Why Trauma-Focused Therapy Works

     If you’ve heard of the words ‘trauma-informed’ before, you might’ve noticed that term has become the new buzz word in the world of mental health. What most people don’t know is there’s a difference between trauma-informed treatment and trauma-focused treatment. This difference, although subtle in its wording, is significant when it comes to what your therapy session is going to look like and the emotional experience you’re going to have. This article can help you decide what you want to look for in a therapist if you’re interested in processing trauma and want to find a professional that actually specializes in this area.

Introduction

     How the concept of trauma-informed care is defined is by an approach that is guided by four assumptions: realization about trauma and how it can affect people and groups, recognizing the signs of trauma, having a system which can respond to trauma, and preventing re-traumatization.

     At this point, trauma-informed treatment is the standard of care for this field. It is very helpful in making a client feel safe within a practice’s policies, atmosphere, and within the relationship with their therapist along with feeling seen and heard. This is in addition to educating clients of how their current thoughts, feelings, and behavior are influenced by their past experiences (positive and negative). Especially, negative experiences that were traumatic such as by not limited to any kind of abuse (physical, sexual, emotional), neglect, car accident, combat, natural disaters, domestic violence, terrorism

     On the other hand, trauma-focused treatments are specific interventions that are evidence-based that were developed to directly address the impact of trauma through emotional processing. That involves clients re-experiencing the trauma in a safe way, in order for them to be able to more effectively store it in the brain (moving it from short-term to long-term memory), which in turn, results in a reduction in trauma response symptoms (i.e. flashbacks, intrusive thoughts, images, or memories of the trauma, nightmares, avoidance of trauma-related triggers, etc.) as the client has been able to rewire their nervous system in a very impactful way.

     In the most simplistic terms, think of trauma-informed therapy as a philosophy or for lack of a better word, ‘vibe’ and trauma-focused therapy is something you actually do differently than in traditional talk therapy.

     A trauma-informed approach alone is not considered a trauma-focused approach. While a trauma focused approach will be considered informed. If the therapist only has the trauma-informed approach experience, they cannot be considered trauma-focused.

     Now it sounds like I’m just arguing about semantics. But why it matters is because so many people could benefit from trauma-focused treatment who might not know they need it, it exists, or where to find it. That’s where I’d like to help.

What treatments are considered trauma focused?

• Prolonged Exposure for PTSD (PE)

• Eye Movement Desensitization (EMDR)

• Cognitive Processing Therapy (CPT)

• Brainspotting

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• Accelerated Resolution Therapy (ART)

     This is not an exhaustive list but are the most common, well-researched and evidenced-based trauma treatments. They all have overlapping guidelines, goals, and mechanisms. The trauma specific treatment I am trained in is Prolonged Exposure for PTSD and a treatment I underwent myself was EMDR.

How & Why Trauma Therapy Works

     Starting at the very beginning - we all experience trauma at some point in our lives. It could be a single incident or over an extended period of time. This could be anything from physical, emotional, sexual abuse, neglect, a car accident, life threatening illness, loss of a loved one- just to name a few. Anything you feel compromised your safety (physical or emotional) to a significant extent that resulted in you feeling intense fear, horror, guilt, or shame.

     These feelings tend to persist after that traumatic event since it needs to be appropriately processed. What does that mean exactly? Basically, you need to feel it to heal it. Sitting with the really hard and painful emotions allows our brain to categorize and organize this information in a sync way, or in other words: wrap its mind around what actually happened and then realize we are not endangered anymore. But when we don’t give ourselves this time - or we simply didn’t have that time or space to process - it becomes stuck. The people that usually develop PTSD are the best at pushing it (memories, thoughts, feelings, reminders) away.

     It makes total sense that one would want to avoid these things. They are painful, uncomfortable, and can elicit such strong feelings of guilt and shame. We are biologically wired to seek pleasure and avoid pain which dates back to the beginning of time.  Due to this, avoidance is what maintains trauma symptoms. If I avoid or escape the distress I experience when I confront the trauma or any reminders, it ‘helps’ in the short-term because the distress is temporarily decreased. Until the memory or reminder comes up again, and again, and again - it always does. However, when we confront the trauma memory and its reminders, the intense anxiety it causes at first, eventually loses its power and decreases. Because it is physiologically impossible for anxiety to last forever. So in the moment, your anxiety will increase and after it hits its peak, it will decrease. Even though it’s challenging to endure, my goal is to teach people the feelings aren’t unsafe, just uncomfortable. [However, at the time they experienced these feelings during the trauma they were in an unsafe situation - that’s what makes the feelings so powerful]

    We are re-teaching your brain that these memories, situations, places or things that remind you of that trauma are actually safe. At the time you experienced the trauma, you were not safe - whether that was emotionally or physically. But when we have you relive it, you are safe and your brain finally gets the message that those memories are not a threat to you anymore.

