Trauma Therapy: What to Know

Given the nature of trauma itself, it is extremely important for those seeking services to be able to choose their treatment option and therapeutic match wisely. Presently, there are many different modalities or methods associated with the treatment of trauma or PTSD (some more indicated or helpful than others): psychodynamic therapy, relational psychodynamic psychotherapy, psychoanalytic psychotherapy, cognitive behavioral therapy, cognitive processing therapy, cognitive therapy, prolonged exposure therapy, eye movement desensitization and reprocessing, brief eclectic psychotherapy, narrative exposure therapy, and so on. 

Clearly, with so many options available, making a decision about treatment can be difficult to say the least. So, with all that said, how do you know what’s right for you? Above all else, the therapeutic setting must be a place and space in which safety and security can develop over the course of treatment; therefore, a good therapeutic fit between therapist and client is essential. Ideally, the therapeutic relationship offers a place and space in which trauma work can be safely managed and negotiated, offering a type of relational connection between therapist and client that can become reliable and grounding over the course of therapy. Since trauma is invariably painful (psychologically and/or physically), I have found that the therapeutic relationship itself is often the “best medicine” for effective pain management during the course of the therapeutic process.

Trauma is a personal experience; there are as many types of trauma as there are individuals (as no one’s experience of trauma is exactly the same). While similarities or commonalities can and do exist across some types of trauma (e.g., Veteran PTSD or Sexual Assault PTSD), differences can and do exist between developmental trauma (e.g., childhood abuse during formative years) and later onset trauma (e.g., witnessing a traumatic event in adulthood). Therapeutic sensitivity to these differences is imperative.

Moreover, trauma focused therapy cannot be expedited or rushed in my professional opinion. Therapies or treatments that ostensibly offer quick fixes pose certain risks (such as retraumatization) for some individuals dealing with certain types of trauma. Quite commonly, and often unconsciously, people with trauma have spent the entirety of their life (after trauma) protecting themselves from insurmountable pains, unknowable truths, and other intolerable aspects of their original trauma. Whatever the case may be, protective mechanisms likely are at work to keep the traumatized self out of the way of the functioning self that has had to survive and go on living. Keep in mind that this conceptualization does NOT mean nor imply that traumatized people are somehow split into parts; it is merely one helpful way to conceptually understand how excruciatingly painful processes might come to be managed and organized within the mind or psyche. Numerous possibilities exist.

For some, it is a matter of developing a kind of compensatory self-reliance to protect oneself from the fears associated with what it means to be exposed in need and/or to have basic needs at all. In other words, the protective thought is: if I don’t need anything from anyone, then I won’t have to feel vulnerable, weak, helpless, and powerless ever again. For others, protection might take the form of an incessant, anxious need to please and serve so that others are kept happy and relations appear intact (as in, I’ll do anything you want; just please love me and forgive me for my badness). Additionally, protection may involve a type of unconscious process by which the traumatized self is psychologically encapsulated and sealed off from conscious awareness (or the functioning self). Sometimes, the mind deems it safer to lock away the traumatized self, as if placing it in a safe house or some other chamber within oneself. However, it is there that the traumatized self remains isolated, neglected, abandoned, and wounded. In this way, a kind of trauma derivative continues. Similarly, some people with trauma struggle with having a body that doesn’t feel like their own, a body that might be too dangerous or difficult to embody or inhabit psychologically. Clearly then, it is of vital importance that any emergence of or access to the traumatized self be carefully and thoughtfully negotiated by the therapist and client over the course of therapy.

With this in mind, it stands to reason that people with trauma may find themselves conflicted about deserving and/or receiving the very care they were seeking from a therapeutic treatment. One way to understand this is to consider the dilemma in the following way: if the functioning self made the appointment, is the traumatized self ready to give consent? If it was dismissed, denied, and/or neglected in its abject horror and pain growing up, for example, can it truly receive attention, recognition, and care in present day without consequence? Can that even be allowed? Does it even deserve care? Can it trust such compassion? What if it’s angry and prone to attack to protect itself? What if it is forbidden? Does it have a voice that can speak the unspeakable? What about its shame? What if it won’t be accepted or wanted? Maybe it should just continue to dismiss itself like it was dismissed by those who were supposed to care? Maybe it’s not really all that important anyway? How could it be? Is it really safe to come out? Is it really safe to feel? 

Such questions represent completely valid and understandable potential conflicts for someone in therapy for trauma. It is crucial that the therapeutic process be patient and mindful when working with such profound conflicts and fears. Given that some trauma involves being forced to conform to the will or desires of another, and given that it can remain difficult for many such individuals to say no to authority, I find it essential to provide the traumatized self with a sense of agency/control in the therapeutic process so as to not recreate or reenact an unnecessary power dynamic or scenario that could potentially lead to countertherapeutic effects. Trauma does not wait for consent; therapy should.