Types of Trauma Therapy and How They Work
A traumatic event is defined as exposure to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. Traumas can be experienced in any one of four ways:
directly experiencing the event
witnessing the traumatic event, in person
Learning that a traumatic event occurred to close friend or family member (violent/accidental)
Experiencing first-hand repeated or extreme exposure to aversive details of trauma (not via media, unless work-related)1
Traumatic events can impact people in a multitude of ways. Some people naturally recover from traumas while others may struggle with debilitating trauma-related symptoms for years. Given the heterogeneity recovery trajectories following trauma, clinicians need to be equipped with a multitude of tools and interventions to appropriately address individual client trauma-related symptoms and needs. In this post, readers will learn about different types of therapy for trauma related symptoms and how different trauma therapy types work.
Different types of therapy for trauma
The impact of trauma can vary widely; therefore, it is recommended that clinicians conduct a thorough assessment of trauma-related symptoms before jumping into any treatment. These assessments can include gold-standard measures such as the Clinician-Administered PTSD Scale-5(2) (CAPS-5). The purpose of this evaluation is to ensure that we fit a client’s goals, needs and symptoms to the appropriate type of therapy. If clinicians need a refresher on assessment and differential diagnosis, the webcourse below can help:
https://learning.simplepractice.com/courses/trauma-exposure-differential-diagnosis
PTSD Treatments
For clients who meet criteria for Posttraumatic Stress Disorder (PTSD), including Complex-PTSD, there are several short-term effective treatments that can lead to full remission of symptoms. PTSD is characterized by:
Recurrent re-experiencing of the trauma(s) during daytime or at night, in the form of nightmares.
Avoiding thinking or feeling about the trauma(s) and any reminders of the trauma(s).
Changes in thinking and changes in mood, including significant trauma-related blame and changes in thinking about safety, trust, power/control, esteem and intimacy.
Changes in physiological arousal and reactivity, such as exaggerated startle reaction, being super-alert and on-guard, hypervigilance, and trouble with concentration and sleep.
These symptoms must be present for at least one month following the trauma(s), they must lead to significant impairment and/or distress and they cannot be accounted for by another mental or physical illness(1).
The most effective treatments for PTSD are Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE) and Eye Movement Desensitization and Reprocessing (EMDR). These treatments have over two decades of research showing that they lead to clinically significant improvements that are long-lasting3. All of these treatments are specific subtypes of Cognitive Behavioral Therapies (CBT) and address avoidance and problematic beliefs that form after trauma(s), as both of these factors are known to maintain PTSD.
Treatments for interpersonal difficulties
After traumatic events, some clients may struggle with power/control dynamics in relationships. This may be evidenced by difficulties appropriately setting limits/boundaries with others, trouble asking for their needs to be met in relationships and challenges with asserting themselves. For clients with these types of challenges there are several different types of trauma therapy that can be beneficial. Specifically, Skills Training in Affective and Interpersonal Relations (STAIR), Dialectical Behavior Therapy (DBT) and Schema Therapy all focus, to some degree, on relational skill building and on addressing problematic beliefs and behaviors that inhibit healthy power-sharing in relationships. These types of trauma therapy help clients clarify their relational wants, need and limits and teach clients language for communicating more effectively what their needs, wants and limits are with others.
Treatments for mood and anxiety disorders following trauma
Two very common sequela following traumatic events is the experience of mood and anxiety-related issues. For mood disorders, such as Major Depressive Disorder, Cognitive Behavioral Therapy for Depression (CBT-D) and Interpersonal Therapy for Depression (IPT) have a robust evidence base. For anxiety disorders, CBT methods, such as Exposure-Based Treatments can be very effective at assisting clients in overcoming fears and anxieties. Another type of trauma therapy that addresses mood and anxiety symptoms following trauma is Acceptance and Commitment Therapy (ACT).
One thing to keep in mind is that there are many different trauma therapy types that are advertised broadly, but are lacking empirical basis. Meaning that even though some trauma therapy types may get a lot of visibility or seem popular in media, they may not actually have any sound science showing that they are effective for trauma-related symptoms. Therefore, clinicians are encouraged to become competent consumers of the scientific research on different trauma therapy types in order to provide the most ethical and effective clinical care.
How trauma therapy techniques can help
Trauma therapy can help with a lot of different symptoms and difficulties. The benefits of trauma therapy can include decreased trauma-related intrusive images or nightmares, increased ability to effectively manage negative thinking or rumination, decrease in painful mood states like depression, anxiety and guilt and improvements in assertiveness and interpersonal effectiveness.
Decrease in trauma-related intrusive images and nightmares
Trauma therapies that treat PTSD, like CPT, PE, and EMDR, significantly reduce daytime and nighttime trauma intrusions and re-experiencing symptoms of PTSD(3). In PTSD, trauma-related intrusions are typically very impairing and/or distressing. However, effective treatments for PTSD facilitate emotional processing of the traumatic events and facilitate making meaning of trauma in such a way that trauma-related intrusive imagery can be a thing of the past.
