"But They Seemed Fine": Recognizing Trauma When Affect Doesn’t Match the Story

Camille McDaniel, LPC (00:00:24)
Welcome back to another episode of Christ in Private Practice. This is episode 98. Can you believe it? We are just two weeks away, just two weeks away ⁓ from episode 100. And so before we start today’s episode, I want to just give you a quick update about the podcast since we ⁓ are ⁓ so very close to a major milestone.

Episode 100. I I actually cannot even believe that we are so close to that episode when I think about how this podcast even started ⁓ and how ⁓ I was so unsure of whether or not I should even press record to ⁓ do the first podcast. And here we are ⁓ only two weeks away from episode 100. And so that’s that’s huge for Christ in private practice. And I wanna thank you so very much.

For the support, for the journey up until this point, for sharing this ⁓ with many people. This has been shared with, my goodness, this has been shared with college classes. This has been shared amongst ⁓ clinical supervision groups. This has been shared with other individuals. This is just wonderful. And I I just want to thank you greatly. So ⁓ as we kind of approach, you know, episode 100, I just wanted to give you.

A little detail about just a few little changes. ⁓ after episode 100, the podcast is going to be moving from weekly episodes ⁓ to episodes happening twice a month. ⁓ Now, stick with me here. ⁓ you know, ⁓ I absolutely enjoy greatly, greatly ⁓ bringing new information every week, ⁓ but after nearly a hundred episodes.

I feel like we have covered ⁓ so much ground ⁓ around ethically and professionally integrating ⁓ Christian faith into clinical practice. ⁓ And ⁓ I do not want to get caught in a cycle where I am just bringing ⁓ any kind of content just because the next week shows up, ⁓ just because I’m committed to ⁓ bringing episodes every week, even if I am not.

Camille McDaniel, LPC (00:02:50)
really hearing any particular message to bring. I don’t want to do that. ⁓ I want to make sure that the things that I bring to you ⁓ are relevant. ⁓ you know, they are faith integrated, they are clinically useful, ⁓ and that they are important to be talking about at this particular time. ⁓ And so because of that, I was just feeling a shift that after this, ⁓ I have really given a lot of what Christ in private practice

Is supposed to be giving. And don’t get me wrong, that is not to say that there’s not more to give, because there is. ⁓ it’s just to say that I am recognizing that there is a bit of a shift ⁓ in the frequency of of messages that I’m receiving ⁓ from the Lord in order to share things or how certain topics are coming up and certain things are evolving ⁓ in my clinical practice and in my training. And so ⁓ in looking at what

should happen for Christ in private practice podcasts at this time. ⁓ I want it to actually continue to be very, very valuable. ⁓ And I think that based on what we have created in the first ⁓ almost 100 episodes as of this recording in the first 98 episodes, ⁓ I think a lot of the groundwork, like I said before, ⁓ has been laid. And now what I bring forward from here on out.

will just continue to ⁓ I guess capitalize off of what has already been built ⁓ and prayerfully ideally will be very relevant to what is going on for you ⁓ in your practices ⁓ when the podcast episodes do come out. Now if you are on the newsletter, the newsletter is still going to go out ⁓ and ⁓ the newsletter might even go out at

A greater frequency than the podcast episodes. But there will be more information ⁓ on that for episode 100. ⁓ But I just wanted to be able to give you some information ahead of time so it didn’t seem like ⁓ all of a sudden things just dropped off. It’s like, what’s going on? ⁓ Nothing is going ⁓ on. I am still going to be here ⁓ in a lot of ways, still going to be

Camille McDaniel, LPC (00:05:16)
offering podcast episodes that can qualify for continuing education. ⁓ Still going to be offering the Faith Integrated Consultation Circle, which is happening now. And I hope to be offering again ⁓ at the beginning of 2027 when the current ⁓ ones ⁓ end and a new one begins. ⁓ Still going to be offering even additional continuing education trainings that are going to have opportunities for multiple CEs.

like the one that I’m offering right now that’s going well and I’m going to be adding a few more for the new licensing ⁓ term that’s coming up soon. ⁓ So there’s just a lot of different ways that I’m still going to be connected to you, still going to be supporting you, still going to be here. All right. ⁓ and so I just wanted to give a heads up for all those who have been traveling this journey over a year with me. And for those who are new who are just like, wait a minute, what’s happening? What’s going on?

Nothing is going away. Nothing is going away. ⁓ Just a again, just a slight shift, just a little bit of a new rhythm. ⁓ And I just wanted to make sure to share that with you ahead of time. ⁓ So ⁓ let’s with that get into what we are going to be talking about today, which I am excited about this topic. ⁓ I feel like this is very, very important for those of us, especially who are working with clients who might

Come to us. Actually, I feel like this is important for all of us. ⁓ For those of us who are coming or working with clients who are coming to us who have backgrounds of violence or abuse or some type of traumatic incident. ⁓ For those of us who don’t even specialize in trauma, we’re working with a client ⁓ on a different topic ⁓ to strengthen their mental, emotional, and spiritual well being.

But they may then let us know that they have some history ⁓ that is along the lines of violent ⁓ or traumatic in one way or another. ⁓ I think that we need to still be aware of this skill, which is why ⁓ the topic or the title for today’s podcast ⁓ is appropriately titled, but they seemed fine recognizing trauma when the affect doesn’t match the story.

