A psychotherapist worries that the Healing Trauma imagery might provoke a dissociative episode or flashback in her patient with PTSD, although she uses other CDs in her practice with no concerns whatsoever. I love your "stuff" and use the tapes and CDs a lot in my psychotherapy practice. But I am a little hesitant about one....

Please ask Belleruth a question for me re: the trauma CD.

Can this CD provoke a dissociative episode or a flashback in a patient with PTSD?

Jan S

Dear Jan,

Flashbacks are unlikely, but always possible. Most of my imagery is very cushioned and created in such a way that it doesn’t turn loose a cascade of distress. On the contrary, it helps to retrain the listener to get back into balance. However, the Healing Trauma imagery is emotionally evocative and designed for the time when a trauma survivor is ready for the de-numbing phase of healing. It is powerful and it’s good for integration at a deep level. So if somebody listens to it when they’re not yet ready for it, it can create anxiety or distress.

As a result, we generally encourage people with PTSD to start with something simple and relaxing, build up their self-regulation capacity first, then move into using this more intense imagery. As long as someone is struggling to handle the intense waves of emotional distress that flood someone with PTSD, we recommend they start with the more soothing, relaxating imagery exercises of General Wellness or Relaxation & Wellness, or simple breathing and meditation (like Andy Weil’s CD).

We also always suggest that people stop listening if they feel it’s too much for them. This is why God invented the ‘pause’ button! That said, however, it’s important to note that many people are ready to use the Healing Trauma imagery immediately and they find it extremely healing and comforting from the get-go. It’s a very individual thing.

As for triggering a dissociative episode, guided imagery in itself is a form of strategic, purposeful dissociation, albeit a positive one, so dissociation is part of the experience, always. Generally speaking, the experience is intensely positive, and research suggests that using a dissociative technique in a positive, conscious way actually helps people reduce their unwitting, unconscious dissociation.

However, some trauma survivors will get very agitated when tasked with relaxing to a soothing voice, period, and they should not have to struggle with this - there are other techniques that can help that don’t create upset.

And it is of course always important that the listener ''dose'' him/herself with a gentle eye to his/her own vulnerabilities. Some listen in small increments of increasing by 5 minutes each time... others totally immerse themselves in the imagery, listening 10-12 times a day. Some like to have their therapist in the room with them, or nearby. It''s very individual and, as a therapist, you may want to listen with them on the first run.

I hope this helps!