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What Trauma Treatment is right for me?

Writer's picture: Yin-Yee YipYin-Yee Yip

I am often contacted by individuals who recognize that their past trauma impacts their ability to live the quality of life that they want for themselves today. The question they frequently ask is what kinds of trauma therapy do I offer and which therapy I think would be best for them. I respond with a question back to the client asking how they would like to engage with their trauma processing and healing.


Trauma therapy is varied and there are many options that make it difficult for an individual to decide what might work best for them. One thing to remember with trauma therapy and healing is that it will be painful and individuals will have developed adaptive protective responses to prevent themselves from feeling the emotional distress of what happened. Avoidance is a posttraumatic stress disorder (PTSD)/trauma symptom and must also e acknowledged as a safety seeking behaviour but avoidance only temporarily protects an individual from emotional distress and does not reduce the ongoing impact the traumatic event/traumas has on the individual, and in fact may build and reinforce anxiety about the trauma(s) and any reminders of it. This is why regardless of the time and distance from the trauma, the intensity of distress and reaction to reminders feel as threatening as if they are happening in the moment.


Trauma therapy involves confronting the trauma and allowing for a full emotional processing of the event(s) with the physical and time distance from the experience(s). The trauma has the same emotional and physiological experience today as it did when it was happening because it sits as "unfinished" business and trauma healing is about going back to acknowledge the full context of what happened which understandably may feel painful and distressing. The principal of hurting in the service of healing applies and the old adage "it gets worse before it gets better" applies.


There are ways to support an individuals' capacity and ability to go back and process their past trauma and here are a few of the trauma therapies that are a possibility if you work with me:


Cognitive Processing Therapy (CPT) for PTSD is an evidence-based cognitive behaviour therapy treatment that focuses on changing the negative cognitions that may have developed after trauma. This is a 12 50 minute session protocol that requires individuals to confront their trauma through a written account around their thoughts about the "cause" and why of their traumatic event and to identify how beliefs may have formed about themselves, how they see others, and the world. Engaging with this therapeutic approach requires an individual to complete worksheets after each session which may feel empowering to experience the ability to directly control their healing process. Here's a journalist documenting her CPT process and CPT in more detail.


Prolonged Exposure (PE) Therapy for PTSD is an evidence-based emotional processing therapy that involves imaginal exposure and in vivo homework. This therapy is ideally delivered in weekly 60-90 minute sessions resulting in anywhere from 8-15 sessions dependent on the client-led processing required. The protocol starts with providing an overview of treatment, psychoeducation around trauma, and supporting a client to approach and process their trauma which will result in reducing the severity and frequency of their triggers. PE involves taping a re-telling of the traumatic event in session and the homework of listening to the recording daily between sessions, along with planning gradual exposures to trauma reminders to habituate to safety and grounding in the present. PE challenges a client to confront what they have been avoiding as PTSD symptoms cause distress and while moving away from these may offer short-term relief, they impede one's natural ability to heal. The variability in sessions is tailored to a client's needs so this therapy will feel manageable and never more than an individual can handle.


Cognitive Behavioral Conjoint Therapy (CBCT) for PTSD is an evidence-based cognitive therapy that is shown to decrease the severity of an individual's PTSD symptoms while simultaneously improving the connection and intimacy in a relationship. CBCT is a dyadic or couple therapy that is designed for when one person or both have PTSD. It focuses on strengthening the relationship of primary importance which might be an intimate partner, family, or friend. After an intake session with the couple and each individual separately, three phases are delivered, encompassing 15 75-minute sessions. The first phase is trauma psychoeducation to gain an understanding of how trauma has impacted the relationship. Phase two involves building relationship satisfaction and challenging the avoidance that maintains the PTSD symptoms as a team and phase three involves supporting the couple make sense of their trauma(s) together. Phases one and two may be delivered in a group format while phase three is always delivered solely with the couple and clinician to focus on that couple's trauma.


Somatic Experiencing (SE) is a therapeutic modality developed by Dr. Peter Levine based on the premise that it is not the event that causes a trauma but how an individual's body, physiology, and nervous system responds to it. A SE practitioner (SEP) trained in this modality supports an individual to reconnect with their body and to create opportunity and tolerance to process suppressed emotions. This therapy may be ideally suited for individuals who struggle with being stuck in their cognitions, intellectualize their experiences, or compartmentalize. Engaging in this type of therapy does not require re-living or re-telling the traumatic experience and instead focuses on re-engaging the body's nervous system and supporting completion of the impeded or blocked fight/flight/freeze response. A client will be invited to notice internal sensations and learn a language that invites curiousity following a SIBAM (sensation, imagery, behaviour, affect, and meaning) model and build a practice to be present.


I want to acknowledge the struggle at times with cognitive therapy; therapy that focuses on changing/challenging your thoughts/beliefs to improve your mood, where I will hear clients say, "I know, I get it, but I can't seem to make the changes I know I want for myself". Cognitive therapy is considered a "top-down" therapy as it is focused on learning a new way to talk to yourself, to challenge unhelpful thoughts and beliefs gained through what was shown, modelled, and told to us when we were growing up. When we are able to change and reframe our thoughts, it creates an opportunity to affect our emotional experience and change our behaviour to align with the alternative and more balanced belief. It is like a new language that you can only become proficient in with the intentional use of and repetition, and takes consistency in application. If you have been in therapy before, this may be your experience, and you may be looking for how to take your healing to the next level.


I was first drawn to the therapeutic approach for healing trauma when I worked at a residential treatment centre where SE was offered as an adjunct therapy and I saw the transformative nature it had surpassing multiple sessions of cognitively focused therapy. SE is considered a "bottom-up" therapy as it is focused on healing and connecting with the sensations within a person's body that has held or trapped trauma that is stuck as "unfinished business". We are whole bodies when we live through our traumatic experiences and there is a story that our body holds about what happened.


Through the support of a SEP, a client can be guided to complete a survival response that was prevented, access and process the emotional impact of the event, and restore the body's equilibrium. The human body has a natural way to heal itself but this may not occur if there is something that impedes the natural recovery such as lack of safety, functionally needing to continue (such as First Responders, individuals in abusive relationships, etc.) or remaining in an environment that contains the threat. SE as a therapy supports the development of self-regulation techniques learned through titration which is working with small manageable pieces of the trauma at a time rather than overwhelming the system. This creates an opportunity for an individual to build confidence and a felt sense of their own capacity and ability to value the information we receive in our body.


Top-down and bottom-up approaches work in tandem and offers a holistic whole system approach to healing the complex and multifaceted system's experience of trauma and helps to restore an individual's sense of safety, connection with themselves and others, and well-being. One unique feature of SE is that it does not require the story to be known in order for healing to happen. This may apply to any trauma that happened pre-natal, in infancy, in childhood or adulthood for which there is no memory due to dissociation occurring or the lack of brain development to understand the story. I have supported individuals to process past events without words as the body knows the story and SE helps that story to be fully told.

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Please reach out if you have any questions or are interested in exploring the possibility of working together.

Yin-Yee Yip CD MA CMAT CPTT SEP

Registered Clinical Counsellor

Plum Blossom Counselling Inc. 

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Victoria, BC, Canada

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