Recently I attended a weekend workshop on Death and Dying Consciously. It was held in the Beacon Yoga Ashram in Beaconsfield, a southern suburb of Perth and run by a beloved mentor of mine. That place was full of ghosts for me. My own ghosts, the ghosts of the place and the ghosts of the workshop participants.
A growing collection of articles on the art, craft, process and philosophy of psychotherapy, and occasionally other things. Transformative? Because good psychotherapy is alchemical; it changes you, using the ingredients of what is already present in the unconscious and the conscious with the addition of insight, creativity and choicefulness, as well as tools for continual transformation.
Friday, 14 August 2026
Ghosts by Dr Elizabeth McCardell, M. Couns., PhD
Wednesday, 20 August 2025
Delayed Emotion after Trauma By Dr Elizabeth McCardell, M. Couns., PhD
September 2025
One of my first clients years ago when I was starting out as a therapist was a Vietnam veteran. He had just retired as an aircraft mechanic when he came to see me in a state of deep anguish. He had been a helicopter pilot during that war responsible for picking up broken bodies in Vietnam jungles. He said that at the time he just did his job, just got on with it. Didn’t feel much. After he returned home from the war, he settled into his job with a couple of airlines: went to work, came home, showered, cooked dinner, watched a bit of television, and went to bed. Same thing day after day for decades. No hanging out with friends, no intimate relationships. And then he took early retirement and suddenly found himself standing on a bridge about to throw himself in. Instead he went to his doctor and, after that, came to see me. Suddenly he was feeling all those emotions that he cut himself off from for all of his working life.
I get this. In the past month or so I’ve been suddenly feeling the deep sadness from nearly dying this time last year when I was hospitalized with blood poisoning that damaged my kidneys. Suddenly sad, coupled with recurring iterative memories of being in three hospitals with tubes in me for blood transfusions, temporary dialysis and other indignities.
I feel for those in the Northern Rivers, and particularly Lismore, who lost their houses, livelihoods and animals after the 2022 floods. I was lucky, living as I did in Lismore Heights above the devastation. The floods and aftermath are one reason I returned to my hometown of Perth, Western Australia where flooding doesn’t happen. The trauma felt, I know, was not immediately felt by all and many, I’m sensing, are feeling it now. I must admit that I’m feeling the feelings now delayed as well.
Why are feelings sometimes delayed for so long? You’d think that in the face of immediate catastrophe that feelings would be running high. They are for some, but not for others. Our immediate reactions in the aftermath of trauma are complicated and shaped by our life experiences, culture, coping skills, and community support. Coping styles are individual and variations in how a person copes (including those who just get on with life, without feeling much) is not a sign of psychopathology. There is no “normal” response to trauma. The realization of this is relatively new to those who study trauma. When I was studying for my Master of Counselling degree this wasn’t really talked about and the advice given to us was to encourage the person to talk about their experiences at the time of the traumatic event. A person like my Vietnam vet client, or me, for that matter, would not be helped by this approach – until they were ready to feel their emotions; emotions have to be felt in their own good time.
Coping styles vary from action oriented to reflective, from emotionally expressive to reticent. There are those who just get on with life, and there are those who are left exhausted, confused, sad, anxious, agitated, numb, dissociated, confused, in emotional and physical pain, and feeling nothing much at all. Of course, these feelings can become crippling and lead to long term distress: nightmares, sleep disorders, iterative thoughts, flashbacks, anxiety and depression, suicidal thoughts, as well as avoidance of emotions that are associated with the trauma.
Delayed emotional responses are not inevitable. Why this is so, is poorly understood. It could be that the event is not felt life threatening, or perhaps it is familiar to some lucky people. The thing is, though, that we cannot assume that if a person who has been in a horrible event is not showing much emotion is ok. Care and support is necessary whatever the person exhibits, or doesn’t.
Creative arts, therapy, mindfulness exercise, watching the breath, and sometimes medication helps. What doesn’t, is self medicating with drugs and alcohol. The thing is, be gentle and practice self care.
Friday, 27 May 2022
Trauma by Dr Elizabeth McCardell, M. Couns., PhD
It is timely to write about trauma. After all, we have experienced horrendous floods this year and fires three years prior and many people suffered directly and indirectly the effects of these. On social media many were saying that everybody affected have Post Traumatic Stress Disorder (PTSD). It needs to be said right here, that this isn’t true. Not all who went through these experiences are affected in this way.
Our responses to threat are primarily instinctive and biological, and secondarily psychological and cognitive. We go into fight, flight, and freeze mode, common to all mammals. First, we enter the arousal cycle. Our muscles tense, as we identify the source of possible danger. Then we enter the mobilization stage where our bodies begin to produce adrenaline and cortisol, the two primary chemicals that energize us to fight or flee. In the third stage, we discharge this energy by completing the appropriate defensive actions (fighting or fleeing). The fourth and final stage happens when the nervous system, no longer aroused, returns to a state of equilibrium. If we are overwhelmed by the threat and are unable to fight or flee, we instinctively employ the third action plan, the "freezing response”. Here we are in a dissociative state where our minds seem to separate from our body, but we are still highly aroused, setting the stage for high anxiety which may continue for awhile.
I note here that PTSD is identified as the ongoing experience of trauma lasting more than three months. Less than three months, and this trauma response is identified as Acute Stress Disorder (ASD). Not all experiences of stressful events become disorders (a very important point here).
