A Trauma Therapist Explains Trauma & The Process of Recovering from Trauma Through Therapy In Understandable Terms
By Laura Reagan, LCSW-C, Founder of Trauma Therapist Network
What Is Trauma?
We have all heard the word “trauma” used to describe terrifying events. This includes surviving a plane crash or something like the loss of a pet (which is not minor at all to us). Each person has their own unique experiences and perceptions. The list of things that can cause trauma responses is infinite. But, as a trauma therapist, I strive to create an easy way to define trauma in order to begin recovering from trauma.
Paraphrasing Dr. Bessel van der Kolk, an internationally known trauma expert and author of the bestselling book, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma,” trauma can be defined simply as any experience which overwhelms the Central Nervous System’s ability to process and recall memories. It is not exclusively an emotional experience. However, it is one that affects our sensory perception, cognitions (thoughts), our sense of identity, our bodies, the way we see our lives and the world. It can even interfere with our connection to fellow humans, other living beings, nature, and our sense of spirituality.
Trauma Seems Simple, But Has Many Intersections
While this definition of trauma is simple, it is also complex. In this YouTube video, (Content Warning: mentions examples of potentially traumatic experiences of a child’s death and sexual violence) Dr. van der Kolk, a Dutch psychiatrist, explains how traumatic events can be impossible for our body and mind to integrate into our experience.
Dr. van der Kolk doesn’t go into this in the video. Yet, we know that traumatic material that we can’t integrate is in fragments in our consciousness. It is away from our conscious understanding (processing). So it is stored outside of our awareness in other ways, which I will begin to explain below.
Understanding Trauma’s Impact’s Recovering from Trauma
Our interpretation of traumatic experiences is made up of many factors. This includes sensory perception, emotions, and our cognitions (thoughts) during and after the experience.
The 5-Sense Perception that is familiar to most of us (also known as our Near Senses) includes:
- Images we see with our eyes and in our mind’s eye (our visual system)
- Sounds we hear through our auditory system
- Scents that we smell through our olfactory system
- Tastes that we perceive through our gustatory system
- Sensations that we feel through our tactile (touch) system
Additionally, we sense and perceive through our “far senses,” which are listed below.
- Vestibular System – controls balance and orientation in space
- Proprioception – perception of motor movements of muscle and joints
- Interoception – responses related to regulation, including a sense of hunger, fullness, thirst, heart rate, need to urinate, etc.
Click here to read an article from the STAR Institute based on Sensory Integration theory. This goes into more detail about the near and far senses mentioned above.
In addition to our sensorimotor perception of a traumatic event (listed above), other aspects that may or may not be integrated include:
The emotions we felt during the experience – some common emotions elicited by traumatic events are:
- Intense sadness
And our thoughts during the experience – some examples:
- A sense of being “bad” or worthless
- Wanting to escape from what is happening
- “I can’t live through this,” “I can’t handle this,” “I need to disappear”
- No thoughts – going blank, zoning out or going away in our mind
Trauma Is Confusing And Can Make Us Doubt Our Own Perception Of An Experience. This Can Make Recovering from Trauma More Challenging
What is even more confusing about surviving a traumatic experience is that we often lack complete memory or verbal narrative. This makes it challenging to make sense out of what has gone on. Plus, it can make recovering from trauma a slower process. This causes so many of us to feel confused and question whether our perception of a traumatic event is real.
To make matters more complex, during the event we may lose our ability to move (paralysis). We may lose our ability to speak. Or, we may run or fight during traumatic experiences. This is because our body’s threat response system is active without our conscious awareness. As a result, we may do things and say words that later do not make sense. Likewise, we may NOT do or say things that would make sense.
Sometimes, When Processing Trauma, We Think About How This Could Be Prevented
We may find ourselves thinking obsessively about why we did or did not do what seems obvious in retrospect. An example of this is when someone is raped. It is common to think back on the experience and ask oneself “Why didn’t I fight back?” when our body/mind did what it had to do to survive the experience at the time. This is problematic because our brain is lacking complete information (i.e. not understanding trauma responses). So we assume the situation could have been avoided if we had “fought back”. See the section on the trauma reaction of “submit,” below to learn more.
