Working With Trauma in Therapy
This is what trauma treatment can actually be like
People sometimes come to therapy knowing they have had some pretty difficult experiences in their life, but they would not call what happened to them trauma.
They sometimes say things like, "It wasn't so bad." Or, "Other people had it worse." Or they know that whatever happened to them affected them, but they don't really understand why it still affects them now.
Sometimes they become anxious. Other times, they shut down during conflict. Sometimes they become much more upset about something than they think they should. Other times, their body reacts before they even know what they are reacting to.
Some people are reluctant to go to therapy because they imagine reliving their trauma by describing it in exacting detail to the therapist.
That is not necessarily what happens in therapy. Sometimes we don't talk about the hardest things right away at all.
Trauma Does Not Always Look Dramatic
When people hear the word trauma, they often think of war, assault, accidents, natural disasters, or something else obviously terrible.
Those things can certainly cause trauma.
But trauma can also happen over time.
It can be caused by growing up in a house where you had to monitor the moods of the adults to feel safe. Being criticized constantly. Being repeatedly ignored emotionally. Being bullied. Having to take care of adults when you were still a child.
Sometimes there was not one giant event. There may have been years of smaller things.
And sometimes the person looking back says, “That was just my childhood.”
Well, yes. But your nervous system was there for your childhood too.
Trauma is not only about what happened. It also has to do with how helpless, frightened, trapped, or alone a person felt while it was happening, and whether anyone helped afterward.
PTSD can develop after very frightening or threatening experiences. People may have nightmares, intrusive memories, strong reactions, avoidance, or a sense that danger is still nearby even when they know, logically, that it is not.
There is also complex PTSD, which is usually associated with trauma that happened repeatedly or over a long period of time, often in relationships. People may struggle with shame, trust, relationships, emotional reactions, or the feeling that there is something wrong with them.
You don't need to walk into therapy knowing whether you have PTSD, complex trauma, childhood trauma, relational trauma, or any other category.
You can just start with, “Something happened, and I think it still affects me.”
That is enough. It doesn't need a big diagnosis for something to have been traumatic.
Sometimes Your Body Has a Different Opinion
One of the odd things about trauma is that your brain may understand very well that something is over while your body seems not to have gotten the memo.
You may know your partner is not an angry parent, but you react as though they are.
You may know the medical crisis ended years ago, but you freeze at the thought of having an annual exam.
You may know you are not in that relationship any more, but you mistrust your current partner who is not at all similar to that person.
And then something happens and your heart is pounding, your stomach tightens, you freeze, you get angry, you cannot think, or you suddenly feel far away.
Your brain says, "Don't worry. This is fine."
Your body says, "Danger! Danger, Will Robinson!"
That is one of the reasons why I don't rely on talking alone. Don't get me wrong, talking is important. I am a therapist. We talk. Understanding what happened, making connections, looking at patterns, looking at beliefs we developed along the way — all of that matters. But sometimes a person is deeply insightful about themselves and is still having the same reaction.
That is where the body becomes important. Therapists sometimes call it top down and bottom up work. Top down means we start more with thoughts, language, understanding, and meaning. Bottom up means we pay attention to what's happening in the body and the nervous system first.
I use both.
And sometimes it is actually more helpful to develop some of those body-based skills before we talk very much about the trauma itself.
We Don't Have to Start With the Worst Thing
When someone has been through a great deal, I don't think the first thing we should do is open up their file cabinet and pull the file marked "WORST THINGS THAT EVER HAPPENED" and start rummaging through the contents.
First I want to know what happens when things get difficult.
Do you get anxious and agitated? Do you go blank? Do you suddenly feel like you are not quite in the room anymore? Do you get very sleepy or numb? Do you feel like you need to escape? And what helps you come back?
Sometimes that is where we start.
We may spend some time learning how to notice what is happening in your body before it becomes overwhelming.
Sometimes a small movement helps. Sometimes changing position helps. Sometimes pressure or warmth or simply stopping and noticing what is happening helps. Sometimes breath work helps. Sometimes it absolutely does not.
I have worked with people who become more anxious when they focus on their breathing. So I am not going to insist that everyone take a deep breath and calm down. That can be incredibly annoying anyway.
We try things.
We see what works.
And just learning, “Oh, this is what happens to me when I start feeling unsafe,” can be a big deal.
The Room Matters Too
I do think the room matters. I want my office to be calm and contained. There is a weighted blanket and other blankets if someone wants them to throw over their shoulders or to wrap themselves in. Some people really appreciate that kind of pressure and containment.
Others don't like it at all and feel trapped. So we try things out and see what works. It's different for everyone.
Sometimes the most important thing is simply that there is a place where we can slow things down.
You don't have to explain everything perfectly. You don't have to perform. You don't have to keep talking because you think I expect you to.
I think of part of my job as holding a space where difficult things can come up without taking over everything.
Where Yoga and Somatic Therapies Fit In
When I tell people I am also a yoga therapist, I am pretty sure some imagine that I suddenly pull out a yoga mat halfway through psychotherapy and expect them to twist themselves into impossible pretzels. That is not at all what happens.
Yoga and somatic therapies give me another way of working with the body.
Sometimes that may involve movement. Sometimes breath. Sometimes posture. Sometimes simply paying attention to what changed in the body when we started talking about something.
I might say, “What just happened?”
Or, “Did you notice anything change?”
Or, “Do you feel more here or less here right now?”
We are not trying to do any of this perfectly. We are just noticing.
Over time, people often get much better at recognizing what is happening before it completely takes over.
And that gives them more choice.
Choice Is a Very Big Part of It
Trauma often involves helplessness. One's autonomy and agency are taken from them. For example, something happened, and they could not stop it from happening. They could not leave. They could not protect themselves. They could not say no.
So choice matters very much in therapy, but especially in trauma therapy. You don't have to close your eyes because I suggest it. You don't have to talk about something if you are not ready to. You don't have to keep going just because we've gotten started.
You can say no. You can say stop. You can change your mind.
We can try something and decide it's not helpful. That might not sound like much, but for some people, that is huge.
Over time, the person may discover: I can notice what is happening. I can stay with it for a while. I can step away if I need to. I can come back to it. And eventually, maybe, I can remember something without feeling like I am right back inside it.
The Goal Is Not to Forget
Trauma treatment is not about erasing memory. It is not about convincing yourself that something terrible is actually fine. It is not about never being triggered again.
It is really about allowing the past remain in the past. Helping the brain and the body recognize that something did happen then, and it is not happening now.
Sometimes we get there from talking. Sometimes through understanding. Sometimes through the body. Usually it is a mix of all of it. And usually it happens gradually.
The past does not disappear. But it can stop running the show quite so much.
