ABSTRACT: How might pastors begin to care for Christians who have experienced real trauma? Trauma literature generally outlines four features of care: know the person, reclaim the body, retell the story, and offer help to live in the present. Pastors and other leaders in a church might usefully apply this framework in their own ministry to sufferers, even as they fill each step with Christ and his word. In the end, common yet profound words from Christ, offered skillfully over time, can uniquely address the depths of the most complex pain.
Public attention to particular human struggles has its seasons. Multiple-personality disorder, for example, had a season in the 1980s, and ADHD after that. We notice the height of the season when a struggle shows up in bestseller lists or as a top hit in search engines. After a while, the hype settles into a quieter season marked by less attention and gradual refinements, perhaps finding new life in the next generation. Currently, we live in trauma’s season, and we have reason to believe that the season will be a long one.
The purpose of this brief essay is to review how Scripture guides us in understanding and caring for those who have gone through real trauma. We expect to find that trauma is a complex and nearly inscrutable fracturing of body and soul among those who survive it. We also believe that common yet profound words from Christ, offered skillfully, with humility and compassion, across the long journey of faith, will contribute to spiritual strength in the midst of weakness.
My interest here is not to give the details of pastoral care for those who have gone through trauma; rather, I aim to sketch the interests of the trauma-informed literature and how Scripture speaks to those concerns in ways that renew your confidence in how Christ and his word uniquely address the depths of the human heart. With humility, you come to this life-dominating trouble as a learner, without much confidence in yourself but with certainty that God in Christ speaks life and love to all kinds of troubled souls.
Trauma Described
Today the word trauma is applied to all kinds of pains and personal offenses, not all of them truly traumatic. Think of it as an imprecise way of referring to a painful past that has deleterious consequences in relationships and work, even decades later. A pastoral response is less interested in guarding the boundaries of the word than it is in understanding the descriptions and experiences that can be crammed into it.
Time, indeed, does not heal all wounds; some only seem to get worse. Traumas include wars and their destruction; sexual, physical, or verbal violence that you witnessed or experienced; loss of a child; addictions in the home; and abandonment, betrayal, or neglect from someone who was supposed to love and care for you, to name a few of its causes. If you have not experienced trauma, you will discover that it is all around you. Our world is covered with injustices and death. We know of the relentless wickedness within human hearts, even as we will always be grieved by its endless destructive consequences.
With only this simple description, Scripture opens wide and invites us in, especially through the links it makes between the flesh, death, and the devil. The flesh includes wickedness that tears down and destroys, which is among death’s signature moves as it wreaks havoc among the living. Both the flesh and death share a connection to the devil, who comes to steal and kill (John 10:10). We can expect that trauma will be accompanied by spiritual battles full of accusations, guilt, shame, hopelessness, and lies about God’s care. This means that pastoral care is essential for those who have experienced trauma.
As one small entry point, we could say, “One thing we know is that whenever death comes close, especially by the wickedness of others, the devil’s accusations and lies will likely follow, with lies and accusations about both yourself and your Lord. Have you noticed that warfare?”
Four Common Features of Care
Trauma literature generally includes four discernible features of care: know the person, reclaim the body, retell the story, and offer help to live in the present. All four categories are natural to Scripture and offer a useful framework for us, even as we seek to fill each category with Christ-centered aims.
1. Know the person.
There are two basic movements in individual pastoral care: know the person and know Scripture, in that order. Whereas you can preach without knowing specifics about your hearers, you cannot do pastoral care without first knowing the person. Misunderstandings here will impede growth and discourage the person.
The case to know Scripture in pastoral care is obvious. Know the person is more intuitive or perhaps assumed. Of course we want to know people. How can we help if we don’t understand a person’s actual struggle? But since know the person is a fuzzy category that often doesn’t appear in theological textbooks or receive emphasis in seminary curriculums, our knowledge of the person can be haphazard and unguided. Trauma can have complex consequences, so skills in knowing people are critical.
