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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