I’ve made a lot of videos about trauma and trauma treatment, so I get asked in a lot of emails this question: How can I find a therapist who does trauma treatment like you?
And it’s a great question, not because I’m the world’s best trauma therapist (that is not the case) but because when it comes to therapy, it’s really good to be an informed consumer.
There are hundreds of different types of therapy, and every therapist is different in how they approach issues. So whether you’ve never tried therapy before or you’ve worked with other therapists in the past and you want something different, learning about different treatment modalities can be really helpful.
So first, what is trauma?
Trauma is any experience that was overwhelming, threatening, that caused pain, distress, or fear to the point where you felt helpless. It can include assault and abuse and witnessing tragedy. It could include frightening medical experiences, near-death experiences, or a severe loss.
But basically when your response to these situations interferes with your life, you might receive a diagnosis of PTSD. Or, if the abuse was ongoing for long periods of time, you might get a diagnosis of complex PTSD.
And symptoms include nightmares; feeling tense or anxious all the time; being jumpy; feeling numb or detached; feeling exhausted and depressed; struggling in relationships, sleep, and work.
So while almost all therapists have some skills in treating depression, anxiety, and trauma, because these are such universal problems, not all therapists specialize in trauma treatment. This means that most therapists have at least a handful of tools to treat trauma, but some therapists have a lot of skills and interventions and resources and experience to help you out.
And that’s not exclusive to trauma. The more specific you can get with your diagnosis, the more specific you can get in finding a therapist who has interventions tailored to your needs.
So what are the trauma treatment options out there, and how do you find a therapist who uses them?
There’s a gazillion ways to do therapy, but I’m going to highlight the ways that are research-backed, meaning they have a strong body of consistent evidence that these treatments are effective.
Cognitive Therapy for Trauma and PTSD
So the first approach to treating PTSD is cognitive therapy. And this is called a top-down approach. So it includes cognitive behavior therapy, cognitive processing therapy, and prolonged exposure.
Cognitive approaches focus on talking about your trauma, changing how you think about it, and changing behaviors that might be making it worse.
So for example, you would tell your trauma story, and your therapist would notice that you blame yourself for your abuse, and then they would help you to challenge that type of thinking and replace it with something healthier, like placing the responsibility on the abuser and forgiving yourself.
Now, CBT has a lot of research for a couple of reasons: it’s been around for a long time and it can be standardized. They can put it in a manual and say, “Oh, in session one, do this. In session two, do this.” And then they can measure outcomes.
Most therapists include some form of talking and examining thinking patterns as a part of therapy, but with a CBT therapist they may have a very clear set of instructions for you.
Prolonged exposure is another type of cognitive therapy. It’s essentially exposure therapy. You talk about your trauma over and over until it’s no longer as scary for you. Essentially, you teach your brain that you can face your trauma and be okay.
Now, cognitive approaches have been around for a long time, and they have a lot of research behind them.
One study at Kaiser showed that even just the simple act of a doctor saying, “I see that you have a history of trauma or abuse. I’m sorry that happened to you. Would you like to talk about it?” and then just listening — just that simple act of addressing trauma without any specific interventions — this decreased the physical symptoms of trauma in a significant way.
I don’t mean to minimize the effectiveness of talk therapy with trauma, but I think that I and many other therapists find that trauma treatment benefits from a really well-rounded approach. And cognitive therapies focus on thoughts and memories, but they don’t do much to address the physical reactions of trauma.
Cognitive therapy can also be really uncomfortable, and in some cases it can re-traumatize the participant by having them talk about trauma without the skills to calm their body down.
Now, that being said, cognitive therapy is still an effective approach. According to the VA, around 53% of people who do cognitive therapy no longer have PTSD after three months of treatment.
EMDR Treatment for Trauma and PTSD
EMDR is another great approach to treating trauma. It’s got a lot of research behind it. It incorporates body-based soothing with cognitive work while also including eye movement and bilateral movement as a part of the treatment.
EMDR stands for eye movement desensitization and reprocessing. So basically, scientists found out that when we have bilateral movement — so that’s moving your eyes back and forth or patting your legs one and then the other — that it stimulates the part of the brain that processes memories.
This is similar to what happens in REM sleep, rapid eye movement sleep, because when you dream, your eyes move back and forth. And this is a critical time when your brain processes memories without too much emotion so that it can file them away.
So with EMDR and somatic approaches there isn’t nearly as much of a focus on retelling the trauma story or challenging thoughts or homework assignments.
