Differences between talk therapy and trauma therapy
Trauma therapy differs a lot from “traditional” therapy. It’s more structured and directive, it’s highly relational, and it’s truly compassionate.
It doesn’t pathologize the client and it sees the symptoms as a consequence of what happened to the client instead of who the client is.
Trauma therapy is not talk therapy. If you work with a trauma therapist, don’t expect to be talking about your terrible memories soon; don’t come prepared to cry a lot—you won’t; wear comfortable clothes because you may move around —many interventions include the body (movement, posture, sensations). Be prepared to learn about yourself inside out: from how your nervous system works to how society influenced your symptoms.
Trauma therapy is highly informed by neurobiology. For this reason, it has the understanding that exposing clients to their traumatic memories too soon is counterproductive and can even be re-traumatizing.
Most of the literature suggests a 3 phase treatment based on Pierre Janet’s vision of a phase-oriented treatment to treat trauma more than a hundred years ago. Since trauma was not officially recognized as a disorder until the ’80s, it’s treatment was not implemented until the late ’90s by Judith Herman. That design consists of:
Phase I: Stabilization
Phase II: Processing
Phase III: Re-programing
The model has been modified a little but the philosophy is basically the same:
Stabilization: probably the most important phase of the trauma treatment; even more important than processing the traumatic memories. If this phase is done in an effective way, the processing of the loaded material could go smoothly and fast. It has several steps:
Establishing safety
Psychoeducation
Self-regulation
The steps include establishing safety (living situation, health, habits, income, wellbeing, etc), learning regulation skills, developing tolerance to affect, creating awareness of emotions-reactions-triggers, growing resilience, accumulating resources, creating emotional capital, and reaching a point where emotions and memories are manageable without overwhelming the system.
If the trauma is developmental —or complex (C-PTSD), there is also the need to strengthen the prefrontal cortex, to develop trust, to discover how to attach securely, and to learn how to reparent the infant wounded self parts.
Processing: includes retelling the story of the traumatic event to achieve memory reconsolidation, which means replacing the negative charge of the original memory with a more appropriate charge according to the actual circumstances. It’s when you recall —or not— the events and finally make sense of the past, and how you had been carrying it with you all this time as it was the present.
Re-programing: involves reconnecting with others, rewriting the story, developing social skills, and mourning all the losses from the years you spent “living” in survival mode.
Trauma modalities
Since trauma is a disorder based on the dysregulation of the nervous system that affects the personality, the memory, the mood, the behavior, etc., it needs more than one modality to go through the healing process (Modalities are a series of techniques adhering to a specific philosophy about how to target specific problems, to solve them). Most trauma therapists train in at least 2 and attend countless workshops to become proficient in the 3 phases. How the sessions look like depends on the modality that the therapist uses. They can be top-down sometimes, or bottom-up others. They can be body-based, or more cognitive, or more energy-oriented, or they can even use computers and cables connected to your skull.
The most common modalities for each phase are:
Stabilization:
Mindfulness (ACT, CFT, etc.)
Yoga, Tai Chi, Theater, EFT, etc.
Hypnosis, EFT, Hakomi, Gestalt, Schema therapy, etc.
Parts language (from IFS, sandbox, etc.)
DBT for mindfulness, skills and stabilising day to day life
Biofeedback (breathing, HRV)
Neuromodulation (Entrainment, brain stimulation)
Neurofeedback
Processing:
EMDR
Somatic Experiencing/Sensorimotor Psychotherapy
AEDP
Internal Family Systems
Re-programing
Narrative therapy
Positive psychology
Grief and lose counseling
etc.
Trauma therapy is empowering.
Trauma therapy is not about coping with symptoms, it is about healing. It’s about helping clients recover their whole self, and to get their lives back.