“Our wounds are often the openings into the best and most beautiful part of us.” ― David Richo
Trauma-Informed Care understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize. It is crucial that treatments to address trauma be trauma specific, in that they explicitly address the traumatic experiences and the impact of the experiences on the survivor's life. The treatments should be sensitive to person's cultural beliefs and values.
Trauma-specific treatments are delivered by specialized mental health professionals and are generally designed to “help an individual regain a sense of control over the trauma, destigmatize the potential shame the trauma has left, and normalize symptoms as common and understandable responses to the traumatic event. Typically, these interventions include the use of specific strategies such as trauma narratives, cognitive reframing, and emotion regulation skills. In addition, trauma-specific treatments often require active participation of parents, caregivers, and other other's who support the person.
Types of Trauma-Focused Treatments
Pharmacotherapy is the use of medications to manage disruptive trauma reactions. Medications have been shown to be helpful with the following classes of reactions/symptoms:
Taking medication does not make one’s trauma reactions and pain evaporate. Medications can only help make the symptoms less intense and more manageable. If you decide to use medications, consult a psychiatrist and continue working with that psychiatrist for as long as you take the medications. Inform the psychiatrist of how the medications are impacting you. Some medications have side effects that may or may not be tolerable to you, and some people do not respond favorably to medications. Medications are most effective when individuals pursue therapy at the same time. Behavioral therapy is most common form of exposure therapy. In exposure therapy, one gradually faces one’s fears–for example, the memories of a traumatic event–without the feared consequence occurring. Often, this exposure results in the individual learning that the fear or negative emotion is unwarranted, which in turn allows the fear to decrease. Exposure therapy has been found to reduce anxiety and depression, improve social adjustment, and organize the trauma memory. There are various forms of exposure therapy:
Imaginal exposure: An individual imagines the feared event as vividly as possible.
In vivo exposure: The exposure occurs in the therapy.
Systematic desensitization: The individual is exposed to successively more fear-inducing situations. This exposure is paired with relaxation.
Cognitive behavioral therapy (CBT) is grounded in the idea that an individual must correct and change incorrect thoughts and increase knowledge and skills. Common elements of cognitive behavioral therapy trauma therapy include:
Teaching individuals how to breathe in order to manage anxiety and stress
Educating individuals on normal reactions to trauma
Identifying and evaluating negative, incorrect, and irrational thoughts and replacing them with more accurate and less negative thoughts
Hypnotherapy guides the individual in therapy into a hypnotic state, then the hypnotherapist engages the person in conversation or speaks to the person about certain key issue. Most hypnotherapists believe that the emotions and thoughts that an individual comes into contact with while under hypnosis are crucial to healing.
Psychodynamic trauma therapyworks to identify which phase of the traumatic response the individual is stuck in. Once this is discerned, the therapist can determine which aspects of the traumatic event interfere with the processing and integration of the trauma. Common elements of psychodynamic therapy include:
Taking the individual’s developmental history and childhood into account
Placing emphasis understanding the meaning of the trauma
Looking at how the trauma has impacted the individual’s sense of self and relationships, as well as what has been lost due to the traumatic event
Group therapymay be led by therapists or by peers. Some are educational, some focus on giving support, and other groups are therapeutic in nature. Groups are most effective when they occur in addition to individual therapy. It is important for a trauma survivor to choose a group that is in line with where one is in the healing journey:
Safety/victim phase: Choose a group focused on self-care and coping skills.
Remembering and mourning/survivor phase: Pick a group focused on telling the trauma story.
Reconnection/thriver phase: Join a group that aims to create connection with people.
Educational groups are appropriate during all phases.
Trauma-focused cognitive-behavioral therapy (TF-CBT) is a cognitive-behavioral intervention used primarily to treat traumatized children ages 3 to 17 and adults. It is based on a conjoint child and parent psychotherapy model. TF-CBT consists of several core treatment components including:
psychoeducation about trauma;
strategies for managing distressing feelings, thoughts, and behavior;
exposure to and processing of trauma-related memories through development of a trauma narrative; and
enhancing parenting skills and child safety.
Children and non-offending caregivers are initially seen individually. When both are ready, they can come together, so the child can share the trauma narrative with his or her caregiver.
Parent–child interaction therapy (PCIT) is a behavioral intervention for children and their parents. The focus is on enhancing the quality of the parent–child relationship through a combination of didactic training and coaching of parent–child interaction skills and positive behavior management. Child–parent psychotherapy (CPP) also focuses on relationship enhancement by helping children and parents develop secure attachments and a sense of safety and trust within the parent–child relationship. It also addresses the meaning of the event or trauma. Sessions emphasize parent–child interactions to support and foster coping, affect regulation, and appropriate reciprocity between parent and child.
Cognitive-behavioral intervention for trauma in schools (CBITS) is a group and individual trauma-specific approach designed for delivery in school settings by mental health professionals working in close collaboration with school personnel. CBITS is based on cognitive-behavioral techniques, including psychoeducation, relaxation, cognitive restructuring, exposure, and development of a trauma narrative to reduce symptoms, improve peer and parent support, and enhance coping skills.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that helps people to heal from the symptoms and emotional distress that are the result of traumatic life experiences. EMDR uses a patient's own rapid, rhythmic eye movements. These eye movements dampen the power of emotionally charged memories of past traumatic events. Treatment involves the person in therapy mentally focusing on the traumatic experience or negative thought while visually tracking a moving light or the therapist’s moving finger. Auditory tones may also be used in some cases. Debate regarding whether eye movements are truly necessary exists within the field of psychology, but the treatment has been shown to be highly effective for the alleviation and elimination of symptoms of trauma and other distress.
Trauma Systems Therapy (TST) is a comprehensive model for treating traumatic stress in children and adolescents that adds to individually-based approaches by specifically addressing the child’s social environment and/or system of care. TST was designed to provide an integrated and highly coordinated system of services guided by the specific understanding of the nature of child traumatic stress.
Other trauma-specific treatments include Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT); Attachment, Self-Regulation and Competency (ARC); Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS); and Trauma Adapted Family Connections (TA-FC).
No matter which trauma-focused therapy model you choose, it's important to make sure your therapist is specifically trained and has achieved certification in that modality.