And according to the VA, around 53% of people who do EMDR no longer have PTSD after three months of treatment.
Somatic Experiencing, Sensory Motor Therapy, and Polyvagal Approaches to treating Trauma and PTSD
This next group of therapies incorporates a much more body-based approach or a bottom-up approach to healing trauma. It includes somatic experiencing, sensory motor therapy, and polyvagal approaches to trauma treatment.
These approaches focus on the body and the nervous system and how they get stuck in a trauma response, and they teach people skills to soothe the body and turn off the fight/flight/freeze response and to activate their nervous system and work through the physical tension of trauma.
It’s based off of the work of Bessel van der Kolk, Peter Levine, Stephen Porges, Pat Ogden, Deb Dana, and others. And it’s gaining a lot of momentum, and the research behind its effectiveness is growing.
Interventions include things like yoga, learning nervous system calming skills, gaining a greater awareness of your body’s reactions, and working with your body to restore a sense of calm.
I teach a bunch of these skills in my free course, Grounding Skills for Anxiety, Stress, and PTSD. So if you’d like to learn some of them, just check out the link in the description.
When someone asks me how to find a trauma therapist who does trauma work the way I do, this approach is one that I’m drawn to the most.
Now, I understand a lot of cognitive work. I’ve read books or attended trainings on most of the approaches. And for me, the body-based approach really adds a lot to the cognitive work that many people have already tried.
Somatic experiencing is also a newer approach, so there’s less research behind it, but studies are promising. Some smaller studies have found that 67% of people experience a reduction of PTSD symptoms, and a meta-analysis of 16 studies found overall positive effects of somatic experiencing therapy on PTSD symptoms.
Narrative Therapy for Trauma and PTSD
Another type of therapy is narrative therapy. And this is often used in a small-group setting. It’s another approach that has been used with good results.
Basically, you just get a group of people together to talk about and work through their experiences. People explore their narrative or their interpretation of traumatic events with other people, and they create a new story around their humanity. And it has a lot of good evidence.
Medication for PTSD
Medication is another option to treat PTSD, and it can be combined with therapy. Antidepressants like Prozac, Paxil, Effexor, and Zoloft can be helpful at treating overall symptoms. Basically, medication helps to quiet the alarm system that seems to be constantly stuck in the on position.
According to the VA, medication is effective for 42% percent of people. Also, prazosin can help with nightmares, and anxiety medications can help with the anxiety symptoms.
Medication does come with the possibility of side effects, and the benefits may go away if you stop taking the medication.
Certified Trauma Therapists
Now, I don’t think that there is one approach to trauma treatment that is best for everyone, so you may need to try a few different things to find out what works for you.
Also, a combination of approaches may be best. Many therapists will integrate a cognitive approach with body-soothing skills while also encouraging you to work with a doctor to explore medical treatments as well.
Regardless of which approach you want to try, it’s important to find a therapist who is experienced. So let me show you one way I recommend doing that.
If you go to psychologytoday.com (not a sponsor), their therapist-finder tool has some great filters.
You just start by entering your location, and then you can select trauma-focused EMDR or somatic, and then you can see a list of the providers in your area. You can also filter by gender, religion, by the insurance they take, and a bunch of other characteristics.
Now, just because someone says they’re trauma-informed or they practice a certain modality doesn’t mean they’re certified in it. For someone to be EMDR certified, they need to have done something like 40 hours of training and 50 plus hours of supervised practice. So look for a certified provider whenever possible.
To become a certified somatic experiencing practitioner you have to do eight training modules of four to six days in length spaced out over two and a half to three years. So this is really different from someone who’s just trauma informed or has a different certificate.
Other Approaches to Treating Trauma and PTSD
There are a ton of other approaches to trauma treatment that are gaining popularity, but they just don’t have as much research behind them. These include brain spotting, neurofeedback, mindfulness, acceptance and commitment therapy, tapping.
There’s a lot of other things that you can try that may help, but they don’t have as much evidence behind them. Other other interventions include things like journaling, dancing, exercise, improving your overall mental health, certain nutritional approaches, and sharing your story with compassionate people.
All these things can be really helpful; they’re just not necessarily meeting that gold standard of evidence-based treatment.
Now, for all we know, these may work. But the further you get away from research, the less we know about how the treatment will affect you. I’m pretty cautious about recommending treatment without rigorous evidence, but I do encourage people to try a few things until they find something that works for them.
So there you have it: a handful of different approaches to treating trauma. I hope this helps you choose a treatment option that works for you. Thank you for reading, and take care.