Increased ability to manage negative thinking and rumination
Several different trauma therapy techniques provide skills for identifying problematic and unhelpful thinking patterns that can develop after a traumatic event. In addition to skills for identifying unhelpful and problematic thoughts following traumatic events, there are numerous additional skills for modifying how one thinks about things. For example, thought records are a technique that supports recognizing thoughts that fuel painful emotions, while cognitive restructuring skills and related worksheets facilitate arriving at different conclusions based on the facts of a situation. These skills build on each other and are often practiced over time until they become automatic.
Improved interpersonal effectiveness
Trauma therapy can provide scaffolding for interpersonal effectiveness skills, which are often negatively impacted by the experience of trauma, particularly if one’s trauma type was interpersonal in nature. Clients can learn numerous skills for reflective listening, assertiveness, setting boundaries, making requests for change and giving positive and negative feedback. In addition, clients can learn about power-sharing healthfully in relationships and how different relationships may offer them different things.
Answering your questions about different types of therapy for trauma
Even with access to the internet, it can be really challenging to know about all of the options available for trauma therapy. It can also be a challenge to decide which treatment approach is right for you. Below, I will answer some frequently asked questions about different types of trauma therapy available.
What’s the most effective type of therapy for trauma?
There is no one-size fits all approach when it comes to trauma therapy as people are affected by traumatic events in different ways. When it comes to PTSD, however, there are several treatments that have been shown repeatedly to be superior to other therapies; namely, CPT, PE and EMDR. However, for other post-trauma reactions (e.g., depression, trouble with concentration, anxiety, low self-esteem), there may be different approaches that could be a great fit for clients.
When selecting a provider for trauma therapy, consumers should look for therapists who have had coursework, supervised practica and/or mentorship by experts in the field of traumatic stress. In addition, consumers are encouraged to look for providers who have had specialized training in evidence-based trauma treatments. Simply having the “experience” of working with traumatized clients will not ensure that a therapist is truly an expert; experience can pertain to the number of clients seen, while expertise speaks to specialized knowledge and competence in addressing specific mental health needs.
In general, the most effective forms of trauma therapy types are those that have been extensively evaluated and tested on hundreds or thousands of clients, and those treatments that, when scientifically compared to other trauma therapy types, show that they are more effective at reducing specified post-trauma difficulties and/or symptoms. Consumers can prepare themselves to ask their prospective trauma therapists about the clinical research supporting the interventions that are suggested.
How can people choose the type of therapy for trauma that’s best for them?
Consumers can be empowered with knowledge by doing research into different evidence-based treatments for trauma-related symptoms. They can arm themselves with questions to ask prospective providers during initial consultation calls and during their first appointment.
First, consumers should work with a competent, well-trained mental health professional who can aid them in discerning which trauma therapy is right for them. Other factors that a person may consider when choosing which trauma type is a good fit include what goals they have for therapy, any specifications/limitations regarding the frequency or length of treatment and modality of trauma treatment they prefer.
Goals for therapy
It is essential that consumers spend time determining what their goals are for therapy. While some individuals will want to eliminate trauma-related nightmares or flashbacks, in the case of PTSD, others may wish to improve their self-esteem or feelings of guilt or shame following the trauma. The client’s goals for treatment are an essential component of collaborative treatment planning in therapy.
Frequency of sessions and length of treatment
Some clients may be eager to engage in intensive treatment that takes place multiple times each week, whereas some clients- due to finances or psychosocial constraints- may only be able to attend therapy sessions each month. These factors will help determine which treatment to undertake as some therapies work best in a specified frequency.
Modality of treatment
Some trauma therapies can only be delivered individually, while other trauma therapies can be conducted in other modalities, such as group therapy, family therapy or couple therapy. Therefore, client preferences regarding the modality of trauma therapy delivery can be a great aid in ensuring that a client’s needs are met in trauma therapy.
Learn more about different trauma therapy techniques
There are a number of very effective therapies for trauma-related symptoms. These trauma treatments vary in their focus, length and modality. Consumers can do a great deal to ensure that they work with a provider with expertise in the trauma therapy. Below are several resources that consumers may use to learn about trauma treatments and to find providers who are trained in evidence-based trauma treatments.
International Society for Traumatic Stress Studies (ISTSS)
National Center for PTSD
Child Traumatic Stress Network
For therapists who are looking to enhance their expertise in trauma-informed care and in the provision of trauma therapy, the Trauma Therapist Training Course provides an excellent training opportunity. The Trauma Therapist Training Course provides a breadth and depth of learning about trauma therapy techniques; it includes live group and individual consultation to support the application of skills learned during the course into clinical practice. For more information, see the link below:
https://www.howtobecomeatraumatherapist.com/
References
(1) American Psychiatric Association. (2013). Trauma and Stressor-Related Disorders. In
Diagnostic And Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: Author.
(2) Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M.
(2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
(3)Forbes, D., Bisson, J.I., Monson, C.M., & Berliner, L. (2020). Effective Treatments for PTSD
Third Edition: Practice Guidelines from the International Society for Traumatic Stress Studies. Guilford Publications.
How to Become a PTSD therapist?