Camille McDaniel, LPC (00:07:41)
Okay, and so ⁓ this episode actually does qualify ⁓ for one continuing education credit. ⁓ And the description of the training for this podcast episode and the learning objectives ⁓ are all online if you so desire ⁓ to get a continuing education ⁓ hour for listening to this podcast episode. ⁓ So

Let me start by asking you a question. Have you ever had a client who has shared with you ⁓ something that was quite traumatic in nature? ⁓ but they didn’t sound traumatized by it. You know, there were no ⁓ signs that we are usually trained to recognize. There was no tears. ⁓ there was no anxiety present in the body or in the facial expression.

No shaking of the voice ⁓ or shaking of the body didn’t seem like anything changed. Even their voice ⁓ barely even changed. And maybe ⁓ they even kind of laughed it off a little bit. ⁓ And you kind of sat there and and maybe you didn’t pick up on much because it didn’t seem like it was that impactful to the client.

And before you really even had time to process it anyway, the client had totally moved on, shifted the conversation in a whole nother different direction. And it might sound like something like, I’m gonna give an example. So let’s say you have the client before you and they tell you something along the lines of, yeah, I mean, sometimes when I bought things that they just really didn’t like or they thought that I was, you know, buying it without their permission, they wouldn’t rip it up, they would cut it.

You know, and ⁓ I there was a pair of shoes that I really I really did like those shoes. My mother bought them for me and ⁓ you know, she’s no longer here and yeah, they burned those shoes up. ⁓ There were just a lot of things that they would do, you know, when they were in those moods. I mean they put me out of the house a couple of times and I slept in the car. I mean I made it work. But when I got to go to school, now school that ⁓ that’s where I said, I am going to

Camille McDaniel, LPC (00:10:04)
Absolutely make a difference. I am going to do it my way this time. ⁓ It is going to be different this go round. I knew school was going to open a door for me. And you may have noticed ⁓ right as the client is telling you this, right? You listened to the way the tone just seemed very flat when they were telling the first part about getting their clothes cut or getting their shoes burned and.

you know, being put out of the house and the very flat, very just matter of fact. But then when they talked about an opportunity for them to go back to school and get an education in a different area that was going to really make a difference, you may have noticed that you followed them ⁓ right down the path of focusing on school, right down the path of changing the topic to another ⁓ another conversation.

And you might have even said, well, tell me about school. I mean, you really lit up with that, right? ⁓ Not really even noticing right away ⁓ what they had been talking about before. And you might notice that maybe down the line you start reflecting, like, wait a minute, what did they just say? Did they just say that their their clothes were often cut up? The favorite shoes that they always wanted that their mother gave them, and their mother is no longer here.

They noted that. And those were the shoes that were burned. Or that sometimes they were put out the house, but they made the most of it and slept in the car. Wait a minute, how often did that happen? You know, you start kind of maybe even thinking through ⁓ what ⁓ were they experiencing during this time and what else happened during that relationship? And did I miss something there? So ⁓

As you kind of listen to the way I said it and you kind of reflect on how easy it is to maybe follow the client sometimes when they’re talking about things that don’t seem to be very impactful, but then follow them where their voice picks up and their, you know, body language changes and they seem more engaged. And then you kind of sit and you’re like, hmm, maybe there was something that I needed to tap into about that. Maybe I missed something there.

Camille McDaniel, LPC (00:12:30)
And so I want to talk about ⁓ those moments because sometimes you will have someone experiencing trauma. They’ll come into your office for their appointment ⁓ looking ⁓ totally different than the way we were trained to pick up on trauma. They may not present with any major. ⁓

you know, outward expression. No crying, no trembling. Again, like I said a little earlier, maybe even laughing some things off, kind of joking a little bit, dark humor.

Camille McDaniel, LPC (00:13:15)
Maybe not even expressing intrusive thoughts, not expressing nightmares.

Sometimes ⁓ you may have someone who is sitting right across from you, ⁓ and they will tell you some of the most ⁓ you know, distressing, ⁓ heavy, ⁓ disturbing ⁓ events ⁓ in a very conversational tone and say very plain, very matter-of-fact, yeah, it happened, and change the subject.

So we want to talk in in today’s episode about what happens. ⁓ You know, what happens in those moments where affect and story just don’t match up. And more importantly, we’re going to talk about whether we as clinicians ⁓ know how to actually hear ⁓ the severity of somebody’s story ⁓ when their emotional presentation doesn’t give us much to go on.

Camille McDaniel, LPC (00:14:53)
And so I want to move forward ⁓ with a made up, ⁓ a fictitious ⁓ example, just for the purpose of the podcast to get us thinking. Again, this is definitely not based off of anyone. ⁓ I am making this up. If anything, maybe this could be something that was taken from like a example in research, something that is openly published, something that you can find on a television show.

But this is not based on a real individual. I don’t want anyone thinking that I would put ⁓ clients ⁓ information out there. This is totally made up. So ⁓ with that, let’s imagine ⁓ this ⁓ made up character. Let’s say it’s 42 ⁓ year old female and ⁓ I don’t know, we’ll let’s call him Suzy Q. ⁓

So Susie Q originally comes to ⁓ to counseling care because she’s struggling with anxiety. And let’s say she’s struggling with having challenges with her sleep, and ⁓ maybe she’s even having some some conflict with family or different relationships on her job or in her environment, but it basically some relationship challenges. And ⁓ during a session that Suzy Q has with you.

