Understanding PTSD Treatment: A Therapist’s Perspective on Trauma Healing
PTSD is one of the most widely known mental health disorders, and yet it can be so hard to talk about and fully understand. The way PTSD is experienced is incredibly unique to each individual, and therefore the treatment for it has to be as well. Traumatic experiences are deeply personal, often repressed, and carry a lot of fear and shame. This is why, as a professional trauma therapist, I find it so important to not assume I know anything about how a person’s trauma has impacted them. Creating safety in the therapy space in order to create the possibility of self-discovery and healing from PTSD is essential.
What Is PTSD and How Is It Diagnosed?
Understanding the DSM-5 Criteria for PTSD
First things first, let’s get through some of the really important stuff: the diagnostic criteria for PTSD. There are eight sets of criteria that a client must meet in order to have a diagnosis of PTSD (and of course, the DSM-5 provides more detail for each criteria).
What Is The Diagnostic Criteria for PTSD?
Exposure to actual or threatened death, serious injury, or sexual violence.
Presence of one (or more) intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred (such as intrusive memories, distressing dreams, etc).
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred.
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred.
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred.
The duration of the PTSD symptoms is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Why Can Trauma Symptoms Can Exist Without a Full Diagnosis?
Trauma comes in all different shapes and sizes and can manifest differently in each individual. It is important to know that all trauma matters.
Now, is this to say you can’t do trauma healing treatment without meeting the PTSD diagnostic criteria fully? Absolutely not.
You can have many symptoms of PTSD without meeting the full diagnosis. Trauma comes in a lot of different shapes and sizes, from tragic car accidents to developmental trauma – it all matters.
Big “T” and little “t” trauma is a phrase that a lot of people have heard about. It is basically the idea that there can be one big trauma event, or there can be chronic and repeated trauma over time. Neither is less important than the other! I myself don’t like to use the distinction because it feels to me like it dismisses the little “t” survivors. The idea that some trauma is more important than others is the reason why a lot of people don’t go to trauma therapy for years – they think that their trauma isn’t “bad enough” to warrant their feelings about it and do the work to heal from trauma.
Complex PTSD (CPTSD): What Makes It Different?
While Complex PTSD (or CPTSD) isn’t recognized by the DSM-5, it is recognized by many professionals in the field. CPTSD is a form of PTSD and meets all of the PTSD criteria, but it also encompasses other symptoms.
CPTSD is categorized by repeated, chronic trauma, usually involving interpersonal trauma.
What Are Examples of Causes of CPTSD?
Exposure to domestic violence
Childhood abuse
Frequent community violence
Sex trafficking
War
What Are The Symptoms of Complex PTSD?
In addition to the traditional symptoms of PTSD, Complex PTSD will encompass other symptoms such as:
Individuals who have Complex PTSD may deal with the traditional symptoms of PTSD as well as symptoms such as issues in relationships, problems with self-esteem, and trouble with emotional regulation.
Issues in relationships
Problems with self-esteem
Trouble with emotional regulation
As a trauma therapist, I have found that it can be validating for my clients to hear that CPTSD is something they could have. It can be a source of validation for all of the stress they went through.
A lot of people with Complex PTSD symptoms feel like PTSD doesn’t quite fit because they have these extra sets of relational dynamics that they are working against, so it can be helpful to name. Most of the time, people feel relieved to know that they aren’t alone; that there are so many other people experiencing symptoms of CPTSD that professionals decided it is worth having its own category.
Click here to read about Michael’s story about C-PTSD.
How Does PTSD Affect the Nervous System?
Trauma interrupts the nervous system by sending it signals to stay safe – we go into fight, flight, or freeze as our survival responses. An event becomes traumatic when we can’t perform one of these survival tactics, and that stays stuck in our nervous systems.
Real-Life Example of Body-Based Trauma Reactions
Kim was a 35 year old woman who was afraid of driving. She could be on side roads and streets with little to no stress, but on the highway she could barely cope. She found herself in cold sweat, panicking, and being hypervigilant of the cars around her. When she started doing somatic therapy she realized that her foot kept doing this weird thing. As she slowed down the response in her foot, she realized that she was trying to push the brake of her car. After understanding what was happening, she was able to really connect that her fear of driving was related to a near-crash that happened when she had to swerve off the side of the road and hit the median. After really being able to visualize and enact completing the self-protective response, her fear was manageable on the highway and she felt more confident driving.
What Do Fight, Flight, and Freeze Have To Do With Trauma?
Our brains are trained to spot danger and respond. With trauma, this danger sensor is on hyperdrive, sending the body into fight, flight, or freeze more than it should. A body that spends a lot of time in this survival energy (fight or flight) or lack of energy (freeze) has energy to do little else. This means that the allostatic load placed on the body is high, putting this person at risk for other diseases associated with chronic stress.
