The Trauma Sandwich

The Trauma Sandwich – Davy Hutton (EMDR Consult)

The Trauma Sandwich is a metaphor

Ingredients to make a good trauma sandwich

What do we need to consider in a therapy session, so that EMDR will work well?

We need to figure out how to have a well-balanced therapy session. We need to manage the client’s emotional distress in a focused but friendly way.

Ultimately, we need to keep the client in their window of tolerance.

Sounds easy – right? Not always so. Trust me - I have thousands of hours of clinical practice as an EMDR therapist and consultant. Those hours were spent with clients experiencing severe trauma and/or PTSD, and Complex PTSD.

Addressing traumatic material can be emotionally overwhelming for clients. Each client carries their own personal tsunami. We need to ensure that as therapists, we are not overwhelmed either. Or washed away.

What is the primary goal?

We know that the primary goal is to keep the client within their window of tolerance while being able to tolerate increased affect.

The Trauma Sandwich and the Window of Tolerance

If this consideration is not adhered to, the client stops “processing rationally” and is operating on amygdala hi-jack and emotional arousal.

This means the client is subconsciously working via either hyper or hypo arousal networks (reptilian brain) and is therefore outside of their window of tolerance.

Their sense of past/present/future is also often confused, unclear, and bewildering.

However, if we can keep a client within their window of tolerance, this enables them to engage with the traumatic material, raise their emotional distress levels, while maintaining a grounding in the present. This enables them to discuss past difficult experiences/material.

The window of tolerance is a concept introduced by Daniel J. Siegel. It describes the equilibrium our systems need in order to heal from trauma. Here's a handy infographic from NICABM.

The Trauma Sandwich and the window of tolerance

How the trauma sandwich is useful

A more helpful way to remember this and how it applies to the process of any therapy session and particularly in tandem with the 8 phases of EMDR. This is the metaphor for the trauma sandwich.

The Trauma Sandwich is a metaphor

The outer layer of the sandwich …. here, you need to think of Safety (as in the sandwich image above). Within the framework of a therapy session, we start with resource installation, that is, teaching the client ways to self soothe, for example, deep breathing, relaxation, or use a quiet/calm place.

Then, when the client has mastered these self-soothing resources and

ONLY then

would the therapist begin to address the traumatic material.

The ‘meat’ of the sandwich is the traumatic material ….. here, you need to think of Traumatic Material (as in the sandwich image, above). This could be taking a trauma history, walking through the trauma minefield or the reprocessing stage of EMDR.

The outer layer of the sandwich …… here, you need to think of Safety (as in the sandwich image, above).

Each session finishes with the grounding exercises again. We teach/demonstrate these, we help the client to carry them out, and we ensure the client is calm again at the end of the session. The client needs to exist in the real world for the rest of the week. This helps lessen the prospect of the client being continually emotionally hi-jacked by the traumatic material that they were addressing in therapy.