Trauma Therapy?

What is Trauma Therapy?

Trauma therapy, also known as trauma-focused therapy or Traumatology, is a specialized form of therapy that focuses on addressing the emotional and psychological effects of traumatic experiences. It aims to help individuals heal and recover from the impact of trauma on their lives.  

Single event trauma or PTSD (Post Traumatic Stress Disorder) refers to the outcomes of a single highly impacting event on the subject. This primarily requires stabilisation and then memory reconsolidation, followed by recovery. Complex trauma (or developmental trauma), or C-PTSD is different in that the primary therapeutic need after stabilisation is to unpick and recover from the long term effects in belief, behaviour, relationship and experience of having been subjected to repeated traumatic impact over time. Thus with C-PTSD memory re-consolidation is of far less importance, and should be used sparingly. It is unfortunately common for non specialist therapists not to understand the distinction fully and to leap to using methods like EMDR in cases of complex trauma, long before the client is ready. Methods of memory reconsolidation like EMDR are used far later in complex trauma cases, otherwise harm can occur.

It is amazing how many people, including and perhaps especially therapists, who believe that talking therapy alone in a counselling or psychology based model is enough to address trauma. Evidence has built since the 1990’s through the work of pioneers like Bessel Van Der Kolk, Ruth Lanius, Gabor Mate, Peter Levine and Stephen Porges that there are vital physiological, sensory, behavioural and even spiritual effects of trauma due to the fundamental dysregulation that occurs during traumatic events in the whole body and mind of the subject. Trauma exists in Mind AND Body, since these are not separate, and because during trauma multiple systems in the body become dysregulated, such as the Central Nervous System, polyvagal system, endocrine system, digestive system, cardiac system and immune system, as well as specialist systems such as the reproductive system in female clients.

What to avoid!

  • Therapists who are only qualified in general therapy. Being a counsellor or psychologist does not mean you are a specialist. Look for Certifications in Clinical Trauma Specialism.
  • Therapists who have a “pet” therapy like EMDR and can not wait to use it! Each therapy has a possible part to play at the right time, with the right client. “If all you have is a hammer, everything looks like a nail
  • Therapists who treat COMPLEX trauma as single event PTSD and do not understand the difference
  • Anyone who uses trauma debriefing – see the NICE link below and the fact it is recognised this method is outdated and harmful
  • Anyone who claims their “method” works but can not point you to proper peer reviewed, published clinically reviewed evidence.
  • Anyone who claims they can cure or “move you on” from trauma quickly.
  • Any therapist who does not realise trauma is a mind – body problem and thus has a range of psychological and body (somatic) methods, together with functional / integrative medicine knowledge. Choosing such a therapist is a little like buying a guitar with only one string!

Here are some key aspects of trauma therapy:

  • Rapport from an understanding and specialist therapist: without rapport and trust, and a gradually built relationship with a truly knowledgeable and skills rich therapist who “gets it”, it is impossible to expect the survivor of trauma to feel safe and start rebuilding their life! Most have been dominated, abused, hurt, scared or otherwise manipulated and need time, evidence and experience to build a trusting rapport with a therapist.
  • Understanding Trauma: Trauma therapy recognizes that traumatic events can have a profound and long-lasting impact on an individual’s mental, emotional, and physical well-being. It acknowledges that trauma can affect anyone, regardless of age, background, or the nature of the traumatic event.  
  • Trauma-Informed Approach: A trauma-informed approach is central to trauma therapy. This means that the therapist understands the complexities of trauma and its effects, and they create a safe and supportive environment for the individual to explore their experiences and emotions.  
  • Focus on Processing Trauma: Trauma therapy helps individuals process their traumatic experiences in a healthy and constructive way. This may involve revisiting memories, exploring emotions, and developing coping mechanisms to manage trauma-related symptoms.  
  • Building Resilience: Trauma therapy aims to help individuals build resilience and develop strategies to cope with the challenges that may arise as a result of their trauma. This can involve developing self-care practices, improving emotional regulation, and strengthening relationships.  
  • Individualized Treatment: Trauma therapy is tailored to the individual’s specific needs and experiences. The therapist works collaboratively with the individual to develop a treatment plan that addresses their unique challenges and goals.  
  • In the UK the National Institute of Clinical Excellence (NICE) guidelines are clear that only a specialist should be consulted, a “manualised treatment protocol” (in other words specialised and evidenced based trauma therapy system and not general therapy) should be used, and that knowledge and competence in addressing a whole range of mental and physiological co-morbidities (other problems that often co-occur) is required.

