Fear in the Therapy Room: a survival guide for working with complex trauma.
As counsellors, psychotherapists, clinical and counselling psychologists and mental health nurses and workers, our professional lives are spent engaging with people whose fear systems (our automatic biological responses to threat and danger) are in a constant state of activation. This triggers our own fear responses and in the therapy room we can experience tension, anxiety, fright, loss of our ability to concentrate or think clearly, anger, irritation, frustration, feelings of uselessness and hopelessness or extreme exhaustion.
Many therapists feel there is something wrong with them – that they are inadequate therapists because they feel these things. Nothing could be further from the truth. As one stringed instrument resonates when another is played, so our bodies pick up on the emotions our clients are experiencing and give us vital information about their distress which enables us to be of real help.
However, this resonance, which involves the constant activation of our own fear-system responses, has a huge impact on our body and our mind. It is a significant energy drain, and without a good understanding of what is happening to us, of the difficulties we are up against in this work, and of the massive support that we need, we can easily lose our self-confidence, become discouraged and overwhelmed and eventually burn-out.
This book offers a simple explanation of the biology of the fear-system, so when it activates as we work, we do not become alarmed but can treat it as a source of information. It provides a clear theory of complex trauma (the outcome of the fear system that cannot switch off) so that we can understand how fear is activated in the therapy room and how we can work with it. It explains the importance of working with the body in the context of complex trauma and illustrates various ways of doing this, and also outlines the complexities, frustrations, and setbacks of this work, and why there are no quick fixes.
The book also helps to clarify when we can work in an exploratory way, and when we have to pause this work and focus on regulating fear responses, both in ourselves and in our clients. It notes the particular difficulty of working as a therapist in fear-driven institutions, and the importance of finding or creating a professional support network within which we can feel genuinely safe.
“Fear in the Therapy Room” is due to be published by Hammersmith Books in June 2026. Paperback, plus free eBook £19.99, eBook on its own £9.99.
A pre-publication offer of Paperback plus free eBook plus free postage in the UK at £13.99 or eBook on its own at £6.49 will be available a month prior to publication.
If you are interested in the pre-publication offer, email me (michael.guilding@gmail.com) with “Pre-publication Offer” in the subject line, and I’ll let you know when the offer opens and how to access it.
Contents
Introduction
Part 1 – Understanding fear and complex trauma
Chapter 1 – Defining the fear-system.
The three oldest biological responses to threat – Fear-Alert, Fear-Arousal and Fear-Collapse.
Chapter 2 – Two life and death escapes.
Prey and predator – examples of fear responses in the wild.
Chapter 3 – The Social Engagement System.
The most recently evolved response to threat which makes social living possible.
Chapter 4 – What is complex trauma?
The underpinning theory – Complex Trauma seen as a “fear-system dysfunction”.
Chapter 5 – The biology of the fear-system and how it affects us.
What happens in our body when fear responses activate.
Chapter 6 – How the fear-system resets.
The physical reactions of the body that deactivate our fear responses.
Chapter 7 – When the fear-system cannot reset.
What causes us to get stuck in “fear-mode”?
Chapter 8 – Making sense of anxiety and depression.
How I came to see anxiety and depression as aspects of Fear-Arousal and Fear-Collapse.
Chapter 9 – The long-term impact of complex trauma.
Impact on our emotional state, behaviour, learning, relationships, our ability to function as a society, and our physical health.
Chapter 10 – Fear in the therapy room.
How we notice the three main fear responses in ourselves as we work.
Chapter 11 – The prevalence of complex trauma in our society.
Proposing the idea that complex trauma is ubiquitous as a normal condition of our “traumatised species”.
Part 2 – Working with the body
Chapter 12 – Why we need to work with the body.
The stuck fear-system is an embodied condition.
Chapter 13 – Regulating fear responses.
Therapeutic progress is dependent on fear regulation.
Chapter 14 – Reducing chronic tension.
Fear-system deactivation may require the release of chronic tension.
Chapter 15 – Strengthening the ventral vagus.
Simple ways to increase the regulating power of the ventral vagus nerve.
Chapter 16 – Completing the body’s defensive responses.
Resetting the fear-system by reactivating trauma-related defensive responses.
Part 3 – Working with complexity
Chapter 17 – The problem of complexity.
Working with the tangle of problems created by complex trauma.
Chapter 18 – The three stages of trauma work.
Judith Herman’s trauma framework.
Chapter 19 – Working at the speed of organic change.
Understanding and working with organic changes in the body.
Chapter 20 – Working with constant setbacks.
Sustaining the therapist and client through the setbacks of trauma work.
Chapter 21 – Fear and the suicidal client.
Surviving the stress of working with the risk of suicide.
Chapter 22 – Working on many fronts.
The range of different approaches and interventions we may need to consider.
Chapter 23 – Working within our own competence.
Understanding competence and knowing when we are out of our depth.
Part 4 – The importance of safety
Chapter 24 – The centrality of safety.
A visceral sense of safety is essential if the fear-system is to reset.
Chapter 25 – The safe therapist.
How we become “safe-enough” and enable our clients to feel safe.
Chapter 26 – Internal and external safety.
Threats from within and without – creating a sense of safety in the internal and external worlds.
Chapter 27 – Safety and catharsis.
The myth that expressing emotion is always therapeutic.
Chapter 28 – The power of safety.
The story of the twins – the biological transformation triggered by a visceral sense of safety.
Part 5 – Supporting the therapist
Chapter 29 – Training and continuing personal and professional development.
Issues in training that can undermine the therapist, and reflections on my own training and personal and professional development.
Chapter 30 – Clinical supervision.
Reflections on what we need from our clinical supervisors.
Chapter 31 – The Management of therapists.
The support therapists need from their managers.
Chapter 32 – Creating a network of friendship for professional support.
How to find supportive colleagues to sustain you for the long term.
Conclusion
Appendices
Appendix 1 Complex Post Traumatic Stress Disorder (CPTSD) in ICD-11
Appendix 2 Thoughts on the confusion in language within the literature of trauma
Appendix 3 Fear-Collapse: A shutdown of energy production in the body
Appendix 4 Polyvagal Ladder and Curve – alternative metaphors
Appendix 5 Practical techniques and exercises for regulating fear-system responses in the therapy room
Appendix 6 Can trauma memories be erased?
Appendix 7 Thoughts on dreams and dreaming
Appendix 8 Simple ideas for building a supportive group
Appendix 9 Books and articles I have found particularly helpful
References
