A Brief Introduction to Trauma Therapy: What is Trauma and Why is it Important to Treat Trauma Using Trauma Therapy?

Trauma is a subjective experience that involves a horrific or life threatening incident or series of incidents inflicted onto a person that tints a person’s beliefs about themselves, others, and the world around them. Trauma comes in any form and no two people experience trauma the same way. The ways in which trauma can affect people can differ in intensity and severity, but it changes one’s world view significantly.

What counts as trauma? You might be familiar with the terms small T and big T traumas. Regardless of whether they are small or big traumas, they are all traumas. What is most important is that the survivor considers these experiences adverse and distressing that have caused and continue to cause them harm. Sometimes a trauma survivor may receive a Post-Traumatic Stress Disorder (PTSD) diagnosis after they have experienced a one-time traumatic incident. Complex Trauma is not currently recorded as a diagnosis in the Diagnostic Statistical Manual (DSM) but is experienced by many people who have endured long standing traumatic experiences such as childhood abuse and/or neglect or intimate partner violence. Other examples of trauma include grief and loss that could stem from a betrayal, chronic illnesses, displacement, medical negligence, an impending divorce, the loss of a job, or war. To read more about the other types of trauma, please read the blog post ‘An All-Exclusive About Trauma: Let’s Define Trauma, Understand Types of Trauma, & Explore Trauma Symptoms. https://aheapfulofhope.com/what-is-trauma-and-what-do-trauma-symptoms-look-like/

A trauma survivor organizes their beliefs, thoughts, feelings and behaviours around their trauma and their trauma symptoms. For example, a trauma survivor who has been stalked by an ex-partner may be hypervigilant of her environment and may get easily startled if someone shows up outside of her purview. She may feel highly anxious at times and often depressed. She may think that the world is not a safe place, that others are out to get or hurt her, believe that she is weak and not good enough, and that she does not deserve love.

Even if a trauma survivor seeks regular therapy that is not trauma treatment, the survivor may find some relief and support with their therapist. However, without a targeted trauma treatment approach tailored to help the trauma survivor work through her trauma, she would likely maintain her  beliefs, thoughts, feelings and behaviours around their trauma. It is also less likely that the trauma symptoms would cede or improve over time with regular therapy.

Hence, it is critical for trauma survivors to seek specialized trauma treatment to improve their quality of life and most importantly, find relief that can allow them to channel renewed energy into building the lives that they wish to live.

What is a Trauma Therapist?

A trauma therapist is a counselor or psychologist by training and pursues specialized trauma training to work with clients impacted by trauma, as defined above. Trauma therapists are highly skilled to work with clients who present with mood issues such as anxiety and depression, grief and loss, and debilitating health conditions.

What are the Training and Qualifications of a Trauma Therapist?

A trauma therapist starts out with a basic training program in counseling or psychology which is typically a Master’s degree.  After basic training in counseling or psychology, the next first step an aspiring trauma therapist may pursue is specialized training in at least one trauma approach. It would also be important to ensure that the trauma therapist you choose is one who is certified in a trauma treatment approach.

Certification in a trauma treatment approach demonstrates that the therapist has undergone rigorous training and standards that have been shown to help clients under her care. Like an apprentice who has studied under the tutelage of a highly skilled and experienced master, it also indicates that beyond the basic training, the therapist has invested time to learn from a consultant who is both experienced and skilled in the trauma treatment approach, and is able to effectively treat clients impacted by trauma.

Trauma is a complex condition that requires a significant amount of skill-building.  Other than being trained in a trauma modality, it is important that a trauma therapist  continues to hone their skills through continued professional development courses and seeks ongoing consultation for client cases.

In addition to professional qualifications in trauma treatment, some clients may seek therapists who have lived trauma experiences, and who can understand their experiences. Other clients may seek therapists who are not only certified in a trauma modality, but can integrate it with other therapy modalities.

What Motivates Trauma Therapists to Specialize in Trauma Therapy?

Just as some therapists may choose to specialize working with clients in a school setting, others may enjoy family therapy work. Some trauma therapists may have lived trauma experiences and are drawn to helping others who have walked the road less traveled.

What is a Trauma Therapist’s Job Scope?

Trauma therapists’ job scope includes multiple roles that will be discussed here today. Some of these roles include conceptualizing clients, develop a specialized treatment plan, apply specialized skills in trauma therapy, consultation and continuous education.