Humans have a threat response system in our limbic system which we share with other mammals. It is active in response to survival threats. Under threat, our nervous systems make a decision so quickly that our cognitive brain can’t even begin to understand what is happening. Additionally, we are unable to follow a decision-making process based on logic, as we would in a non-traumatic situation.
Consider This Example When Thinking About Our Body’s Responses
I often use the example that comes from Dr. Peter Levine’s work. This explains that if you are in the jungle and you encounter a tiger, you will likely run away, freeze (play dead), climb a tree, throw something, use a weapon, or do whatever you have to do to escape from that tiger. Our brain instinctively recognizes the tiger as a much larger and more powerful predator than most humans. This is done before our thinking brain even has a chance to register “did I just see a tiger?” We tend to blame ourselves for what we did or didn’t do during a traumatic experience. Yet, our reaction is not in our control – it is automatic.
Our Threat Response System Activates Automatically During A Traumatic Experience
The threat response system is made up of these automatic trauma reactions which you may have heard of:
- Fight – using our body or an object to protect ourselves from harm by, for example: hitting, kicking, throwing something, etc. – can also show up in verbalizations like “No,” “Stop,” etc.
- Flight – physically removing ourselves from the space where the threat is by, for example, walking, running, crawling, etc. to escape the threat; can also include going away in one’s mind (dissociation)
- Freeze – physical immobilization, like playing dead, fainting, unconsciousness despite a great deal of physical activation in the body – for example, what you see when watching a nature video where a lion captures an antelope which immediately goes limp in the lion’s jaws. It appears to be dead, the lion may drop it, and sometimes the antelope seems to wake up and then runs away, escaping death.
- Submit – often looks like compliance but used when there is no way to escape the threat. For example, if you are withdrawing money from an ATM and someone comes up behind you with a gun and quietly demands your money. You calmly hand over the money, adding, “here, take my ATM card too, the PIN is 1234. I promise I won’t call the police, just please let me leave.” This is highly adaptive but often leads to blame by self and others who don’t understand the behavior that was used to stay alive and limit harm to the extent the victim was able to do so.
- Cry For Help (also called “Attach Cry”) – may be a scream, yell or other vocalization or actually calling out for help.
The Development of a Diagnosis is Largely Based on the Events That Occured Afterwards
One major factor in whether we develop trauma symptoms that make up the diagnosis of Post-traumatic Stress Disorder (PTSD), which we will learn about in more detail later in Part Two of this guide, is how people responded to us following a traumatic event. If someone was there to comfort us and help us through the situation, we are more likely to be able to integrate the experience into our conscious awareness. Therefore, we are able to better begin recovering from trauma and heal without long-term harm.
Unfortunately, often we are met with a misattuned response – meaning that others do not understand our reaction or even believe that our experience was real. This leads us to be unable to integrate the experience immediately and the emotions, sensations, and cognitions are stored away in a fragmented place in our body/mind. This is what causes the common reactions to trauma that create most mental health symptoms and eventually (hopefully!), sometimes decades after the events have ended, lead us to search for a trauma therapist.
The Past Can Affect Us More Than We Realize
It’s also important to note that when we have experienced previous traumas, especially during childhood, we may be unable to integrate later traumatic experiences into our conscious awareness on our own. This is true even if someone is there who tries to understand and comfort us.
The good news in all of this is that with the right help, trauma can heal. We do not have to suffer for our entire lives because of things that happened decades earlier. Especially, if we find a skilled trauma therapist who is trained and experienced in trauma healing methods.
Remember, Trauma Looks Different on Everyone
What is traumatic to one person may not be traumatic to another. There are many experiences, especially those occurring in childhood, which most people would agree fit into that definition. The most important thing to remember when seeking to understand whether or not you have experienced trauma is this: if it feels like an event was traumatic for you, trust your own inner knowing to guide you. If someone tells you that something that happened to you is not traumatic, remember that your experience is yours alone. You are the expert on what you’ve been through and how you feel about it. Recovering from trauma is your own journey and no one can tell you otherwise.