You could begin here: “Please, try to tell me about how your past is affecting your life today.” The present can be a way to move into the past. Small steps. When you know and care for the person in the present, that person might feel safe enough to describe the disturbing fragments of the past. You invite the person to speak because your care requires that you know something about him or her. Even more profoundly, these questions and answers are often preliminary to the person being able to speak these fragments to God, who invites us to pour out our heart to him (Psalm 62:8).
Fear often leads the way. That is one obvious consequence of destructive acts. “I stood in great fear of the multitude, and the contempt of families terrified me, so that I kept silence, and did not go out of doors” (Job 31:34). Traumatized people live with what feels like three options: fight, flight, or freeze. The freeze response is connected to what is known as dissociation, a common feature of post-traumatic stress disorder (PTSD). Dissociation yanks you into your past while you are in the present.
You can understand why trauma discussions talk about the importance of a safe place. If the brush with death came from a father or brother, a woman speaking with a pastor in his study — or even with a pastor and his spouse — could be more than enough to drag her back to past events. Without such knowledge, you could assume that a woman is quietly understanding and appreciating your encouragement, though really she is too frightened to say anything. To establish a safe space, you might say, “I am concerned that you could feel intimidated or outnumbered by even being here,” and then consider ideas for what might help.
Most pastoral care cases involve working through a prominent struggle: a conflict, a miserable boss, a distant child. Trauma, however, brings a kind of internal shattering in which multiple troubles live together. Along with fear comes almost every imaginable form of misery. Pain, chaos, panic, depression, anger, disfigured desires, guilt, shame, and discernment that seems unmoored given how past wickedness was justified by perpetrators — these are just some of what you will find. Notice that the word of Christ gives the only meaningful and healing answers to all of these. To begin disentangling this web, you might say, “Sometimes there are so many voices inside you that you don’t even know where to begin. Maybe you could begin by describing what is happening within you now.”
Trauma could present as anger. But if anger immediately drives you to James 4:1–3, you might miss what is most important. With trauma, anger is usually an expression of fear. The traumatized can be sinfully angry, like anyone else, but their anger is more often a means of protection. To miss this is to leave the person even more isolated.
Trauma could also present as withdrawal. When the words come, they are vague and not specific. The person seems distant. A natural question is, “How can I help you be here? For example, do you have any questions about the room?” (This is one way to invite the person into the present.)
Pastoral blunders come when we do not understand a person accurately. Your goal is to know a person in such a way that you can describe the person and even help him or her have words for the chaotic experiences that seem ineffable. As a way to love others, you could supplement your knowledge of PTSD by conferring with those in the church who have helped or experienced trauma; you could also read online stories or a book such as Darby Strickland’s Trauma: Caring for Survivors. You don’t need to have complete knowledge of a person before you can help. You can never know another person fully. But you can know the person accurately and identify those experiences that are most intense.
2. Quiet the body.
With PTSD, the body can control your attention. The person feels powerless to rule over emotions and bodily reactions. The word anxiety begins to capture it. Whereas fear can usually identify particular threats, anxiety focuses on the physical symptoms that accompany fear. You have probably heard of Besser van der Kolk’s book The Body Keeps the Score. Like any popular book, it has had its detractors, and some question the reliability of the scientific studies he cites, but the basic idea is important — the body keeps a record of some past events. The woman whose husband left her in September has a depressive swoon every fall, though she is happily remarried. A man who had cancer treatments at a local hospital is nauseous whenever he passes the location, even though his treatments ended five years ago.
Imagine the horror of going to bed when trauma intrudes into the present. First, you are out of control when you are asleep. Trauma can find that vulnerability intolerable. Second, you might be able to distract yourself from intruding thoughts and emotions during the day, but you can almost sense that flashbacks and nightmares are just waiting to burst out at night. Hypervigilance is the order of the day. You are on the front lines of a battle and must be alert to the snap of a twig. The afflicted person may live at the edge of a panic attack. The desire to literally jump out of one’s skin is compelling. One way to counterbalance that bodily vigilance is numbness, and drugs or alcohol are an efficient way to get there. You live in a world of fragments that is unfamiliar, unstable, and unpredictable.
How do you begin to set such a person at ease? You might ask, “Could you say something about what it is like to live in your body, with your emotions?” Expect that words will be hard to find.