She starts talking about, you know, ⁓ a relationship that she had once upon a time, and she just says, Yeah, ⁓ you know, ⁓ I was in a relationship with somebody who, you know, was pretty controlling. ⁓ And then you ask as the clinician, so, you know, what did controlling look like? ⁓ And Susie Q just kind of shrugs her shoulders and just says, you know, well, you know.

He he didn’t wanna know where I was all the time. You know, he handled the money and ⁓ I didn’t really have access to his accounts. I mean, I was free to go where I wanted. Like I said, I mean, he he didn’t really care where I was, but you know, when it came to accessing the accounts or the money, ⁓ you know, he just always said I was never good with money ⁓ and that’s why he needed to just make sure to

Camille McDaniel, LPC (00:17:16)
keep track of it, you know. And then let’s say Susie Q kinda laughs ⁓ and and says, But you know, honestly, I probably wasn’t that good with money actually. And then she continues to tell you, Yeah, I mean he he would check the mileage on my car just to see, you know, how far I drove it and I wasn’t really supposed to go too many places. I mean, he didn’t really ask me where I went, but

He didn’t expect that I would go that far. So he would just check the mileage. ⁓ And but that was years ago. And then Susie Q immediately starts to talk about a current relationship that she was in. And that’s it.

But did you catch it? What did Suzy Q just tell us? Suzy Q just told us that she was under monitoring. She was being monitored and financially controlled. Her ⁓ description says that ⁓ he didn’t really care where I went. He never really asked. But he was checking her mileage.

We’d want to know a little bit more about that. And Susie Q didn’t really have access to accounts that had money in it. ⁓ and she was just told that she’s probably just really she’s not great at the money, and she believed it. And so maybe she was in potentially an environment where not only was she being monitored, but she was being financially controlled. And I wonder in what other

She was possibly being controlled. She was in an environment where she learned kind of to downplay things, ⁓ like her ability to handle money. And so it doesn’t, it doesn’t present as though she’s making a big deal about it because she’s just agreeing that maybe she wasn’t that great ⁓ anyway with money. ⁓ Listen how she she kind of shrugs things off. She kind of laughed a little.

Camille McDaniel, LPC (00:19:31)
She minimized. She kind of blamed herself, even right. ⁓ And so as we are listening, we’re noticing that Susie Q is describing something that is pretty significant, but she says, ⁓ happened a long time ago. And then she moves right along. So there is sometimes a pull ⁓ as a clinician to kind of move along.

as well because it’s like, ⁓ well the client’s moving along. It’s probably really nothing. I mean if if it was something they probably would have stopped. So let’s move along. But

As this is the first major point that I want us to understand for this podcast, ⁓ affect ⁓ is clinical data, but it does not tell us severity. So the intensity of a client’s visible emotions ⁓ and their responses, it can’t by itself really tell us the severity of what was happening to them ⁓ at that time. A person

doesn’t have to cry ⁓ for an experience to have been devastating. They don’t have to shake. They don’t have to have panic attack symptoms. ⁓ you know, they don’t have to be visibly dysregulated. ⁓ Matter of fact, for some, the intensity of what they experienced has caused them to have great control of their affect. It may have very well been

Something to sometimes save them from danger. We cannot automatically look to affect as a meter of severity. Because intense affect doesn’t automatically establish trauma. Our responsibility is to assess, and that means that we are going to have to learn to really listen ⁓ to at least ⁓ what is the client showing me.

Camille McDaniel, LPC (00:21:42)
⁓ And what is the client actually telling me? And those are not always the same. So before we go any further, I want to ⁓ I want to be really careful with you know terms because you know that’s important. And it would be very easy to call like every presentation that I’m describing today dissociation.

And I know that that is a big thing. And I know that that actually occurs within traumatic situations. ⁓ but I want us to kind of not just land totally on dissociation only, because dissociation is a very broad ⁓ clinical concept, and ⁓ trauma related ⁓ dissociative phenomena can also include experiences that are involving like

Alterations in people’s awareness or their memory or their identity, ⁓ their perception or even their connection with themselves ⁓ and their surroundings. And so within ⁓ PTSD, especially ⁓ the the DSM dissociative subtype ⁓ centers on depersonalization and derealization. And depersonalization can involve feeling detached.

from oneself as though you’re like observing yourself ⁓ or as though what’s happening isn’t quite happening to you. You know, you’re not all the way feeling it, right? ⁓ Derealization involves a sense that ⁓ one’s surroundings are unreal, kind of like dreamlike. They’re they’re kind of distorted. It’s like some some distant thing, like you’re really not in it.

And so those are some things that can also occur that don’t necessarily show up in people’s affects. So a client could be calmly recounting ⁓ traumatic experiences, but it doesn’t automatically mean that the client is dissociating because the client is just being very calm ⁓ and controlled in that moment. ⁓ we really have to assess more to determine what is going on.