Trauma Is Highly Prevalent In the United States, But Still Misunderstood By Most of Us, Even Trauma Therapists and Other Health Care Professionals
Trauma is actually a lot more common than many of us think. Best-case scenario, we have the opportunity to begin recovering from trauma very soon after the events. Unfortunately, because of the lack of awareness of trauma’s prevalence and how the process of healing trauma works, many of us suffer much longer than is necessary. I created the Trauma Therapist Network website along with the Trauma Chat and Therapy Chat podcasts to help people identify whether they have been affected by trauma and if so, to have an easy-to-navigate place to find help.
My Own Story with Trauma Has Lead me To Help Others Find The Best Trauma Therapist
As an experienced trauma therapist, I myself am a trauma survivor and I “pushed through” for decades without understanding how I had been impacted by events that happened when I was very young. I have found my way back to a whole and integrated mind, body, and spirit. Here I deeply connect and develop meaningful personal and professional relationships.
On top of a commitment to share the information and resources that helped me with other people who want to begin recovering after trauma. I received my first 40 hours of training in trauma almost 20 years ago, and I’ve had hundreds of hours of additional training in trauma since then. Yet I still didn’t recognize that some of the things I went through as a child and young adult were traumatic and affected me in all areas of my life. This includes how I felt about myself and other people. I want you to be able to find help if you’re suffering, too, and I hope this guide will help in that process.
The Adverse Childhood Experiences Study
Starting in 1995 and continuing over the next two years, a United States internist, Dr. Vincent J. Felitti, MD, conducted a study through the Kaiser Permanente health system in San Diego, California in which patients were asked whether, before age 18, they had experienced:
- Emotional, physical or sexual abuse
- A family/household member with mental illness
- Emotional or physical neglect
- Parental substance abuse
- Witnessing mother being abused at home
- Parents divorced or separated
- A family/household member who was incarcerated
These questions do not encompass a complete list of experiences that could be traumatic, whether occurring in childhood or adulthood. However, the responses were striking enough and led to a more accurate impression of the prevalence of childhood trauma than had previously been documented. Based on the responses to the study questionnaire, researchers identified that at least 61% of American adults have experienced at least one, and more than 20% have experienced three or more traumatic events in childhood.
Trauma Doesn’t Always Occur Just Once
If you’ve ever experienced any of the events listed above, you know that each one is not a discrete event – meaning it didn’t happen only once. Growing up, if you had a parent with a substance abuse problem, it was likely an ongoing problem that had numerous effects on family functioning for a period of months or years during your childhood. The same is true of most of the items on the questionnaire, so even if someone “only” endorsed having experienced emotional abuse, it is something that would have affected their identity formation and brain development for a continuous period.
In addition, the questions clearly didn’t capture so many other important types of experiences like bullying, death of a parent, community violence, racism, discrimination, oppression, poverty, war, immigration, combat, torture, imprisonment, natural disasters, and many others too numerous to list, that can have significant impacts on the developing brain of a child and long-lasting health effects.
Diversity Factors Need to Be Included in Trauma Research
Another important point to consider when looking at the 1997 study’s findings is that the study population of over 17,000 participants was demographically almost 75% white and well-educated (at least some college). Since then, further studies have been done with more diverse populations. Plus, the questions have been expanded to capture a more complete picture of the problem of childhood trauma, with similar findings. The study’s conclusions about the connection between toxic stress and the developing brain on long-term emotional and physical health are sobering. They indicate that trauma is a problem that must be taken seriously. Some people say, and I agree, that childhood trauma is the most significant preventable threat to public health. Therefore, government funding for prevention and recovery from trauma would significantly improve the public health of a country, and by extension, the world.
To learn more about the Adverse Childhood Experiences Study visit: https://acestoohigh.com/aces-101/. This TED Talk by Dr. Nadine Burke Harris, who is now the Surgeon General for California, describes the public health epidemic of childhood trauma and why we need to take it seriously. I highly recommend watching it to the end!
What Is Trauma Therapy? How is it Different From Other Types of Therapy?
