What is trauma-sensitive counselling?
If you have been wounded relationally, you may be wary with good reason about choosing a therapist or going to therapy at all.
Your gender, culture, and experiences with violent trauma, emotional blackmail, family violence, hate and discrimination might also make it difficult to reach out.
Pacing, a safe relationship and consistency are important in trauma-sensitive therapy
When you come to see me, I don’t expect details of traumatic events, although I will ask for what has brought you into therapy at this point as an open-ended question. If starting our conversation talking about what feels most painful is right for you I will help you hold it, but we can also begin elsewhere.
I may use gentle invitations to help you put words to thoughts, feelings and bodily sensations. I know shame is a frequent companion alongside trauma, and it thrives in being unnarrated.
Being Trauma-sensitive is a balance between approaching, but not in a bluster, so your agency is lost. Lost agency and subsequent lack of help from others is what can enable trauma a debilitating, long term impact.
Not everyone who comes to therapy is aware of the impact of trauma, but may have struggled for a while with anxiety, depression or numbness (dissociation).
Safety comes in the form of the consistency of a regular appointment time on the same day at the same time, week after week.
If you lose your words and find it hard to speak, and words come out jumbled, that is okay, we have enough time to do the work.
Why I prefer to use the word trauma-sensitive instead of trauma-focused
What can happen if we focus narrowly on trauma instead of being sensitive to trauma in relation to all the different aspects of you?
We may overlook the whole you. I come from the position based on research and experience, that if we focus only on the trauma, on technique and quick fixes, we may overlook the impact of early and long-term relational traumatic experiences. Additionally, we may overlook the relationship with other things that matter, such as culture, gender, personality styles (styles, not to be confused with disorders) and sense of self.
Overall, the best predictor we have for good outcomes in therapy (Bargmann and Chow, 2014) is still the common factors. One of these is the therapeutic relationship and, in particular, the therapist’s ability to adapt what they are doing to your needs. For example, I use the relational aspect in our sessions. I use attunement to underlying feelings kept in check by anxiety and fear, mental and bodily sensations.
Who’s the best trauma-therapist?
A final word, I don't engage in profession-bashing. I studied my master's degree in Narrative Therapy within a cohort of people from clinical psychology, social work, Occupational Therapists and general counsellors.
Training and length of training matter, but also therapists doing their own work such as explained in this blog article by psychotherapist Jodie Gale.
This fits with what research tells us, namely that some of the therapists who get better outcomes are the therapists who also understand that relationships matter (Shedler, 2010) over techniques and that therapists with a high reflective function have better outcomes.
References
Bargmann, S., & Chow, D. (2014). Feedback Informed Treatment (FIT): Achieving Clinical Excellence One Person at a Time. Independent Practitioner (APA).
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist, 65(2), 98-109. https://doi.org/0.1037/a0018378
