now outmoded, defenses as a misfiring of their fight, flight, freeze, or fawn responses. In the context of a secure therapeutic alliance, they can begin to replace these defenses with healthy, stress-ameliorating responses. I introduce this phase of the work by giving the client the list of 13 cognitive, affective, somatic and behavioral techniques (listed at the end of this article) to utilize outside of the session. I elaborate on these techniques in our sessions as well.
As clients begin to respond more functionally to being triggered, opportunities arise more frequently for working with flashbacks in session. In fact, it often seems that their unconscious desire for mastery "schedules" their flashbacks to occur just prior to or during sessions. I recently experienced this with a client who rushed into my office five minutes late, visibly flushed and anxious. She opened the session by exclaiming, "I'm such a loser. I can't do anything right. You must be sick of working with me." This was someone who had, on previous occasions, accepted and even been moved by my validation of her ongoing accomplishments in our work. Based on what she had uncovered about her mother's punitive perfectionism in previous sessions, I was certain that her being late had triggered an emotional flashback. In this moment, she was most likely experiencing what Susan Vaughan's MRI research (The Talking Cure) describes as a gross over-firing of right-brain emotional processing with a decrease in cognitive processing in the left brain. Vaughan interprets this as a temporary loss of access to left-brain knowledge and understanding. This appears to be a mechanism of dissociation, and in this instance, it rendered my client amnesiac of my high regard for our work together.
I believe this type of dissociation also accounts for the recurring disappearance of previously established trust that commonly occurs with emotional flashbacks. This phenomenon makes it imperative that we psychoeducate clients that flashbacks can cause them to forget that proven allies are in fact still reliable, and that they are flashing back to their childhoods when no one was trustworthy. Trust repair is an essential process in healing the attachment disorders created by pervasive childhood trauma. PTSD clients do not have a volitional "on" switch for trust, even though their "off" switch is frequently automatically triggered during flashbacks.
The therapist therefore needs to be prepared to work on reassurance and trust restoration over and over again. I have heard too many client stories about past therapists who got angry at them because they would not simply choose to trust them.
The therapist therefore needs to be prepared to work on reassurance and trust restoration over and over again. I have heard too many client stories about past therapists who got angry at them because they would not simply choose to trust them.Retuning to the above vignette, I wondered out loud to my client, "Do you think you might be in a flashback?" Because of the numerous times we had previously identified and named her current type of experience as an emotional flashback, she immediately recognized this and let go into deep sobbing. She dropped into profound grieving that allowed her to release the flashback—a type of grieving the restorative power of which I have witnessed innumerable times. It is a crying that combines tears of relief with tears of grief: relief at being able to take in another's empathy and make sense of confusing, overwhelming pain; and grief over the childhood abandonment that created this sense of abject alienation in the first place.My client released some of the pain of her original trauma and of the times she had previously been stuck in the unrelenting pain of flashing back to her original abandonment.
As her tears subsided, she recalled to me a time as a small child when she had literally received a single lump of coal in her Christmas stocking as punishment for being 10 minutes late to dinner.
As her tears subsided, she recalled to me a time as a small child when she had literally received a single lump of coal in her Christmas stocking as punishment for being 10 minutes late to dinner. Her tears morphed into healthy anger about this abuse, and she felt herself returning to an empowered sense of self. Grieving brought her back into the present and broke the amnesia of the flashback. She could then remember to invoke the self-protective resources we had gradually been building in her therapy with role-plays, assertiveness training and psychoeducation about her parents' destruction of her healthy instinct to defend herself against abuse and unfairness. The ubiquitous childhood phrase of "That's not fair!" had been severely punished and extinguished by her parents. She reconnected with her right and need to have boundaries, to judge her parents' actions unconscionable, and to fiercely say "no" to her critics' subsequent habit of judging her harshly for every peccadillo.
Finally, I reminded her to reinvoke her sense of safety by recognizing that she now inhabited an adult body, free of parental control, and that she had many resources to draw on: intelligence, strength, resilience, and a growing sense of community. She lived in a safe home; she had the support of her therapist and two friends who were her allies and who readily saw her essential worth. I also observed that she was making ongoing progress in managing her flashbacks—that they were occurring less often and less intensely.