Note: today’s post is a little longer than others, but stay with me because I dig into some really important stuff!
If you’ve ever sat in a therapy session wanting to work on complex trauma and you’ve quickly realized that this therapist has a cookie cutter approach to therapy, I’m sorry.
One of the very frustrating things about talk therapy is that you have to invest a lot of time and energy into the initial meetings. You have to complete the intake, go through your life story, and get a feel for how that therapist works. The absolute last thing you want to do after that is comb through your list of in-network therapists and do it all over again. So we stick out the bad or bland therapists.
It is so frustrating to me (and others) that so many medical schools train therapists in this approach because it does nothing for the individuals they claim to want to help. It wasn’t until a year or two ago that I saw the term “trauma informed therapy” and balked at it. In my mind, calling therapy trauma informed is like calling the sky blue. It’s self-evident.
Except it’s not.
When I ask ChatGPT what makes trauma informed therapists different from other forms of talk therapists, it kicks out the following:
“While traditional talk therapy often focuses on thoughts, feelings, and behaviors in a straightforward way, it might not account for the complexities of trauma. Standard therapy could inadvertently dismiss or misunderstand trauma responses, potentially pathologizing them rather than seeing them as adaptive reactions to adverse experiences. [Trauma informed therapists’] training and methods are designed to create a safe and supportive space where individuals can process their experiences without re-traumatization.”
If you replace “straightforward” with “cookie cutter,” you’d get a pretty accurate picture of “standard” therapy, but I digress.
I might only be speaking from my own experiences here, and I have no medical training past CPR, but do therapists think things like depression and anxiety are pathologies that have no root cause? That they’re independent of “adverse experiences”? I mean… what?
In my experience, and from talking with others who live with various mental illnesses, these illnesses don’t “just spring out of holes in the ground.” They are rooted in “adverse experiences,” or what might in many cases be called trauma.
It might be a little careless of me to suggest that all mental illness is caused by trauma, because that also doesn’t seem right, but at the very least, I can’t get with the premise that one just “develops” depression, for example. And don’t even get me started on big “T” and little “t.”
I didn’t know there was such a thing as traumatology until I saw it written in Gabor Maté’s book The Myth of Normal, which I’m still working my way through. Moreover, it’s almost impossible to talk about traumatology without also mentioning Bessel van der Kolk, author of The Body Keeps the Score (among others).
In an interview published by Penguin Random House, van der Kolk says:
“One of the most devastating effects of trauma is that people’s biology changes into a biology of threat; this is expressed on multiple levels, in stress hormones, immunology and what the brain selects to pay attention to. [...] As a consequence, traumatized people stay on hyper alert; they feel chronically unsafe and in danger, and they have problems feeling calm and enjoying the moment and they are out of touch with their surroundings. [...] Trauma survivors are vulnerable to a host of medical illnesses and chronic pain syndromes, insomnia, drug and alcohol addiction, depression, obesity, and other issues related to optimal functioning of the entire organism**, and the capacity for self regulation and self-care.”
Okay, that was a long quote, but worth reading. Here’s another as seen on Medium, quoting The Body Keeps the Score:
“All trauma is preverbal. Our bodies re-experience terror, rage, helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate. Trauma by nature drives us to the edge of our comprehension.”
This might explain why some of us struggle with memory problems and putting words to how we feel, which makes us sound like hypochondriacs constantly complaining (yeah, we’re tired of this too). We might even react (body/nervous system) to things that don’t make sense in the given moment. From what I’ve read about developmental psychology, trauma, anxiety, and depression, and my own lived experience, this is because we are physically reacting to triggers of traumas past.
This is why identifying your triggers and working with (good) trauma informed therapists is so important.
Pulling again from ChatGPT (last block quote, I swear), trauma informed therapists:
“[...] have specialized training in recognizing the wide-ranging effects of trauma, including physical, emotional, and psychological symptoms like hypervigilance, dissociation, or emotional numbing. They view a client’s struggles (e.g., anxiety, depression, difficulty trusting others) through the lens of trauma, understanding these as survival responses rather than pathology.”
