What is trauma-informed therapy? Is it listening to a client describe a painful experience they’ve had? Is it handing someone a box of tissues while they recall their traumatic memories? Being a licensed mental health professional does not necessarily mean a clinician is trauma-informed.
When potential clients search for therapists, so many clinicians have gained the general knowledge and experience required for certification, and they list “trauma” as one of the issues they can help clients with. Trauma therapy is more than just reading a trauma book while in graduate school. Trauma-informed therapy is an art, a science, and a relationship–and it shouldn’t be taken lightly.
I hope therapists will use this information as a springboard to deeply understand trauma. Your clients have been hurt, and you don’t want to unintentionally perpetuate that pain. You don’t have to earn a bunch of additional certifications. Read these books. Listen to these podcasts. Work with a therapist to heal your own trauma. If you are going to engage in trauma therapy, please don’t do it halfway. You don’t have to be perfect. Be authentic and human. You need a strong foundation for safe trauma work. This has been deeply personal to me as a client. Read about my therapy experiences here.
I have recently heard some of the most meaningful podcast episodes related to this topic, and I highly recommend them to therapists and clients. Trauma therapy is evolving, and the good news is that there are a variety of hopeful treatment options. Ultimately, the most important piece–no matter the modality–is the strength of the therapeutic relationship. Listen to these:
Podcasts: Challenge Your Thinking About Trauma-Informed Therapy with New Episodes
- Therapy Chat Polyvagal-Informed EMDR with Rebecca Case; 50 minutes (2023) all about the therapeutic relationship in trauma therapy: therapists doing their own work, cues of safety, co-regulation, vicarious trauma, building a foundation of safety and comfort, hypervigilant clients, and neuroception.
- Stuck Not Broken How Nervous System Co-Regulation Can Help in Trauma Recovery; 19 minutes (2023) the biological process of co-regulation is an essential part of healing from trauma; it explains how deep connection can help us become unstuck; why specific people make us feel calmer and more secure.
- Being Well What Really Helps Trauma? with Dr. Jacob Ham; 1 hr 11 minutes (2023) a felt sense of connection, parts work, anger, empathy, grief, love, vulnerability, shame, presence, taking risks, pain, processing trauma, protector parts, technique, individuality, authenticity.
Additional podcast episodes are listed at the bottom of this post.
Trauma-Informed Therapy Techniques
In her article “What Is Trauma-Informed Therapy?“, Amy Marschall, PsyD states:
“Trauma-informed therapists emphasize the following areas in their practice:
- Physical and emotional safety. A trauma-informed therapist will take steps to ensure that clients feel both physically and emotionally safe in their sessions.
- Collaboration. Trauma-informed therapists aim to empower clients by educating them about their options and giving them an active role in their care.
- Transparency. Trauma-informed therapists are open and honest with clients.
- Competency. Trauma-informed therapists make sure that they are educated and up-to-date in research and best practices for working with clients who have experienced trauma. They are also aware of the unique cultural considerations that each client experiences.”
Additionally, therapists will ideally utilize a combination of top-down and bottom-up therapy modalities to treat their clients.
Understanding Trauma Symptoms
Trauma-informed therapists should be prepared for a variety of symptoms and presentations of trauma. Common symptoms include but are not limited to:
- anxiety
- depression
- emotional dysregulation
- dissociation
- intrusive thoughts
- flashbacks and/or nightmares
- avoidance
- detachment
- relationship difficulties
- hypervigilance
- irritability
- loss of beliefs
- shame
- difficulty concentrating
- hopelessness
- self-medicating
- physiological symptoms
- difficulty sleeping
- fear
- difficulty trusting others
- sadness
- confusion
- exhaustion
- numbness
- muscle tension
- self-harm
- negative thoughts
The Brain, The Nervous System, and Neural Pathways
In the words of Dr. Bessel van der Kolk, arguably the world’s current leading expert on trauma, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.” In other words, trauma literally rewires our brains. He says, “After trauma, the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their lives.”
“Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected.”
Dr. Peter Levine
It is imperative that therapists understand the depth and nuance of working with trauma survivors. The therapeutic relationship should be a priority. Therapists should have a general understanding of how trauma affects the brain in terms of brain structures like the prefrontal cortex and the limbic system. The coping strategies and trauma responses you see are survival skills located in the deep parts of the brain. These really can’t be “fixed” cognitively.
Ideally, trauma therapists will have an understanding of the nervous system and polyvagal theory of the nervous system developed by Dr. Porges and applied to clinical practice by Deb Dana LCSW. Polyvagal theory is “the science of safety” based on the body’s vagus nerve. I realized the importance of this through my own personal experience. I have fled from therapy sessions, not once, but twice. This is fight-or-flight. I was so dysregulated that I walked out on two therapists. My prefrontal cortex was not online in those instances. It was pure survival response. I have also been so dysregulated by therapy that I have shut down. What happens in the therapy space is like a microcosm of our everyday life. I have experienced anxiety, depression, and dissociation for as long as I can remember. My nervous system craves co-regulation.
“Cues of safety deepen our feeling of connection while cues of danger pull us out of feeling anchored in our lives.”
Deb Dana
“It’s interesting–most people think about therapy as something that involves going in and undoing what’s happened. But whatever your past experiences created in your brain, the associations exist and you can’t just delete them. You can’t get rid of the past. Therapy is more about building new associations, making new, healthier default pathways. It is almost as if therapy is taking your two-lane dirt road and building a four-lane freeway alongside it. The old road stays, but you don’t use it much anymore. Therapy is building a better alternative, a new default. And that takes repetition, and time, honestly, it works best if someone understands how the brain changes. This is why understanding how trauma impacts our health is essential for everyone.”
