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  What Is... - Counselling Approaches

Trauma Counseling Approaches

There are many trauma counseling approaches and techniques available to address the symptoms of PTSD. Choosing which is the most appropriate might seem confusing.

When selecting a therapist to assist you, they will, hopefully, be trained in a number of approaches so that they can select the approach that is the best fit for you. That choice is will often dependent on your particular struggles. Presenting a clear and honest description of what you are experiencing will help the counselor treat you with interventions which are the best fit for your needs.

Although there are many types of approaches, many are derived from Cognitive Behavioral Therapy and Reciprocal Inhibition.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is probably the most used, intensively researched, and consistently effective treatments for the symptoms of posttraumatic stress currently used by clinicians that treat trauma survivors. CBT Trauma Therapy combines the aspects of Behavioral Therapy (BT) and Cognitive Therapy (CT) so it includes explicit, observable, as well as the implicit and internal behaviors.

One essential feature of CBT is addressing the distorted cognitions (thoughts) that are negatively impacting your life, limiting your activities, outlets and life pleasures. These include:

  1. Identifying distorted beliefs
  2. Identifying the root of the distortion (when did the belief first surface; what happened at that time?)
  3. Extinguish the old belief (often through various exposure and/or challenging exercises)
  4. Develop new more adaptive and intentional schemas or belief systems (i.e., I am doing my best)

Reciprocal Inhibition

Another essential element of CBT is Reciprocal Inhibition; a theoretical approach developed by Joseph Wolpe in 1958.

Reciprocal inhibition was used to explain and direct the treatment of anxiety and phobia symptoms and most recently post-traumatic stress. The theory of reciprocal inhibition holds that when exposure to an anxiety-provoking stimulus is paired with the relaxation response (i.e., the individual is able to keep the muscles in their body relaxed) and the individual is able to maintain this relaxation, then over time fear-provoking stimulus (such as reminders of a trauma) are eventually extinguished through consistent exposure while feeling safe and/or calm.

Reciprocal inhibition, the pairing of exposure and relaxation, is at the heart of all Behavior Therapy with symptoms of anxiety. Some Behavioral Therapies (e.g. in vivo exposure or flooding) begin with exposure and push their way through the anxiety, hopefully to a point where you can become relaxed in the face of exposure. However, these techniques have the potential of re-traumatizing some people especially when you are not able to fully maintain relaxation throughout the exposure exercise and as well if there is insufficient time to resolve or get used to the trauma memory. This would leave the trauma memory recovery work incomplete. It is not until relaxation occurs in the face of exposure to a trauma memory that symptoms subside. It is our opinion that relaxation is a necessary ingredient to symptom resolution and better learned before and experienced during exposure than experienced after the process of being overwhelmed by anxiety, panic or post-trauma response.

Thus, we identify reciprocal inhibition as a "necessary ingredient" in effective treatments of PTSD. Working with your trauma therapist, you will learn techniques to help approach and confront your traumatic history when you are ready. You will also learn techniques for developing and maintaining a relaxation response during the stabilization stage of your treatment as well as during the trauma memory processing portion of recovery. A skilled traumatologist will help you navigate this journey.

Three Phase Trauma Therapy (Tri-Phasic treatment)

Judith Herman is a psychiatrist in the Boston area who has written extensive about traumatic response and therapy. She recommended an approach to trauma recovery that includes three stages. The Traumatology Institute most recommends this approach, as seen in the book Trauma Practice: Tools for Stabilization & Recovery (Baranowsky, Gentry & Schultz, 2010, 2nd Ed.)

Using a comprehensive three phase approach, the client is:

  1. given a sense of emotional and physiological Stabilization prior to moving into
  2. Remembrance and Mourning, which we will now refer to as Trauma Memory Processing, and then
  3. Reconnection with communities and with meaningful activities and behaviors.