Conceptualize Clients

Firstly, conceptualizing clients is something that is often understated or talked about. It is behind the scenes work or backstage work because there is often a lot of preparation between sessions. During conceptualization, an effective trauma therapist organizes information gathered about a client’s trauma, their life circumstances, and their functioning in various areas of their life. No two clients are the exact same and the same goes for their treatment process. Conceptualization allows trauma therapists to identify where clients are in the trauma treatment process and identifies ways to help them zero in on the treatment process.

Develop Specialized Treatment Plan

Secondly, a trauma therapist uses information gathered about their client, the goals identified, and targets interventions based on the client’s unique needs and goals. Not all clients are the same, and the same goes for each client’s treatment plans. Trauma therapists carve out time between sessions to adjust the treatment plan based on any new incoming client information, monitor clients’ responses to the interventions, and identify any potential and existing roadblocks to carrying out the interventions.

Apply Specialized Skills in Trauma Therapy

There are several empirically-based trauma treatment approaches that trauma therapists utilize. Examples of empirically-based trauma therapy approaches include Eye Movement and Desensitization Reprocessing (EMDR), Prolonged Exposure (PE) and other Exposure Therapies, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (World Health Organization, 2024).

Consultation

Learning does not end after trauma therapists completes their specialized training programme. This is why continued ongoing consultation is not only important but is also critical in the work that trauma therapists do. When a session gets stuck and progress is limited, seeking consultation from a consultant can help the therapist work through any potential issues that may be causing the roadblocks. Sometimes that might mean that the trauma therapist troubleshoots the issue by clarifying some information with the client, or trying a different approach with the client.

Trauma therapists also seek consultation when and if their own personal stuff shows up in the session, that may make it challenging for the therapist to continue carrying out the intervention. While a client may not be aware of this, trauma therapists’ personal issues may sometimes present themselves when working with clients. A third perspective from a consultant can provide clarity to these issues and the consultant can assist the therapist in finding a viable option or two to resolve these issues and be more effective in helping the client.

Continuous Education

Trauma is multi-faceted and requires various skill sets and different levels of training. Learning from trauma experts and pioneers is a lifelong endeavour and requires continued and renewed interest, motivation, and commitment. Keeping up with new incoming and updated learning keeps trauma therapists sharp and, increases their self-efficacy, and enhances the quality of care offered to their clients.

Are Trauma Therapists Exposed to Any Challenges and Potential Risks?

Trauma therapists are exposed to a significant amount of trauma load, as they work mostly with clients who carry trauma.

One of the biggest risks trauma therapists are exposed to is vicarious traumatization, otherwise known as secondary traumatization. When a client impacted by trauma shares their traumatic experiences, the trauma therapist holds space for clients to share their stories of distress. Over time, this exposure to trauma vicariously predisposes therapists to experiencing some of the trauma symptoms their clients experience such as intrusive thoughts about the trauma content.

Not all trauma therapists are made the same. One therapist may have a lower threshold for emotional load when working with trauma clients and can only see a few clients a day, while another therapist may be able to work with more trauma clients a day without feeling depleted. What is key is for the trauma therapist to recognize their capacity and work within their limits.

Burnout is another potential risk trauma therapists can experience. The nature of trauma therapy is intense emotional and relational work, and therefore burnout can happen to the most well-meaning trauma therapist. If trauma therapists are caught unaware of the early signs of burnout, it may lead to aversion towards seeing their clients, feeling low and depleted around the work they do, and result in the tendency to make mistakes that may have serious repercussions on clients. Overall, the quality of work provided by a trauma therapist who is burnt out would suffer.

Other risks as a result of vicarious traumatization and/or burnout may be that the trauma therapists experiences a poorer quality of life. For example, the trauma therapist may suffer from increased relational conflicts and rupture or disillusionment from their personal and professional identities. Without early recognition of these signs of burnout or vicarious traumatization, a trauma therapist’s career may be shortened prematurely.

How do Trauma Therapists Take Care of Themselves?

There are five ways trauma therapists can take care of themselves during. To manage the said challenges and risks above,  trauma therapists can employ different strategies to manage their self-care regime. When a trauma therapist senses one of the above challenges or risks mentioned above, a helpful way to help themselves would be to restrict the number of trauma clients they see or balance their case load with other clientele who are not impacted by trauma.