The “medical model” is a common approach to mental health. It involves the diagnosis of mental disorders and treatment to reduce trauma symptoms. Often typical mental health therapy focuses on identifying the mental disorder causing symptoms. This is true for Bipolar Disorder, Schizophrenia, Generalized Anxiety Disorder, Major Depressive Disorder, Post-traumatic Stress Disorder, etc. Additionally, finding a treatment that reduces or eliminates the trauma symptoms is complex. This often includes medications to reduce symptoms. Behavior modification and coping skills are often addressed as well.
In contrast to the medical model of mental health treatment, trauma therapy takes a stance that there is a reason for the symptoms that are bothering the person. Plus, it addresses many behavioral concerns, even self-harming behaviors, eating disorders, and substance abuse issues.
These are often unconscious coping strategies that will resolve when the underlying cause is successfully treated. In trauma therapy, the trauma therapist understands the emotions, body sensations, thoughts (cognitions), and behaviors exhibited by the person seeking therapy through the lens of trauma. This means that instead of assigning multiple diagnoses which explain the behaviors, the treatment is focused on treating trauma with a belief that trauma is the cause of the person’s difficulty in functioning.
An Example of How This Plays Out in Trauma Therapy
Here is a simple example of this – please note I am not listing all of the criteria for the mental health diagnoses I am mentioning here because I am making a simple point. A person who is seeking therapy and identifies repeated bouts of prolonged sadness and/or inability to function may be diagnosed with Major Depressive Disorder. It may be true that the person may meet the criteria for this diagnosis.
Perhaps the person also describes frequent panic attacks, nightmares, and feeling on edge at all times. Then the diagnosis of Panic Disorder and/or Generalized Anxiety Disorder may be added to the list. Or the person may be diagnosed with Bipolar Disorder. They may carry all of those diagnoses and maybe a few others.
In fact, when I worked in a community mental health outpatient clinic, I frequently met clients who were new to me but not new to the mental health system. They often had all of the diagnoses I mentioned, yet despite spending years in therapy and receiving psychiatric care (often taking 4 or 5 medications – antidepressants, anti-anxiety medications, and even anti-psychotics daily), their symptoms – and their lives – seldom improved much. It was certainly discouraging for clients to be doing everything they were told to do to get better and not feeling much different than they did before the treatment.
Addressing the Trauma is Important to Healing
As a trauma therapist, when I would meet these clients I would ask them about their lives and they would tell me about repeated experiences of physical, emotional, and sexual abuse. Additionally, they would describe the physical and emotional neglect in their childhoods; and so many losses of people they loved. Anyone who had been through what they’d been through would be struggling. Their adult lives were marked by unsatisfying relationships with their families of origin, friends, partners, and children. Yet, despite them being forthright with their previous therapists and psychiatrists about the traumatic events they had been through, their diagnoses almost never included PTSD.
When We Don’t Address the Root Issues in Therapy, People Don’t Get The Support They Need to Begin Recovering from Trauma
Even if PTSD was listed in their charts by previous therapists, the treatment was usually focused on the other diagnoses. Every single one of these clients said that no one ever explained trauma to them, despite their extensive histories of childhood and adult traumatic experiences.
Talk about strength – to continue trying to get better in spite of seeing such little improvement over years of therapy and psychiatric treatment. The worst part is that in the absence of a better explanation, trauma survivors are likely to blame themselves for their lack of progress in treatment and become increasingly hopeless about their likelihood of ever feeling better.
The Difference Of A Trauma Focused Treatment Approach in Recovering from Trauma
When working in two different community settings that were trauma-focused, I was able to see my clients’ sense of self-worth improve. I saw anxiety, depressive symptoms, self-regulation skills, and the quality of their relationships beginning to improve in shorter periods, like 3 to 6 months. Clients learn to identify the ways that trauma reactions create issues and symptoms. Thus, they learn new ways to cope with those symptoms.
During the first phase of trauma therapy, which I will explain in detail in Part Two of this guide, the focus is on building a trusting therapeutic relationship. Then, psycho-education about trauma and identifying the situations that tend to activate trauma symptoms is the focus. Next we begin finding more effective coping strategies to deal with those symptoms. So even in shorter-term therapy a lot of improvement can happen. This is true even while working in phase one of treatment.