Posttraumatic Stress Disorder (PTSD) is a debilitating mental health concern (Olatunji et al., 2009; Shurr et al., 2009) that can follow the experience of a traumatic event and is characterized by trauma-related re-experiencing symptoms, avoidance, changes in thinking and mood and changes in physiological arousal and reactivity (APA, 2013).
For therapists, working with clients with PTSD can be extremely rewarding and meaningful. It can be transformative for therapists to help clients regain their sense of identity and power, and to help clients drastically change their lives. In order to effectively treat this at-need population, therapists need specific PTSD counselor training and PTSD counselor certifications.
While there is specificity about the competencies therapists need to acquire and about the content counselors need to learn (APA, 2015), there are different routes for how to acquire these competencies and skills to become a PTSD therapist.
A step-by-step guide for how to become a PTSD counselor
The first step for how to become a PTSD counselor is to get clarity about what you actually need to learn. This post will provide an evidence-based, clear and comprehensive step-by-step guide for how to become a PTSD counselor. The information in this guide is influenced by the American Psychological Association (APA) competencies for teaching and training for working with clients with trauma and PTSD (APA, 2015).
Why become a PTSD counselor?
The benefits of becoming a trauma therapist are vast.
First, there is a growing and at-need population of individuals who have experienced traumas and who are seeking treatment for PTSD. Therefore, becoming a PTSD therapist or PTSD counselor allows clinicians to work effectively with a large population of clients in many different settings.
Second, PTSD is highly treatable with the right treatments (Resick et al., 2012). Specifically, evidence-based cognitive-behavioral treatments called Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE) and Eye Movement Desensitization and Reprocessing (EMDR), can lead to decrease and even full remission of symptoms in most individuals with PTSD (VA/DOD Clinical Practice Guidelines for Management of PTSD, 2010).
Therefore, clinicians can experience meaning and purpose, as well as a sense of professional effectiveness when treating clients with PTSD.
Third, research shows that utilizing evidence-based PTSD treatment methods decreases therapist burnout, decreases therapist vicarious traumatization and enhances self-efficacy and satisfaction of therapists (Becker-Heimes, 2021; Deighton et al., 2007); therefore, becoming a well-trained PTSD counselor yields the secondary benefit of inoculating therapists from possible deleterious effects of working with traumatized individuals.
Fourth, there is great marketability for clinicians that are trained in evidence-based PTSD treatments.
Getting a PTSD counseling degree
While there is no such thing as a PTSD counseling degree from any accredited academic graduate institution, there are many opportunities within graduate programs in counseling, psychology and social work to obtain quality specialized training and specialization in trauma and PTSD.
Unfortunately, most graduate programs do not automatically build in such training into their curricula, and most students are not yet aware of their need to advocate for and intentionally seek out such opportunities, meaning that most therapists complete their graduate training being unprepared to work with clients with PTSD (Cook, Newman, & Simiola, 2019; Henning, Brand, & Courtois, 2022).
Fortunately, knowing this is powerful as it allows therapists-in-training and licensed therapists desiring a specialization in PTSD to seek out specific experiences and training opportunities that will provide them competencies needed to work effectively with clients with PTSD.
One avenue for obtaining training in PTSD counseling is to attend one of the very few graduate programs that provide specialized training in trauma or PTSD. For example, the University of Colorado, College Springs (https://psychology.uccs.edu/phd-clinical-psychology-trauma), Northern Illinois University, Palo Alto University (https://www.paloaltou.edu/academic-programs/phd-clinical-psychology/areas-emphasis/trauma-emphasis) and Northern Illinois University (https://www.niu.edu/clas/psychology/academics/graduate/clinical/trauma-focus.shtml) offers graduate training programs that include trauma and PTSD-specific coursework, research and clinical training opportunities.
Another option for obtaining specialized training in PTSD counseling is to apply to work with faculty, mentors or other staff who specialize in trauma or PTSD. This mentorship may be specific to overseeing and supporting research activities related to PTSD or may allow students to work with PTSD clients in the context of clinical research.
Other mentorship opportunities may include clinical supervision of PTSD clients while working in an in-house practicum or while working in a specific trauma or PTSD clinic as an external clinical placement. Alternatively, this mentorship may include overseeing graduate work as a graduate-level instructor or as a Teaching Assistant (TA).
Another avenue for pursuing specialized PTSD counselor training is during the clinical internship. Doctoral-level therapists-in-training in Psy.D. and Clinical and Counseling Ph.D. programs are required to complete a one-year clinical internship.
There are internship programs that have excellent training in PTSD; for example, clinical internships in Veterans Affairs Hospitals afford therapists-in-training access to quality muli-day trainings in gold-standard evidence-based treatments for PTSD for free along with post-training clinical consultation.
Completing PTSD counselor training
The American Psychological Association has developed Guidelines on Trauma Competencies for Education and Training (APA, 2015). These well-researched and vetted guidelines can help prospective PTSD therapists to select trainings, workshops and lectures that are likely to improve the positive outcomes of the clients they work with.
PTSD training courses should be taught by a subject matter expert with appropriate credentials, training and expertise in PTSD and the content taught should be supported by science.
