What is Trauma Informed Therapy?
The vast majority of clients I work with aren’t in therapy due to a lack of insight.
Most people seem to have a very clear sense of their distress — what it is, why it hurts, sometimes even what’s causing it. For example, when a client comes to therapy to address an issue with substance abuse, they can usually tell me plainly something like: “I drink to escape my anxiety, but I usually just end up feeling even worse later.”
Just look at all of the awareness packed into that statement! 1) The client is aware that they are in a cycle of behavior involving drinking. 2) They are aware that they engage in this cycle to reduce their anxiety (which means they probably know that alcohol is a substance capable of doing that). 3) They’re even aware of the paradoxical nature of their relationship with alcohol — how it both alleviates and worsens their symptoms. So much awareness, which begs the question: why do they need therapy?
Usually we can see, plain as day, the patterns that we are caught up in. And in many cases, it’s actually the awareness of those patterns that can be particularly painful. The gaps between what we know and what we habitually do can often be excruciating to face. The same is true for gaps between what we know and what we feel. For instance, you may know that you are technically safe but deep down in your body you may feel like something is wrong.
So what causes these gaps between our thoughts, feelings, and behaviors? For many of us, the cause is trauma.
Trauma has a way of creating disorganization within your nervous system, making it hard to gauge whether you are safe or in danger, loved or hated, in control or out of control. And because trauma activates our most primitive neurobiological systems (i.e. the fight-and-flight and freeze responses), the truth is: self-awareness isn’t enough to address the problem.
Allow me to say that again —
For those with a trauma history: self-awareness isn’t enough.
Look: insight about yourself is a wonderful thing — that is, when you are in a state (physically, mentally, and emotionally) that allows you to make any use of that insight. However, when someone is traumatized, that kind of state can be hard to come by. I have worked with many clients who describe feeling like they can logically connect to an idea in their head (e.g. they logically know that they are a worthy human being), but everything inside of them from the neck-down seems to disagree. Trauma-informed therapy is neck-down therapy.
But what does that mean exactly? Here are a few ways I would describe trauma-informed therapy.
#1. Trauma-informed therapy is neuroscience-informed therapy.
Your brain and body are at the center of this kind of work. A therapist who is truly trauma-informed knows about the function of your autonomic nervous system (i.e. the fight, flight, and freeze responses that I mentioned earlier). They know about concepts like neural integration (i.e. the connection between your brain and body) and the “window of tolerance” (i.e. a marvelous state we enter as human beings that allows us to take safe enough risks).
Your trauma-informed therapist will also know about the deeper regions of your brain, the ones that evolved long before you and your ancestors could simply walk on two legs into a therapy office. They know about the hierarchy of your nervous system — how your body might actually enter life-saving states in response to neutral threats. And most importantly, they know how to work within this hierarchy — how to help your body and brain orient to the reality of your current experience rather than the realities of your past experiences.
#2. Trauma-informed therapy is about giving you back a sense of agency.
Many types of trauma involve experiences in which you are not the one in control. Incidences of abuse, violence, illness, etc. — these are all situations that rob an individual of their sense of agency. Because we are treating the impact of disempowerment, trauma-informed therapists look for opportunities to give power back to their clients wherever possible. For me, this looks like being intentional about framing opportunities in therapy as a choice. If I think a certain intervention might be helpful, I don’t just launch into it; I offer it as an option. And if the client declines, I celebrate their willingness to set boundaries with me.
This has become routine in my practice, particularly after hearing from so many clients about past therapy experiences in which they felt pushed or even coerced to explore things they didn’t feel ready to explore. While trauma-informed therapy is about finding ways to process tough stuff together, the client gets to decide when to do that — not the therapist.
#3. Trauma-informed therapy is about honoring your coping strategies (even the ones that aren’t working so well for you anymore)
Human beings are just incredible. When faced with far-from-ideal circumstances, we often find ways to adapt. That’s what it means to have a coping strategy — to engage in a behavior that helps you survive. The difficulty with this is that sometimes these strategies have a way of sticking around long after they are actually useful, particularly for those with a trauma history. Here’s a non-exhaustive list of some of the coping strategies I see as a therapist: negative self-talk, overthinking, enmeshment in relationships, shutting people out, distraction, behaviors in excess (eating, drinking, exercise, etc.), procrastinating, self-harm, suicidal ideation, outbursts of anger, etc.
Many people come to therapy to address these things, but any trained trauma-informed therapist knows that to set aside a behavior, we first have to honor the very good reason why it exists in the first place. In this kind of therapy, you will learn to have compassion for parts of yourself that feel objectionable to you, and that will be the key to your healing.
#4. Trauma-informed therapy prioritizes process over content.
What you share in therapy is so important, sacred, and precious to your therapist. But trauma-informed therapy is about more than just the story you tell; it’s about the experience you have while you’re telling it. Our bodies hold implicit memories that emerge in the form of sensation and emotion. In trauma-informed therapy, the goal is to bring these sensations and experiences into your awareness. In doing so, you will hopefully be able to engage with them in a new way.
For instance, while in a therapy session, you may recognize the feeling of a hollow ache in your chest as sadness. Feeling sadness is a vital, adaptive human experience that is necessary for your own wellbeing. However, if your trauma has left you with negative associations with sadness, you may have developed a protective strategy to shut down when sadness comes up.
In trauma-informed therapy, your therapist might help you override this protective strategy by inviting you to slow down when you notice that ache in your chest. They might ask you to describe it in greater depth, to breathe into it, to share a memory or an image that comes to mind as you feel it. By examining your internal experience alongside a safe, non-judgmental other, your mind and body may begin to develop new associations with your emotions.
That’s what trauma-informed therapy is essentially all about: developing new associations. Our nervous systems are wired around our experiences. While traumatic experiences can cause the wires to get crossed (so to speak), the wonderful news is that new experiences can set them right again. Trauma-informed therapy is about creating opportunities for positive new experiences that will hopefully help you feel more like yourself than ever before.
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What has your experience in trauma-informed therapy been like? Feel free to let me know in the comments below!