Camille McDaniel, LPC (00:24:05)
So what we’re going to kind of continue talking about in this episode, ⁓ it really can involve ⁓ a couple of overlapping clinical ⁓ definitions. Yeah. And so we just want to be aware of that. But it’s good for us to just be aware of those definitions and be aware because again, ⁓ that can be showing up in our sessions. ⁓ And ⁓ and again, the person may not really give.

The the regular or the typical ⁓ signs ⁓ and symptoms. Because we might actually see people who are emotionally ⁓ numbing themselves, right? ⁓ Or restricting or constricting their affect. We might notice that people are very detached, ⁓

logically from emotionally or mind and the mental thoughts and logical thoughts from body and physical and what’s happening. And so one doesn’t know what’s happening with the other. We could notice that what’s happening, it may not necessarily be dissociation. ⁓ It may not necessarily be depersonalization, derealization. It could be avoidance. It could be minimization, right?

Maybe the person is compartmentalizing. The person may be one who is an intellectualizer. ⁓ everything gets intellectualized, right? So ⁓ again, we want to just be open to the idea that when we are first going to be aware of what a person is telling us, ⁓ not just the affect, and also if the person is saying it in a way that makes it seem, ⁓

not not that big of a deal or yeah it happened I’m over it. They don’t say those words, but they are giving nonverbals with regards to their body language, with regards to their tone of voice, and even the words that they are saying, pretty neutral, pretty matter of fact. We can also consider that ⁓ some of these other things that I just mentioned, compartmentalizing, minimizing,

Camille McDaniel, LPC (00:26:20)
avoidance, ⁓ detachment, you know, some of those things could be going on. And then yes, it could also be dissociation. We just want to be aware ⁓ of what’s going on so that we can kind of track ⁓ it during our sessions and see if certain things show up ⁓ more frequently. And so we can go from there. ⁓ One of the things that we don’t want to forget also is for our clients who have medication that they’re taking.

We want to make sure that it’s not the medication that we’re seeing. Medication can definitely affect a person’s presentation. Okay. Depression. Cultural norms. ⁓ These are all things that we need to also be aware of, just kind of in the back of our mind, right? ⁓ family of origin norms, things that maybe contribute to how they’re presenting now, especially for those who have had ⁓

long history with different types of trauma. ⁓ And then ⁓ neurodevelopment differences. And that can definitely ⁓ impact the way that somebody presents ⁓ and and even describes some of the traumatic instances that they have had. So some clients just they don’t communicate distress ⁓ very well through affect. ⁓ And some clients have really genuinely

Process their experiences and they now can discuss them, and it’s really not a problem for them. They don’t become emotionally overwhelmed. So it’s not for us as clinicians ⁓ to determine, ⁓ you know, well, this person ⁓ isn’t crying. So it has to be dissociation. Instead, we want to be curious. And I’ve talked about this in other episodes with different topics. We want to go in curious.

We want to look at all the different possibilities. We want to ask more questions where we need to. We want to better understand their worldview and their experiences and their culture, their their norms, so that it can all come together to help us have a better picture of what might be going on.

Camille McDaniel, LPC (00:28:39)
I want to give us some language for something that I’m going to ⁓ call high significance and low affect disclosures. So I’m using that to kind of describe this ⁓ this kind of the podcast episode and what we’re talking about today. This is not like a a diagnosis or anything like that. ⁓ just high significance in what the person’s talking about, but low affect.

in what they’re showing. So it could be where someone’s saying like, they’re they’re talking about their family of origin and they’d say like, yeah, my my mom would disappear for like a couple of days sometimes. But I mean we were pretty independent kids. Right. ⁓ Or ⁓ I I you know, I don’t remember much before I was ⁓ the age of twelve years old. Yeah, I I have almost no memories before then.

⁓ something else. ⁓ you know ⁓ my wife never really hit the kids. I mean, she just mostly threatened me. ⁓ Or I you know, I learned pretty quickly ⁓ not to tell ⁓ my dad no.

So as we go on, and I’m you can recount some yourself that you may have heard. You know, ⁓ you want to think, okay, did I really hear what they were just saying? Especially again, if they said it in in a very, very matter-of-fact way or a tone that didn’t indicate urgency, didn’t indicate fear, didn’t indicate any emotion. ⁓ Did I hear what they said?

Because every one of those statements ⁓ really deserves some more curiosity, some more questioning. Now, it’s not that every statement that I just said as an example proves anything just by itself. Now, obviously, we’ve done initial intakes, and so we may very well have more information that does substantiate the

Camille McDaniel, LPC (00:30:53)
sentences that I just said as examples. So we may know that for sure there has been abuse that was taking place or there was something traumatic that occurred. ⁓ But outside of our initial intake, any new things that are said, we want to really be curious about it ⁓ unless we have some background history on it already and therefore we can make a clear conclusion. ⁓ because every statement doesn’t necessarily

⁓ contain information that that could point toward abuse, but every statement ⁓ doesn’t necessarily not contain, you know, so ⁓ so we wanna just we want to make sure that we are asking more questions so that we can conceptualize what is going on. Remember, you know, gosh, many, many, many years ago for some of us, but

you know, in graduate school you had to do these case conceptualizations and for those who are actually clinical supervisors at this time, you probably still do case conceptualizations. ⁓ But you know, you had to you had to take into account all the moving pieces and some of the pieces that ⁓ were missing ⁓ and you had to kind of look at how you might be able to bridge the the gaps and how these pieces all came together to form a story that could apply to your client.

gave you at least a a baseline, something to work with, and for sure something that would then allow you to go back and be curious, ask more questions ⁓ and ⁓ and see what other information you could gather in order to create a full picture to explain how this person came to this point in their life. Right? You know. ⁓ Human beings, ⁓ you know, naturally

They use emotional cues, ⁓ and and ⁓ we are, you know, we are those human beings with clinical experience. And we may notice that we are looking for these cues, these ⁓ natural human cues that show emotional significance, emotional severity. And so when you’re so used to looking for.