Secondly, if a trauma therapist’s schedule is at their maximum capacity, the therapist may wish to refer out any new client referrals and indicate they are not accepting anymore new clients. If they are struggling with their current clients, they may also wish to refer out clients that may require a high level of care.

Thirdly, exercising healthy boundaries is important in both a trauma therapist’s personal and professional life. For example, having a structured schedule can ensure that a trauma therapist starts work at a certain time and ends their day at a specific time. Having a sense of structure builds routine and predictability, reducing the likelihood of chaos and disorganization in a trauma therapist’s life, both personally and professionally.

Fourthly, a trauma therapist may need to set aside time for recovery if they are aware they are getting vicariously traumatized or experiencing burnout. This may look like scheduling a vacation or two, or getting their own personal therapy or trauma therapy. The time taken for a trauma therapist to recover is indeterminate and careful and continuous monitoring is imperative.

Last but not least, trauma can be isolating. Seeking support from fellow peers and trauma therapists could be helpful. Building and strengthening connections with family and loved ones is also critical to forging a sense of belonging in what can often feel like a lonely experience.

All the above suggestions are ways that trauma therapists can exercise care, but the best way to engage in self-care is ultimately prevention. Engaging in the above suggestions preventatively at the start of a trauma therapist’s career is most helpful in ensuring that as trauma therapists, we can balance care for self and others.  This is a continuous endeavour and cannot be overstated.

At A Heapful of Hope, Dr. Isabelle Gaffney is a highly experienced online trauma therapist in Singapore who provides online trauma counseling to Singapore, Southeast Asia, and North Carolina, USA. Her mission is to bring positive impact and help clients break free from their trauma and heal with hope for the future. With her lived trauma experiences, Dr. Gaffney hopes that like her, trauma survivors can transition from surviving to thriving, eventually finding the energy, peace, and liberation to be the person they want to be.

Dr. Gaffney is also an EMDR consultant who helps consultees learn to increase confidence applying EMDR, build their EMDR skills, and troubleshoot difficulties they may experience when using this modality.

References

World Health Organization. (2014). Post-traumatic stress disorder. (2014). https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder

Acknowledgements:

Image by Rosy / Bad Homburg / Germany from Pixabay

From <https://pixabay.com/illustrations/quality-improvement-health-ill-7728402/>

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From <https://pixabay.com/illustrations/broken-heart-sketch-drawing-6533396/>

After studying and treating trauma for almost 13 years now, my understanding of trauma has grown and evolved. Let’s take a look at the definition of trauma, the different types of trauma, and how they manifest in a person in the form of symptoms.

Let’s Define Trauma

Trauma is defined as an event, several events, or situations experienced by a person that causes physical or emotional harm or is life threatening, and has long term effects on the person’s ability to function, as well as impact their well-being in the following areas: physical, psychological, social, emotional, and spiritual (SAMHSA, 2014).

Types of Trauma

There are different types of trauma and we will describe each of these types of trauma:

Acute Trauma: A one-time event such as a car accident, robbery, or natural disaster.

Adverse Childhood Experiences (ACES): Early childhood experiences where a person is or was subject to childhood abuse, neglect, divorce or living with a family member addicted to alcohol or other substances. ACES originated from a study by the Centers for Disease and Prevention Control (CDC) who created an ACES screener that indicates a person’s risk for negative outcome the more adverse childhood experiences the person has gone through.

Carceral Trauma: When people are being detained, separated, or isolated from their families and larger communities, or are incarcerated, they experience carceral trauma. Carceral trauma affects not only incarcerated individuals, but also their families, correctional staff in prison facilities, and ultimately the communities.

Chronic Trauma: When trauma is repeatedly experienced, in one or multiple forms, over a period of time, a person can be said to experience chronic trauma. This may include domestic violence, sexual abuse in childhood or in an intimate partner relationship.

Complex Trauma: Similar to chronic trauma, complex trauma is a result of repeated traumatic events. However, in complex trauma, the interpersonal traumas stem from childhood that can affect one’s self-concept, emotional dysregulation, and create trust issues. It is also known as C-PTSD because in addition to the conventional PTSD symptoms, it has features of interpersonal and attachment wounding and challenges.

Historical and Intergenerational Trauma: Much less discussed when we consider trauma is the idea of historical trauma. Historical trauma is a form of collective trauma specific to an ethnic or cultural group due to oppression and is passed down from one generation to the next. For example, people who experience historical and intergenerational trauma have experienced slavery, colonialization, or other forms of systemic oppression.

