Understanding Trauma (Part 2)

In my earlier blog article on "Understanding Trauma" (click here to read) I offered an overview on the definitions of trauma and Post-Traumatic Stress disorder and some information about the impact traumatic events can have on our lives.

I wanted to dedicate this blog article on discussing trauma recovery and some of the trauma-informed and trauma-focused approaches. My hope is that this article will provide a helpful overview to enable you to make an informed decision about whether trauma-informed or trauma-focused approaches might be something that could be helpful in your recovery journey.

Trauma work is one of the main areas of my practice as a clinical psychologist. I work with many people and organisations on the impact traumatic experiences can have on individuals and professional teams (e.g. those working in caring roles or other professions where exposure to traumatic material is part of the role). One of the main dilemmas and points of conversation (and sometimes conflict) that can arise in clinical practice when thinking about trauma is the decision around when to offer what people often refer to as "trauma therapy".

There can still be a lot of confusion around what we mean by "trauma therapy". A helpful way to clarify this is understanding the difference between trauma-informed and trauma-focused therapies.

As I explained in my earlier article (available here), not all people who have experienced traumatic events in their lives will develop a diagnosable mental health condition (e.g. PTSD, Complex-PTSD). The majority of people recover and heal in a natural way. For a proportion of people, the traumatic memories impact on their lives in a more intrusive way months or even years after the event has taken place.

Understanding how your past experiences impact on your life in the here and now can be a good starting point to decide whether you might benefit from trauma-informed or trauma-focused approaches. Here are some of the differences between these two approaches.

Trauma-informed approaches involve being aware of the complex impact traumatic experiences can have on our lives and how these experiences can shape a person's belief system and ways of coping in life. A trauma-informed approach integrates this knowledge into all aspects of the therapeutic process but does not directly involve processing the traumatic memories in detail. Trauma-informed therapy is not a specific type of therapy but it is a way of tailoring interventions in the context of the person's trauma history, triggers and specific needs resulting from this.

To give you an example, you may be accessing therapy for Obsessive Compulsive Disorder (OCD) and therefore the focus of the work might not be to directly reprocess traumatic memories from your past but past events will be taken into account to understand why OCD developed and what is keeping it going.

Not all therapists are trauma-informed in the way that they practice. Most therapists will be exposed to trauma work in their training but not all therapists will have completed additional training in trauma-informed approaches. If you feel that a trauma-informed approach could be beneficial for you, you can ask potential therapists about their training and experience in working with people who have experienced traumatic events.

Trauma-focused therapies differ from trauma-informed approaches in that they directly target the traumatic memories and the symptoms resulting from these events by using different therapeutic techniques to help the brain process what has happened in a different way. There are different therapeutic approaches that would be considered trauma-focused therapies.

In the UK, guidance from the National Institute for Health and Care Excellence (NICE) (click here if you are interested in reading the full guidance) recommends Trauma-Focused Cognitive Behavioural Therapy (these include cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy and prolonged exposure therapy) and Eye Movement Desensitisation and Reprocessing (EMDR) as the primary therapies for people who experience symptoms of post-traumatic stress disorder (PTSD) or complex-PTSD.

Both trauma-focused CBT approaches and EMDR are effective therapies to support people experiencing PTSD/CPTSD. However, there are some considerations to be made when thinking about accessing trauma-focused approaches.

1. Are you prepared and able to commit to regular sessions focused on your traumatic experiences? Trauma-focused therapy can be really helpful but it can trigger difficult emotions and it is important that you are able to commit to a regular course of sessions and that you are prepared for the emotional impact that the sessions can bring.

2. Are you willing to complete tasks in and out of the sessions? Therapy sessions are typically only for 50-90 minutes per week and therefore it is important that you are able to dedicate time to your recovery outside of the sessions to get the most out of your therapy.

3. Are you able to tolerate the difficult emotions that can arise during the course of therapy without resorting to risky coping strategies? Are you keeping yourself physically and emotionally safe between sessions? Whilst it is normal for trauma-focused sessions to trigger difficult emotions, it is important that before embarking in a journey of reprocessing difficult traumatic memories, you are able to consider with your therapist how you may manage these emotions between sessions when you therapist is not there in the room to support you.

4. Are you and your therapist able to establish a safe and trusting therapeutic relationship? This is possibly one of the most important factors to consider when making a decision about whether trauma-focused therapy feels possible. Being able to trust and feel safe with your therapist is paramount as there might be times in the course of the therapy when you may need to rely on your therapist to help you be safe during a session (e.g. if dissociation arises).

If the answer to any of the above question is "no", this does not automatically mean that trauma-focused therapy is not for you but it might be worth discuss your worries and concerns with your therapist so that you can both make an informed decision about what might be the best course of actions. For example, this might involve spending more time thinking about how to form new coping strategies to manage the emotional impact of the therapy, before starting reprocessing work.

I hope this article has answered some of the questions you might have had about trauma therapy approaches. If you would like to discuss this further or book an initial session, visit our contact page.

Please note Psychology Brighton is not a crisis service. If you feel you are experiencing a mental health crisis and require urgent support, visit the following link on Where to get urgent help for mental health.