working with trauma

What is Trauma?

Life has many experiences that impact how we view ourselves, others, and the world around us. These experiences can be positive such as healthy relationships and achieving goals. Other experiences can be negative and significantly damage us in profound and subtle ways. These experiences, labeled as “trauma” can shape and or change how we move through life. 

There is a misconception that for something to be classified as “trauma” it would fit into a very limited scope of experience. The field of psychology has been working to expand this definition to include experiences that don’t fit the stereotypical definition of trauma. 

Posttraumatic Stress Disorder (PTSD)

This is a diagnosis that requires an individual to meet certain criteria from four different domains. These symptoms have to be present for longer than one month following a traumatic event. The four domains include: 

1. Re-experiencing Symptoms 

  • Flashbacks, nightmares, intrusive memories, etc. of the traumatic event(s).

2. Avoidance Behaviors 

  • Avoiding disturbing memories, people, places, conversations, etc. which remind you of the traumatic event(s). 

3. Alterations in Cognition/Mood 

  • Negative beliefs about self, others, the world, self-blame, feeling detached from others, etc. as a result of the traumatic event(s).

4. Alterations in Arousal 

  • Irritability, reckless behavior, hypervigilance, etc. as a result of the traumatic event(s). 

an evolving understanding

As the field has grown and research on traumatic reactions has expanded, we have come to understand trauma from different perspectives. The following are not official diagnoses in the DSM-5, however are helpful ways to understand traumatic reactions that may not fit neatly into the criteria for PTSD and deserve clinical attention. 

Developmental Trauma Disorder 

DTD occurs when a person experiences long-term periods of abuse and neglect in childhood. These experiences interrupt the development of a stable sense of self and others resulting in issues with attachment. 

As adults, people may experience difficulty with: 

  • Identifying emotions 

  • Discerning safety from danger 

  • Desperate attempts to avoid abandonment 

  • Intense emotional/behavioral reactions 

  • Extreme dissociation 

  • Self-destructive behaviors 

  • Helplessness leading to an inability to take action to change their circumstances

  • Given labels like “dramatic” “unstable” and “needy.” 

Adverse Childhood Experiences (ACEs) 

Adverse Childhood Experiences or ACEs is another way in which the field of Psychology is expanding its understanding of trauma and is used as a “predictor for future health problems.” The ACE’s screener is a 10 question, self-report questionnaire that asks you about experiences of abuse, neglect, and other traumatic events throughout your childhood. The higher the score, the higher the likelihood a person will experience health issues in the future including chronic health and social/emotional issues.

Complex Posttraumatic Stress Disorder
(C-PTSD)

With C-PTSD, traumatic events may have begun in childhood (DTD) and then as an adult, the individual experienced further victimization, leaving the person feeling fundamentally flawed. 

Individuals may experience difficulty with: 

  • Emotion regulation- suicidal thinking, explosive anger, persistent sadness 

  • Consciousness- difficulty remembering aspect of the traumatic events, feeling detached from the world

  • Self-Perception- helplessness, shame, stigma, feeling broken

  • Distorted perception of the perpetrator- preoccupation with revenge and/or with the perpetrator

  • Relationships- isolation, distrust

  • Meaning- loss of faith, despair, hopelessness 

Betrayal Trauma 

When abuse or victimization is perpetrated by a primary care-giver and or someone in a trusted role or when a person in a trusted role does not intervene on abuse/victimization, a person can experience betrayal trauma. 

Betrayal trauma often occurs within the context of developmental trauma and complex traumatic experiences and can leave the individual feeling confused, abandoned, and isolated. Many (but not all) people who experience betrayal trauma will report feeling more intense anger towards the person who did not intervene than they do towards the perpetrator of abuse. 

My Approach to Treatment of Traumatic Reactions

In our work I will let you define what you have experienced in whatever way feels most authentic to you. I will never tell you that something isn’t “traumatic” if you define your experience in that way. We will work together to understand how those experiences have shaped your current ways of thinking and behaving, in contrast to how you would like to think and behave. 

I will work with you to develop a safe, therapeutic space in which you can come as your authentic self and feel as though your experiences are heard, seen, and validated. I treat trauma from a Phase-Oriented, evidence-based approach, which prioritizes healthy coping, emotional processing, and integration with the life you are already living in order to achieve the life you hope to live. 

I emphasize the belief that your responses to trauma have been your brain’s best attempts at keeping you safe from situations that you had no blueprint for navigating. Those attempts may have helped you survive in unfathomable circumstances, but unfortunately those old means of coping may not fit into your current life and quite often result in more harm than good at this time. By partnering with your brain in this way, we are able to help you access compassion for yourself, while learning new ways to respond to triggers. 

Phase Oriented Approach to Trauma Treatment 

Originally defined in a Three-Phase approach by Dr. Judith Herman, the Phase Oriented Approach to Trauma Treatment is a sequential and fluid process aimed at addressing the impacts of trauma in different areas of functioning in your life. Phase approaches to trauma emphasize first establishing your safety and then transition to working directly with any traumatic memories/experiences. Dr. Herman’s model is outlined below.

Phase 1- Safety and Stabilization

This Phase focuses on the installation of solid, healthy coping skills, while simultaneously decreasing unhealthy means of coping. This could look like finding new ways to manage emotional distress other than self-harming or substance use. It could also entail setting healthy boundaries in relationships and/or ending relationships that are too toxic and stand in your way of healing. 

Phase 2- Reprocessing

This Phase focuses on facing your trauma history and gaining a full understanding of the impact they have had on your life. This is done through varying interventions including narrative therapies, structured cognitive/behavioral approaches, and experiential therapies. This is always done in a safe, contained, and structured way that is set to your pace. 

Phase 3- Integration

This Phase emphasizes the meanings you have made about yourself, others, and the world based on the traumatic experiences you have had. It works to rewrite those meanings and build an understanding of how you can integrate your experiences into the narrative of your life and your understanding of yourself.