Camille McDaniel, LPC (00:33:12)
evidence of ⁓ severity through these emotional cues and ⁓ and verbal and nonverbals but you’re not getting it that that can sometimes be a little confusing you know it’s clear when a client bursts out into tears that something is is behind there you know your your attention kind of peaks gets a little sharper right when your client

like lowers their tone and maybe their shoulders start to to slump as they say something, then you you pick up on that. That kind of that kind of gives you a little bit more information or maybe their breathing starts to change and you can notice that. But when the client says something that’s enormous, ⁓ but they use the same tone of voice that they use to tell you

What they ate for lunch. ⁓ Well, we have to train ourselves to hear the content, ⁓ even when ⁓ their affect, their voice volume, their body language.

Doesn’t change.

Camille McDaniel, LPC (00:34:35)
All right. Let’s go back and visit Suzy Q. So if we go back and we visit Suzy Q, we’re gonna go ahead and we’re gonna slow down a little bit. And we’re gonna say, you know, Suzy Q, I want to go back. I want to go back to something that you just said a minute ago. You had mentioned a minute ago that ⁓ the person you were in a relationship once upon a time, they they didn’t

really care where you went, but they check the mileage on your car. And let’s say Susie Q is like, yeah. Mm-hmm. Yeah. And so then you might ask, you know, well what would happen if the mileage didn’t match ⁓ what they thought you should have?

And then Suzy Q pauses, maybe is quiet just for a minute, and then gives you some information that now gives you another piece to the puzzle. ⁓ Maybe Suzy Q says, Mm, ⁓ well yeah, well then ⁓ it’d be a problem.

Camille McDaniel, LPC (00:35:51)
But you got something there. Notice as you were curious on something that Susie Q just presented, very matter-of-factly, and you went back just to be curious about it, you got some information that allowed you to have another piece to this emotional puzzle that we are putting together. ⁓ And you’re not trying to interrogate anybody, make them feel uncomfortable. We’re just trying to understand.

the language that they’re using because again, the tone of voice, the body language, you know, the facial affect didn’t give us anything to go off of. ⁓ So we wanted to just make sure that we were not missing anything that could be beneficial to Susie Q’s counseling care. And then you could go from there, let’s say, you know, if Susie Q said, yeah, then it’d be a problem, you could go into asking more questions about what kind of problem.

What would that look like if if a problem arose in in that person’s eyes? And and then you you know, you can continue to help ⁓ Suzy Q process, right? ⁓ So then you you could see what would happen. What would happen. And you same thing about you mentioned also that you you slept in the car a couple of a couple of times, huh? And they’re like, I mean, yeah.

It was no it was no big deal. I mean, it actually was better in the car than to be in the house anyway with you know, with the attitude. So you kind of you probe a little bit. ⁓ you ask a few more questions. How often did you have to choose the car? How often ⁓ were you forced to choose the car because you couldn’t go back in the home? What do you mean it was better?

Then, you know, having to deal with the attitude. What did attitude look like if you did have to be around it? You know, and you’re you’re gonna pick up cues ⁓ along the way from Susie Q about whether or not ⁓ she’s comfortable even going that far. But that that alone, if you start getting pushback, it tells you, ⁓ I’ve hit something. I’ve hit something that might be significant. And so you just keep that in in your mind. We’re not here to

Camille McDaniel, LPC (00:38:14)
push someone to go farther than they are comfortable going, ⁓ because everybody needs to be able to feel safe and we understand. But we at least now have an understanding there’s something back there. ⁓ And that something could be impacting Suzy Q and what she’s dealing with today. Because that could impact the way she adjusts herself in the world.

The way she sees people in this world, the way she reacts to things in this world. And so that is ⁓ more important information for us ⁓ as we are helping our clients to overcome some of their cycles, ⁓ some of their thought patterns, ⁓ you know, cycles as in behavioral cycles is what I was meaning. ⁓ some of the thought patterns that are keeping them ⁓ stuck, you know, this is this can all be then very

very useful information. And so notice we can catch things if we are listening and not just always ⁓ looking for the client to have some reaction, but listening to the words that they use, listening to the way that they use it. How are they expressing ⁓ what happened, how it happened, ⁓ what they had to do in order to get through it.

And then you can use your clinical judgment to say, hmm, that doesn’t seem like that might be comfortable for most people, or that doesn’t seem like that would be ⁓ no big a big deal or not a big deal for most people. Let me let me just be curious here. And again, there is the possibility that Suzy Q has already processed all of this and and it really is no big deal, but we don’t want to gloss over it. Yeah, we don’t want to gloss over it.

