What Is Trauma?
When I talk about “trauma” I’m talking about both PTSD and trauma which are not necessarily the same thing under psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM). If you have PTSD you have been traumatized. However, you can have severe trauma symptoms yet not meet the psychiatric criteria for PTSD.
Trauma can be virtually anything you couldn’t cope with physically, mentally, emotionally, or spiritually at the time … anything that still interferes with your life weeks, months, or even years later. It’s not so much the event that’s traumatic, but the way you perceived and reacted to that event. Two people can experience the exact same thing yet have totally different reactions to it … because they are different and unique people with different life experiences, values, perceptions, beliefs, histories, etc. Sometimes we know what happened to us, and at times we don’t. We simply know we’re stuck, something is missing or wrong in our lives, and we haven’t been able to fix it on our own.
Trauma can be acute (a one-time event), chronic (a series of small, cumulative events), or complex (a violation of trust and safety) and it is possible to have experienced and suffer from all three. Developmental trauma by definition occurs when we’re babies, infants, young children. It can be acute, chronic and/or complex and can affect brain development, resulting in lifelong social, emotional, and cognitive impairment. Developmental trauma can also lead to risky behaviors later in life, result in increased disease and disability, and ultimately contribute to early death. We often have no memories before the age of 2 or 3. As a result we may have no cognitive or verbal memories of trauma as an infant, but we can still have life-long physical and emotional reactions as a result of those events. You can also have delayed trauma, events you’ve not thought of till retirement or illness suddenly gives you more time to think, and those memories come back in.
Families and caregivers can also suffer secondary trauma or vicarious trauma. Secondary trauma is an acute or sudden response to someone else’s story or experience of a traumatic event. Vicarious trauma or compassion fatigue, on the other hand, sneaks up on us. It is cumulative and insidious.
Common trauma reactions people experience can be a bewildering mix of behavioral, physical, mental, emotional, spiritual, relational and social. Reactions can be sudden and acute but they are quite often gradual, showing up weeks, months, or even years after a traumatic event. Seeing those links between our current reactions and past experiences can be tough. Others may see the changes, but often a person with a history of trauma either doesn’t see it or tries a variety of ways to survive, to cope … suppression, repression, denial, alcohol, drugs, medications, emotional suppression, over-working, over- or under-eating, social withdrawal, self-harm, fighting, sexual acting out … ways that may work for the short-term but not for the long-term.
Trauma reactions are all too common. They are not disorders or mental illnesses, although they are often misdiagnosed as such. They are painful yet understandable reactions, survival behaviors, to abnormal events. And everyone can and does have their own unique patterns of reactions.
Why I Focus on Trauma
Trauma is cumulative. Multiple traumas in life are not good but few people have experienced only one traumatic event. The more traumas we’ve experienced the more likely we are to be affected.
Who has a history of trauma? Bluntly … everyone. The vast majority of those with mental health and substance problems have experienced more than one trauma as a child, and often additional occurrences as an adult – trauma is rarely a one-time event. Approximately 66% of the general population has an Adverse Child Events (ACE) score of 1 and many of us have a score greater than 1. Even if you have an ACE score of zero chances are very good you live, work, socialize with, or otherwise know someone who has a significant trauma history that is affecting their lives now … and possibly yours.
Trauma can occur at any point in our lives – from the womb to the present. And it causes damage. Damage to ourselves, to our relationships, to our ability to function, to our hopes and dreams for the future. It’s damage that hurts us on the physical, emotional, and spiritual levels. And all three levels need attention, often simultaneously, in order to recover.
How I Work with Trauma and PTSD
I assess all my clients for trauma and share those results with them. I use a three-phased and structured approach in treating trauma/PTSD, tailored to your specific needs.
I work with you to suggest various options, but I always start with education to help you better understand your reactions, as well as safety, emotional regulation, various life skills, mindfulness, resiliency, and body awareness. I also encourage you to do regular exercise, have some fun in your life, and work on your diet/nutrition. This phase is indirect work, doesn’t directly address your trauma history or problems, but it does help make it much safer for you to do more in-depth work.
I also encourage all my clients to do some form of body-work to address physical reactions to trauma, reactions we often carry around as chronic muscle tension and pain. Finally, you may need medication for initial stability. However, medication doesn’t address under-lying causes and should never be used long-term or be the only form of treatment. That’s Phase 1.
Phase 2 builds on Phase 1, adds much more psychotherapy, and helps you move toward living according to your own values with a renewed sense of purpose and control over your life.
Phase 3 is direct trauma work where you and I work together to address your specific trauma problems. In this phase we continue the skills learned earlier and, depending on your needs, may introduce EMDR, EFT, internal family systems, and other forms of therapy as needed.
Every person is unique and their needs in terms of treatment will be different. Some people need all three phases plus body-work. Others do just fine and are happy with only the first phase and body-work, or with body-work alone.
Trauma can occur at any point in our lives. It can and does cause life-long problems. But it is fixable and you can recover.
Curious about all this, feel “stuck” in life, want to make some changes, or simply want more information? Send me an email asking for a free consultation. Include your availability in the coming week and I’ll respond within 24 hours with a day and time that works for both of us.