Free vs Fee-Based PTSD Counselor Training
Some PTSD counselor trainings are free and available to the public. Below are links to quality PTSD therapist trainings that are free:
https://www.ptsd.va.gov/professional/continuing_ed/index.asp
https://istss.org/education-research/online-learning/free-recordings
https://deploymentpsych.org/training
https://www.nctsn.org/resources/training
The fee of paid trainings will differ based on many factors, such as the length of the training, the content covered, how advanced a topic is, the format of the training and the expertise of the trainer(s).
Face-to-face vs Virtual PTSD Counselor Training
Some therapists prefer face-to-face training opportunities, while others may prefer virtual options due to living in rural areas, inability to travel, or financial limitations to travel.
Live vs On-Demand PTSD Counselor Training
Some counselors prefer live courses, where they can ask presenters questions in real-time however, other counselors might find that they prefer the convenience of on-demand courses that they can watch or listen to at any time.
Depth vs Breadth of Knowledge in PTSD Counselor Training
Some workshops focus on one specific factor or topic (e.g., dissociation, DSM-5 Criteria for PTSD, a specific intervention) and other workshops that provide great breadth of training in a number of topics related to PTSD.
Training with Real-time Clinical Consultation vs Trainings without Consultation
The majority of PTSD trainings and PTSD workshops do not include clinical consultation as part of the training package.
However, for clinicians seeking support in the application of new knowledge into their actual clinical practice with real-life clients, PTSD training programs that include or embed clinical consultation into the training can be an excellent fit.
My approach to PTSD counselor training
The research is clear- the majority of clinicians who are actively working with traumatized clients, do not have adequate training to work effectively with those populations, and are therefore ill-equipped (Cook, Newman, & Simiola, 2019). The clinicians themselves know this and are eager for learning and support.
My approach to providing the most useful and effective training for PTSD counselors and therapists begins with my use of the best available science to clarify the specific competencies that PTSD therapists need in order to provide excellent services.
For me, this has meant leaning on the American Psychological Associations Guidelines on Trauma Competencies for Education and Training (APA, 2015). These guidelines are comprehensive, specific and practical.
They point to key areas, knowledge and skills that clinicians need to acquire for the effective treatment of clients with trauma-related issues, such as PTSD.
In addition to this science-backed comprehensive guide, I use my decade-long experience teaching therapists all over the world how to effectively work with clients with PTSD in my role as a National Trainer and Consultant for Cognitive Processing Therapy (CPT) for PTSD, which is one of the gold-standard treatments for PTSD.
This position has afforded me thousands of clinical contact points with heterogeneous clinicians ranging in culture, ethnicity, age, other personal characteristics, training background, clinical experience and theoretical orientations.
Through this work, several clear themes have emerged regarding gaps in knowledge and common challenges. One of these common challenges is the difficulty integrating workshop/lecture/webinar content into actual practice with real clients.
Thus, a tenant of my approach to PTSD counselor training is integrating consultation into the learning experience in order to facilitate the translation of knowledge into practice.
My PTSD counselor training course
The Trauma Therapist Training Course is an online, live cohort-based course that covers the following topics:
-understanding the impact of trauma
-evidence-based assessment of trauma exposure and PTSD
-case conceptualization and collaborative treatment planning
-gold-standard evidence-based treatments for PTSD
-navigating challenges in trauma therapy (e.g., timing issues , logistics, balancing fidelity and flexibility, working with avoidance, therapeutic ruptures)
-advanced topics (e.g., dissociation, substance use, suicidality, para-suicidal behaviors, co-occurring issues, somatic and pain issues)
Quality On-Demand Video Lectures
Each weeks of the course, therapists receive access to a high-quality on-demand video lecture covering a wide range of topics relevant to working with traumatized clients. Lectures range from 50-120 minutes.
Small-Group Clinical Consultation
Each week, after watching the weeks’ lecture, clinicians meet via HIPPA-compliant videoconferencing to receive live consultation.
Group consultation lasts 60 minutes each week, and consultation groups are capped at 5 clinicians to ensure ample time and individualized learning. During consultation we engage in experiential activities and practice of new skills.
Individual Clinical Consultation and Support
All clinicians have access to one 60-minute individual clinical consultation meeting via HIPPA-compliant videoconferencing during the second half of the course. Prior to this meeting, clinicians complete several forms to clarify and operationalize their learning goals and needs.
These forms are used to structure consultation and maximize learning. In addition, clinicians have unlimited access to the course facilitator for any questions related to trauma and PTSD.
Access to Experiential Practice and a Wealth of Resources
Course participants are provided a weekly experiential practice that aims to enhance self-reflection and self-awareness as it pertains to trauma work.
In addition, each week participants receive access to a wealth of resources for additional learning and for clinical use (e.g., assessment instruments, research articles, websites, additional trainings).
Answering your questions about how to become a PTSD counselor
It is normal to have questions about how to become a PTSD counselor.
In my experience, therapists care deeply about providing great care and they are often well-aware when their skills are not commensurate with the demands of the clinical work they are doing.
Clinicians who have questions about how to become a PTSD counselor, are welcome to contact me.
We can discuss whether your learning needs match up with the learning objectives of the Trauma Therapist Training Course.
How long does it take to become a PTSD therapist?