Here’s the one thing that we want to also ask ourselves, especially when we are working with individuals who have a history of trauma. ⁓ because they they keep on, you know, they’re they’re functioning, they’re they’re doing everything and they’re presenting sometimes as though things are very much in control and what was in the past is no big deal and ⁓ nothing to have to be worried about.

Camille McDaniel, LPC (00:40:35)
But we want to ask ourselves as it relates to that particular type of client, ⁓ what did functioning cost them? Because trauma survivors can be extremely functional. I mean, they go to work, right? They have they have degrees, they’re specialized in certain areas of their field. They raise children, they’re, they’re ⁓

They’re paying bills, taking care of a household, cooking the dinner, grocery shopping, all the all the good things. They’re they’re serving in their churches, they’re taking care of their elderly parents. They, you know, they’re doing all kinds of different things that everybody is doing. They are business owners, they are showing up to counseling, they’re, you know, they’re ⁓ smiling in their photos and all of this kind of ⁓ all of these kinds of things. And sometimes we ⁓

We look at the functioning as evidence that things probably aren’t that bad. ⁓ but functioning tells us what someone can accomplish. Okay. It does not at all tell us what it costs them to accomplish it. Okay.

So again, I’m just gonna I’m just gonna say that again. We just wanna be aware, just because someone is functioning, just because someone is highly intelligent, somebody might be, you know, doing all the things in their personal life, accomplishing all the great things and ⁓ running all all the kids, all the places and managing the household and coming to counseling and you know, actively trying to, you know, cooperate and do all of the things that you all are talking about. And you may feel like, it’s

Yeah, I’m pretty sure that stuff they talked about doesn’t bother them because I mean they’re they’re really they’re doing a lot in counseling. But doing a lot, functioning, being productive ⁓ sometimes goes right along with the internalized narrative ⁓ of ⁓ of what they needed to do in order to survive the trauma that they endured. Sometimes individuals who

Camille McDaniel, LPC (00:42:54)
Have experienced traumatic incidents or violence can be very functional, very aware, very adept ⁓ at hiding things, very productive. So we do not want to look at just functioning as evidence that the individual didn’t experience it that bad or doesn’t have it that bad right now either. Okay. Instead, we want to look at

What does it cost someone to be that functional when they have experiences with trauma or violence or you know abuses of different types, right? Because people can go to work every day ⁓ and ⁓ many, many p many people do, and nobody knows that anything is wrong. Okay. And that is not really like that’s not something to like

I’d be like, my gosh, they’re so strong. ⁓ you know, they’re just plowing through it, right? Well, we already know that as clinicians. It’s wow, what is it costing you to just keep on going like this? And just kind of see what their response is. Sometimes they’re not even used to anyone stopping and caring, ⁓ noticing, ⁓ asking how they’re doing. Sometimes you might even notice people don’t know how to respond.

Because they’re just not so, you know, ⁓ prepared ⁓ for that question. And they can answer it about anything else and anybody else. But about themselves, sometimes you might even hear, ⁓ gosh, I don’t know. ⁓ I don’t know. ⁓ I have never never really thought about it. So, yeah. We just want to be aware of that. We just want to ⁓ take note of

what it might look like when we are working with individuals who have experienced things ⁓ and the way that they present it ⁓ does not give us a clue as to the severity. So the cost of people functioning ⁓ can sometimes ⁓ sometimes come from a lot of places. The cost might be their sleep, the cost might be their appetite.

Camille McDaniel, LPC (00:45:12)
⁓ or they might have, you know, a lot of tension, a lot of stress that they’re carrying. They might show signs of perfectionism, or they might be very isolated. Again, I mentioned earlier, they might be hypervigilant or an overfunctioner, you know. ⁓ they are they’re the project manager, the referee, they are the, you know, the firefighter, they’re doing all the things.

They might even be emotionally numbing as we talked about before. They there are a lot of costs to functioning. ⁓ relationship costs, you know, there are things that then sometimes if they are married can be contributing to the deterioration of the connection within their marriage because of functioning, you know, ⁓ and having ⁓ difficulty recognizing what they need. ⁓

Where they are like in need of some support, of some help, difficulty sometimes even making decisions, ⁓ or maybe a need to have things under control. Again, ⁓ not because these individuals just love control, but because it relates to a level of stability. And stability feels safe. Okay.

Sometimes you might even notice that the person ⁓ is over functioning in their spiritual life. ⁓ They talk about, you know, I pray every day. And ⁓ and when you explore that more, just, ⁓ okay. That’s, you know, all right. That sounds like something that is is very consistent for you. You know, ⁓ what does that do for you to pray every day?

And I know sometimes we we don’t want to assume we might just think, well, they pray every day. I mean, we all know what prayer is, but right, this is a clinical setting. We’re curious. So it’s like, ⁓ okay, pray every day. Great. And what does what does prayer do for you? And that that might lead you to ⁓ a very healthy positive response. It might lead you to a response that causes a little more concern.

Camille McDaniel, LPC (00:47:33)
you know, and so you you wanna just explore. You wanna explore, that’s for sure.

Camille McDaniel, LPC (00:47:42)
⁓ One clinical skill that I want us to just kind of ⁓ talk about, recognize ⁓ in in this ⁓ next section here is learning to hear the sentence underneath the sentence. Okay. So with the sentence underneath the sentence, we’re we’re not making meaning out of nothing. We’re not gonna be assuming or anything like that. It’s just hearing.

