In the client-counselor relationship, describing traumas from past experiences can reveal unresolved suffering in which a client’s beliefs, emotions and behaviors are filled with deep negative images. Ideally, clients will share their trauma with therapists and how images from the past continue to affect them. By describing their trauma, many clients can normalize past experiences and are able to face future traumas with more positive attitudes.

However, as counselors, we realize how accessible these traumas become for clients who slowly drift back into old patterns when new trauma enters their lives. New trauma that is even remotely similar to past trauma can resurrect old beliefs, trigger negative emotions and generate compulsive patterns of behavior. The question becomes, how do counselors stop clients from drifting back into old traumatic patterns when new traumas enter their lives?

 

Using metaphors

One successful possibility is the use of metaphors. According to Judy Belmont, metaphors allow counselors to unlock a client’s way of thinking by creating flexibility and evoking emotion. They allow clients to visualize their thoughts and connect them to their feelings.

Neurologically speaking, metaphors allow the neuropathways of the brain to realign in a way where thinking and feeling bring into account a similar picture from a past incident. This leads to a more comprehensive understanding of experiences such as trauma, abuse, loneliness and loss.

Let’s look at one such example with elements that most people around the world would understand — namely, wounds and scars. It may be impossible to get through life without experiencing some form of physical or psychological wound that affect a person’s everyday experience. You trip and fall down the stairs, you are in an accident, someone close to you dies … these are examples of wounds that hopefully will heal. If they do heal, many times you are left with a scar that reminds you of the incident that took place.

But there can be confusion over the healing process and how the person perceives his or her wounds developing into scars, especially if they are psychological scars. My hope is that the metaphor “a scar is not a wound” will help clarify this healing process with an emphasis on psychological healing.

When someone has a wound, the healing process can involve suffering that may feel worse than the initial acquiring of the wound. However, most people find this experience tolerable based on a belief that a certain level of suffering is required to allow the wound to heal. In turn, people with a healing wound assume that they are “on the mend.”

In many cases, a healed wound may leave a scar as a reminder that successful healing has taken place. Although the scar may be ugly, annoying, a topic of conversation or not as favorable as regular tissue, it is still an image of success signifying that a wound has healed. If the scar begins to throb or becomes painful at a future date, many people still tolerate it as a reminder of successful healing. They do not hold the scar to the same traumatic standard as they do the original wound.

At this point, it may be safe to say that, metaphorically speaking, a scar is not a wound.

 

An overview

When helping clients understand their past traumas, it may benefit therapists to describe these traumas as open wounds that need to heal. In mental health, when someone experiences a past mental wound, the healing process can be quite similar to that of a physical wound. For example, in therapy, when exposing past mental wounds, the associated suffering may feel worse than the suffering from the original traumatic experience.

Furthermore, mental health clients can confuse the difference between necessary and unnecessary suffering with these wounds. When experiencing a physical wound, it seems much easier to accept suffering as necessary. A mental wound may be harder to accept or tolerate, however. Even when clients work through the suffering associated with mental wounds, they may remain anxious about the possibility of the wound returning.

Many clients in mental health are at a disadvantage when it comes to the healing process, in part because they cannot look at their wounds and watch them heal. Instead, they must trust in the therapeutic alliance between client and counselor to form a belief about how the mental wound heals. Neither can these clients look at their wound and visualize growth and change.

For therapists who find meaning in the power of images, this may be an appropriate time to introduce the metaphor “a scar is not a wound” to help clients visualize their healing. When normalizing past traumas with clients, therapists can describe trauma as an open wound that needs to heal. Eventually, the client and therapist may want to discuss turning wounds into scars.

A scar can be used as a metaphor that reminds clients of past open wounds but in a positive manner. Helping clients transform wounds to scars is a metaphorical way of making past trauma meaningful and positive. Instead of clients looking at new trauma as a return to an open wound, they can use the metaphor of a scar as reassurance that they have gained resilience for future traumas in their lives.

This begs a question: Can mental scars be more than reminders of past wounds? Can they be viewed as products of successful healing? The scar metaphor creates growth and change by using the natural process of healing as a model for mental health. Such a model can be used when future traumas that are even remotely similar to those from the past might suggest a traumatic relapse. Recognizing the difference between a scar and a wound can stop a continued drift into old beliefs, emotions and behaviors.