Some common types of psychological trauma therapy include:

  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This therapy helps individuals identify and change negative thoughts and beliefs related to the trauma.
  • Counselling & Listening Skills: whether within analysis, conversational hypnosis, coaching, psychology or psychotherapy, building rapport and listening is a vital component.
  • Eye Movement Desensitization and Reprocessing (EMDR): This therapy uses bilateral stimulation, such as eye movements, to help individuals process traumatic memories.  
  • Prolonged Exposure Therapy: This therapy involves gradually exposing the individual to trauma-related memories and situations to help them reduce fear and avoidance.  
  • Narrative Therapy: This therapy helps individuals reframe their traumatic experiences and create a new narrative that empowers them.  
  • Hypnotherapy: Hypnotherapy can be used instead of EMDR for memory reprocessing, conversational hypnosis can be used instead of counselling style when using CBT or narrative methods. it can also be used to support exposure therapy.
  • Interpersonal Therapy: trauma effects relationships and attachment styles so attachment based interpersonal therapy is vital to help build support, relationships and prevent isolation.
  • Behavioural analysis and change: Specialised methods of modifying behavioural and perception and enabling change are vital in moving from “survival” to “recovery”, through to “thriving”. Commonly used methods include DBT (Dialectic Behavioural Therapy), RO-DBT (Radically Open DBT), ACT (Acceptance and Commitment Therapy), CBT (Compassion Based Therapies), ABA (Applied Behavioural Analysis), CBASP (Cognitive Behavioural Analysis System of Psychotherapy).
  • Compassionate Inquiry: A philosophical based method created by Gabor Mate, a leading expert in the field, using gentle questioning (inquiry) to reveal deeper meaning and enable change.
  • Critical Thinking / Socratic Challenge: Complex or developmental trauma forces the person to adapt to their situation (adaptation). This is a survival mechanism. After the trauma however the adaptation is not suited to normal life. Thus re-adaptation back towards a normal development plan is needed. Part of this process involves gently challenging trauma based adapted beliefs and behaviours (“trauma think”) so that they can be modified, and also uncovering deeper identity and belief facets of the individual client that have been suppressed and encouraging them to come forward and be nourished.

Some typical other therapies needed in trauma therapy include:

  • Psychological education (psychoeducation) or psychological coaching in order to ensure understanding of the condition and self management.
  • Self regulation methods such as Polyvagal breathing, breathwork, mindfulness, self hypnosis, trauma informed yoga, Chi Gung, EFT and others.
  • Ingredients for health“: coaching and educating the client in other areas of functional and integrative medicine, such as diet and nutrition, supplements, sleep management, activity, and positive wellbeing.
  • Somatic Therapies: A vital part of processing involves body-mind psychology. It is known that memory is stored in a fragmented manner, with factual (explicit) and feeling (implicit or somatic) memory stored in different areas of the brain and central nervous system. initially this is a protective or defensive mechanism. Part of healing requires memory re-consolidation. To do this requires somatic processing. Talking therapy alone can not re-consolidate trauma memory! Hakomi, mindfulness, somatic experiencing are examples of somatic therapy.

Trauma therapy can be beneficial for individuals who have experienced a wide range of traumatic events, including:

  • Abuse (physical, emotional, sexual)
  • Neglect
  • Accidents
  • Natural disasters
  • War
  • Witnessing violence
  • Medical trauma
  • Grief and loss  

If you are struggling with the effects of trauma, seeking professional help from a qualified trauma therapist can be a crucial step in your healing journey. They can provide you with the support, guidance, and tools you need to process your experiences, develop coping skills, and move towards recovery.

