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.
EMDR (Eye Movement Desensitization and Reprocessing) is a type of therapy that enables people to heal from the distress and ongoing symptoms that can result after experiencing trauma. Repeated studies show that by using EMDR clients can streamline the therapy process; EMDR therapy enables individuals to experience the benefits of years of psychotherapy in a much shorter amount of time.
One study*, focused on sexual assault victims, found that 90% of PTSD sufferers exhibited eliminated symptoms after only 3 sessions of EMDR.
The American Psychiatric Association, the World Health Organization, the Department of Veteran Affairs, and the Department of Defense all recognize EMDR as one of the most effective treatment for trauma and other disturbing events.
Read more about EMDR Psychotherapy: What is EMDR?
Kayla Burningham, AMFT is an EMDR certified therapist, and specializes in helping clients overcome the trauma from their past.
Contact our office to speak with Kayla and learn more.
*Rothbaum, B. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.
Choosing the best therapist for you can be difficult. This is the person you hope to share your deepest darkest secrets with!!! You might ask, “How can I know if I will be able to trust him or her!” “How do I know if this person is right for me?” “How can I know they can help me?” or “Can they really understand what I am going through?”
It’s important to ask yourself these questions and find someone that you feel understands your needs and that you can trust to help you. Many people seeking help can go through several therapists until they find the one they are comfortable with. A good therapist understands this and will respect your choice to find safety. As a practicing therapist, I have functioned in both the capacity of someone’s first therapist as well as someone’s last.
Research has shown that the best outcomes in therapy come from two very general dynamics (Cooper & Lesser, 2011, p.33; (Teyber & McClure, 2011):
- The client’s comfort and connection with the therapist and
- The therapists sense of hope in the client’s progress.
In practical terms, this means to attend one or two initial sessions and trust your instincts on whether there is a good connection. You may need to explore different therapists – but it is worth it.
Here are some other thoughts to consider:
- We Don’t Sell!
- Be aware that a good therapist will be inviting, but will not try to sell you on their treatment….you may feel motivated to continue with a therapist after the first session(s), but you won’t feel pressure.
- We are All Unique!
- Every therapist has a different personality and a different style of practice. For example some may be skilled at listening and letting you come up with solutions, some are more directive. Choose the person that you feel will suit your needs and personality. Ask your therapist what his/her process of change looks like in dealing with your issues. Understand your treatment plan.
- We Don’t Give You Fish….We Teach You to Fish!
- Both the therapist and the client need to be working together towards the issues that the client feel are important towards him and her. A therapist doesn’t force the client to change or make a habit of telling the client a specific course of action to resolve a dilemma. They should however, help you develop skills and perspectives that allow you to own and solve your own issues effectively. In this way you continue to grow long after therapy is over. Assignments and opening your heart and mind to new perspectives are important in this regard, not necessarily advice giving. Over time, you will learn to both trust yourself and work with others in getting answers.
- There is No “Right” Way!
- There are many different theories of practice out there (e.g. cognitive-behavioral therapy, emotional focused therapy, etc.) and many different types of therapists (LMFT, LCSW, CMHC or LPC, Psychologists, Psychiatrists). Ask your therapist what theories they practice and how they view change and progress with individuals and families. Ask them to give you a basic outline of these theories.
- Be Committed to the Process!
- Most therapists will do a 15-30 minute consultation for free to find out all of these questions and get to know them more; here at Connections, we offer a 30 minute consultation. Don’t be afraid to shop around. But when you do choose a therapist, spend more than a few sessions with them. Therapy can take time. If you find yourself not progressing or feeling uneasy in your session, or if you are concerned with how your therapist is handling certain issues, talk to them about it! A good therapist will be open and helpful with this information. They will be respectful of your issues and seek to come to an understanding of your needs if you feel they don’t already.
- We Don’t Need our Ego Brushed. Be Honest with Your Feelings!
- There have been many times clients have been concerned with how I say something or do a certain therapeutic process, but will be afraid to speak up. If I don’t catch it right away, the client will not receive the amazing benefits that come from working through relationship concerns with someone skilled in this process. When a client opens up about some of his/her concerns, these can be some of the most uplifting, growth inducing processes in a session. It is necessary to have a safe and open dialogue with your therapist. If you feel that you can’t, you need to be direct and honest with them.
- If you feel that you aren’t understood or heard when this happens, be honest and seek to find a therapist you feel that you can be honest with and that you feel will validate your concerns. Often times this isn’t about the therapist or you as the client nearly as much as it is about the therapeutic style, personality compatibility, and your current motivations for change and growth. Don’t be afraid to be honest with your feelings towards your therapist. A good therapist will be able to emotionally handle any feedback they are given. You are paying them to help you. They understand this. Don’t waste your money on unsaid and unspoken language.
- Not all Therapists Are Trained the Same!
- There are different types of therapists that are best suited for specific issues. Ask your counselor what they are trained in. Therapists have been trained on most client issues but their training and approach is particularly suited to some issues more than others. Ask your therapist about their experience in the areas that are of interest to you. As an MFT (marriage and family therapist), people will often assume that I only specialize in family and couple counseling but not individual counseling. This is a mistaken assumption. Most MFTs work mostly with individuals with a variety of issues. They are just trained to view many problems in the context of the relationship and family system. Psychiatrists and psychologists are often misunderstood as well. Psychiatrists attend medical school and most of their work consist of diagnosing and prescribing medication. Psychologists don’t prescribe medication but can diagnose and test. Most therapists have the training to diagnose, but might send you to a psychiatrist or psychologist for further testing or medication.
A Few Final Points…
Recognize your expectations with the therapy process and open up to your therapist about them. Clients will often expect their therapists to lead the counseling sessions. Meier and Davis discuss a few important factors to consider when starting counseling:
- The pain can get worse before it gets better, so consider with your therapist if the pain you are experiencing in therapy is legitimate pain of growth, or if it is making things worse.
- Therapists take confidentiality very seriously but you should talk to your counselor about the exceptions to confidentiality.
- People who go to counseling are those with the courage and capacity to seek and consider input in helping them function more happily and effectively in their every day lives. Getting help is not a weakness….
Kyle is a Marriage and Family
Therapist, specializing in individual,
relationship, and family work.