The training to become a PTSD therapist usually takes several years and may occur during graduate training or thereafter. To become a PTSD therapist, a clinician must meet the minimal standards of knowledge so that they can ethically work with traumatized individuals.
Becoming a PTSD therapist is a life-long endeavor. One reason is that, as new science emerges, we are responsible for ensuring our knowledge base and clinical approaches are updated.
In addition, we all change over time. Our capacities, our psychological resources and our interests will shift; therefore, clinicians are encouraged to reassess their nature of their work, their work environment and relationship with work over time and to make shifts to ensure they are able to provide optimal care to clients with PTSD throughout their personal and professional evolution.
Start the Process of PTSD counselor training today
As outlined in this guide, the process of becoming a trauma therapist can take many different forms.
For some, the process begins in graduate school; for others, becoming trained as a trauma therapist may occur long after a graduate degree has been obtained.
Therapists may choose from a menu of PTSD trainings that range in format, structure, timing or breadth. Burgeoning PTSD therapists are encouraged to use the best available science to inform the trainings they seek so that they do not obtain training in approaches or interventions that are harmful or ineffective with clients with PTSD.
The Trauma Therapist Training Course is an evidence-based, comprehensive web-based, live 6-week course that offers quality training and real-time consultation and support to clinicians seeking an intensive and enriching learning experience. The course is offered quarterly.
If you are interested in enrolling in the Trauma Therapist Training Course or learning more about it, contact Dr. Stephanie Sacks here.
References:
American Psychiatric Association. (2013). Trauma and Stressor-Related Disorders. In
Diagnostic And Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: Author.
American Psychological Association. (2015). Guidelines on Trauma Competencies for Education and Training. Retrieved from: http://www.apa.org/ed/resources/trauma-competencies-training.pdf
Becker-Haimes, E. M., Wislocki, K., DiDonato, S., & Jensen-Doss, A. (2022). Predictors of Clinician-Reported Self-Efficacy in Treating Trauma-Exposed Youth. Journal of traumatic stress, 35(1), 109–119. https://doi.org/10.1002/jts.22688
Cook, J. M., Newman, E., & Simiola, V. (2019). Trauma training: Competencies, initiatives, and resources. Psychotherapy (Chicago, Ill.), 56(3), 409–421. https://doi.org/10.1037/pst0000233
Deighton, R. M., Gurris, N., & Traue, H. (2007). Factors affecting burnout and compassion fatigue in psychotherapists treating torture survivors: is the therapist's attitude to working through trauma relevant?. Journal of traumatic stress, 20(1), 63–75. https://doi.org/10.1002/jts.20180
Henning, J. A., Brand, B., & Courtois, C. A. (2022). Graduate training and certification in trauma treatment for clinical practitioners. Training and Education in Professional Psychology, 16(4), 362–375. https://doi.org/10.1037/tep0000326
Management of Post-Traumatic Stress Working Group [Internet]. VA/DOD clinical practice
guidelines for management of post-traumatic stress. Washington (DC): Department of Veterans Affairs, Department of Defense; 2010. Available from: http://www.healthquality.va.gov/ptsd/ptsd_full.pdf
Olatunji, B. O., Cisler, J. M., & Tolin, D. F. Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572-581. https://doi.org/10.1016/j.cpr.2007.01.015
Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term
outcomes of cognitive-behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of consulting and clinical psychology, 80(2), 201–210. https://doi.org/10.1037/a0026602
Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to Veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29(8), 727-735. https://doi.org/10.1016/j.cpr.2009.08.006.
What is Trauma Therapy? Everything you Need to Know
Trauma is really common, with more than 70% of individuals experiencing a traumatic event at some point in their lives. People who have experienced are more likely to seek mental health care than those who have not.
For consumers, it is essential to be educated in what trauma therapy is, and what treatments are effective in order to make informed choices about one’s mental health care.
For providers, it is important to be aware that most clients that seek therapy will have experienced trauma at some point in their lives.
In order to provide ethical care, clinicians need to be well-trained and knowledgeable about trauma based therapy and trauma-focused therapy.
This post will clarify what trauma therapy is, what someone can expect from trauma therapy, who trauma therapy is for, how trauma therapy can help and how to find trauma therapy that’s right for them.
What is trauma focused therapy?
Trauma focused therapy is psychotherapy or counseling that aims to address and ameliorate the psychological after-effects of a traumatic event.
A traumatic event is defined as exposure to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. Traumas can be experienced in any one of four ways:
Directly experiencing the event,
Witnessing the traumatic event in person,
Learning that a traumatic event occurred to close friend or family member (violent/accidental),
Experiencing first-hand repeated or extreme exposure to aversive details of trauma (not via media, unless work-related).
Examples of traumatic events can include:
Childhood sexual abuse and physical abuse
Rape or sexual assault
Physical assault
Intimate partner violence
Combat
Serious motor vehicle accident
Natural disasters
Terrorism/shootings
Witnessing serious injury or death
Learning about death of someone close
Exposure to death
Immediately after traumas, most people experience some posttraumatic distress. While many people naturally recover and distress dissipates over time, others experience a “stalling out” of recovery and many continue to struggle with trauma-related symptoms for months, years or decades, especially if left untreated.
