A Trauma Therapist Explains Trauma and the Process of Recovering from Trauma Through Therapy in Understandable Terms
By Laura Reagan, LCSW-C, Founder of Trauma Therapist Network
This is Part Two in a series of articles about the process of healing after complex PTSD and trauma. If you missed Part One, you can find it here.
In Part One of this Comprehensive Guide to the process of recovering after traumatic experiences, I explained what trauma is and how it affects our emotions (feelings), cognitions (thoughts), and sensory experience – both our 5-sense perception or what is called the near senses: Auditory – what we hear; Visual – what we see; Olfactory – what we smell; Tactile – what we can touch and feel; and Gustatory – what we taste. The other aspects of our sensory experience include our Vestibular system; our Proprioception and our Interoceptive senses. For more information on this, review Part one here. I also talked about the importance of a trauma-informed approach in accurately assessing, diagnosing and treating trauma. And I mentioned that visitors to the Trauma Therapist Network therapist finder can search for a therapist with specialized training and experience to help trauma heal.
What Is Post-Traumatic Stress Disorder (PTSD)?
As I explained in this recent post, the Diagnostic and Statistical Manual of Mental Health Disorders is a diagnostic manual used by mental health professionals to assess and diagnose the Western Medical view of mental health disorders. Post-Traumatic Stress Disorder, also known as PTSD, is the diagnosis that describes a series of acute and/or chronic symptoms including exposure to a traumatic event, re-experiencing symptoms; avoidance symptoms; negative alterations in mood and cognitions (thoughts); and alterations in nervous system arousal and reactivity which have significant negative effects on functioning and persist for more than a month after the traumatic event. PTSD can be accompanied by specific Dissociative Disorders as well, according to the DSM.
Getting Diagnosed with PTSD
Diagnosis of PTSD requires that the person meet a certain criteria based on assessment of symptoms and functioning. It is the best diagnosis we have in the United States to capture the symptoms of trauma that affect so many people – at least 61% of adults, according to the Adverse Childhood Experiences Study (ACES), as mentioned in Part One of this Guide. Many therapists who are inexperienced in assessing and treating trauma are unfamiliar with how their clients’ symptoms may align with the PTSD criteria. More trauma training is needed so trauma therapists can meet the need for competent trauma therapy.
What Is Complex PTSD – How Is It Different From PTSD?
Complex PTSD is a new diagnosis that is listed in the International Classification of Diseases – 11th edition (ICD-11). This classification system is used outside of the United States, while in the USA mental health practitioners use the DSM-5. So in countries outside of the USA people may be most accurately diagnosed with Complex PTSD (also called C-PTSD) while that formal diagnosis is unavailable here.
The significance of the complex PTSD diagnosis is that it reflects the impact of repeated relational traumas during childhood. For example, child abuse is an experience that does not occur once – rather, it is an environment in which a child’s development is affected in every way. Repeated abusive experiences have a cumulative effect on the individual’s sense of safety and ability to have a regulated nervous system, and the symptoms of PTSD that survivors of childhood abuse and other repeated traumas like Intimate Partner Violence exhibit, are different from the symptoms that individuals who have experienced a single traumatic incident describe in their therapy sessions. The main difference between the PTSD diagnosis and the diagnosis of complex PTSD is that an individual must have all of the criteria of PTSD at clinical levels; and in addition, they must have difficulty in these three areas as well:
- Emotional regulation
- Self Identity
- Relationship Issues
How Does Complex PTSD and Trauma Show Up In Our Lives?
Trauma creates major disruption in the way we feel about ourselves and others. Many trauma survivors report difficulty in relationships with friends, family, partners, coworkers, family of origin and parenting. It is common for people who have experienced multiple traumas in childhood to have relationship struggles as adults. This is because trauma affects us in so many areas of our lives.
Some of the challenges that are common to trauma and complex PTSD survivors include:
- Low self worth
- Chronic illness
- Eating Disorders and body image issues
- Substance misuse/abuse
- Mistrust of self
- Trouble setting boundaries
- Mistrust of others
- Difficulty dealing with conflict
- Chronic pain
- Suicidal thoughts
- Memory issues
- Scattered, disorganized thinking
- Sleep issues
- Panic attacks
- Impulse control issues
- Self harming behaviors
What Does The Process Of PTSD Treatment and Trauma Therapy Look Like?
There are various ways to get complex PTSD Treatment and trauma therapy. How the process looks depends on what you want help with and how you approach the work. Short term and long term therapy methods can be helpful. Short term methods tend to focus on symptom reduction and long term methods work to change deeply ingrained patterns of communication, boundaries and relationships.
Most trauma therapists will recommend weekly therapy sessions, particularly at the beginning when you and the therapist are building rapport. It is very important to find a therapist you trust so you can feel safe to express your feelings. And a skilled trauma therapist who understands what is affecting you and how to heal is a very important aspect of the process. Take a look at the Trauma Therapist Network counseling directory to see some of the different ways trauma therapists can talk about their work.
What Is A Top-Down Approach To Trauma Therapy?