Trauma-informed responses have a particular interest in these symptoms, but their recommendations are not highly technical or exclusive to physicians. Common treatments include breathing exercises like those in Lamaze classes or exercise, Pilates, and other body-movement programs that help you to feel your body in the present. Some will try medication, though it is rarely a long-term solution for sleep or anxiety. It is important to know what the person has already tried. You could ask, “What strategies do you have for quieting your body and focusing your mind on what is in front of you?”
One familiar strategy is EMDR, which stands for Eye Movement Desensitization and Reprocessing Therapy. The heart of EMDR is when a therapist asks you to recall traumatic events while also moving your eyes in response to various prompts (such as a moving light or an upheld finger that you follow). Through a handful of sessions, the goal is for this pairing to reduce the intensity of the traumatic recollections. Some research suggests EMDR can lessen bodily reactions to trauma. My own observation is that those who have gone through it do not describe it as a cure but acknowledge some change in their symptoms. (I will make some pastoral suggestions about this therapy toward the end.)
3. Retell the story.
Kurt Vonnegut wrote about World War II veterans who “had the war part missing.” The experience of trauma does not necessarily mean that a movie of old events replays in someone’s mind. Instead, the past is a patchwork of sensations, smells, flashes of disorganized scenes. You can quiet some of that chaos by building, in partnership with the traumatized person, a narrative that brings some order and coherence to life.
Consider how your own past informs the present. A stable home in which you were loved lays a firm foundation for what follows. It helps you deal with the present on its own merits rather than import the chaos of your past into present decisions. Your experience of life today is different if your home was unpredictable and dangerous. A woman who went from one foster home to another learned to be small, absent, silent, and frozen whenever there was any disruption in a home because she knew that it often meant she would be moved to another place. In her marriage, she retains the same instincts.
A disoriented life needs a narrative arc. A secular retelling will be superficial at best, and it will always risk revealing the vanity identified in Ecclesiastes. We, in contrast, have been given the story of the cosmos. “In him all the fullness of God was pleased to dwell, and through him to reconcile to himself all things, whether on earth or in heaven, making peace by the blood of his cross” (Colossians 1:19–20). Knowing this, the pastoral challenge is to bring a traumatized person into Jesus’s story in a way that the person is understood, leading to growth in small and gradual steps (with inevitable setbacks along the way). Knowing that every story can be brought into Jesus’s story is not the same as knowing how that happens with a particular person. We need skills and pastoral wisdom if we are to help meld those two stories into one. But we know what path to take.
One useful beacon in this process is to find promising stories in Scripture and then set out to inhabit them with the fractured person. Have a seat in the synagogue as Jesus reads about his ministry from the scroll of Isaiah (Luke 4:16–21). Notice how, when you are separated from his flock, he seems to have eyes for only you and he brings you home (Luke 15:3–7). Watch the apostle Paul bring you into God’s royal line through Jesus Christ (Galatians 3:23–29). Another way into Scripture is to read through the Psalms until fragments of a psalm catch the person’s attention. Once in, you can ask the person to embellish the psalm, add details, and see that it is Christ’s psalm.
Scripture specializes in bringing outsiders into a very different story. This is what we want for every person in our care.
4. Return to the present.
Trauma literature has a pragmatic core. It asks, What helps? That help focuses on how to live today. Are relationships in tatters? Learn ways to heal them. Is the body especially jumpy? Do some physical activity every day. Do you have thoughts that you cannot tolerate this pain anymore? Do something that is both worthy and desired rather than being paralyzed by those thoughts. And be careful about counterfeits to peace such as drugs, alcohol, and gaming. In suggestions such as these, the secular literature follows, on a lesser scale, one of the patterns in Scripture.
“Seek first the kingdom of God and his righteousness, and all these things will be added to you” (Matthew 6:33). Jesus is speaking to those who are fearful and anxious. The past can haunt us; the future can seem apocalyptic. In response, we trust that he will make right those past brushes with death, and he will be the one to worry about tomorrow. Then we, as young children, trust that he cares for us and live with the grace that he gives us for today. We seek to live out his righteousness in small steps. What have you said you would do? Do that. How will you love the person in front of you? What work needs to be done?