The scar/wound metaphor is a clear and simple way of reminding clients with posttraumatic stress disorder, secondary traumatic stress reaction, apathy, abuse, loneliness or loss that traumatic experiences can sometimes create resilience. Therapists can help clients learn from their scars. They can be symbols of successful healing. They can be viewed as a source of wisdom, similar to what is found in many survivors of physical wounds. Scars are not wounds, and when a new trauma is experienced, counselors can help clarify the difference.

This metaphor follows a growth and change model for treating clients. Ironically, it also follows a medical model by explaining the process of healing that takes place when doctors treat a physical wound. More important, it references the natural healing process, whether mental or physical.

This provides clients with a more holistic view of healing. It also allows clients to rely on a schemata or map of healing that they know and understand. Finally, it puts traumas in a different light in which necessary suffering is viewed as a natural process that can have positive results.

 

Multicultural implications

Metaphors are used in most cultures, making them especially useful in the field of therapy. Universal themes that transcend cultural differences give certain metaphors more reliability and validity. The “scar is not a wound” metaphor leaves little room for cultural misrepresentation.

Furthermore, the image of a scar is a universal concept that has deep meaning from a cultural perspective. For example, some African cultures create scars on their faces and bodies as a statement of rank, courage or pride in their communities. The scar may signify going through some difficultly and coming out the other side intact.

The “scar is not a wound” metaphor, therefore, becomes multicultural because scars and wounds are viewed as universal phenomena that can be interpreted in many different ways, with most of these interpretations symbolizing a sense of healing.

 

Group supervision

Because supervision and instruction are often provided in a group format, the “a scar is not a wound” metaphor can encourage more dynamic and inclusive results. Some examples of questions for groups are:

1) When is an effective time to bring up the “a scar is not a wound” metaphor when discussing the group members’ past traumas?

2) What were your experiences of having a wound turn into a scar, either physically or mentally?

3) What are your beliefs regarding your physical and mental scars?

4) Do you know of any culture that views scars as a sign of success when working through a difficult time?

5) Do you think it is ethical to use examples from physical healing to describe mental healing?

 

Potential problems

For those looking for a more scientific explanation of healing, the “a scar is not a wound” metaphor may be viewed as too conceptual, with little use of facts to back up one’s description. This may be especially true with new supervisees who are looking for factual definitions for such phenomena as trauma, DSM-5 disorders and other natural scientific concepts that make up the lexicon of mental health counseling.

There also might be those who question whether clients who have experienced trauma want to look at their scars in such a positive light. These clients may view their scars as grim reminders of past traumas that should be buried and not revisited. They may view these scars with failure and embarrassment and not appreciate the intrinsic value in seeing scars as a “success story.”

In addition, those who are looking for a more linear, step-by-step approach to healing may find such a metaphor too esoteric and not fitting for mental health counseling. These clients may want cause-and-effect answers that help control their anxiety about the possibility of future traumas.

Some counselors may find the use of the metaphor too nondirective, preferring more control over the information they share with their clients. In addition, it may not appeal to those therapists who hold little interest in the workings of the unconscious mind.

 

Additional applications

This metaphor can work well with groups whose members have suffered “wounds” that have produced negative results in their lives. For example, many individuals struggling with addiction have a history of trauma ranging from intrapersonal to interpersonal and leading them to their individual addictions. Some of these traumas remain open wounds that go even deeper than the addictions themselves. Blame, shame and low self-esteem may haunt these clients. Their open wounds have not turned to scars and may be the major cause of any relapse that takes place. Sometimes the open wounds become their own emotional addictions. In fact, healing the individual’s physical addiction may require healing his or her emotional addiction. This phenomenon can take place in both addictions counseling and mental health counseling.

In addition, counselors can build a repertoire of other metaphors grounded in the “scars are not wounds” metaphor. For example:

• “You can’t see the picture while inside the frame.” — A metaphor for a therapeutic alliance
• “A counselor should focus on trauma not drama.” — Staying with the counseling process
• “It is the broken helping the broken.” — Getting away from counselors as experts
• “No client is as sick as his or her file.” — Looking for possibilities, not facts
• “It takes more courage than brains to be an effective counselor.” — Being a model for change

 

 

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Peter D. Ladd is a licensed mental health counselor and the coordinator of the graduate mental health counseling Program at St. Lawrence University. His interests include existential and phenomenological counseling and conflict resolution. He has written 10 books from this perspective. Contact him at pladd@stlaeu.edu.

 

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