Top-Down trauma therapy approaches are those that focus on the cognitions (thoughts) around the experience using your thinking brain. Some examples of Top-Down therapy approaches are:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavior Therapy (DBT)
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Prolonged Exposure (PE)
- Solution Focused Brief Therapy (SFBT)
- Cognitive Processing Therapy (CPT)
What Is A Bottom-Up Approach To Trauma Therapy?
Bottom-Up Trauma Therapy methods include those that are focused on connecting mind and body to access and heal trauma. These methods are most effective at processing unconscious and/or nonverbal or preverbal trauma. Some examples include:
- Eye Movement Desensitization Reprocessing (EMDR)
- Sensorimotor Psychotherapy
- Somatic Experiencing
- Psychedelic Assisted Psychotherapy
- Dance/Movement Therapies
- Drama Therapies
- Expressive Arts Therapies
- Sand Tray therapy
- Yoga therapy
- and others
Learn more about the difference between Top-Down and Bottom-Up approaches to trauma therapy by reading this article. It’s important to understand that therapies which rely on being able to remember what happened can be inadequate for trauma memory that is stored in the tissues of the body.
For example, if a baby cries in their crib because they are scared, hungry, or need a diaper change and the caregiver is not responsive to the baby’s needs, it can be traumatic. The baby is completely dependent on their caregiver for survival. The baby’s unmet survival needs can lead to trauma reactions.
The baby’s developing brain reacts to the traumatic experience and the memory is stored, but since a baby cannot communicate in language, and does not have the cognitive skills to understand and explain how they felt during that experience, the memory is not accessible using traditional talk therapy. However, the image may come to mind along with the sense of terror that the baby felt at the time, later when Bottom-Up therapy methods are used to access the traumatic material, and there is an opportunity to process and heal what could not be integrated when it occurred.
What Is A Phased Approach to PTSD Treatment and Trauma Therapy?
By the time most people seek out trauma therapy to heal from traumatic experiences, they have usually been suffering for a long time and they desperately want, need and deserve to feel relief. Oftentimes these individuals have tried therapy before but maybe they haven’t found the right trauma therapist to help them process and heal from these experiences.
Although we may be in a hurry to find relief from the trauma symptoms we have been dealing with for years, maybe even decades, there is no “quick fix” in healing after traumatic events. Trauma can cause severe disruption in relationships, self concept and many other areas of functioning. It took years for the defensive/protective strategies to develop which were so helpful during the traumatic experiences of the past, and it will take time and a trusting therapeutic relationship to relieve the symptoms that interfere with a sense of wellbeing and satisfying connections with others. Healing really is possible!
In her classic 1992 book, Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, psychiatrist Dr. Judith Herman explains the connection between combat/war trauma, which was recognized as causing PTSD as of the time the book was published; and other types of repeated traumas like childhood abuse and domestic violence. She identified the idea of chronic or complex PTSD in her book. She also advocated for a Three Phase approach to trauma treatment.
The three phases approach to complex PTSD are as follows:
Safety and Stabilization – in this phase, the therapist and client are working to develop a trusting therapeutic relationship and improve interpersonal regulation, as well as addressing any current crises in client’s life.
Remembrance and Mourning – in this part of therapy, therapist and client are working to acknowledge the ways trauma is showing up in the client’s life and grieving for what was lost. This is when processing trauma begins, when the client is in a safe and stable state.
Reconnection and Integration – the third phase of trauma treatment involves accepting the changes that have occurred as a result of the trauma and moving forward into a life in which traumatic experiences are not separate from the self identity of the client, but rather they are integrated into a person’s life story as part of what has shaped them, but not defining them. Post-traumatic Growth happens in this stage.
Although the 3 phases are not linear and one may move in and out of the various phases at different points in the trauma treatment process, many trauma therapists recommend using this guideline in counseling. It is a helpful way to conceptualize the treatment process, as well.
One thing that is often said in complex PTSD treatment and trauma therapy is that “slow is fast,”…
This means that it is wise to pace the work in such a way that the individual’s capacity to cope is not overwhelmed. Trauma therapy is not intended to be re-traumatizing, but it can be, when therapists rush into processing too quickly. For this reason, the Three Phase Approach is an excellent guideline.
This website article explains the three phase approach in more detail. Also, in her book, “Journey Through Trauma, A Trail Guide to the 5-Phase Cycle of Healing Trauma,” Dr. Gretchen Schmelzer argues for two additional phases, adding in one before Herman’s Phase One and one after Herman’s Phase Three.
Trauma is overwhelming, confusing and exhausting, but healing is possible. Find a trauma therapist today at www.traumatherapistnetwork.com.
Find a Trauma Therapist Who Specializes in Complex PTSD in Our Directory
If you’re ready to find the trauma therapist that is going to help you have a breakthrough then check out our online therapy directory. Know that we are regularly adding therapists to our directory. Therefore, the list will only continue to grow. To get started follow these steps:
- Head to our find a therapist page.
- Begin looking for a therapist in your area and select one that is a good fit.
- Visit their website and learn about our therapists.
- Get in touch and begin finding hope and healing!
*If you’re a trauma therapist who offers support for complex PTSD our directory is for you. If you’re looking to be a resource for individuals needing help, learn about our directory. Then, visit our page to get set up as a therapist today!