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Going to therapy is hard! It can be scary for a lot of people, especially trauma survivors. A symptom of PTSD is avoiding any reminders of the trauma, so the idea of going to a therapist specifically to focus on the one thing you’ve been avoiding is terrifying. Plus, most people don’t even know what to look for in a therapist or what the process of therapy entails which only causes more anxiety and overwhelm. That’s why in this article we’re going to discuss what you can expect (and, therefore, should be looking for) if you’re thinking about entering trauma therapy.
The first thing you should know is that the most important factor to success in therapy is the relationship between you and your therapist.
Study after study have shown that the therapeutic relationship is the most potent factor affecting the change you’ll experience in therapy with it accounting for up to 60% of the change. I say that to say, it’s really important to find a therapist who is a good fit.
Most people are just trying to find any therapist and I get it. Our mental health system honestly sucks and it can be really difficult to find a therapist who will even call you back so when you do, its tempting to stick with what you have. BUT it is so worth it to spend the time to find a therapist who is a good fit, even if you’re still working with the one you have until you do that. Any therapist worth their salt will want you to get what you need out of therapy, even if it isn’t with them, won’t center their feelings over your therapeutic progress, and will provide you with referrals to other therapists they know and trust, if you ask for them.
What does a good fit with your therapist even mean? I conceptualize fit as having 3 major factors: finances, expertise, and compatibility.
You want a therapist who takes your insurance or if you don’t have it, offers a rate that you can afford. You’ll also want a therapist who is upfront about finances and organized with their systems. This reduces the stress and distraction that can sometimes arise from unexpected billing issues or having the cost of therapy cause additional stress.
Second, you’ll want someone who specializes in the issues that you are dealing with. This is especially true of trauma survivors. It is too easy for professionals who are not trauma-informed and trained to stigmatize behaviors or symptoms as personal defects instead of the body’s physiological responses to trauma or just be plain unhelpful. This cannot only prevent you from getting better but can actually retraumatize you and make things worse.
Last, you’ll want someone who is compatible with you and what that means for each of us is a little different depending on our preferences and values. At it’s core though, it’s having a therapist who gets you and sees you in the best possible light. Figuring out if someone else can do that takes time though so it is possible that you might have to try a few therapists, which is a huge pain but really worth it to find the right fit and get the outcomes you’re looking for.
Figure 1 - The process of trauma therapy
The next thing you can expect from quality trauma therapy is that it’s going to follow a foundational process similar to what’s outlined in Figure 1.
This will look different with each therapist and each modality that they are trained in or practice but the general stages and flow of trauma therapy will pretty much be the same.
This process starts with…you guessed it, building the therapeutic relationship which, as we already discussed, is so important to any therapy but especially to trauma therapy. Trauma survivors need to feel safe in order to do the work of healing and that starts with safety in the relationship with their therapist and themselves.
This process also starts with building hope for the future by helping you to see a future past the symptoms you’re experiencing in the present. This is also really important with trauma survivors since one of the big symptoms of PTSD/CPTSD is hopelessness or negative expectations about the future which can be a hindrance to the therapeutic process.
The next stage of trauma therapy is teaching you interoception and self-regulation skills. Trauma is a nervous system disorder that results from overwhelming or scary experiences that cause reactivity in the sympathetic nervous system, which controls your involuntary response to stress or danger. A huge part of trauma therapy is teaching you how to recognize this response in your own body (interoception) and intervene to disable the sympathetic nervous system and access the parasympathetic nervous system, which is the body’s brake.
Woven throughout this process, your therapist will be educating you on trauma and helping you to understand its symptoms and effects on the body and mind. This should help to normalize your symptoms and help you to see yourself as someone struggling with a predictable set of symptoms instead of someone who is broken or defective.
For over half of people in trauma therapy, these initial stages will be enough to resolve their symptoms and help them move into the final stage of post-traumatic growth. However, some people will continue to struggle with the intrusive symptoms of PTSD like flashbacks and nightmares. For those folks, they will need to move into the final stage.
The last stage of trauma therapy is processing the actual trauma that occurred. There are many options for processing trauma from EMDR (eye movement desensitization response) or Brainspotting to Prolonged Exposure or Cognitive Processing. Whatever model you use, the goal is to help you access memories of the trauma while in a relaxed, parasympathetic state. Once you’ve accessed the trauma in a relaxed state your therapist will help you to contradict the problematic learning that occurred during the trauma and help you to create new, healthier learning that is more supportive of your growth and wellness.
So what are the takeaways from this information that can help you as you look for your own trauma therapist? Here’s a few:
1. There’s a basic structure that trauma therapy should follow. The most important part of that is focusing on the therapeutic relationship and your ability to manage your body’s symptoms before accessing traumatic memories.
2. Fit is the most important factor to success in therapy so consider the 3 factors we discussed: finances, expertise, and compatibility.
3. Your therapist should focus on the therapeutic relationship including ensuring that you feel like they see you, understand you, and perceive you in the best possible light even if they are challenging you.
4. Your therapist should educate you on the dynamics of trauma and normalize your experiences and symptoms.
5. Your therapist should teach you ways to identify when you’re in sympathetic nervous system dominance (can be called other things like triggered, trauma response, fight or flight, etc.) and how to engage your parasympathetic nervous system.
6. You should feel like you’re in the driver’s seat of therapy and not being pushed into doing anything you’re not comfortable with or don’t feel ready for.
7. You don’t have to talk about your trauma until or if you feel ready. In fact, as we’ve discussed, for most people processing the actual trauma is unnecessary once the foundational work has been complete and you’re confident in your ability to manage symptoms that might arise from this work.
8. Trauma therapy has been highly researched and is super effective at reducing distress and improving quality of life. Therapy is often seen as a shot in the dark or lacking in scientific basis but this is a really outdated idea. There is enough research to know what works for most people in therapy and success rates for trauma therapy specifically are between 77% and 100%*
Trauma therapy can help you to move past what happened to you so that you can enjoy your life and create a better future. Taking the time to find someone who is a good fit and who implements an evidence-based model of care can help to set you up for long-term success. Being educated on the process and what you should expect can also help you to choose a therapist from an informed place.
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* https://sbtreatment.com/program/therapies/trauma-therapy/#:~:text=What%20are%20the%20success%20rates%20of%20trauma%20therapy%3F,medications%20to%20treat%20their%20symptoms.