Stages of Complex Trauma Therapy

Part of the reason why a multi skilled specialist therapist is needed, is the stage by stage nature of complex trauma therapy recovery. Each stage requires different therapy types, knowledge and skills.
While the specific stages and terminology might vary depending on the therapeutic approach, here’s a general outline of the stages involved in trauma therapy:

1. Safety and Stabilization:

  • Establishing Safety: The initial focus is on creating a safe and trusting therapeutic relationship and environment. This involves building rapport with the therapist, establishing clear boundaries, and ensuring the individual feels comfortable and secure.
  • Symptom Reduction: The therapist helps the individual identify and manage overwhelming emotions and distressing symptoms, such as anxiety, flashbacks, nightmares, and hypervigilance. This may involve teaching coping skills like grounding techniques, relaxation exercises, and mindfulness practices.
  • Developing Resources: This stage involves identifying and strengthening internal and external resources that can support the individual’s healing journey. This might include connecting with supportive friends and family, engaging in self-care activities, and building a sense of self-efficacy.

2. Remembrance and Mourning:

  • Trauma Processing: In this stage, the individual begins to process their traumatic experiences in a safe and controlled manner. This may involve revisiting memories, exploring emotions, and making sense of what happened.
  • Emotional Expression: The therapist provides a safe space for the individual to express and work through a wide range of emotions related to the trauma, including fear, anger, sadness, and shame.
  • Challenging Negative Beliefs: The therapist helps the individual identify and challenge negative thoughts and beliefs about themselves, the world, and others that may have developed as a result of the trauma.

3. Reconnection and Integration:

  • Rebuilding Connections: The focus shifts towards reconnecting with oneself, others, and the world. This may involve rebuilding trust, improving communication skills, and developing healthier relationships.
  • Finding Meaning: The individual explores ways to find meaning and purpose in their experiences and to integrate the trauma into their life narrative.
  • Developing New Skills: The therapist helps the individual develop new skills and strategies to manage triggers, cope with challenges, and prevent re-traumatization.

4. Consolidation and Resolution:

  • Strengthening Resilience: The individual continues to build resilience and develop coping mechanisms to navigate future challenges.
  • Moving Forward: The focus is on consolidating the gains made in therapy and moving forward with a renewed sense of hope and purpose.
  • Self-Care and Growth: The individual prioritizes self-care, continues to develop healthy habits, and focuses on personal growth and well-being.

It’s important to remember that the stages of trauma therapy are not always linear. Individuals may move back and forth between stages as they process their experiences and develop coping skills. The duration of each stage can also vary depending on the individual’s needs and the complexity of their trauma.

A common stage by stage approach with just three stages that you may hear quoted is the Heller 3 stage method. This method is important since although maybe a little more basic than the general approach above, it has a weight of research evidence behind it showing it’s effectiveness. It is therefore at the core of most other methods, which simply add additional details, such as the example above.

The Heller 3-stage method, also known as the NeuroAffective Relational Model (NARM), is a therapeutic approach developed by Dr. Laurence Heller for addressing developmental trauma. It focuses on how early childhood experiences shape our nervous system, attachment patterns, and sense of self.

NARM’s three stages are:

1. Connection:

  • Focus: This stage emphasizes re-establishing a connection with oneself, particularly with the body and emotions. Early trauma often leads to disconnection from bodily sensations and emotions as a means of coping.
  • Goals:
    • Increase awareness of bodily sensations and emotions.
    • Learn to identify and regulate emotions.
    • Develop self-compassion and acceptance.
    • Begin to build a sense of safety and trust in the therapeutic relationship.

2. Attunement:

  • Focus: This stage centers on developing healthy attunement with others. Early trauma can disrupt the ability to form secure attachments and accurately perceive social cues.
  • Goals:
    • Improve interpersonal skills and communication.
    • Develop healthy boundaries.
    • Increase capacity for empathy and intimacy.
    • Heal attachment wounds and build secure relationships.

3. Identity:

  • Focus: This stage addresses the development of a healthy and integrated sense of self. Early trauma can fragment the sense of identity and lead to feelings of shame, inadequacy, and worthlessness.
  • Goals:
    • Develop a coherent and positive sense of self.
    • Heal shame and internalized negative beliefs.
    • Increase self-esteem and confidence.
    • Create a meaningful and fulfilling life.