Immigration Trauma: When people are purged from, become refugees, or voluntarily migrate from one country to another, they are predisposed to immigration trauma.

Racial Trauma: When people are exposed to bias, racism, and prejudice on a systemic level on a regular basis, they experience racial trauma. Racial trauma can be understood in terms of overt and covert racism. While overt racism is more explicit and includes responses that are clearly discriminatory, covert racism is more subtle and discreet which can be easily denied by the perpetuator or results in the impacted persons second guessing their experiences.

Secondary or Vicarious Trauma: As the word ‘secondary’ suggests, trauma is not directly experienced but the effects of the trauma experienced by an individual can affect others, such as mental health professionals or the individual’s family and loved ones. This is due to ongoing exposure to others’ trauma stories and suffering firsthand.

Trauma Symptoms: What Do They Look Like?

Janina Fisher, a trauma expert, shared the many ways that trauma can manifest. Depending on the chronicity, intensity and severity of trauma, some people may experience a few of these symptoms while others may experience many or most of the symptoms.

I have categorized the symptoms below as follows:

Mood Difficulties: Irritability, depression, anxiety, hopelessness, overwhelmed, shame, worthlessness 

Somatic Disturbances: Somatic pain, headaches

Sleep: Insomnia, nightmares

Connectivity to the Traumatic Events: Few or no memories, flashbacks, panic attacks

Destructive Coping Mechanisms: Self harm, substance abuse, eating disorders

Future Outlook: Loss of sense of the future

Difficulty Staying in the Present: Feeling unreal or out of body, numbing, hypervigilance

Interpersonal Challenges and Functioning: Mistrust, difficulties focusing on tasks at hand

Intrapersonal Challenges: Loss of identity and loss of interest in what used to be enjoyable

In another blog post, we will discuss trauma treatment modalities and what trauma treatment looks like.

References

Fisher, J. (2021). Transforming the living legacy of trauma: A workbook for survivors and therapists. PESI Publishing & Media.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. (2014). https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/samhsa_trauma_concept_paper.pdf

Acknowledgements:

Header Photo by Susan Wilkinson on Unsplash

Photo by Savannah B. on Unsplash

Featured Image by Gordon Johnson from Pixabay

Learn more about EMDR Therapy on the Being Human Podcast where Dr. Isabelle Gaffney and Dr. Chua Sook Ning share a conversation on EMDR, its purpose, applications, and what clients can expect in the therapy room.

Why do We Need Supportive Conversations on Mental Health?

All of us have mental health and yet, approaching conversations about mental health may feel awkward and uncomfortable. Mental health sits on a continuum similar to physical health, and people can enjoy good mental health or find themselves with mental health issues. Hence, you may inadvertently find yourself landing in a conversation about mental health in any setting, in your personal life with family and friends, professional settings with co-workers, or in community settings. When not approached with the right intention and skills, these conversations may cause hurt and perpetuate mental health stigma. Words can hurt or heal and do matter in supportive conversations on mental health. Although there is no one-size-fits-all way to approach these conversations, there are some absolute Dos and Don’ts that we will discuss in our blog post today.

Do’s in Supportive Conversations on Mental Health

• Do Communicate Care and Interest. Before finding words on what to say, it is important to express care and interest towards the other person.  Ways you can communicate care include maintaining eye contact, providing space for the person to talk, and being encouraging. Ways you can encourage someone to share include empathic statements such as “This must be hard for you” and “That seems really exhausting.”
• Be Non-Judgmental. Your attitude is just as important as your words. If you are striving to be non-judgmental towards someone struggling with a mental health concern, your words will naturally fall into place. Being non-judgmental means not driving the conversation into the direction you would like it to. Examples of ways you can speak non-judgmentally are to restate what the person said about their difficulties, and to honor their unique experiences without trying to force them into a box or label.
• Be Sensitive. Try to read the room and if you notice that someone is withdrawing from the conversation, maybe take a breath and give them some space to process what is going on. It may not have been anything that you have said and sometimes, it can be challenging for one to share about their mental health challenges. They may need a break or simply cannot share any further. If the person finds it hard to continue sharing, you can let them know that they can approach you later.
• Do Offer Support. Ask the person what they need from you at the end of the conversation. Sometimes, there is nothing they need more than a listening ear. Extending care, time and thought is more than sufficient sometimes. There may not always be a solution to the problem and you may be relieved to know you don’t have to be the one to provide a solution to their problems.