What needs to be clarified? Hearing something that really deserves another question. So we’re going to practice this one. ⁓ We’re going to take a look at again, just examples, just random, not coming from ⁓ any kind of ⁓ case that or client case that has ever been worked on by me. But just making this up. All right. So looking at ⁓ someone.

talking about their childhood and they say, you know, in my childhood, my childhood was pretty normal, you know, ⁓ my dad drinks, but I mean, whose dad ⁓ didn’t drink back then anyway? You know what I mean? ⁓ And ⁓ not we’re not going to say like, ⁓ so ⁓ your father was an alcoholic? ⁓ Right. We’re not gonna we’re not gonna do that. ⁓ So again

Where this is where, yes, ⁓ questions are deserved because we’re saying the sentence ⁓ underneath the sentence, right? And this is where we are gonna be curious, we’re gonna ask questions, but not in that way, because we’re not gonna assume. We’re not gonna assume. Instead, we may want to when they are saying, like, yeah, you know, I mean my childhood was pretty normal and my my dad drank and then it’s like, Yeah, but back then, you know, a lot of people drank or whose dad didn’t drink back then and to that then instead we might not

Talk about like, dad’s an alcoholic, but instead, so when when you say that he drank, well what did that look like in your home?

Camille McDaniel, LPC (00:49:49)
You might ask, you know, what changed when he was drinking? How how did you know ⁓ whether it was like a good night or a bad night? Or did you ever feel responsible for like, you know, ⁓ managing things that happened in the house when dad was drinking? Okay, now we start to then ⁓ look at the sentence, but this sentence potentially has more story behind it.

So we want to ⁓ ask a few more questions so that from that one sentence we can get a better understanding of what that might have looked like for our client ⁓ at that time in their life. Hopefully that makes sense. You know, it’s just taking what could be just a regular sentence because maybe back in the time that your client is referring to, maybe drinking was very common.

But we don’t want to assume anything. We don’t want to assume anything. And so we wanna just look at, hmm, ⁓ I wonder ⁓ what made that ⁓ something that they felt was quite normal and and what did it look like in their home? All right, and then you kinda go from there. We’ll do another one. ⁓ Another one might be like, ⁓ yeah, my mom had depression. So, you know, I mostly took care of myself. Yeah, it was it was fine. It was actually

Quite nice. Okay. So sometimes it can throw you off when you have a situation where a client is basically telling you like that was enjoyable.

⁓ Well let’s let’s get curious, right? Because taking care of yourself when we already know that depending on what stage of life you’re in and all of that, it’s not so easy. ⁓ it’d be different if it was like, yeah, I mean, I took care of myself, you know, and it was quite nice actually, and the person was a college student, right? That’d be different than if the person was in elementary school. So

Camille McDaniel, LPC (00:52:02)
What we’re going to do is we hear the sentence, Yeah, my mom struggled with depression. So I mean I mostly took care of myself.

Now, what comes up for you? What kind of questions do you want to know? Because let’s say your client is just telling you this first time. What do we want to know? ⁓ We want to actually know a lot. How about, ⁓ really? So how old were you at that time? Right? What did taking care of yourself actually look like? Because again, we might hear the person.

presented in a way where it seems favorable and then they just move right along with their sentence or their story. And you might notice that you too get kind of caught up in moving right along with them. But wait a minute. Wait a minute. Because if we have, you know, someone whose parent can’t get out of bed and then ⁓ all of the responsibility falls on them, how much fun could that be? Well it might be a little fun initially, right? ⁓ Until you really need something.

That only an adult can do for you. So we got a few more questions, right? ⁓ who prepared the food in the house? how’d you get to school?

So what happened ⁓ if you were ever sick? Were you ever sick during any of these times? Was a another adult available close by to check on you? ⁓ And if the person had siblings, then we want to know did did you have to care for your siblings as well? How did that go? Again, we’re assessing. We’re we’re not though just taking the client’s

Camille McDaniel, LPC (00:53:46)
word at face value because sometimes there is more there’s more underneath ⁓ and we want to be able to make sure that we are hearing ⁓ fully what the client is saying okay so again this might be something ⁓ you know ⁓ another example of something that could be traumatic for people and and sometimes people don’t even realize right

But let’s say again the sentence here is ⁓ he didn’t hit me. I mean he just punched the walls. It’s like okay. Now I think many of us would, you know, be very inquisitive here. Because it’s like, ⁓ okay, so you didn’t get hit, but well ⁓ where did where did this happen? When did this happen? ⁓ Did did he ever

Allow you to leave while he was punching the walls? Did he ever throw things, destroy property, threaten you, threaten himself? Right, there’s there’s so much more underneath that sentence that can allow us to be really curious so that we can determine what might have been going ⁓ on in the client’s life, right? Okay, yeah. So

Here’s one more. And this goes back to something that I gave as an example earlier. It says, I don’t really remember much of my childhood. ⁓ you know, ⁓ yeah, I don’t remember much of it, honestly. So let’s say somebody said that, right? Now, we could very well find ourselves saying, ⁓ that’s definitely trauma, right? ⁓ But

But there can really be a lot of reasons for someone having limited memory. So we don’t want to just go straight toward an answer. We really want to ask a few questions. And some of those questions might be, you know, so when you say you don’t remember much, like what does that mean? Because first of all, we do want to get clear on ⁓ we want to get clear.

