A difficult experience does not have to be happening now to continue affecting us.
Sometimes people come to therapy because of something recognisably traumatic: an accident, abuse, violence, bereavement or another frightening event. At other times, there is no single dramatic incident. Instead, there may have been years of criticism, bullying, rejection, instability, emotional neglect or relationships in which it never felt entirely safe to be yourself.
The circumstances may be long over, yet their effects can remain surprisingly present.
You might know intellectually that you are safe, for example, while your body reacts as though danger is close. A particular tone of voice may make your stomach tighten. Conflict may leave you disproportionately shaken. You may avoid situations without fully understanding why, struggle to trust people, become highly alert to signs of rejection, or find yourself repeatedly thinking about events you would much rather leave behind.
Difficult past experiences are among the factors that can contribute to anxiety, according to current NHS guidance.
Why can the past still feel present?
Our brains are very good at learning from danger.
If touching something hot burns us, remembering that experience is useful. Psychological learning can work in a similar way. After threatening or painful experiences, the brain may become particularly sensitive to situations that resemble what happened before.
The difficulty is that resemblance is not the same as danger.
A person who was repeatedly criticised may become unusually sensitive to disapproval. Someone betrayed in an important relationship may find themselves scanning a new partner for signs of abandonment. Someone who experienced frightening events may react strongly to sounds, places, sensations or situations associated with them.
These reactions are not necessarily conscious decisions. Sometimes the emotional or physical response arrives before we have had time to think.
This can produce a frustrating experience: I know there is nothing to be frightened of, so why do I still feel frightened?
The answer may be that knowing something and emotionally experiencing it as safe are not always the same process.
Trauma does not look the same for everyone
It is also important not to use the word trauma so broadly that every unpleasant experience becomes a disorder.
Experiencing adversity does not automatically mean that somebody has post-traumatic stress disorder (PTSD), and diagnosis should be left to appropriately qualified professionals.
Nevertheless, difficult experiences can affect people in many ways. Problems may include anxiety, shame, guilt, anger, avoidance, disturbed sleep, intrusive memories, difficulties in relationships or feeling constantly on guard.
For PTSD specifically, NHS services recognise features such as intrusive memories and avoidance of reminders, and NICE recommends established trauma-focused psychological treatments, including trauma-focused CBT and EMDR.
That distinction matters. Ethical therapy should not promise that one technique is appropriate for everybody or present an approach with a more limited evidence base as equivalent to a NICE-recommended PTSD treatment.
“But other people had it worse”
One of the most common ways people minimise their own experiences is through comparison.
Perhaps somebody else experienced more severe abuse. Perhaps your childhood looked perfectly ordinary from outside. Perhaps the relationship was not always bad. Perhaps you survived something that other people appeared to cope with more easily.
None of those comparisons tells us very much about how an experience affected you.
Therapy does not require you to win a competition for who suffered most. A more useful question is often:
What did I learn about myself, other people or the world because of what happened?
Someone might have learned:
I have to keep everybody happy.
I cannot trust anyone.
There must be something wrong with me.
If somebody is angry, I am in danger.
I must never make a mistake.
People eventually leave.
Such beliefs can once have been understandable attempts to make sense of experience. Years later, however, they may be restricting a life that is now very different.
Therapy is not simply about repeatedly telling the story
Some people avoid seeking help because they imagine therapy will require them to recount painful experiences repeatedly and in exhaustive detail.
Good therapy should be more thoughtful than that.
Assessment comes first. A therapist needs to understand what is happening now, what you would like to change, whether the work falls within their competence and whether another service or therapeutic approach would be more appropriate.
Depending upon the problem and the therapist’s training, treatment might then involve exploring beliefs and patterns, developing emotional regulation skills, changing avoidance behaviours, processing memories, or working with the emotional responses that have remained attached to past experiences.
Different problems require different approaches. NHS talking therapies themselves include several forms of psychological therapy, and treatment should be matched to an individual’s needs rather than assuming that one method suits everyone.
For some people, establishing sufficient trust and stability before directly addressing traumatic material is particularly important; NICE guidance explicitly recognises this in PTSD treatment.
You do not have to erase the memory.
A realistic aim of therapy is not usually to make somebody forget what happened.
Memory is part of our personal history. What can potentially change is the relationship we have with that memory.
An event may remain something you would never have chosen, while becoming less capable of determining how you feel about yourself today. A reminder can become a reminder rather than an alarm. A belief learned in one relationship can be reconsidered rather than automatically carried into the next.
Perhaps one of the most useful questions is therefore not:
“Why haven’t I got over it?”
but:
“What did I have to learn then that I no longer need now?”
The past cannot be rewritten. Our responses to it, however, need not remain permanently fixed.
If difficult past experiences continue to affect your relationships, emotions or everyday life, speaking with an appropriately trained therapist can help you explore what is happening and what form of support may be suitable. In England, NHS Talking Therapies also accepts self-referrals for a range of anxiety and depression-related difficulties, including PTSD.