Therapy for Trauma- By Kaci Pennington, LMHCA
So, you’re thinking about going to therapy for trauma. Starting therapy to resolve trauma can be really intimidating. Like most therapists, I’ve gone through my own therapy. I understand how scary that first session can be — whether starting with a new clinician or starting therapy for the very first time. If any of the questions below resonate with you, stick around and see if you can find some answers here.
The most common questions I hear are:
· What is trauma? Does what I experienced even count as trauma?
· What does therapy for trauma look like?
· What is expected of me in a therapy session? Am I expected to show up and discuss my trauma in the first session?
· When is it OK to seek help for trauma?
My goal in this article is to, first, put together a few thoughts to ease some of the anxiety around these common questions and concerns.
Second, I want to help you identify, for yourself, if working with a therapist is the right next step. If not, that’s OK. My hope is that you’ll leave with a better sense of what you want in a therapist and approach to care. If you read through this and find that you have questions, please don’t hesitate to reach out.
What is trauma?
Trauma is an emotional and psychological response that happens after an event that is distressing or disturbing. Trauma most often comes from experiences that make us feel unsafe and/or disrupt our ability to function either emotionally or physically in the here-and-now. We often think of trauma as the big scary events (serious injury, sexual assault, acts of violence, car or plane accidents, natural disaster, etc). While true, these are not the only causes of trauma. There are also many causes of trauma that are more ingrained into our daily lives (chronic illness or pain, financial concerns, relationship conflict, bullying, loss of a pet, witnessing abuse, racism, homophobia, sexism, emotional or narcissistic abuse, career changes, infidelity, and many others). Sometimes these can be experiences we no longer think of as traumatic because we have lived with them for so long.
We often think of a trauma occurring as a single event, but traumatic events can also occur over time. They can occur at different times on different occasions and do not need to be on-going.
When does trauma “count?”
Whenever you feel like it does. Everyone reacts differently and your reaction is valid. Even if your reaction looks different from that of someone else, even if someone else has experienced “worse,” and even if parts of your life are going well. You and your experience are valid here.
See “Impact of Trauma” for common signs and symptoms.
What does this therapy look like?
Trauma is a mind and body-based neurophysiological and biochemical condition. All this means is that trauma involves the nervous system and can impact chemicals, like our hormones (think adrenaline or cortisol, etc.) in our body. In counseling we will work toward resolving trauma through the nervous system and the body to access very specific parts of the brain.
There are many ways we can work through trauma and what we choose will be individualized to what works best for you. We will always start by building our relationship and trust. Traumatic experiences and our responses are varied. Sometimes folks are ready to jump in and sometimes, for others, it takes a while in sessions to be ready to begin to discuss. However, it looks for you, trust that it’s OK.
We will work on identifying your symptoms so that we can work toward managing them in a way that works for you. Our goal is to improve your overall quality of life and reduce the impact to your daily life as much as we can. We will work on building skills for emotional regulation and stability, identifying the strengths and resources that you already have (yes, you’ve already got some), and then move toward processing and integration of trauma. This treatment varies broadly depending on each person’s individual needs. For some folks, learning skills to regulate emotions takes the most time. For others, processing and integrating trauma memories may take longer. There’s no right or wrong, your process will be uniquely your own.
We may work to build skills through use of:
· DBT or CBT skills
o Emotion regulation
o Distress tolerance
o Mindfulness (breathwork, meditation)
· Multisensory guided Imagery for internal resourcing
· Meridian-based interventions for physiological arousal reduction
· Mentalization Training
· Medication assessment and management (through referral, not provided in-house)
· Brainspotting techniques
o What is Brainspotting? Here’s a quick video: https://brainspotting.com/
Exploring trauma may be done through art therapy, narrative therapies, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), doing inner child or parts work, Body/Mind work, Brainspotting and/or using psychodynamic approaches.
We may explore trauma through use of:
· Art Therapy
· Narrative Therapies
· Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
· Inner child or parts work
· Body/Mind work
· Brainspotting
· Psychodynamic approaches
The process of work with trauma is about exploring what works best for you in each unique situation. The important thing to remember is that this is your work. We are in collaboration together during this process, but you control the pacing of exploration and healing. If certain techniques, skills, or interventions don’t work or feel right for you, you have the power to say so.
What should I know about the first session?
The first session is our intake. We will talk about the paperwork/policies and ensure you understand what you’ve signed and the risks/rewards of therapy, how our therapeutic relationship will look, and all things confidentiality. You will have a chance to ask questions and get all of those answered. I will also ask questions — about why you’re coming in for care and a little bit about your life (work, school, family, friends, pets, your medications, any other mental health treatment, etc.). I want to get a good idea of who you are as a person, not just what has happened to you.
Do I need to tell you details about my trauma?
You can share as many or as few details as you would like. There is no need to go through details of trauma if that does not feel right for you. If you want to keep things vague, I get that. One strategy is to provide the “chapter titles” version of what happened, as if your life was a book and you had to come up with a chapter title. For example, “I experienced physical abuse from a family member when I was a child.” I might ask for general information like age ranges, but sharing is up to you. Any additional questions would be related to ongoing events, where I would need to assess for any ongoing threat of harm to you. Specific questions or discussion causing you to recall events in detail will not be needed unless you feel it is important to your healing.
What is the goal here?
You get to decide your goals. There’s no right or wrong goal.
It’s also okay to not know your goal. Maybe you just have this sense that there’s something in your past that you’d like to resolve. That’s OK! Many times, defining what your goals are is part of the process.
Most commonly I hear things like:
· “I want to relieve my symptoms of anxiety/depression/nightmares/flashbacks/etc.”
· Or simply, “I just want to feel better.”
Maybe your goals are about how you function in the world/school/work. Maybe your goals are relational — how you show up as a parent, friend, or partner. Whatever your goals are, they’re valid and you’re deserving of the work and time needed to get there.
My goal in any therapy is to work toward improving quality of life alongside the client, forming a meaningful and safe therapeutic relationship, and being a place where a client can show up authentically and be met with compassion, acceptance, non-judgement, and understanding.
I hope this has helped provide clarification and reduction of anxiety. If all of this feels like a good fit, I look forward to hearing from you when you’re ready. While traditional talk therapy is a very common approach, know that it’s not the only option and there are many other options available.
All the best, Kaci P, LMHCA
If you are in need of some additional resources please check out our resources page here!
Kaci is a therapist at The Brave Life Therapy located in Indianapolis, Indiana. Kaci specializing in working with individuals experiencing trauma, anxiety, depression and is a brainspotting provider. You can reach her at www.thebravelifetherapy.com/kaci
