Trauma Therapy

I am a member of the international network of healthcare professionals and scientists devoted to the understanding and treatment of the effects of trauma on human beings. The rapidly growing body of theoretical work, research, and clinical experience focused on trauma has powerfully influenced my practice. I believe that as we learn more, trauma theory will help us to explain the development of most kinds of psychological disorders, dysfunction, and suffering.

Traumatic events have different effects depending on whether they happened to a child or to an adult, and depending on whether the trauma consisted of a single event or a continuous experience over time. We currently know about a number of risk factors that increase the probability that a person will develop Posttraumatic Stress Disorder after a traumatic incident. These factors include characteristics of the event, pre-existing characteristics of the person, and the quality of support provided by his or her family and community. Trauma seems to have a cumulative effect, so people who have been through multiple traumatic events in childhood or adulthood are at greater risk of developing psychological problems after an additional incident.

Single Traumatic Incidents: Depression and PTSD

Most adults recover completely from single traumatic incidents. People who do develop posttraumatic psychological disorders are about as likely to be diagnosed with depression as with PTSD, and of those diagnosed with PTSD, many also have depression.  We now know that depression is one of the most common aftereffects of a traumatic experience. Many survivors try to alleviate their suffering with alcohol or drugs, which adds substance abuse to their list of problems.

Psychological treatments for posttraumatic reactions to single events integrate techniques of cognitive-behavioral therapy (CBT), narrative therapy, and body-focused psychotherapies. One of the most effective treatments for PTSD is called “exposure therapy.” Clients try to master their feelings about a traumatic event through visits to the physical site, through virtual reality simulations of the incident, or through guided imagery exercises. Another CBT technique called “cognitive restructuring” helps people overcome guilt, shame, and damage to self-esteem, by exploring many interpretations of what an event means about themselves, other people, and life in general. Narrative therapy helps people integrate their experience by telling the whole story, orally or in writing. Body-awareness exercises and body-movement work address the physical effects of psychological trauma, and help to process “body memories” triggered by specific kinds of physical stimulation.

Sustained Trauma: Complex PTSD and Disorders of Extreme Stress

When people are subjected to continuous trauma over a period of time, especially when interpersonal coercion and violence are involved, they can develop complex psychological problems as a result. Examples of sustained trauma include the wartime experiences of soldiers, POWs, and civilians living in the combat zone. Other examples include being held hostage, or being abducted and sexually assaulted multiple times. Sustained trauma can cause survivors to lose some of their ability to think and to feel their emotions in a normal way. Their personalities and inner experience may be changed to the point that they cannot remember or connect with their previous sense of themselves. Their feelings about life and other people may become detached and indifferent, and their previous religious beliefs may be rejected. Trauma specialists refer to these long-term effects as “Complex PTSD” or “Disorders of Extreme Stress.” Many of the therapies used to treat posttraumatic reactions to single events can also be effectively used to treat complex reactions to continuous or repeated trauma.

Child Abuse Trauma

Child abuse by family members is one of the most destructive kinds of sustained trauma, because children are still developing neurologically and psychologically, and are vulnerable to intense stress. They generally cannot escape their abusers, and would not even choose to do so, because they are emotionally dependent on them. Subtle kinds of emotional abuse and inappropriate adult behaviors can be as harmful to children as the more obvious forms of domestic violence. Emotional abuse is also more difficult to identify or describe when victims try to communicate their experience to potential helpers, either in childhood or in later years.

Familial child abuse also differs from other kinds of trauma in that family members may ignore the abuse, minimize its importance, or regard it as normal. As a result, abused children tend to become confused about the accuracy of their perceptions and memories, and the appropriateness of their emotional reactions to the abuse. By the time they grow up and enter therapy, they may know only that they suffer from chronic depression and anxiety. When the therapist inquires about childhood experiences, adult clients often deny or minimize mistreatment by family members, and dismiss its role in causing current emotional and interpersonal problems.

Therapy for adults abused or abandoned as children is an intensive process requiring a substantial commitment of time and effort by both the therapist and the client. The good news is that recent progress in the field of trauma therapy offers everyone new hope of recovery.  

The emotions experienced during the childhood abuse can emerge in an intense way when someone says or does something that reminds the victim of traumatic incidents. When they feel safe with a therapist, people can begin to see how they interpret their present interactions with other people in terms of past abuse. They often express surprise that they are re-experiencing incidents from their childhood in their current relationships with other people, whose resemblance to the original abusers may be minimal or non-existent. Over time, survivors can change their images of themselves as helpless victims of adult abusers into a new sense of being adults capable of self-protection.

Treatment of the long-term effects of childhood trauma requires extensive use of the therapeutic relationship. In my work I use techniques developed within the psychoanalytic tradition of psychotherapy, as well as cognitive-behavioral, experiential, and body-based therapy strategies.