The nature of someone’s trauma-related difficulties can vary widely. Therefore, the best way to determine the most appropriate course of trauma therapy is to consult with a mental health professional, particularly one with expertise in trauma.
Because the impact of trauma is heterogeneous, therapies to address trauma symptoms can also greatly differ, depending on the specific nature of a client’s symptoms, difficulties and treatment goals.
For example if someone’s post-trauma difficulties are mostly interpersonal, they would benefit from trauma therapy that addresses relational challenges and improves interpersonal skills.
If someone’s post-trauma difficulties are more consistent with Posttraumatic Stress Disorder (PTSD), then they would most benefit from a gold-standard, evidence-based PTSD treatment like Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE) or Eye Movement Desensitization and Reprocessing (EMDR).
Types of trauma based therapy
There are many different types of trauma focused therapies. It is important to note that some trauma therapies have extensive research showing that they are effective for a majority of individuals with trauma-related symptoms, while other trauma based therapy options lack sound empirical support.
For prospective clients and clinicians alike, it is useful to know which treatments are backed by science and which are not in order to have realistic expectations of what to expect from trauma therapy.
For clients who meet criteria for Posttraumatic Stress Disorder (PTSD), including Complex-PTSD, there are several short-term effective treatments that can lead to full remission of symptoms. PTSD is characterized by:
Recurrent re-experiencing of the trauma(s) during daytime or at night, in the form of nightmares.
Avoiding thinking or feeling about the trauma(s) and any reminders of the trauma(s).
Changes in thinking and changes in mood, including significant trauma-related blame and changes in thinking about safety, trust, power/control, esteem and intimacy.
Changes in physiological arousal and reactivity, such as exaggerated startle reaction, being super-alert and on-guard, hypervigilance, and trouble with concentration and sleep.
These symptoms must be present for at least one month following the trauma(s), they must lead to significant impairment and/or distress and they cannot be accounted for by another mental or physical illness.
The most effective treatments for PTSD have over two decades of research showing that they lead to clinically significant improvements that are long-lasting.
All of these treatments are specific subtypes of Cognitive Behavioral Therapies (CBT) that address avoidance and problematic beliefs that form after trauma(s), as both of these factors maintain PTSD.
Cognitive Processing Therapy (CPT)
CPT is a short-term trauma-focused PTSD treatment that helps clients address problematic and painful thoughts that often follow trauma.
These thoughts often center around the meaning that one makes about why the trauma happened (“it was my fault,” “it could have been prevented”) and the impact of the trauma on how someone thinks about themselves (e.g., “I am broken”), others (“no one can be trusted”) and the world (“nowhere is safe”).
CPT helps decrease avoidance, facilitates processing natural emotions and helps clients develop skills for making sense of the traumatic events and their impact in more balanced ways.
Prolonged Exposure Therapy (PE)
PE is a short-term trauma-focused PTSD treatment that teaches clients how to gradually approach trauma memories and people, places and activities (that are objectively safe) that have been avoided since the trauma(s), in a safe and supportive manner.
Confronting these challenges leads to a decrease in PTSD symptoms and to a greater sense of self-confidence.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR helps clients process distressing memories, feelings and thoughts about trauma(s) they have experienced while focusing on an external stimuli that moves back and forth (e.g., lights, sounds, tapping). Although EMDR has been shown to be effective for PTSD, there is disagreement about exactly how it works.
If someone is struggling with trauma-related symptoms, but they do not suffer from PTSD, there are a number of other treatments that may be a great fit, including Dialectical Behavior Therapy (DBT), Seeking Safety, Skills Training in Affective and Interpersonal Relations (STAIR), Acceptance and Commitment Therapy (ACT) or general Cognitive Behavioral Therapy (CBT) skills.
Who trauma focused therapy is for
Trauma therapy is for anyone who is looking for relief from symptoms that began or got worse after the experience of a traumatic event.
Trauma focused therapy is especially beneficial for those who suffer from PTSD. Trauma therapy can help with any of the following kinds of difficulties.
Trauma-related memories and nightmares
Trauma therapy can decrease the incidence of intrusive unwanted memories of traumatic events.
PTSD treatments like CPT, PE and EMDR are very effective at reducing, and often eliminating, trauma-related memories that occur in daytime or at night in the form of nightmares.
Anxiety and hypervigilance
Following trauma, some people may start to think of the world as unsafe and may become fearful of their surroundings due to fear that catastrophe will occur again.
Certain stimuli that was present during the trauma can continue to elicit a fight-flight-fear reaction, even after the threat is gone, especially when individuals avoid those trauma triggers.
Trauma treatments can help people gradually confront objectively safe situations in order to reduce intense physiological arousal and anxiety.
Guilt and shame
Following traumas, especially interpersonal traumas, people may believe that they were at fault for the trauma(s) or could have prevented them somehow. These kinds of thoughts typically lead to feelings of guilt and shame.
Sleep problems
While sleep problems can be due to many factors, sleep problems are very common for survivors of trauma.
Sometimes sleep problems occur due to hypervigilance or fears about safety when falling asleep, other times sleep issues are due to disrupted sleep due to trauma-related nightmares.
