Practitioner Series
This article is part of my Practitioner Series, where I provide mental health tools for functional medicine practitioners in order to assist them with supporting their clients' emotional needs.
Functional Medicine Practitioners Conduct Adverse Childhood Experiences (ACES) Quiz, But Clients Are in Denial
As a functional medicine practitioner, do your clients have high ACES scores, but they’re in denial about how their childhood affects their adult health?
Denial is a common response to being confronted about traumatic memories and past experiences. There are several reasons for this response. In this post, I discuss 3 likely reasons for the denial. Moreover, I provide 5 steps that practitioners can take now to help clients overcome their denial.
Three Reasons Your Client Might be in Denial about ACES
1. Blinded by expectations.
New functional medicine clients might not expect to complete an ACES assessment. New clients might expect a more traditional doctor visit, where mental health is not typically addressed. They might be confused as to why they’re completing a quiz about their childhood when they “only” need help with gastro issues. They don’t know that the two issues are likely correlated. In this case, a brief education about ACES and physical health might be all that is needed. Sharing a link to an ACES website, like Aces Too High or the CDC's Veto Violence, or providing an ACES handout, like this Veto Violence PDF or AdvoKids could prove useful.
2. Triggered by the ACES questions.
The ACES quiz itself might be triggering for some clients. Seeing words that describe their childhood, like “hit you so hard” or “too drunk to take care of you,” can be triggering. The words themselves take the client back to the experience and might cause them to re-live the trauma.
Therefore, the ACES quiz ultimately causes a flashback. Once a client is in a flashback, they no longer feel safe. In a flashback, we respond with the same trauma response that kept us safe during the trauma: flight, fight, freeze, or fawn – the 4 Fs. Some clients might exhibit a combination of the 4 Fs.
How a 4 Fs trauma response might look during an appointment with you:
Client breaks eye contact and physically turns their shoulders or head away from you (flight).
Client raises their voice and with a bit of anger tells you that you’re wrong, or they vehemently disagree with you (fight).
Client stares at you in silence with a blank look on their face (freeze).
Client agrees with you, praises you for discovering the trauma, and adheres to treatment plan simply to please you but has no internal commitment or motivation to follow through (fawn). It is important to note that fawn takes people pleasing and praise to dysfunctional levels. This often translates into long-term lack of follow through on diet & lifestyle changes. Once you discontinue frequent meetings with the client - hence the client has no one to please - the client has no motivation to maintain the diet and lifestyle changes.
3. First time confronting the trauma.
This is similar to being triggered by the ACES quiz itself. For some clients, this is the first time ever that the client has been asked about their childhood trauma. The client might be ashamed and kept it a secret. Perhaps the client has never discussed the trauma with anyone – not even their spouse.
Furthermore, this might be the first time they’ve ever been directly confronted with the idea that they have childhood trauma. In other words, they’re in denial that they had trauma. Admitting it out loud to anyone, let alone admitting it oneself, can trigger the 4 Fs trauma response.
For instance, perhaps the client realizes dad was an alcoholic, but the client has always made excuses for dad’s behavior. However, seeing the ACES questions, as well as the score, forces the client to see the past differently – for the first time. Again, this can elicit the 4 Fs trauma response.
In addition, the client might be overwhelmed by their high ACES score: seeing that number forces them to confront the trauma. They’re trying to process the emotions of a high ACES score. It might take the client several days or weeks to adjust to the news. The news might be shocking to them, like receiving a cancer diagnosis.
Keep in mind that these are just a few reasons for the client to respond with denial. Everyone is different; therefore, each client has a unique root cause for the denial.
5 Steps to Help the Client in Denial about ACES
First, recognizing a client is triggered is the most important step.
It provides an opportunity for emotional support in the moment. Simply observe their body language. Look for the cues like listed above. Notice any changes that are out of sync and incongruent with their words, such as they’re discussing something traumatic, but they’re laughing or smiling. Having awareness that the client might be triggered opens the door to the next step.
Second, be with the client.
Just be there in time and space with them. No magic words. No secret sauce. Just be present and in the now. Hold space for them to have whatever feelings they are having. You might find it extremely challenging to be in the now with the client, especially if they share a tragic story with you. You might be triggered also. You might find it difficult to be in the now because you’re experiencing your own reaction. This is normal. You're human, not an AI!
To come back to the now:
Do some deep belly breathing*
Do progressive muscle relaxation*
Check in with 3 senses (name 3 things you can see, 3 things you can touch, and 3 things you can smell) right now.*
*Repeat as necessary until your awareness is back in the present moment.
It can be extremely helpful to invite the client to join you in one or more of these activities together. This is especially beneficial because you’re demonstrating a key self-care task live and in-person with the client! A valuable tool!
You might say to the client, “Talking about childhood trauma can be triggering. I can feel the weight of those feelings. Perhaps we could take a moment and re-focus our attention to the now. Would you join me in 60 seconds of deep belly breathing? Let me first demonstrate how it’s done, and then we’ll do it together. Is that ok with you?”