Don’ts in Supportive Conversations on Mental Health

• Don’t Make Assumptions or Give Unsolicited Advice. To exercise support for someone, try to meet the person where they are. It can be easy to slip into the rabbit trail of making assumptions of the person’s experience based on incorrect information you may have been exposed to or preconceived notions about a mental health condition. Offering advice that has not been asked from you can be harmful. An example of giving advice could be, ‘Why don’t you just stop thinking about this issue and just move on?’ or to someone with an eating disorder, ‘Why don’t you just eat more?’
• Don’t Extend Sympathy. Feeling sorry for someone who shares about their mental health is unhelpful and reduces the person’s status. Nobody wants to be pitied for having a medical condition and likewise, for experiencing mental health difficulties. Instead of saying phrases like ‘Oh you poor thing’, try to imagine what its like to be in their position and empathize with them. An example might be, ‘This is really tough and I can only imagine how difficult it is to battle these thoughts on a daily basis.”

• Don’t Use Stigmatizing Language. Examples of stigmatizing language include words such as ‘crazy’ or ‘mental’ to describe someone with mental health issues. Oftentimes, we may even hear others describe behaviours that are ‘OCD’ without truly understanding the mental health condition, and that can minimize the experience of persons with the mental health condition. Stigmatizing language is insulting and derogatory and has no place in supportive conversations.

Wrapping Up

As with everything, practice makes perfect. You may find yourself catching something you said that was insensitive or judgmental. You may make mistakes along the way. Perfection is not key. Rather, continuous learning and the desire to seek out information on conversing with others about mental health can help you strengthen your ability to support others who share their mental health challenges.

What is Telehealth or Online Counseling?

While there are various forms of online counseling, we will discuss video-conferencing counseling sessions for the scope of this blog post. When you meet your counselor over a videoconferencing platform such as Google Meet or Zoom, that is a telehealth or online counseling session.

Globally, digital literacy is growing, especially amongst digitally competitive countries such as Singapore (7.8 score index) and the United States (6.3 score index) (The Digital Skills Gap Index). People are spending a lot of their time online, shopping online, learning online, and engaging with each other through online communication modalities such as messaging daily.

Receiving counseling services online is an option for traditional face-to-face counseling. Since the COVID-19 pandemic, the rate of individuals seeking mental health services has increased. For example, in the United States, the rate of young adults who sought mental health services between the ages of 18 and 44 increased from 18.5% to 23.2% between 2019 and 2021 (National Center of Health Statistics, 2022).

What are the Benefits of Telehealth or Online Counseling?

Recently I had an appointment with my service provider, and I requested an online appointment. It would save me an hour and a half of commuting time and any associated transportation costs.

In addition to telehealth being more cost-effective, other benefits of telehealth include accessibility, convenience, and comfort. Telehealth can allow people to gain access to treatment sooner rather than later. For people who may be deterred from attending in-person counseling services, telehealth can help to overcome this logistical barrier. Another added benefit is that people can enjoy counseling in the comfort of their home or office. If you have access to a quiet room, the telehealth option is already available to you.

Does Telehealth or Online Counseling Really Work?

Before the pandemic outbreak, telehealth was considered an option that was suboptimal to traditional counseling. The key reasons included a lack of information and training amongst mental health providers about telehealth and how to provide care online. Additionally, there was a lack of research on the efficacy of telehealth.

A recent research study of 27,500 participants in mental health treatment demonstrated that telehealth works just as well as traditional in-person sessions (Catarino et al., 2023).

Telehealth may not be for everyone. However, it can be a viable option for people who have access to a quiet room and would like to enjoy counseling in the comfort of their homes or offices.

References

Catarino, A., Harper, S., Malcol, R., Stainthrope, A., Warren, G., Margoum, M., Hooper, J., Blackwell, A. D., & Welchman, A. E. Economic evaluation of 27,540 patients with mood and anxiety disorders and the importance of waiting time and clinical effectiveness in mental healthcare. Nature Mental Health, 1, 667-678.

National Center of Health Statistics (September 2022). Mental health treatment among adults aged 18-44: United States. https://www.cdc.gov/nchs/products/databriefs/db444.htm

The Digital Skills Gap Index (DSGI). https://dsgi.wiley.com/global-rankings/