The Concept of Self in Recovering from Trauma Plays A Huge Role
A big factor in recovering from trauma symptoms is that our self-concept begins to shift. Our perspective changes from seeing ourselves as “broken,” to realizing we were always whole. People who have childhood trauma have gone through terrible things that affected them. Usually, toxic stress begins in early childhood.
Trauma therapy is by nature strengths-based and de-pathologizing. This is because its basis is on the idea that there is nothing wrong with us. We are just right as we are. Yet, we are affected by trauma in ways that are not our fault. Fortunately, with trauma-focused therapy, we can begin recovering from trauma. People who go to trauma therapy will begin to notice ways it shows up in their lives leading them to feel much better.
Understanding The Cause of Trauma Matters
Dr. Bruce Perry, a psychiatrist specializing in the effects of childhood trauma on brain development, and Oprah Winfrey wrote a book together that talks about this type of trauma therapy approach. It’s called, “What Happened To You? Conversations On Trauma, Resilience, And Healing“. As the name implies, the question we (as mental health professionals and everyone who cares about trauma survivors) should be asking ourselves is what happens to cause this human being to have the difficulties they are currently facing. This should be done rather than seeing them as someone who is broken and needs fixing.
Trauma therapy operates under the assumption that the person has inside of them what they need to heal. The trauma therapist’s job is to help them reconnect with that inner wholeness. This cuts out the barriers while addressing the trauma stories. We do this rather than allowing those experiences to be a fragment outside of one’s conscious awareness.
Understanding Trauma is a Crucial Step to Recovering from Trauma Long Term
For the past eight years, I’ve owned a private practice. Here I help people who have histories of trauma. In practice, I come upon the same issues as when I worked in community mental health. People have come to me who have been in therapy that wasn’t trauma-focused for 5 years, 10 years, or longer. It’s even more complex when they have childhood experiences that include traumatic events which they disclosed from the beginning.
Yet, their previous therapists and psychiatrists never mentioned the word “trauma” to them. Additionally, they were treating them for other diagnoses. It’s insane and even unethical. Especially considering the research on trauma is not new. Plus, there are effective treatments based on research that is available. If you don’t begin treating trauma, how can people begin recovering from trauma?
My Mission as A Trauma Therapist
I am determined to do as much as I can to spread the message that trauma is real, and recovering from trauma is possible, and help is available. Trauma is also preventable. It is impossible to completely eliminate all situations which could potentially cause trauma; but we can focus our attention, effort, and federal funding dollars toward addressing this preventable public health epidemic. This would improve the well-being of millions of people living now and future generations, and maybe even save the planet. So count me in the camp who calls childhood trauma the biggest public health issue of our time.
What We Will Cover In Part Two and Part Three of This Guide
In Part Two I will talk about the PTSD diagnosis as well as Complex PTSD (C-PTSD); list some of the common ways trauma shows up in our lives; explain the two perspectives on trauma therapy; describe the three-phase approach to trauma therapy, and in Part Three I will talk in detail about how to choose a trauma therapist.
If You’re Seeking Support with Recovering from Trauma Then Visit Our Therapist Directory
To find a trauma therapist, use the Find A Therapist link on the site. More trauma therapists and other resources are being added to the site each week. If you don’t see a trauma therapist in your area on the Find A Therapist section of the Trauma Therapist Network, try these other directories to find a trauma therapist who has completed at least one of the training levels for these methods:
*If you’re in need of support in recovering from trauma our directory is for you. If you’re looking to be a resource for individuals needing help, learn about our counseling directory. Then, visit our page to get set up as a therapist today!
Trauma Resources to Help in Recovering From Trauma
While waiting for parts Two and Three you can learn more about trauma by listening to the Trauma Chat podcast. In this show, I talk about trauma in brief episodes with examples that make the complicated information clear and understandable. All of Season One is available for download (free) on the Trauma Therapist Network site. There you can also listen (for free) to the Therapy Chat podcast, where I interview therapists, authors, researchers, and others who specialize in trauma work. We are getting close to 300 episodes, and they are being added to the site gradually but they’ll all be available there soon.