The person you are helping belongs to Christ. He is not his own; she is not her own. So you reflect with him or her on the way of wisdom: “You walk, today, by faith in Christ, and consider what small steps you can take that build his kingdom. When you are not sure what that means, you ask for help.”
The Structure of Pastoral Care
Pastoral care with trauma can take different forms: care through preaching, care through referrals, and care with you as the primary shepherd.
Pastoral Preaching
Public ministry proclaims what Jesus has done. It also invites people who cannot imagine being invited to him, such as the poor and the oppressed (Luke 4:18–19). You, as a preacher, are bringing listeners to Christ and into God’s telling of their story. Those who don’t feel like normal Christians, such as those who have been through trauma, may be reluctant to feel included unless you can describe something of their experience. This is true with any passage you preach.
For example, when you preach about anger, you might describe some of the quieter versions of anger so the passage can be available to everyone. For those who have experienced trauma, even a short description of how a passage might relate to them will show that they too can come before the God who knows our hearts and responds with compassion and mercy. You could say, “When we hear Scripture, we bring ourselves, our sins, our pasts, the shameful ways we have been treated, our many fears. We speak these to the Lord, and we listen to him.”
Pastoral Referral
Your pastoral care is shaped by your available time. Deep spiritual change comes gradually. Spiritual change with a traumatic past will almost certainly follow that pace. We all need pastoral care, and we need it for life. But most of us rely on the normal means of grace and the help of friends. Those who live with trauma benefit from more regular care.
As a pastor, you always share the load of pastoral care with the wider body of Christ. This is especially true with trauma. You look for people in your church or community who can help. Ideally, you refer someone to a mature believer who is vetted (however formally or informally) and functions as an unofficial extension of your church’s care.
There are times, however, when such help is not available or a congregant has already sought the help of another person. When pastoral care is outsourced, you still maintain a meaningful pastoral relationship. For example, you could meet quarterly and ask questions such as these: “What is one way I can pray for you?” “Where do you feel stuck?” “What truths about Christ — his death and resurrection, the Spirit he has given you — are landing in your soul?” “Is there anything that would be helpful for me to understand?” Consider together with the person how he or she is linked to the normal means of grace in the church such as a small group, a friend who prays and reads Scripture with him or her, opportunities to serve, and the Lord’s Supper. The Lord’s Supper, in particular, offers an occasion to discuss how the sacraments contribute to the person’s spiritual well-being, even speaking to the heart of his or her struggle with past trauma.
During your care, either you or the person you help will hear of various strategies for diminishing intrusive symptoms, among them EMDR and medication. How do you speak about these? I would suggest that if Scripture doesn’t prohibit it (either explicitly or by wise inference), you don’t either. Instead, welcome ideas that quiet painful physical reactions while remaining certain that what we have in Christ is deeper and of far greater value than them all. You hope to maintain an imbalance: Help from God is more important than help found in physical strategies (2 Chronicles 16:12; 2 Corinthians 4:16–18).
Primary Pastoral Care
If you choose to be the primary point of regular pastoral care and counsel, you will still forge all these links as you get to know the person, find ways to quiet the body, retell their story in and through Christ, and offer help for living in the present. Also consider meeting with a trusted, well-informed adviser for ongoing consultation. Consultation, a standard practice among counselors, is rarely prescribed for pastors (though it has become common practice among pastors in Australia and is often figured into their church budgets). While you have the utmost confidence that trauma is addressed most deeply in Christ and him crucified, you also know that wise care seeks out and listens to wise help and advice.
What if you are not sure a person’s struggle is best described as trauma? What if someone even applies the word in ways that change the rules of relationships, such that normal means of overlooking some offenses, trusting the God who judges justly, or reconciliation are replaced by demands for radical confession with consequences? Rather than adopting or disagreeing with the trauma label, be biblically descriptive with what happened, work through the matter with the help of others, and know that your best efforts do not always lead to peace.
Pastoral life is already too busy. This essay is not intended to add to your workload. I do, however, hope that it gives you confidence to move toward those who suffer, know them, care for them wisely, and recognize that even your small steps of care are both essential and likely to be more fruitful than you know.