Dr. Bruce Perry
Attachment and Trauma
Often, trauma comes with an attachment injury. Trauma therapists should have an understanding of attachment theory and the work of Bowlby and Ainsworth. Therapists must understand their own attachment style. Additionally, therapists must understand what it means to serve as a secure base for their clients.
“Many traumatologists see attachment disorder as one of the key symptoms of Complex PTSD.”
Pete Walker
“The patient brings with him into therapy all the failures and suspicions and losses he has experienced through his life. The defensive forms of insecure attachment – avoidance, ambivalence, disorganization – will be brought into play in relation to the therapist. There will be a struggle between these habitual patterns and the skill of the therapist in providing a secure base – the capacity to be responsive and attuned to the patient’s feelings, to receive projections and to transmute them in such a way that the patient can face their hitherto unmanageable feelings. To the extent that this happens, the patient will gradually relinquish their attachment to the therapist while, simultaneously, an internal secure base is built up inside. As a result, as therapy draws to a close, the patient is better able to form less anxious attachment relationships in the external world and feels more secure in himself. As concrete attachment to the therapist lessens, so the qualities of self-responsiveness and self-attunement are more firmly established in the inner world.”
Dr. Jeremy Holmes (Dr. John Bowlby and Attachment Theory)
Don’t miss my post Healing Attachment Trauma: The Therapeutic Relationship.
Doing Their Own Work
Like I mention in The Most Important Qualities of Effective Therapists and Does My Therapist Need Therapy?, it is strongly recommended that therapists attend their own regular therapy and/or supervision sessions. Therapists are vulnerable to vicarious trauma and burn-out. Many people say that therapists can only take you as far as they have gotten themselves.
In this podcast episode about trauma therapy, Rebecca Kase compares therapists to surgeons. The surgeon should perform surgeries with a clean scalpel for each patient. The therapist’s own nervous system is their most effective tool.
Must-Read Book for Trauma Therapists
Sometimes it can be difficult to find time to read when we are being pulled in a million different directions. Listening to audiobooks has been the best solution for me. I have found that I can easily get through a book each week just by listening during my driving commutes and while I fold laundry.
Dr. Bessel van der Kolk’s The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014) is hands-down the most important book for any clinician as it provides the foundation for understanding PTSD and practicing modern trauma therapy.
For additional important and relevant books about trauma and therapy, please see my reading page.
If you are new to trauma therapy, consider 101 Trauma-Informed Interventions: Activities, Exercises, and Assignments to Move the Client and Therapy Forward (2013) by Linda Curran.
More Podcast Episodes About Trauma Therapy
Being Well So You Want to be a Therapist? with Forrest Hanson, Dr. Rick Hanson, Lori Gottlieb, Terry Real, and more; 1 hr 45 min (2023) key traits of good therapists, complacent therapists, mistakes in therapy, emotional intimacy, self-regulation, heal yourself first, messiness, modalities, boundaries, what therapy is actually like, being yourself, human connection, vulnerability, first sessions, career paths, transference, imperfections
Complex Trauma Recovery Untangling Inner Knots 55 minutes (2023) childhood vulnerabilities & powerlessness, attachment, IFS, safety, trauma symptoms, felt sense of the world, adaptations, coping techniques vs. deep healing
Complex Trauma Recovery Somatic Experiencing & Attachment Based EMDR with Adele Martelle; 1 hr 28 min (2023) religious trauma & deconstruction, shame, lack of community, control, resistance, colonization, trauma responses, polyvagal interventions, freeze responses, resourcing with IFS & EMDR, attachment to therapist, misdiagnosis, corrective relationships
Being Well Healing Your Attachment Wounds with Dr. Diane Poole Heller; 60 minutes (2021) attachment system disconnection, unpredictability, chronic disappointment, fear of abandonment, disorganized & avoidant attachment, safety in relationships
Notice That Introduction to EMDR Case Conceptualization 54 minutes (2021) targets vs. getting lost in details, resource installation, anxious energy, the unique biology of mammals and need for relationship, polyvagal theory, loneliness, safety, early relational trauma, shame, invalidation, expressing needs, risk of disconnection or rejection, repressing emotions, unresolved generational trauma, interpersonal neurobiology
The Whole Therapist Nonverbal Communication 31 minutes (2023) somatic work, regulation with the therapist, early attachment wounds, grief work, sensory information in therapy, moving slowly, attuning to nonverbals, eye contact, embodiment
The CPTSD Podcast Your Inner Parts & Healing from CPTSD 27 min (2023) protector parts and behaviors, exiled parts and pain, the ages and functions of parts, blended parts, triggers, trust
Therapy Chat Complex Trauma, The Freeze Response + Somatic Therapy with Dr. Arielle Schwartz; 47 minutes (2021) Dissociation, resilience, childhood trauma, parts work, window of tolerance, “high functioning,” unexpressed distress, authenticity, emotion
Therapy Chat Trauma + Opening Up in Therapy with Dr. Robert Muller; 60 minutes (2023) vulnerability, control, childhood trauma
Science of Psychotherapy EMDR, Polyvagal Theory, Therapeutic Relationship, & Trauma with Rebecca Kase; 40 min (2023)
Ten Percent Happier Become an Active Operator of Your Nervous System with Deb Dana, LCSW; 59 minutes (2022)
Other relevant posts:
Top-Down vs. Bottom-Up Therapy for Trauma: Which is Better?