Key Principles of NARM:

  • Somatic Awareness: NARM emphasizes the mind-body connection and encourages clients to connect with their bodily sensations and emotions.
  • Present-Centered Approach: While acknowledging the impact of the past, NARM focuses on working with present-day experiences and patterns.
  • Relational Focus: NARM recognizes the importance of healthy relationships in healing trauma and emphasizes the therapeutic relationship as a model for secure attachment.
  • Self-Regulation: NARM helps clients develop self-regulation skills to manage emotions, navigate triggers, and cope with stress.

NARM can be beneficial for individuals who have experienced various forms of developmental trauma, including:

  • Early childhood abuse or neglect
  • Attachment disruptions
  • Witnessing domestic violence
  • Growing up in dysfunctional families

If you’re considering NARM, it’s essential to find a therapist specifically trained in this approach. They can guide you through the three stages and help you address the impact of early trauma on your life. The NARM approach is at the root of many training programs including those of the Trauma Institute International and many PESI courses.

What conditions co-exist with Complex trauma, and what other diagnoses might a trauma survivor have?

It is important to remember that many diagnostic labels are descriptive only and describe outcomes and presentations and not causes. Trauma based diagnosis refers to cause, where as others such as eating disorders refer to outcomes, or clusters of symptoms such as anxiety based diagnoses. Therefore please remember it is normal for a survivor of complex trauma to have collected a number of diagnostic labels! It does not mean you have lots of different problems, it means the same root problem turns up in a range of different ways!

Complex trauma often occurs alongside other mental health conditions. Here are some of the most common co-occurring behavioural or mental health conditions:  

1. Post-Traumatic Stress Disorder (PTSD):

  • Shared Symptoms: Both complex trauma and PTSD involve intrusive memories, avoidance behaviors, negative thoughts and mood, and changes in arousal and reactivity.  
  • Key Difference: Complex trauma often stems from chronic or repeated traumatic experiences, particularly in childhood, leading to broader difficulties with emotional regulation, sense of self, and relationships compared to PTSD.  

2. Complex Post-Traumatic Stress Disorder (C-PTSD):

  • Closely Related: C-PTSD is a relatively new diagnosis that captures the more extensive effects of prolonged trauma, including disturbances in self-organization, relationships, and systems of meaning.  
  • Overlapping Symptoms: Many individuals with complex trauma meet criteria for C-PTSD, experiencing symptoms like difficulties with emotional regulation, distorted self-perception, and problems with relationships.

3. Depression:

  • High Co-occurrence: Depression frequently co-occurs with complex trauma, as individuals may experience persistent sadness, hopelessness, loss of interest, and fatigue due to the impact of trauma.  

4. Anxiety Disorders:

  • Generalized Anxiety: Individuals with complex trauma may experience chronic worry, tension, and fear due to their heightened sense of threat and difficulty regulating emotions.  
  • Panic Disorder: Panic attacks can be triggered by trauma reminders or overwhelming emotions, leading to intense fear and physical symptoms.  
  • Social Anxiety: Difficulties with trust and distorted self-perception can contribute to social anxiety and avoidance of social situations.

5. Substance Use Disorders:

  • Self-Medication: Individuals may turn to substances to cope with the emotional pain, intrusive memories, and hyperarousal associated with complex trauma.  
  • Increased Risk: Complex trauma increases the risk of developing substance use disorders as a way to numb or escape from distressing symptoms.  

6. Dissociative Disorders:

  • Dissociation as a Coping Mechanism: Dissociation, a disconnection from oneself or reality, can be a coping mechanism for overwhelming trauma.  
  • Dissociative Identity Disorder: In severe cases, complex trauma can contribute to the development of Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder.

7. Borderline Personality Disorder (BPD):

  • Shared Features: Complex trauma and BPD share features like emotional instability, impulsivity, unstable relationships, and fear of abandonment.  
  • Trauma History: Many individuals with BPD have a history of childhood trauma, suggesting a potential link between the two conditions.  

8. Eating Disorders:

  • Control and Coping: Trauma survivors may develop eating disorders as a way to exert control over their bodies or cope with difficult emotions.  
  • Body Image Issues: Trauma can negatively impact body image and self-esteem, contributing to eating disorder development.  

9. Self-Harm and Suicidal Ideation:

  • Increased Risk: Complex trauma significantly increases the risk of self-harm and suicidal thoughts or behaviors as individuals struggle to cope with overwhelming emotions and distress.  

