“The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.”
― Judith Lewis Herman,
Often, survivors of trauma seek refuge in a safe therapeutic relationship with qualified trauma-informed psychotherapist. Whether the client experienced abuse (psychological/physical/sexual), witnessed a catastrophic event (i.e. a violent accident or political uprising resulting in terror/violence), or survived a natural disaster (hurricane, etc), the individual often manifests symptoms of PTSD, Post-Traumatic Stress Disorder (DSM-5, 2014), or in some circumstances where trauma is long standing and chronic, Complex-PTSD (Herman, 2015).
What is Trauma-Informed Psychotherapy?
The notion of trauma-informed care is an umbrella term, which describes the overarching principles regarding trauma recovery. The SAMHSA (Substance Abuse and Mental Health Services Administration) defines trauma-informed approach to helping survivors of trauma as demonstrating the following key components of client-centered, strengths-focused, and evidence-based care: 1) safety, 2) trustworthiness and transparency, 3) peer support (creating safety in community), 4) collaboration and mutuality, 5) empowerment, voice and choice, and 6) embracing understanding of cultural, historical and gender domains (SAMHSA, 2015).
Safe Holding Environment
Survivors of trauma require a “safe holding environment” (Winnicott, 1965) whereby the client feels psychological safety to explore their trauma and release it. By virtue of the concept of trauma, a survivor cannot move through and recover from trauma unless and until they have access to a psychologically and physically safe environment from which to heal. A skilled, strengths-focused, trauma-informed therapist will create a “safe holding environment” for their clients to do the tough work of trauma recovery.
Focus on Trauma Recovery
The client will benefit from strategically working with their clinician utilizing interventions which address how trauma is “held” in the body (van der Kolk, 2015). For example, EMDR (Shapiro, 2016), expressive arts therapies, mindfulness based cognitive behavioral therapies, and other modalities that address mind-body connection have shown evidence in studies to assist in the releasing of trauma and accompanying losses (van der Kolk, 2015). Clearly, the trauma-informed clinician needs to be trained in such modalities and demonstrate competence and compassion.
Collaborative and Strengths-Focused Approach
Clinicians working with trauma survivors employ a humanistic or Rogerian approach to working with clients (Boundless, 2016). The therapeutic relationship is considered a collaborative and team effort between client and therapist, whereby the client is empowered to drive the treatment with the therapist creating the “safe holding environment” and the scaffolding of compassionate clinical expertise so that the client can release trauma. Pathological terminology and diagnostic labeling of the trauma survivor is contraindicated, as narrating an empowering story of resilience and fortitude assists the client in achieving mastery of their traumatic experience(s).
Part of good trauma-informed psychotherapy also includes helping the client to access and utilize internal and external resources for healing. To reframe the traumatic reaction (freezing, numbing, hypervigilance, etc) as a protective response to survive an incomprehensible trauma is to help the client to release any shame or self-blame. Assisting the client to learn more adaptive coping skills (relaxation strategies, etc) and innate capacities (i.e., a client’s propensity to journal about trauma/loss), guides the client to restore and reclaim a sense of agency and internal locus of control.
Restoration of Safe Community and Connection to Safe Others
“Traumatic events destroy the sustaining bonds between individual and community. Those who have survived learn that their sense of self, of worth, of humanity, depends upon a feeling of connection with others. The solidarity of a group provides the strongest protection against terror and despair, and the strongest antidote to traumatic experience. Trauma isolates; the group re-creates a sense of belonging. Trauma shames and stigmatizes; the group bears witness and affirms. Trauma degrades the victim; the group exalts her. Trauma dehumanizes the victim; the group restores her humanity.” ― Judith Lewis Herman,
Finding a safe support group specific to the type of trauma/loss can be instrumental in a client’s healing (i.e. a bereavement groups specific to parents of teens who committed suicide). When a sense of safe community and connection is restored, the client obtains the building blocks to move through to the challenging work of releasing held trauma. The good news is that trauma is very treatable, and with excellent trauma-informed care, a client moves from surviving to thriving.
Boundless. “Humanistic Therapy.” Boundless Psychology Boundless, 20 Sep. 2016. Retrieved 30 Aug. 2017 from https://www.boundless.com/psychology/textbooks/boundless-psychology-textbook/treating-psychological-disorders-19/approaches-to-psychotherapy-98/humanistic-therapy-372-12907/
Ciccarelli, S. K., & White, J. N. (2014). Psychology: DSM 5. Boston: Pearson.
Herman, J. L. (2015). Trauma and recovery: aftermath of violence from domestic abuse to political terror. New York: BasicBooks.
SAMHSA’S CONCEPT OF TRAUMA AND GUIDANCE FOR A TRAUMA … (n.d.). Retrieved August 30, 2017, from https://www.bing.com/cr?IG=F7904E5C6E58424AA71E3BB80A54DE7D&CID=1C931DBC92E660AD0AA5175293E061F4&rd=1&h=7Gx_yRhgB38r3H0uGu7Uo3kIrdPb62oWVLsS7BMvtms&v=1&r=https%3a%2f%2fwww.pathwaysrtc.pdx.edu%2fpdf%2ffpS1510.pdf&p=DevEx,5403.1
Shapiro, F., & Forrest, M. S. (2016). EMDR: the breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic Books.
I. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, MD | Key Takeaways, Analysis & Review. San Francisco: IDreamBooks Inc.
Winnicott, Donald Woods. The Family and individual development: D.W. Winnicott, .. London, Tavistock, 1965.