Types of Trauma Therapy

Before I talk about types of trauma therapy, I’d like to address a question I get often:

what is "healed trauma"?

First, the word "healed" is tricky. It implies a complete end point, a place where the thing is over and we are done with it. These things don't happen. No matter how "healed" we are from anything, we will always be impacted by it. By no means does this mean we cannot heal trauma. It's just important to acknowledge that we cannot completely eradicate the lasting effects of trauma. That being said, we can CHANGE them.

While trauma is "unhealed", survivors may experience flashbacks, nightmares, hypervigilance, difficulty sleeping, difficulty concentrating, negative thoughts about themselves, feeling unsafe (in the world and in their own body), difficulty trusting, among other things. All of these experiences contribute to a feeling that *trauma* is in charge and is running your life. Trauma decides whether and where you go outside your house. Trauma decides whether and when you remember. Trauma decides whether, when and with whom you feel safe.

First and foremost, healing trauma is putting yourself back in the driver's seat. It is releasing trauma as the primary narrative of your life. There's a great quote from Michael Rosenthal:

“trauma creates change you don’t choose, healing is about creating change you do choose.”

I love this. Trauma healing is about empowerment. Regaining control where you didn't have it before, while also realizing that you'll never have full control of everything.

Trauma healing is about re-learning how to feel safe in your body, and in the world. It is about soothing and rewiring your nervous system. Healing is embodying an authentic sense of self, defined by YOU. It is living with purpose, meaning and connection.

And this healing is totally available to you. I know it.

So, how do we heal from trauma?

There are a million ways to heal trauma--and not one of them is the single “correct” way to go about healing. Different things work for different people, and I want to be clear that psychotherapy is only one factor in trauma healing. A short and incomplete list of other things that support trauma healing includes: social justice, supportive relationships, financial stability and a sense of purpose.

When it comes to therapy though, there are a lot of different approaches to treating trauma. Most therapists you meet will have an eclectic approach, meaning they will blend techniques and interventions from various different theoretical approaches. It's great to ask your therapist what approaches they draw from and what that means for your treatment.

Here are *a few* of the trauma treatment modalities you might run into:

Sensorimotor Psychotherapy (created by Pat Ogden): This is a type of therapy that believes that we store trauma in our bodies through procedural/implicit memory. When trauma becomes PTSD, it is (in part) because our active mobilizing defenses like fight/flight get truncated or are incomplete and subsequently get trapped in the body. Sensorimotor Psychotherapy interventions support regulating autonomic nervous system dysregulation, and help move that truncated defensive response through the body in a mindful way. This expands the window of tolerance and increases embodiment, empowerment and a sense of groundedness. A very similar approach is Somatic Experiencing (created by Peter Levine).

EMDR (Eye Movement Desensitization and Reprocessing; created by Francine Shapiro): EMDR also believes that trauma gets trapped in the body, along with deeply held negative beliefs about self and the world. This can lead to phobic avoidance of traumatic memory which is associated with symptoms of distress like intrusive memories, flashbacks, nightmares, avoidance of triggers, and negative thoughts about self. EMDR uses bilateral sensory stimulation (visual by tracking moving fingers or a light bar, or tactile, typically using light buzzers in each hand), memory recall, and grounding resources to reduce distress and desensitize clients to the traumatic memory.

TF-CBT (Trauma-Focused Cognitive Behavioral Therapy): This therapy asks, what negative beliefs or stories are you telling yourself as a result of the trauma? Examples: the world is not safe, this is all my fault, all people are dangerous. TF-CBT focuses on these thoughts and emotions to challenge these beliefs through both thought challenging and behavioral action.

[Personally, I like to use this in conjunction with SP so we can get at both the thoughts and body memories associated with trauma.]

Prolonged Exposure Therapy (PE): This is quite similar to phobia treatment. The idea is that we become phobic of traumatic memory, and that avoidance of the memory creates greater distress and exacerbates other symptoms of PTSD. PE therapists will help you create a list of graduated exposures (starting with least triggering to most triggering) to practice approaching triggers while using skills to regulate emotion. In PE therapy, you will also tell the story of your trauma repeatedly, again, to desensitize to the trauma memory. 

I won’t speak necessarily to the pros and cons of each type of treatment, because it really depends on the client, type of trauma, and clinician’s experience and training. What is most important when working through trauma in therapy is that you find a therapist you feel safe with, who can explain their treatment frame to you, and that their treatment frame resonates for you. If these factors are in place, then likely any of these modalities are likely to be effective for you.

There are also quite a few therapies that don’t necessarily conceptualize trauma specifically in their literature, but are still quite supportive in healing from trauma. These include:

-Yoga therapy

-DBT (Dialectical Behavioral Therapy)

-CBT (Cognitive Behavioral Therapy)

-ACT (Acceptance and Commitment Therapy)

-IFS (Internal Family Systems therapy)

This is by no means a comprehensive list. The treatment frames listed above are ones that I have training in or am familiar with enough to be able to speak on them. There is no one right way to treat trauma, it's about finding what works for you. As I said before, healing is totally available to you. I know it.