Third, be empathetic.
It might be helpful to say things like:
“It sucks you had to go through that.”
"You're having a normal response to an abnormal situation."
“I can understand why you’re having the feelings you’re having.”
“Anyone in your situation would have those feelings.”
“It’s normal to have those feelings.”
“It’s ok. You're human and experiencing normal human feelings.”
“You’re safe now.” (This assumes the client is actually safe now and no longer lives with her abuser.)
Fourth, provide educational resources.
You might consider providing a list of resources, like websites and books, about triggers, flashbacks, and trauma. Some helpful books are:
Complex PTSD: From Surviving to Thriving by Pete Walker
Adult Children of Emotionally Immature Parents by Lindsay Gibson
It Didn’t Start with You by Mark Wolynn
One of my favorite handouts is Pete Walker’s 13 Steps for Managing Flashbacks. Simply reading the 13 steps out loud can pull clients out of the flashback and into the now. You might want to read a few steps out loud to clients to help them out of the flashback. You can find the handout on Pete's website here and a PDF here.
** NOTE ** Please keep in mind that reading books about trauma can be triggering for the client. Please alert them to this fact.
Fifth, invite the client to seek a trauma therapist to work through the trauma.
As a functional medicine practitioner, you have a unique opportunity to alter the course of your clients' lives. By encouraging and supporting clients to work with a trauma therapist, also called a trauma-informed therapist, you set them up for life-long success.
Keep in mind, some clients might not consider seeing a therapist. The reasons are numerous: (1) have never been to therapy, (2) don't understand the benefits, (3) are intimidated by the idea, (4) don't know how to find a therapist, (5) had a bad therapeutic experience in the past, and/or (6) avoid therapy to avoid re-living painful memories. Again, each client is unique, and the reasons not to seek therapy are also unique.
For instance, clients might assume that they will have to re-tell their trauma story over and over, thus experience the nightmare repeatedly. This is absolutely not true. A trauma therapist will never pressure a client to re-tell their story.
In fact, a trauma therapist empowers the client to determine the level of disclosure and therapeutic pace of sessions. Trauma therapists take great care in making sure their clients are not re-traumatized during the therapy process. This includes teaching the client how to regulate their nervous system so that the client can tolerate emotions without getting emotionally flooded.
Therefore, it can be helpful to outline the benefits of working with a therapist, such as:
Benefits of Working with a Therapist to Overcome Trauma, ACES, and CPTSD
Re-establish safety: A trauma therapist helps clients re-develop internal (emotional, psychological, relational) & physical (touch, the environment) senses of safety, through activities & discussions that target these domains.
Identify & manage triggers: A trauma therapist helps clients learn to recognize what experiences or feelings may be associated with traumatic reminders (aka triggers) & work to be able to adapt their response over time.
Develop healthy coping skills: A trauma therapist helps clients discover skills & improve coping strategies to better respond to reminders & emotions associated with the trauma.
Decrease stress symptoms: A trauma therapist helps clients decrease depression, anxiety, dissociation, anger, frustration, irritability, trauma-related shame or guilt, and/or intrusive symptoms, such as flashbacks & nightmares.
Regain power and control: A trauma therapist helps clients re-narrate the story & organize these unique experiences into everyday life.
Make meaning of the trauma: A trauma therapist helps clients understand the how & why; reframe and incorporate it into view of self and the world.
How to Help Your Client Find a Trauma-Informed Therapist
It's beneficial to provide recommendations about how to find a therapist. You might want to recommend they search directory listings like Psychology Today or Monarch, where they can filter for therapists who specialize in trauma and complex PTSD. You might recommend they contact their insurance company for a list of providers. You might want to provide the client with a list of therapists who specialize in ACES, trauma, and complex PTSD.
Questions to Ask a Trauma Therapist
Reaching out to a trauma therapist is the first step. It is critical that clients find a therapist with whom they feel safe and whom they can trust. It is suggested that clients interview different therapists in order to find the best fit. Clients might find it helpful if you share a list of questions to ask a therapist, such as:
What is your educational background (degree, certifications, license)?
What are your specialties?
How long have you been conducting therapy?
What is your experience in working with people who have experienced trauma?
What is your approach to working with people who have experienced trauma?
What type of specialty training do you have in the treatment of trauma?
Why do you consider yourself a trauma-informed therapist?
In Conclusion
This article discussed 3 reasons why a client might be in denial about their adverse childhood experiences (ACES), and 5 steps that functional medicine practitioners can take to help those clients in denial about ACES.
Trauma work is sacred work. It is imperative the client work with a therapist who meets them where they are, accepts them for who they are, and is willing to go on a journey to the deepest parts of the soul. Collaborating with trauma clients on their journey to healing and recovery is a deeply rewarding experience.
Thank you for reading this article about clients in denial about how their adverse childhood experiences affect their adult health. I honor and appreciate my fellow functional medicine practitioners. Thank you for leading the evolution in healthcare.
If there are more topics you'd like me to write about, please send me a message here or email me at christine@dotswellness.com.