The trauma therapy model outlines the stages of therapy and the steps that happen in each stage. But different therapists will use different treatment approaches within the model to help you deal with the trauma.
In order to understand what to expect at every stage of the trauma therapy model, you need to know the range of therapeutic approaches your therapist may use. The following example shows how the trauma therapy model can include different approaches to working with clients.
A trauma abuse survivor tells her therapist that she is very anxious and can't sleep. The trauma therapy model says that her anxiety needs to be dealt with and managed before other issues in her life are looked at. The techniques used to help her with her anxiety and sleeplessness will differ depending on what the therapist has been trained in.
One therapist may use a treatment approach called cognitive-behavioural therapy (CBT). Another therapist may use other approaches, such as eye movement desensitization reprocessing (EMDR), hypnotherapy or guided imagery. These aim to help the woman feel calmer and less overwhelmed by her emotions. A psychiatrist may prescribe medications to help her sleep and reduce her anxiety. These treatment approaches are all described below and in the glossary.
Most skilled therapists are trained in several different types of treatment, which they may use in combination or alone. But all treatment approaches should follow the stages of the trauma therapy model. Effective therapists will adapt the different treatment approaches to suit you best.
Here is a brief description of the main therapeutic approaches:
Psychoeducation
Psychoeducation teaches abuse survivors about different psychological processes and their effects. For example, the therapist may explain that what you are feeling and doing is typical of reactions that other survivors also describe; after learning that your feelings are normal, you may begin to feel less isolated or “crazy.” Your therapist may also explain the effects of trauma in both the short term and long term, and how trauma can affect your body, your emotions and how you develop.
The therapist may also give you information about abuse and neglect.
All of the information isn't given at one time, but throughout your therapy, depending on what you are discussing and dealing with at the time.
Cognitive-behavioural therapy
Cognitive-behavioural therapy (CBT) focuses on helping the client become aware of how thoughts, attitudes, expectations and beliefs can contribute to feelings of unhappiness. The client learns how certain beliefs, which may have been developed in the past to deal with difficult or painful experiences, are no longer helpful or true in the current situation. The client can then try to change the behaviours, thoughts and beliefs that are no longer helpful.
Often, CBT involves homework or written exercises. For instance, the client may do various written exercises in which she explores the accuracy of certain negative beliefs (e.g., the mistaken belief that she somehow responsible for her own abuse) by questioning or challenging evidence to support her perspective.
CBT can also involve what is called “exposure techniques.” This is particularly helpful for people with simple post-traumatic stress; that is, those who have been traumatized by a single event. Exposure therapy involves gradually exposing the person to the feared situation until she becomes desensitized, or no longer reactive to what originally created so much fear.
CBT can also involve helping the client to develop coping strategies to reduce her anxiety. This may include breathing retraining, relaxation and imagery or visualization exercises.
Eye movement desensitization reprocessing
Eye movement desensitization reprocessing (EMDR) is a new psychotherapy used to treat responses to traumatic experiences, such as anxiety, guilt, depression, panic, sleep disturbance and flashbacks. EMDR is not a complete therapy system, but is a technique that can be used within a therapeutic approach to treat trauma.
The idea behind EMDR is that people who have experienced trauma or other difficult experiences have stored memories without adequately processing them. EMDR is a therapeutic approach that accelerates the integration of traumatic memories. EMDR stimulates the brain's natural information processing normally and become integrated.
Traumatic memories are believed to be “locked” in the nervous system. As a result, various triggers can cause the person to re-experience the original traumatic images, sensations and thoughts at a later time.
Because the left hemisphere (section) of the brain helps to create meaning and organize memories, left hemisphere processes can help relieve distress. However, traumatic memories are believed to be stored in the right hemisphere and so cannot be processed by left hemisphere processes.
Side-to-side stimulation (for example, through eye movements) seems to unlock memories by allowing the processing of information between the right and left hemispheres of the brain. In the way the person processes the traumatic memory, which had been “locked” into one side of the brain, and balance is restored. This process is thought to be similar to what happens during dreaming and REM sleep.
Note: EMDR can only be done by a properly trained clinician and is used as part of a larger treatment plan.
Medication
Many people with post-traumatic stress find that medication gives them relief from sleeplessness, depression, panic attacks and other reactions. Psychologists, social workers and other non-medically trained therapists cannot prescribe medication. So if you are considering medication, you will need to be referred to a medical doctor or psychiatrist. The doctor should be trained in understanding post-traumatic stress as well as in psychotropic drugs (the medications used to treat mental health issues). Medication can help you manage some of the effects of trauma. But it is not a complete solution, and is best used along with therapy.
Body-psychotherapy
Trauma affects the body and the mind, and a good therapy method should deal with both. Body-psychotherapy is a form of therapy that deals with physiological reactions to trauma. Some body techniques do not involve touch, and are suited to people who are uncomfortable with being touched in therapy.
Sensorimotor Psychotherapy is a type of body-psychotherapy that helps survivors deal with disturbing bodily reactions. It can help you manage and disconnect physical feelings from trauma-based emotions. Sensorimotor Psychotherapy uses the body (rather than thoughts or feelings) as the main way to deal with trauma. In turn, this helps emotional and mental well-being.
Therapists using this technique will sometimes touch clients, but only when clients give consent.