Phase 1: Safety and Stabilization

The central task of recovery is safety. People who have experienced trauma often feel betrayed both by what has happened to them as well as their own bodies. Their symptoms become the source of triggers that result in re-traumatization. This can leave the individual feeling both emotionally and physically out of control. Getting the right help to regain internal and external control is a primary focus of this phase. This is accomplished through careful diagnosis, education and skills development. The safety section of phase one, is focused on skills development to aid you to practice self-soothing and care skills to increase emotional and behavioral stabilization. In cases where you remain in an unsafe environment, plans to establish personal and practical safety remain the focus prior to delving into trauma memory processing work. The overriding goal is to make a gradual shift from danger that is unpredictable to a situation where you can rely on safety both in your environment and within yourself. Accomplishing this goal depends on the circumstances as well as your internal ability to cope with exposure to trauma memories and may take days, weeks, or months to achieve. In some cases, individuals may remain in the emotional safety and stabilization phase indefinitely while they work on establishing physical safety. Although we do encourage clients to work through their trauma memories this must be done in a respectful manner with the mutual consent of both client and therapist.

Phase 2: Trauma Memory Processing

In the second phase of recovery you will begin to work more deeply with exercises to work-through trauma history bringing unbearable memories to greater resolution. Because of the nature of traumatic memories, this process is rarely linear. Bits and pieces of the traumatic events emerge and can be processed. The objective is to create a space in which you can safely work through traumatic events and begin to make sense of the devastating experiences that have shaped your life. A good therapeutic relationship should provide you with a compassionate companion who will "bear witness" to your experiences, and help you to find the strength to heal. Using exercises that are designed for trauma memory processing.

There are many excellent Cognitive Behavioral Therapy techniques that fit well within this stage of trauma memory processing. In addition, there are newer approaches such as Eye Movement Desensitization and Reprocessing (EMDR), Time-Limited Trauma Therapy (TLTT), Layering, and Traumatic Incident Reduction (TIR) that have proven to be helpful in trauma memory processing.

Phase 3: Reconnection

The final stage of recovery involves redefining oneself in the context of meaningful relationships and engagement in life activities. Trauma survivors gain closure on their experiences when they are able to see the things that happened to them with the knowledge that these events do not determine who they are. Trauma survivors are liberated by the conviction that, regardless of what else happens to them, they always have themselves. Many survivors are also sustained by an abiding faith in a higher power that they believe delivered them from oppressive terror. In many instances survivors find a "mission" through which they can continue to heal and to grow. They may even end up helping others with similar histories of abuse and neglect. Successful resolution of the effects of trauma is a powerful testament to the indomitability of the human spirit. Once Phase 2 of Trauma Practice is completed, personality that has been shaped through trauma must then be given the opportunity for new growth experiences that offer the hope of a widening circle of connections and the exploration of a broader range of interests.

Treatment Approaches - Trauma Therapy Interventions

Below is a list of some trauma counselling approaches that might be useful for you in your recovery.

This list does not include all the different types of trauma therapy interventions that are available, but it does do a good job of outlining many approaches that have been found to be useful for trauma survivors.

  • Accelerated Experiential Dynamic Psychotherapy (AEDP)
     
  • Acceptance and Commitment Therapy (ACT)
     
  • Addictions Training
     
  • Attachment, Self-Regulation and Competency (ARC)
     
  • Cognitive Behavioral Therapy (CBT)
     
  • CBT Trauma Therapy
     
  • Contextual Therapy
     
  • Couples & Family Therapy
     
  • Crisis Management Training
     
  • Critical Incident Stress Debriefing/Management
     
  • Dialectical Behavior Therapy (DBT)
     
  • Experiential and Emotion Focused Therapy (EEFT)
     
  • Expressive and Art Therapy
     
  • Eye Movement Desensitization and Reprocessing (EMDR)
     
  • Hypnotherapy
     
  • Individual Therapy
     
  • Internal Family Systems Therapy (IFS)
     
  • Marital & Family Therapy
     
  • Motivational Interviewing
     
  • Mindfulness Based Stress Reduction Program/Meditation (MBSRP)
     
  • Movement Therapies
     
  • Narrative Therapy
     
  • Neurofeedback Therapy
     
  • Neuro-linguistic Reprogramming (NLP)
     
  • Psychoanalytic
     
  • Psychodynamic
     
  • Sensorimotor Psychotherapy
     
  • Somatic Experiencing (SE)
     
  • Suicide Prevention Training
     
  • Thought Field Therapy (TFT)
     
  • Time-Limited Trauma Therapy
     
  • Time-Limited Trauma Therapy (TLTT)
     
  • Trauma Resiliency Model (TRM)
     
  • Traumatic Incident Reduction (TIR)