For this month’s blog, we had a Q and A with wonderful Harborside clinician, Hannah, who shared her perspective on trauma work in therapy.

1. Why should someone with trauma seek out talk therapy?

Trauma, which is another word for “wound” or “injury”, is an emotional response to an event, series of events, or circumstances, which are experienced as significantly harmful or life-threatening. Trauma can create significant and lasting impairment in a person’s relationship to self, safety, and others. When someone experiences severe physical wounds, it is urgent they receive medical treatment; similarly, it is urgent for individuals to receive mental health treatment if they wish to resolve the mental impacts of trauma and establish healthy relationships with themselves and the world around them. A well-qualified therapist can create a safe place for clients to confront their trauma and break free from survival mode; facilitating the post-traumatic growth necessary to create a life worth living. 

2. What are the biggest reasons people with trauma may hesitate to go to therapy?

There are several reasons why individuals with trauma may hesitate to go to therapy. Our society has made incredible gains to understand and accept the role of therapy, but many still perceive a stigma when seeking help. Especially for someone with trauma, who by definition has experienced emotional harm or injury, the idea of opening up to vulnerability and confronting emotional wounds can be quite daunting. Even if a person feels ready to begin healing, they may be stuck in social environments that are unsupportive and reinforce harmful stereotypes. Also, healing from trauma often requires intensive emotional work, and can require one to challenge relational and/or behavioral patterns that may create a false sense of safety under the guise of familiarity. It can be terrifying to change maladaptive coping skills, and sometimes even those who profess to care about us may be scared to see us change too. Fear and shame are powerful emotions that can be quite effective at keeping us trapped in cycles and environments that don’t service healing or growth. 

3. How do I know if I’m ready to address my trauma in therapy?

First, it’s important to acknowledge that even if one feels “ready” to address their trauma, it’s extremely normal to have mixed emotions in doing so. After all, we just listed plenty of understandable reasons people with trauma avoid therapy! However, just because you may have mixed emotions about addressing trauma, does not mean that you are not capable or ready to confront these wounds. In fact, most folks never feel 100% ready. That being said, there are a few good signs to look for when considering whether you may be ready to take that brave step.

1. You want to. Even if you’re unsure or have mixed emotions, you recognize that the damaging effects of trauma are interfering with your ability to enjoy life and meet your goals. You want to better understand yourself and what’s happened to you, and you want to stop feeling held back or defined by it. You want to build a meaningful life on your terms and live it fully. 

2. You’ve addressed and are actively managing any acutely harmful and maladaptive coping behaviors that could interfere with trauma work. Often, and understandably, clients want to jump right to the “root cause” in therapy. But issues such as eating disorders, substance abuse, and self-harm, can easily become triggered while engaging in trauma work. It’s imperative to have a handle on these risks in order to safely confront trauma. A broken gas pipe that causes a house fire must be addressed in order to prevent future fires; but when the flames are lighting up your home’s walls, you call a fireman first— not a repairman.

3. You have a safe and trusting relationship with your therapist, and the decision to pursue trauma-oriented work is one that feels collaborative. You should feel empowered to go at a pace that feels right to you, and safe to pause or reassess how the work is going, at any time. You’ll want to have some trust that you can communicate your needs and advocate for yourself throughout the process, and that you can trust your therapist to be open to hearing your feedback.  

4. What should I look for in a therapist to help me address trauma?  

There are a few qualities you might want to look for in finding a trauma-informed therapist. Research shows that having a safe, trusting, and affirming relationship with your therapist is the primary predictive factor to experiencing successful therapeutic outcomes. So, most importantly, is working with a therapist that you have a positive relationship with. For many, a therapist who is nonjudgmental, who holds space to honor your full emotional experience, and who you believe holds unconditional positive regard for you, can create that safe and trusting relationship. 

Secondarily to the valuable relationship between client and therapist, it will likely be helpful to find a provider who is transparent and informative about the modality they use to treat trauma. There are a few different evidence-based approaches to trauma treatment, and it may be that a certain approach resonates more with your values and experience. Modalities such as Dialectical Behavioral Therapy (DBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Internal Family Systems Therapy (IFS), and Eye Movement Desensitization & Reprocessing (EMDR), have all been shown to be effective, yet have their own pros & cons. You can always do your own research to determine if there’s an approach that most appeals to you. At the very least, however, your provider should inform and prepare you as to which modality, or mix of modalities, they are trained in, to help ensure their approach will be a good fit for your needs.