     Think about if a child gets knocked over by a big wave at the beach. He might not want to get in the water for the rest of the day. They leave and next time he’s presented with going to the shore, his anxiety has generalized to not only include anxiety over going in the water but even visiting the beach. If he escapes or avoids the beach, that anxiety will not have an opportunity to be challenged so he’ll remain stuck in those feelings. However, if he confronts the beach - first by taking a few steps, then a few more then letting his toes graze the water, then getting into the water past his ankles, knees, waist, chest and so forth. He re-adjusted back to the water even though he experienced a scary thing previously.

     Not only from the trauma do we feel less safe - whether that’s in certain places, around people, or in our bodies - we also develop negative beliefs about ourselves, others, and the world. Take a look at this list and pick at a few that stand out to you of how you feel about yourself. The beliefs on the negative list - they have resulted from trauma. 

I don’t deserve love.

I am a bad person.

I am worthless (inadequate).

I am shameful.

I am not lovable.

I am not good enough.

I deserve only bad things.

I am permanently damaged.

I am insignificant (unimportant).

I am a disappointment.

I am different (don’t belong).

I cannot trust myself.

I cannot trust my judgment.

I cannot trust anyone.

I am helpless.

I am not safe.

It’s not okay to feel (show) my emotions.

I am a failure.

I cannot succeed.

I have to be perfect (please everyone).

     Our experiences, especially our early ones, are supposed to help map out our understanding of the world. So when these significant experiences occur, how can they not impact the way we see our internal self and external world?

People Who Might Benefit From Trauma Processing - EVERYONE

     If you have experienced trauma (which let’s be honest, most of us have), it most likely needs process trauma. If you are experiencing any of the following symptoms, you could significantly benefit from trauma-focused treatment.

• Anxiety

• Depression

• Flashbacks

• Intrusive unwanted memories

• Nightmares

• Frequent Avoidance

• Difficulty asking for your needs to be met

• Difficulty forming close relationships

• Forming relationships with others too fast that often are not reciprocated

• Lack of sense of self

• Think poorly about yourself - not lovable, stupid, worthless

• Have difficulty trusting other people

• Have difficulty letting yourself feel your emotions

• Have difficulty letting yourself feel emotions around other people

• Frequently discrediting your accomplishments

• Comparing yourself to other people

• Avoid being by yourself

• Avoid being around other people/isolate

• Keep yourself very busy

• Feel guilty if you’re not productive all the time

• Difficulty saying no to people and setting boundaries

     The list goes on and on…but if we think about it, these issues/symptoms didn’t just come out of nowhere. Something caused this to form - at some point in our lives we did not feel safe, didn’t get the love, attention, or validation we needed and this is how our body is responding, still living in survival mode. When it doesn’t have to be this way, we just have to accept that we need the help.

     So what can we do with this information? You can use this to inform how you go about finding a therapist which will help you achieve the goals you’re looking to accomplish in therapy. The best way to narrow down to someone who specializes in trauma-focused treatment AND takes your insurance is by going to Psychology Today where you’ll be able to filter by which treatment option, what insurance they take, gender, Telehealth or in-person, etc.

     There are additional sites that will give you some experts in the field as they are not only trained, but took it a step further and became certified in the modality such as the EMDRIA Provider and Prolonged Exposure Directory.

     My best advice would be to pick a place that you’ll be able to go consistently. Weekly is best to start, someone you can afford long term, and close enough where you won’t get tired of driving.

     In addition, it may take a few tries to find your right person, even if your original pick does specialize in trauma focused therapy; maybe the style of personality just didn’t match. That is normal, please don’t give up. You will find your person. And when you do, that’s where your work begins.

     My other piece of advice is to keep with it. If you’re with someone that you like and feel is competent at what they’re doing, keep going. The work is going to get harder and more painful, and then eventually it does get easier, you feel lighter. You’re putting in all this work that is going to truly change your life. Even though it’s hard to trust the process, I promise you it’s worth it.

I hope this information can provide more clarity into counseling, specifically trauma focused therapy, where you can find someone with this speciality, why maybe you might benefit from it.

Written by Lindsay Zogheb, MA, LPC - Trauma Therapist & Group Practice Owner