Most important, in my view, is that trauma informed therapists put a high premium on not retraumatizing their patient. I have been hesitant to try EMDR (Eye Movement Desensitization and Reprocessing) specifically because I’ve been afraid of the risk of retraumatization, but I’d be willing to try it with the right therapist.
Other techniques trauma informed therapists might use include, but are not limited to:
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
I have met with at least 3 therapists trained in CBT who didn’t ever use this technique, and I’m not a huge fan of it because of its focus on thoughts, and in my mind, bad or overactive thoughts are a symptom not a cause.
Somatic Experiencing (SE)
Internal Family Systems (IFS)
Sensorimotor Psychotherapy
Prolonged Exposure Therapy (PE)
Polyvagal Theory-Based Interventions
Arts-Based and Expressive Therapies
This includes art therapy, music therapy, drama therapy, and writing/journaling. In Sweden, they’ve started what’s called “kultur på recept,” or literally “culture by prescription,” where patients are prescribed group activities in an effort to undermine high levels of stress, anxiety, and/or depression.
Trauma-Sensitive Yoga
Did you know there’s such a thing as trauma informed yoga? I didn’t until my temporary therapist mentioned it, recommending Parkside Psychiatric Hospital & Clinic’s YouTube videos. I haven’t yet tried them myself but I might. Normally, I’d facepalm at yet another medical professional recommending yoga (as if it’s a cure), but apparently at least one of Parkside’s yoga videos is specifically focused on trauma, so who knows? Don’t ask me what makes it trauma informed, but if it helps, it helps.
Compassion-Focused Therapy (CFT)
Helps clients cultivate self-compassion as they address feelings of shame, guilt, or worthlessness stemming from trauma. As I sometimes tell myself (out loud), “Grace over guilt” or “Grace over shame.”
Now, I’m not a medical professional, so I can’t say if any of these techniques are more pseudoscientific than others. I recommend doing your own research. With that said, I think it’s very important to remember that simply working with thoughts and thinking patterns is not going to cut it when trying to work through trauma.
I’m a big proponent of learning the why of trauma on a psychological and structural level (clearly), but even knowledge isn’t enough because you can’t just think and learn your way through trauma. I would argue that healing requires play and that trauma informed therapists should encourage this in their patients.
Queue Robyn’s 1999 hit “Play.”
Living in fight/flight/freeze, i.e. survival mode, means shutting down any part of us that is not necessary for survival. Personal hygiene can take a hit as well as physical health, but so can putting effort into doing things that bring us joy. When I say joy, I don’t mean instant gratification and impulse shopping. I mean doing things that, however small, make you happy and offer a respite from everything your mind and body are dealing with or screaming at you.
Why do I love playing with kids, telling stories, using my imagination, and reading fantasy fiction? Because for me, a sense of wonder helps ease the weight of everything else and reminds me that there is magic, love and light left in me to spread. Play is not just for kids.
If you need inspiration, here are some things that bring me joy:
Don’t ask me why, but many of my favorite authors tend to have lived in the 1800s. Maybe I prefer them because they were so attuned to the human condition.
As Zoe Williams writes in The Guardian, “the rational mind cannot do the repair work on its own, since that part of you is pretending it has already been repaired.” Your brain basically goes, “I’m not listening!”
I think I’ve been waiting to meet “the right therapist” so that I can finally start healing, but I think sometimes, we need to help ourselves, too. I don’t say that to gaslight you or tell you to pull yourself up by your bootstraps, but sometimes when we feel awful, there’s an element of, “I just want someone to tell me what to do so I can finally feel better.”
Well, sometimes that someone is you, and play is a big part of finally feeling better.
** This reminds me of something Maté writes in The Myth of Normal, namely that, “Although modern medicine’s focus on the individual organism and its internal processes isn’t wrong as such, it misses something vital: the pivotal influence of the mental, emotional, social, and natural environments in which we live. Our biology itself is interpersonal” (54).
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