According to the DSM-IV (a bible of psychiatric diagnoses), for trauma disorder to be diagnosed, the person must experience at least one of five cluster symptoms: recurrent and intrusive distressing recollections, nightmares, flashbacks, intense psychological distress in response to memories or reminders of the trauma, and physiological arousal cued by memories or reminders of the trauma); three or more of seven symptoms of persistent avoidance (of memories or reminders of the trauma) and emotional numbing (dissociative or psychogenic amnesia for important parts of the trauma, loss of interest in important activities, feelings of detachment or estrangement from others, restricted range of affect, and a sense of a foreshortened future); and two or more symptoms of increased arousal (sleep difficulties, irritability or outbursts of anger, concentration difficulties, hypervigilance, and an exaggerated startle response).
PTSD doesn’t necessarily occur after ASD and ASD doesn’t necessarily occur after a stress event. Why is this so? Length of duration may be a consideration, as frequency could be also, but the data is inconclusive. The anxiety response is not the same across all potentially traumatic events. Some events, such as random rape, are transient, while domestic abuse is usually repeated. Hand to hand combat can be transient, but can be repeated many times. Floods and their ongoing destruction go on for a long time, but the time factor isn’t necessarily sufficient to bring on an ongoing trauma response. Other things are at work, and we still really don’t understand everything about this stress response. Some people are more resilient than others, some have better networks and can express their feelings more openly, perhaps.
Several studies have found that low cortisol levels in the acute aftermath of the stressful event and an elevated resting heart rate shortly afterwards tend to result in a stronger and more sustained stress reaction, which is hypothesized to contribute to the development of PTSD. Also an extensive prior history of psychiatric problems and/or substance abuse may make a person particularly vulnerable to the development of PTSD. Prior traumatic history also contributes to the development of a stress disorder.
So how we live our life now matters in terms of how we respond to stressful events. Now is the time to communicate and connect with others and learn to manage our issues without abusing alcohol and drugs. Working through our anxieties and concerns through counselling is really useful in preventing the development of the debilitating conditions of ASD and PTSD because they are not inevitable. Therapy for existing trauma really does matter.
Wednesday, 24 March 2021
Being Present with Another’s Traumatic Experiences by Dr Elizabeth McCardell, M.Couns., PhD
April 2021
“Trauma is not what happens to you, it’s what happens inside you as a result of what happened to you.” Gabor Mate.
We all react differently to things that happen to us and what can feel catastrophic to one person may not be felt that way by another. Some people just seem to ride the waves without being too much affected by what they experience. That said, we can misjudge a person’s reaction when all we see is how they are behaving. A person showing outwards signs of distress may not be in the same degree of shock as the person who is simply sitting staring ahead in silence. The silent one may continue to feel distress many decades after the event, but still not show it. They might be experiencing sleeplessness, nightmares, panic attacks; they might resort to excessive alcohol consumption and taking drugs, or none of these things, but still give the appearance of coping perfectly well.
I’m reminded of one of my first clients many years ago who came to me because he was feeling suicidal. He’d taken early retirement as an aircraft mechanic and a week after giving up work was suddenly inundated with memories from his time in the air force where his job was flying helicopters picking up bodies during the Vietnam war. He’d kept it ‘together’ throughout his working life after Vietnam, not showing any emotion, just pressing on, doing his job. He maintained a holding position, until he couldn’t anymore.
The person yelling and sobbing after traumatic events may be coping better than the silent one. Yet we, in our society, judge the former as being more traumatized than the latter. Thinking here of the quick condemnation of Lindy Chamberlain on the tragedy of losing her baby to a dingo at Uluru in 1980. She showed no emotion at all and was judged as being a cold, calculating child killer, when in fact she was frozen in utter shock.
The Perth psychologist and trauma counselling specialist Michael Tunnicliffe who taught trauma counselling in my Master of Counselling degree explained that the crying person was already adjusting and adapting to the reality of what they have just experienced. The silent person might be numb, not feeling anything, as if the event did not happen. The silent person has got stuck, as it were, along the path to adjusting and adapting to their new reality.
Stuckness in shock is felt bodily. Freezing in fear is what animals do (called ‘tonic immobility’), and it is a survival response, but unlike other animals, people can get stuck there. We do this by repeating our fears in a sort of emotional loop and thus continue the frozen response. If you watch a cat encountering something frightening, they freeze, but then shake it off. Too often we humans recapitulate our fear response by overthinking it. This is where counselling comes to its own. If such a person can talk their experience through, with plenty of emotional and somatic support, then the fear response doesn’t tend to get stuck.
Peter Levine, a pioneer in trauma therapy, (cf Waking the Tiger, Healing Trauma) notes that certain things can effectively loosen the frozen response. He might ask the client to put one hand on their forehead and the other on their chest, or put one hand under their armpit and the other on their upper arm in a kind of self hug. Tapping your whole body or tapping just their hand also works for some people. Such movements contain feelings of panic and lessens the sense of having a hole in a person’s boundaries.
When the sense of frozenness is old, dance, massage, gentle breathing exercises or vocalizations are good ways of releasing seized up emotion. For immediate help, just sitting listening with the person speak whatever it is they want to say really helps. The key is, gently does it. What doesn’t help is more exposure to the same sort of traumatic event.
Just being with a person helps give a sense of safety and containment, which is a beginning to healing.
Monday, 23 December 2013
Survivors' Children by Dr Elizabeth McCardell, M. Couns,. PhD
Either way, a child whose family background story includes extreme trauma may experience some difficulty in their development, including problems at a social level. These may manifest in later life as sleep disorders, habitual smoking, under or over eating, alcoholism, and the like. At the same time, the child may gain some very essential coping skills. It really depends on how much support is given to the survivors from family, friends, and counsellors. Intergenerational transmission of trauma can be averted through the critical intervention of counselling and clinical hypnotherapy. As a mentor said to me once, we always have a chance to heal ourselves and our families. Healing ourselves, heals our families.