It’s important to recognize that these conditions often interact and influence each other. Addressing complex trauma requires a comprehensive approach that considers and treats any co-occurring conditions to support overall healing and recovery.

And here are some of the more common physical conditions:

Complex trauma significantly impacts physical health, increasing the risk of various medical conditions. This connection stems from the chronic stress response triggered by trauma, affecting the body’s systems over time. Here are some common physical illnesses associated with complex trauma:

1. Cardiovascular Issues:

  • Heart Disease: Increased risk of heart attacks, strokes, and other cardiovascular diseases due to chronic stress, inflammation, and unhealthy coping mechanisms (e.g., smoking, substance use).
  • Hypertension: High blood pressure can result from the constant activation of the stress response, leading to damage to blood vessels and organs.

2. Gastrointestinal Problems:

  • Irritable Bowel Syndrome (IBS): The gut-brain connection means trauma can disrupt gut function, leading to symptoms like abdominal pain, bloating, diarrhea, and constipation.
  • Inflammatory Bowel Disease (IBD): Increased risk of Crohn’s disease and ulcerative colitis, chronic inflammatory conditions of the digestive tract.

3. Immune System Dysfunction:

  • Weakened Immunity: Chronic stress suppresses the immune system, making individuals more susceptible to infections and illnesses.
  • Autoimmune Diseases: Increased risk of autoimmune disorders, where the body’s immune system attacks its own tissues.

4. Metabolic Disorders:

  • Diabetes: Trauma can disrupt blood sugar regulation and increase the risk of developing type 2 diabetes.
  • Obesity: Stress and trauma can contribute to weight gain and obesity through hormonal imbalances and unhealthy coping mechanisms.

5. Chronic Pain:

  • Fibromyalgia: Widespread musculoskeletal pain and fatigue are common in individuals with complex trauma.
  • Headaches: Tension headaches and migraines can be triggered by stress and trauma.

6. Respiratory Issues:

  • Asthma: Trauma can worsen asthma symptoms and increase the frequency of attacks.
  • Chronic Obstructive Pulmonary Disease (COPD): Increased risk of COPD, a lung disease that makes it difficult to breathe.

7. Sleep Disorders:

  • Insomnia: Difficulty falling asleep, staying asleep, or experiencing restful sleep is common due to hyperarousal and nightmares.
  • Sleep Apnea: Increased risk of sleep apnea, a condition where breathing repeatedly stops and starts during sleep.

8. Gynecological Issues:

  • Menstrual Irregularities: Trauma can disrupt hormone balance, leading to irregular periods, painful periods, or absence of menstruation.
  • Endometriosis: Increased risk of endometriosis, a condition where uterine tissue grows outside the uterus.

9. Other Physical Health Problems:

  • Skin Conditions: Eczema, psoriasis, and other skin conditions can be exacerbated by stress.
  • Cancer: Some studies suggest a link between trauma and increased cancer risk.
  • Premature Aging: Chronic stress can accelerate the aging process.

It’s crucial to address both the mental and physical health effects of complex trauma. Integrated treatment approaches that incorporate trauma-informed care, therapy, and lifestyle modifications can help individuals manage their physical health conditions and improve their overall well-being.

As you can see from the list, talking therapies alone can never fully address the long term effects of complex trauma. Therefore although your therapist can never be a substitute for ongoing medical supervision and support alongside therapy, they should have a good grounding in Functional and or Integrative Medicine, and be able to guide you in positive wellbeing and self management, and help advise on taking useful information to your medical doctor / practitioner. There are several excellent Post Graduate Post Qualification Certifications available for Trauma Therapy Specialists.

Finally although your therapist should be both a specialist and have a wide range of additional therapeutic skill / knowledge areas, they should also be mindful of carefully avoiding working outside their scope of competence. When advising or providing therapy they should have an appropriate qualification, professional registration and insurance to cover what therapy or area they are working in with you, and if not they should refer you to another practitioner for that part of your support. They should also be careful not to infringe on medical support, and should encourage you to maintain medical doctor / practitioner supervision and support.

You can see the competences Stuart brings to his therapy provision HERE