People enter therapy for a number of reasons. Sometimes it’s because of a relationship and other times it has to do with feeling like they aren’t functioning as well as they would like. This can be the result of anxiety, depression, irritability, sleeplessness, etc. Therapists work with clients to treat these symptoms and hopefully help the client live a more fulfilling life. However, oftentimes finding the root cause and treating that can in turn alleviate pain caused from other symptoms. Imagine taking a painkiller to assuage the pain of a nail in the foot. The painkiller might provide some relief, but the pain might always be there, or at least return, unless the root cause is treated. In this case, the nail needs to be taken out! This is often the case with assessing for and treating trauma in therapy. Treating past trauma gets to the root cause of the pain and can provide relief.
The most common response I get to assessing for trauma in the first couple of sessions is, “But wait! I don’t have any trauma! I’ve had a good life!” Or, “My parents did the best they could. They would be devastated if they knew I thought they could have done better.” Or perhaps, “Sure, some terrible things happened but I’m pretty much over them now.” Sound familiar? The thing with trauma is that those statements can be true and yet you can still be affected by trauma. You might have a good life, but still be affected in some ways by trauma. Your parents might have done the very best they knew how, but it still could have been hurtful for you as a kid—and that might still impact you in adulthood. And yes, you might be largely over pain from the past, but that doesn’t mean you don’t experience any remaining symptoms. For example, here is a list of some symptoms associated with trauma: Anxiety, depression, irritability, insomnia, guilt, shame, withdrawing from others, feeling disconnected or numb, difficulty concentrating, mood swings, fatigue, being startled easily, muscle tension, aches and pains, edginess and agitation, etc. The list goes on and on. This is why I personally always assess for trauma. It doesn’t mean it’s there, it just helps create a more thorough and pertinent treatment plan.
In discussing trauma, there are two types: A traumatic event that fits the DSM-5 criteria for PTSD (post-traumatic stress disorder) and complex trauma, which refers to simultaneous, sequential, and chronic experiences often beginning in childhood. I think it’s important that some examples be given of each.
Some examples of PTSD as defined in the current DSM-5 (the manual for mental disorders that clinicians use when diagnosing and submitting claims to insurances) include extreme events that can be violent or accidental. These events may include feelings of helplessness, horror, fear for one’s own life or the lives of others. A few examples of this type of trauma include rape, war, natural disasters, etc.
However, most of the clients I see don’t fit the criteria for PTSD per say, but they are absolutely experiencing effects of complex trauma. Although Complex Post-Traumatic Stress Disorder has not yet been added to the DSM, there is plenty of literature backing its validity. Complex trauma can include emotional abuse and neglect, sexual abuse, physical abuse, and even being involved or witnessing domestic violence. Complex trauma is what I see the most of in my practice. For example, an only child with two working parents who puts herself to bed each night and wakes herself up each morning may suffer as an adult from the pain of being neglected in childhood, even if her parents were doing all they could to put food on the table. Another example might be a young boy repeatedly molested by a family member as a child. Although he might be a grown adult now with those events long behind him, he might come to therapy presenting to be “terrible” in relationships. Only later would we discover that his fear of intimacy would stem from his childhood experiences of being abused. In both of those examples, assessing for and treating traumas that happened long ago can have a big impact on the effectiveness of therapy.
Do you think you still experience the impacts of a painful past event? Then trauma therapy might be beneficial for you. Clients benefit from a therapist that is empathetic, sensitive, patient, and knowledgeable to properly diagnose and treat it. The last criteria is a must—many therapists don’t receive extensive training on treating trauma. Don’t be afraid to “therapist shop” and ask about their training in dealing with trauma.
Working through trauma is a very personal, emotional journey. Although working through trauma can be painful, it can have a big payoff. It can be liberating and restore hope. It can restore confidence. Perhaps most importantly, it can help us be an advocate for others. Robert Bly once said, “Where a man’s wound is, that is where his genius will be.” Call or email to schedule an appointment today and finally work to put the past, well, in the past.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
The Body Keeps the Score by Bessel Van Der Kolk, M.D.
Kayla is a therapist specializing in trauma. She is trained in EMDR (Eye Movement Desensitization Reprocessing) and uses its practices in conjunction with emotionally focused and narrative therapy techniques to help clients resolve painful past memories and experiences.