Trauma Therapy

I work with clients that have experienced trauma in their lives. Trauma Therapy is not always quick or easy, but if done safely, can help a client to feel safer and more stable,  help in processing and resolving trauma memories and feel more integrated in daily life.

Trauma is deeply disturbing event(s) that infringes upon an individual’s sense of control and may reduce their capacity to integrate the situation or circumstances into their current reality. When most people think about trauma, they tend to think about what we refer to as big "T" traumas which could be exposure to war, combat, natural disasters, physical or sexual abuse, terrorism, and catastrophic accidents.

However, a person does not have to undergo an overtly distressing event for it to affect them. An accumulation of smaller “everyday” or less pronounced events, referred to as covert abuse, can still be as traumatic. Covert abuse operates in a more concealed manner. It often presents an outward appearance that may seem non-threatening, loving, or caring. However, beneath the surface, covert abuse is controlling, dogmatic, and leaves no room for the autonomy of others. Covert abuse is often characterised by what is withheld rather than what is overtly dished out. It includes neglect, abandonment, lack of affection, lack of empathy, withholding connection, silent treatment, stonewalling, and disregarding another person’s perspective or feelings. Covert abuse involves underhanded and deceitful behaviours that the abuser employs to manipulate others without considering their input or needs.

Trauma can develop into Post Traumatic Stress Disorder (PTSD) which results (according to Babette Rothchild - a trauma specialist, trainer and author), "in large part, from loss of the ability to recognise the present as different from the past. It is primarily characterised by intrusive memories in the form of images (visual, auditory) and distressing body sensations that are reminders of overwhelming, life-and-limb threatening events. These unbidden memories can be so intense (flashbacks) that they can fool the mind and nervous system into believing that the past event is essentially happening again in the present".

Complex PTSD (C-PTSD) can develop as a result of sustained, repeated or multiple forms of traumatic events. C-PTSD can happen to anyone who has been exposed to long-term trauma, but it is more often seen in people who experienced trauma during an earlier stage of development, or were abused by someone they thought they could trust, such as a caregiver or protector. Because of this, often the impact on the nervous system around attachment or relationships becomes more deeply ingrained.

Symptoms of trauma

• Shock, denial, or disbelief
• Confusion and difficulty concentrating
• Anger, irritability and mood swings
• Anxiety and fear
• Guilt, shame, self-blame
• Social isolation and withdrawing from others
• Feeling sad or hopeless
• Feeling disconnected or numb
• Flashbacks
• Nightmares
• Intrusive thoughts
• Panic attacks
• Insomnia
• Aches and pains in the body
• Extreme alertness and being on edge

Traumatic events

Potentially, traumatic events can be caused by a singular occasion, or from ongoing, relentless stresses. A potentially traumatic event is more prone to leave an individual with longer-lasting emotional and psychological trauma if:

• The individual was unprepared for the event
• The event occurred out of the blue
• The person felt powerless to prevent the event
• The event occurred repeatedly (such as child abuse)
• If the event involved extreme cruelty
• If the event occurred during the childhood years

Potentially traumatic events are defined as events that are both powerful and upsetting that intrude into the daily life of the person. Generally speaking, potentially traumatic events involve major threat to one’s psychological and physical well-being. Potentially traumatic events may be life-threatening; to one’s own life or the life of a loved one. These events may have very little impact on one individual but can lead to significant distress in another. The impact of a potentially traumatic event may be related to the mental and physical health of the person, past traumatic experiences, presence of coping skills, and level of social and emotional support at the time of the potentially traumatic event.

Examples of events and situations that can lead to the development of psychological trauma may include:

• Natural disasters such as fires, earthquakes, tornados, and hurricanes
• Interpersonal violence like rape, child abuse, domestic violence, or the suicide of a loved one or friend
• Involvement in a serious car accident or workplace accident
• Acts of violence such as an armed robbery, war, or terrorism

Commonly overlooked causes of potential emotional and psychological trauma can also include:

• Breakup or divorce in a significant relationship
• Significantly humiliating experiences
• Surgery, birth or medical procedures
• Falls or injuries due to sports
• Sudden, unexpected death of a loved one
• Diagnosis of a life-threatening or disabling condition

Treatment of trauma

Trauma treatment must first and foremost be conducted safely and there is no quick fix. All good trauma therapy should consists of the following phases (based on Pierre Janet's phase oriented structure):

Phase 1: Establishing safety and stabilisation. This can take one session, several sessions or could take much longer. This is the foundation of all good trauma therapy. A client must be able to feel safe and robust enough to cope in daily life. This phase includes establishing daily coping strategies and resources (including mindfulness, stress management, self-care, relaxation tools and grounding), and enlisting a good support network. If this is not done adequately, the client will be unable to cope when the processing of trauma memories take place and could destabilise or re-traumatise and the client can get much worse, not better. Some clients only complete this phase of trauma therapy and that is okay. If a client is not willing or ready to face the traumatic memories, the goal of therapy could simply be to feel safer and have more self-control in how they manage day to day.

Dan Siegel developed the window of tolerance, a concept to describe the optimal zone of “arousal” for a person to function in everyday life. When a person is operating within this zone or window, they can effectively manage and cope with their emotions.

For clients who have experienced trauma, it is often difficult to regulate emotions and the zone of arousal where they can function effectively becomes quite narrow. When a client is traumatised, it can be especially difficult for them to stay grounded in the present because the past is more vivid and intrusive. Someone constantly living in their past trauma is on alert to detect threats - and enter into a state of defense. That means they generally have a very narrow window of tolerance. The stress of a traumatic memory or trigger may cause them to be pushed out of their window of tolerance. Even seemingly minor stressors can cause a client to dissociate, get angry, or feel anxious – leading to states of hyperarousal or hypoarousal. And this can make it difficult for clients to make progress in therapeutic sessions. This is why resourcing is essential.

Phase 2: Involves processing and resolution of trauma memories. I tend to suggest we use EMDR (please click to read more) to work within this phase. This can only take place once a client is stable and resilient enough to tolerate the work, because there will be some challenges doing memory processing, and a client can feel destabilised for a while. Having adequate tools to cope with this is essential and often is overlooked in short-term trauma therapy. For this reason, I prefer to work open-ended with clients to ensure phase 1 is achieved fully before entering phase 2. The aim of phase 2 is to change the effect the past continues to have on the client now and in the future.

Phase 3: Focus on integration, that is, applying what was gained from phase 1 and 2 into the mainstream of daily life. This includes making meaning and applying the learning from the previous phases to leave the trauma in the past and to make a better future.

Trauma Training

In addition to my core counselling training, I have done further trauma training. This training includes but is not limited to:

Introductory Certificate in Trauma Therapy (Wealden Institute - Joanna Beazley Richard)

Foundation for the Introductory Certificate in Trauma Therapy

Severe and Complex Trauma and Dissociation

Treating Traumatised Children

Attachment, Attachment Disorder, Trauma and Recovery

NICABM - Treating Trauma Master Series

Online training for therapists on the latest development on trauma by the world's most renowned trauma experts.

EMDR (Eye Movement Desensitisation and Reprocessing) - See more information by clicking here.