Trauma: Working Through It, Letting it Go, and Living with It

As a mental health therapist, I currently meet with people who have lots of different types of trauma. A few people who I meet with tell me that they chose me based on my background and training in trauma therapy. Choosing a trauma therapist can be challenging, so here are some things that may be helpful when choosing a therapist, particularly someone with evidence based training in trauma therapy.

When choosing a trauma based therapist, take into consideration what trauma is and our responses to it. Traumas are: What we have experienced, our bio-chemistry, our sensitivities, and our pre-dispositions which make us affected by social interactions and life events. As we all are trauma affected, I’m thinking of COVID here, we’ve all had different responses to it. All of us have experiences that have affected us in some way, and for many of us choosing mental health therapy is a way to work through trauma. There are several different types of evidence based practices which treat trauma in mental health therapy.

A meaningful training I attended as a trauma researcher and therapist came to the forefront at a Trauma-Informed-Care (TIC) train-the trainer workshop I attended in 2012. It was put on by the Federal Youth Service Bureau (FYSB, pronounced fizz-B), and was particularly meaningful to me as a participant.

At that time, I’d had a couple of experiences working in residential settings. One was an experience I had during graduate school. I was the van driver for a group home for adolescent boys who had either broken some sort of law or experienced some sort of abuse or neglect, rendering them unable to stay in their home environment. After being the van driver for a year or so, I utilized the group home for practicum experience and was a therapist to some of the boys who resided at the facility.

My second experience occurred while I was attending the TIC workshop. I was Director of the staff and programming for a Pregnant and Parenting Teen program, also funded by FYSB. We had one location for the 18 and under moms or moms to be. We also had apartments for the moms who were 19 and older.

The training confirmed some of my own biases and opinions that I had formed working in residential facilities with youth. I had always thought that it is important to take into consideration what trauma each of the residents had experienced, and to apply therapy which respected the participant. One thing I learned in the TIC training was about helping connect consequences to the behaviors, and recognizing how trauma can affect the person doing the behavior. For instance, a person may have a very large reaction to the lights being turned on when someone is going to wake them up. If they have trauma associated with lights being turned on and being removed from their home, this makes sense. Respecting the trauma response and waking someone gently with words can be a better route than turning lights on in this scenario.

It also confirmed family therapy I did with families who were affected by Child Protective Services when I did home-based work. Early in my career I was a home-based therapist for families involved with Child Protective Services or at risk for having abuse or neglect in their family. Utilizing TIC when working together with parents of children who had been removed from the home, or with the children who either had been or were at risk for being removed, was important to gaining trust with the families and children.

There are all kinds of traumas that people can experience; and as a therapist in the field for many years, I have been privy to hearing about quite a bit of it.

Some have experienced sexual trauma, others have lost a child, others have experienced abuse that was physical or neglectful.

There are some evidence-based types of mental health therapy that are specifically designed to work with trauma.

As people who are living with and through trauma determine what type of training their therapist has had, there are several different things to consider.

Number one, from pretty much all of the research I have read, is that therapeutic relationship. The therapeutic relationship is tough to know prior to making that first phone call, which is also going to be dependent on cost, availability of the therapist, whether or not they take your insurance or are a fee based (private pay) person. In addition, it is important to consider some of their trainings in areas that are important to the person participating in or facilitating the therapy.

One type of evidence based trauma treatment is utilizing a Trauma Informed Care approach. The TIC approach includes recognizing that trauma plays into interactions that we all have with each other. We can recognize that as we work together in the therapeutic relationship.

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is a trauma-informed approach that includes psychoeducation (teaching about trauma) and including a trauma narrative, which is the story of what the trauma is. It has more of a prescriptive approach to the therapeutic relationship, and has good evidence behind it.

Dialectical Behavioral Therapy (DBT) is an approach which recognizes that there are certain, specific techniques that can be helpful in therapy with someone who has experienced trauma. The training includes learning about these techniques and practicing using them in the therapeutic relationship.

ART, or Accelerated Resolution Therapy, is an eye movement therapy that helps the therapist and the person in session work through traumatic experiences. EMDR is similar to ART, but was developed first and is another evidence based eye movement treatment for those who have experienced trauma.

Of the types of training listed above, I am trained in all except for EMDR, which may be something I tackle next.

Motivational Interviewing is a type of evidence based therapy that I utilize frequently in sessions, where I am working to help the client be motivated to make changes through interviewing, or questioning.

Finding a therapist who utilizes evidence based treatment can be a real plus when working to make changes.

What qualities do you look for when you are finding a therapist?

How do you choose which therapist to contact? Do you look for someone who appears personable in their photo, someone who has a strong history of rapport building, or someone with trainings in evidence based practices? Or do you look for a combination of all of the above?

We’re hearing on the news about how important therapy is. I watched Saturday Night Live last week, and multiple skits included the topic of therapy.

The stigma of participating in therapy is lessening, and more and more therapists are getting trained in the field of therapy, at least here in Texas where I live.

I hope you find a quality therapist. One you can trust, one you can talk with, and one you find helpful as you work through whatever has brought you to therapy.