Benefits of Trauma Based Therapy
Trauma based therapy can lead to different benefits. For some, it provides an avenue for reclaiming power in their lives, for some it provides relief from PTSD symptoms, and for others it can provide avenues for reconnecting to people and activities that are important to them.
Trauma therapy can help survivors gain control over trauma-related memories
For individuals who experience intrusive trauma-related images and memories, evidence-based treatments for PTSD can lead to significant decreases, and often complete remission, from distressing and unwanted trauma-related memories.
For many, this means that they get to control if, and when, they think about traumatic events, rather than the trauma memories intruding into consciousness without choice.
No matter how long ago traumatic events occurred, evidence-based PTSD treatments (CPT, PE and EMDR) can effectively treat re-experiencing symptoms of the trauma(s).
Trauma therapy can help people make sense of a senseless event
It is often extremely challenging to make sense of a traumatic event. By definition, traumas are outliers of human experience and can be difficult to integrate into pre-trauma beliefs people may have held.
This may lead to people getting stuck in certain patterns of thoughts that reflect un-doing the trauma in some way (e.g. “If I had only done x, the trauma wouldn’t have happened,” “if they had done y, this could have been prevented,” “this was my fault,” or “this should never have happened”).
These kinds of beliefs are very common among trauma survivors and can lead to a great deal of guilt, shame and anger. Trauma therapy provides skills and tools to help people make meaning of why and how traumatic events could have occurred in ways that are balanced and contextualized.
Trauma therapy can empower people to stop avoiding and can decrease fear and anxiety
Often after trauma(s), people begin to avoid situations and other stimuli that remind them of the trauma(s). These are often called trauma triggers. Although avoidance can provide a little short-term relief, it leads to many problems when used as a long-term strategy.
Often people describe that avoidance makes their worlds become smaller and smaller. Avoiding trauma cues that prolong unwanted fight-fight-freeze reactions and anxiety, can inhibit processing of the trauma and can keep trauma survivors from learning important information about perceived vs actual risk.
Trauma therapy provides numerous avenues for getting back to living fully and for facing trauma cues that are objectively safe. Trauma therapy provides a path for decreasing avoidance and getting one’s life back.
Who can provide trauma focused therapy
Even though trauma therapy can provide a great deal of relief to many people, a big challenge can be finding a trauma therapist who is qualified, competent and provides treatments based on solid scientific support.
Competent trauma therapists need extensive trauma-specific training within their graduate coursework and clinical placements, as well as after they are licensed professionals via trauma-specific continuing education, comprehensive workshops/trainings and consultation through organizations that are vetted and whose programming is consistent with the best science surrounding trauma-informed care.
With adequate training, professionals with different professional degrees can provide trauma therapy.
Psychologists
Psychologists can have different degrees (Ph.D. or Psy.D.). They typically attend graduate school for 3-5 years, followed by a one-year clinical placement during their last year called a clinical internship.
During their graduate studies they also take part in clinical externships in different clinical settings (community mental health clinics, eating disorder clinics, domestic violence shelters, psychiatric hospitals, Veterans Affairs hospitals, etc).
Psychologists who undergo PsyD programs focus almost exclusively on clinical work, whereas psychologists that obtain PhDs obtain specialized experience in the provision of clinical work, as well as research and teaching.
Social workers
Social workers can have different degrees- some of them are masters-level (2 years) while other social workers may obtain a doctorate in social work (can take 4-5 years). Training in social work focuses on how to help vulnerable people and facilitate change in their environment.
Masters-level therapists
There are many different master’s level degrees that allow clinicians to practice therapy (e.g. LMFT, CMHC) . These degrees are typically 2 years long and include several clinical placement opportunities.
Clinical Nurse Specialists
Clinical nurse specialists are advanced practice registered nurses who have earned a master’s or doctoral degree in nursing. Therapists with this degree then get certified in a specialty of their choice, including in the provision of psychotherapy.
Psychiatrists
Psychiatrists attend medical school for 4 years and then obtain specialized training in psychiatry, which focuses on psychopathology and pharmacotherapy. Some psychiatrists then obtain additional training in to learn how to provide psychotherapy.
Learn More about Providing Trauma Therapy
Currently, the standard curricula in graduate-level education in clinical and counseling psychology does not require training in traumatic stress.
As a result, the majority of mental health providers that provide clinical services to traumatized populations indicate the desire and need for additional education about trauma-related clinical topics.
There is a bourgeoning need for specialized training in how to work effectively with traumatized populations, particularly in the provision of evidence-based trauma focused therapy.
Benefits of offering trauma therapy to your clients
Given how common trauma is, it is imperative that therapists obtain specialized training and support in order to effectively assess and treat individuals with trauma-related symptoms. There are many benefits to offering trauma therapy to clients, regardless of what clinical setting clinicians may work within.
Upholding professional ethics and standards of care
Obtaining specialized training in trauma therapy can help therapists practice consistently with the ethical standards of the profession, including ensuring competence, obtaining adequate training and education and ensuring appropriate assessment and therapy services for clients.
Empowering clients
Many individuals with trauma-related symptoms are inadvertently fragilized by well-meaning health care providers who, due to lack of knowledge and education, fear that trauma therapy will lead to symptom exacerbation.