Camille McDaniel, LPC (00:56:08)
On wording, just because we think we both are hearing the same thing doesn’t mean we really are understanding the meaning ⁓ of the thing we’re hearing. So we want to ask, you know, when you say when you say you didn’t really remember much, you know, what does what does that mean? And we can keep on going, you know. So are there certain periods of time that seem less clear to you versus others?

What’s the earliest memories that you do have? How about ⁓ you know, do other people describe events that you really just don’t remember? ⁓ Or do you experience gaps in your memory even today as an adult? So that this will allow us to better assess what’s going on, you know.

⁓ we just want to be careful overall. We want to make sure that we’re not necessarily following the client ⁓ right on past important information. I mean, ⁓ we are ⁓ trained to follow the client’s lead, to listen to what they’re saying, to make sure we’re respectful of their autonomy and what they want for their tr their client experience and

their goals and that that really can be a good thing. But we want to make sure that as we are following, it doesn’t mean that we we are are kind of ⁓ lit kind of turning it all over to ⁓ just the client ⁓ and becoming kind of passive in our clinical ⁓ detection. You know, we want our clinical red flags to still go up.

When they need to.

Camille McDaniel, LPC (00:58:04)
And ⁓ just again, because sometimes the way things are said, because there is lack of ⁓ body language with it, lack of change in tone ⁓ of voice.

We may find ourselves kind of going with the flow when the client just goes in a different direction or shows much more affect ⁓ and body language for a different subject. So ⁓ we don’t want to assume everything’s okay. We don’t want to assume that everything is not okay, but we do want to be very curious and just be very aware.

That especially for clients that may experience traumatic incidents in their life, the affect may not communicate the severity. Okay. So ⁓ as we are kind of thinking about this topic, ⁓ we want to make sure ⁓ that we keep track of one more thing, too, ⁓ and that ⁓ we don’t want to try to elicit.

feeling from the client just to see if maybe, you know, it it really is actually reaching them, it really is bothering them, it really is touching them. We wanna we wanna just be respectful again of how each person might present for all the reasons that I mentioned before. Whether it’s, you know, neurologically different, whether it’s cultural, whether it happens to be that this individual

is kind of used to controlling their affect. ⁓ a lot of different things could be contributing it to contributing to it. ⁓ And we just want to recognize that. ⁓ we want to remember that clients might be detached from the emotional impact of an experience. ⁓ And that doesn’t mean that we are are there to then try to help them feel the intensity. ⁓ No. ⁓

Camille McDaniel, LPC (01:00:13)
Remember, sometimes that distance definitely serves a ⁓ an important purpose, an important protective purpose. ⁓ Matter of fact, the National Center for PTSD ⁓ describes how depersonalization and derealization ⁓ can actually ⁓ attribute to emotional experience in the face of like overwhelming trauma. Like it can help.

⁓ an individual when they are facing overwhelming trauma. So ⁓ we want to just be careful to be also aware of people’s protective ⁓ functions. Even if those are some protective functions that need to be worked on, processed, maybe ⁓ help them to develop even healthier protective functions. But we we do want to be careful not to just go in and start to dismantle all those protective functions. I mean, they’re kind of like if you can imagine.

⁓ you know, scaffolding when a person happens to be like painting on the outside of a building, or they’re like you see construction workers build these scaffolds so that they can safely climb up high heights and maybe they’re fixing something on the outside of a building, or they’re, you know, I don’t know, adding something ⁓ to the outside of a large establishment. But either way, this scaffolding keeps everybody safe.

While they are doing whatever it is they need to do to upkeep, to maintain ⁓ the establishment that they’re working on. Well, imagine like your clients have internal ⁓ scaffolding, internal emotional scaffolding that’s holding them together. We don’t want to go in and start ripping down scaffolding without having ⁓ another healthy alternative to have in place. So what we do is one step at a time.

You take a little bit off of the old scaffolding while you replace it with something healthier and new and and more healed. ⁓ And as time goes on and they are willing to release some more old scaffolding, you receive it and you then help them to replace and put in some healthier new scaffolding. we never want to just go in and say, that, you know, that that way of dealing, that way of of protective functioning is is no good.

Camille McDaniel, LPC (01:02:36)
You know, and let’s just dismantle it because you can definitely leave clients in a worse-off position, that’s for sure. So we have covered ⁓ a lot this episode, ⁓ and I I hope it really gives you something to think about when you are working with those awesome clients who definitely they present in a way where ⁓ again it might seem like what they’re talking about didn’t really have much ⁓ impact on them. And

Remember that could be because it really didn’t have an impact. They’ve already processed everything, or it could be a part of their protective functioning ⁓ and a way for them to ⁓ not go down that path because they are not ready. ⁓ So this is our topic. I I truly enjoy this topic. It gets you thinking, it gets you hopefully thinking about experiences that you’ve had in. ⁓

in your practice while while conducting your counseling sessions ⁓ and ideally gives you something to consider as you move forward in helping ⁓ your clients to heal. Thank you for listening. ⁓ Share this if you feel someone else can benefit from the information. ⁓ And until we meet again, God bless.