What is trauma therapy?

A brief guide to trauma therapy: History, trauma, and current trauma therapy.

History of trauma therapy

Trauma therapy approaches have had significant changes over the past century. Sigmund Freud, the founder of psychoanalysis, observed correlations between childhood abuse and adult distress and used talk therapy to move client information from the unconsciousness into the consciousness. After World War II, trauma therapy shifted from not talking about problems to listening to the stories of people who experienced trauma. The 1960s saw the onset of increased support for women experiencing intimate partner violence and cognitive behavioural therapy (CBT) approaches. In 1980, Post-traumatic Stress Disorder (PTSD) was a diagnosable condition. By the mid-1980s, trauma practice was established as a discipline and there was an emergence of many different treatment options. Judith Herman's work helped shift PTSD from a disorder of anxiety to shame. The Adverse Childhood Experiences (ACE) Study showed us that adverse experiences correlate with negative health outcomes.

What is trauma?

There are many different definitions of trauma. One way to conceptualize trauma is as an injury from something that has overwhelmed our ability to cope. Bruce Perry defines trauma as, "an experience, or pattern of experiences, that impairs the proper functioning of the person’s stress-response system, making it more reactive or sensitive." Trauma can be described in different ways, such as developmental, relational, systemic, intergenerational, secondary, vicarious, and more. When we are faced with traumatic stressors or events, our nervous system tries to protect us from threat by going into fight, flight, or freeze states. In Dr. Dan Siegel's window of tolerance model, we each have a window or range where we can tolerate emotions and integrate our experience. Outside of our window of tolerance, we can experience hyperarousal (e.g. in a fight or flight state feeling anxiety) or hypoarousal (e.g. in a freeze state feeling numb or dissociated) states.

Clinically, clients may experience varied symptoms following trauma, such as re-experiencing the trauma, avoiding traumatic reminders, and/or a persistent sense of threat. Some clients with complex trauma may have disturbances in emotional regulation, self-concept, and relationships. While trauma can narrow our window of tolerance, trauma therapy can help widen our window of tolerance.

What is trauma therapy now?

Trauma therapies now recognize that client healing and rebuilding resilience is based on empowerment, trust, choice, collaboration, and safety. Many trauma therapies focus on building clearer and continuous narrative memories of traumatic events. While many trauma psychotherapies utilize cognitive or top-down approaches, there are many bottom-up approaches that emphasize healing through emotion and body work. Healing trauma is based on building supportive connections within and outside the self. Trauma survivors may feel disconnected from their internal and external self when they are chronically feeling threatened. Trauma therapy can help clients move into more regulated states and build safer connections within oneself and in relationships with others. Most trauma work occurs at the level of building safety, presence, and connection through orienting to the present, developing emotional regulation skills, and exploring meaning while re-establishing safe boundaries. Healing often involves working with shame from previously violated boundaries. Later trauma work involves integration, meaning making, and rebuilding balance and connection to help clients improve integration within themselves, flexibility, and reconnection with others. You are welcome to book an appointment with me to see if we can be a good fit to begin your journey of healing from trauma.