Therapists who are well-trained in trauma based therapy can be vocal advocates for clients with trauma.
They can provide corrective information to clients and other mental health providers regarding the potential for recovery via effective trauma therapy and can empower clients to change their lives. This resiliency-based approach to therapy highlights client strengths and capacity for growth and change.
Reducing burnout and compassion fatigue and secondary traumatic stress for therapists
While working with clients with trauma can be extremely rewarding, it can also be challenging and draining for therapists.
Research has found that providing evidence-based treatments for trauma clients is associated with reduced burnout, reduced compassion fatigue and less secondary traumatic stress in therapists.
Thus, training in evidence-based trauma based approaches can promote longevity for therapists.
Increasing marketability and capacity to work in numerous settings
There is a great need for well-trained trauma therapists to work with an increasing and at-need population of traumatized clients. Therefore, training in trauma based therapy can increase therapist marketability, desirability and capacity to work in many different clinical settings.
There are certain settings where training in trauma based therapy is a requirement for clinicians, and other settings and positions where specialized training in trauma therapy methods may provide opportunities for leadership and/or growth within an organization.
Trauma Focused Therapy Resources for Clinicians
There are many wonderful training opportunities for trauma based care. Some trauma based trainings focus on assessment methods, others focus on working with specific traumatized populations (e.g., survivors of torture, survivors of intimate partner violence, Veterans), and other trainings focus on specific PTSD or trauma-focused treatments.
Some trainings are in-person while others are virtual. Some trainings offer Continuing Education credits and others offer Certifications. Therapists are encouraged to consider their learning needs and goals as they consider the options that exist.
National Center for Posttraumatic Stress Disorder (NC PTSD)
The NC PTSD is the world’s leading research and educational center on PTSD and Traumatic Stress. The NC PTSD was created within the Department of Veterans Affairs in response to a Congressional Mandate to address the needs of Veterans suffering from traumatic stress.
The NC PTSD website offers free Continuing Education Courses from experts in the field, assessment instruments, and free consultation to providers working with trauma-exposed Veterans.
https://www.ptsd.va.gov/
International Institute for Traumatic Stress Studies (ISTSS)
ISTSS is an international interdisciplinary professional organization that supports the growth of knowledge about traumatic stress.
ISTSS hosts a yearly conference filled with up-do-date information about trauma and the ISTSS website provides many free resources for clinicians, including expert consensus guidelines regarding the treatment of specific concerns related to trauma exposure.
https://istss.org/home
The National Child Traumatic Stress Network (NCTSN)
The NCTSN was created in 2000 in order to improve the standard of care and increase access to essential services for children and families who experience traumatic events.
The NCTSN develops and disseminates resource materials and interventions, engages in research on traumatic stress, offers education and training programs and informs policy and awareness efforts.
Clinicians can utilize this resource for online trainings, including webinars, e-learning courses and other training curricula
https://www.nctsn.org/
Cognitive Processing Therapy (CPT) for PTSD Training Program
The CPT for PTSD training program is a great resource for clinicians looking for specialized training in CPT for PTSD with the ultimate goal of becoming a rostered CPT provider.
CPT workshops are typically 2 or 3 day trainings followed by 6 months of CPT consultation.
These trainings can be offered in person or virtually, and consultation is weekly and can be group-based or individual-based, depending on a therapist’s preferences and needs.
https://cptforptsd.com/
Prolonged Exposure (PE) Therapy for PTSD Certification Program
The Center for the Treatment and Study of Anxiety offers a PE Certification Program for clinicians looking for specialized training in PE for PTSD.
Trainings include a 4 day intensive workshop on PE in addition to weekly PE consultation.
https://www.med.upenn.edu/ctsa/pe_certification.html
Eye Movement Desensitization and Reprocessing (EMDRIA) International Association
For clinicians seeking training in EMDR, the EMDRIA is an excellent resource. This organization spearheads EMDR training, EMDR conferences and EMDR on-demand education.
https://www.emdria.org/
Take a deeper dive into trauma based therapy
Trauma therapy offers many different benefits to individuals who have been traumatized and who have varied mental health needs.
Clients can experience great benefits including greater control over trauma-related memories, the ability to make meaning of the trauma(s) and skills for how to decrease avoidance and improve their quality of life.
For clinicians, seeking training in trauma therapy can ensure they are practicing ethical and competent clinical care, can facilitate client empowerment, can decrease burnout, compassion fatigue and secondary traumatization and can improve therapist marketability.
There are a wealth of resources available to learn about trauma based treatment, though it is recommended that clinicians consider organizations and training programs that are vetted and consistent with the best available scientific evidence.
For therapists seeking comprehensive trauma training that includes all knowledge and skills recommended by national consensus training guidelines, the Trauma Therapist Training Course is an excellent option.
This course is facilitated by trauma expert, Dr. Stephanie Sacks, who has been working in the field of Traumatic Stress for 15 years.
She has been a National CPT for PTSD Trainer and Consultant for 10 years, has been an invited lecturer for the NC PTSD and a frequent contributor to ISTSS.
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