How Does Somatic Therapy Work For PTSD?
One thing clients always ask me when using somatic therapy to heal from PTSD is, “But Stevie, I’m just imagining this and not actually doing it. I’m not in the car right now and braking. How is this actually helping if I’m just reenacting it?”
Fair point. However, when the body is under stress, it can’t tell if it is real or imagined - whether you are actually in the car or reenacting in the therapy room. This is why we have PTSD - the fear is so real even though the threat is not present. Therefore, if we can have an embodied experience while completing a self-protective response using somatic therapy, it will actually send signals to the body that it is safe now.
How Can I Track The Progress of My Healing From PTSD?
Healing from PTSD looks different for everyone, but you can measure your progress by how often and how severely you experience the symptoms of PTSD.
With modalities like EMDR or somatic therapy, it is important to know what trauma healing progress means and/or looks like in trauma healing. In order to be sure that change is being made, knowing your exact trauma symptoms is key. You want to see a marked difference in, for example:
How often you are feeling triggered
How willing you are to be in situations where you might be triggered
How you are sleeping
How often you are having intrusive thoughts
What you feel like as you recall the trauma itself
Your capacity to experience difficult emotions
Your understanding of your own “flavor” of trauma, as I so lovingly call it, really helps the therapist be able to check in on you as well. It can be helpful to co-create a list like this with your trauma therapist as you start treatment.
Is Healing From Trauma or PTSD Linear?
I know a lot of us have heard this time and time again, but it needs to be said: trauma healing is not linear. You will have weeks in therapy that feel like giant revelations and you will leave feeling on top of the world, and other times you will feel confused about why your brain took a sudden turn or why you felt numb the entire time. Things may feel really integrated in between sessions, and at times you may feel like you are regressing due to certain life circumstances. It is all normal.
I tell my clients to look at the overall trajectory of their trauma healing progress. It isn’t going to be a simple line, but that doesn’t matter. Feeling discouraged and tempted to give up on trauma healing is what we really want to avoid, because your healing is worth it!
Click here to read a Somatic Experiencing Practitioner’s experience with healing from trauma.
What Are Some Misconceptions About PTSD Treatment?
“I will have to talk about everything.”
NO, you absolutely won’t. Your trauma therapist should create an abundance of safety within the session, and that includes making sure you know that you have total control over what you share and when you share it. To learn more about the importance of safety in the therapist-client relationship, click here.
“What if I don’t remember what happened?”
I highly encourage you to read a book about trauma healing, called Waking the Tiger by Dr. Peter Levine, who created Somatic Experiencing. Long story short, we remember things in our bodies and our emotions, not just intellectually. It is also okay if we don’t remember everything, because repression is a natural part of PTSD. We can use the nervous system as a guide to tell us how the trauma feels now in order to release the bound energy in the body. This doesn’t always require an exact story.
“Healing from PTSD will take too long.”
Healing from PTSD might take a long time, I won’t lie. However, with targeted treatments like Somatic Experiencing and EMDR, you might be surprised how fast things move! One of the reasons I fell in love with trauma healing work is that it gets right to the heart of the matter instead of walking circles around it. As I always tell my clients, “the body tells the story the mind does not want to.” If we work with it, it will show us where we need to go.
“I am scared that I will be retraumatized.”
The goal in trauma therapy is to process through the trauma in increments that are tolerable. We want just enough “charge,” or survival energy/emotional reaction to happen in order to process it, but not so much that it is retraumatizing. This is where I introduce the concept of titration and pendulation to clients; it is the idea that we keep the intensity of trauma healing work to a tolerable level and also guide the nervous system back to safety in order to get a break. A lot of the time, we don’t even have to guide the nervous system back into regulation, either! It naturally does it on its own.
What Can I Do If I’m Struggling with PTSD Right Now?
If you are struggling with PTSD right now, you can try journaling prompts for PTSD to help you work through your feelings.
Here are a few things you might try if you are struggling with PTSD right now:
Talk to a trusted friend about how you are experiencing the symptoms of PTSD
Try targeted journaling prompts for PTSD
Find a local support group run by a trauma-informed therapist
Do exercises like box breathing or progressive muscle relaxation
Book a therapy consultation with us and start your journey to trauma healing
Start Your Healing Journey Now
Your trauma does not define you and you don’t have to suffer with its effects for the rest of your life. Your body is literally wired for healing, and given the time, space, and guidance, it can happen. Our trauma-informed therapists are here to help you.
Happy Healing!
Frequently Asked Questions About PTSD And Trauma Healing
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PTSD typically stems from a single traumatic event, while CPTSD results from prolonged or repeated trauma, often interpersonal in nature. CPTSD includes additional symptoms such as difficulty with relationships, emotional regulation, and self-esteem.
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Therapists use trauma-informed approaches such as EMDR, somatic experiencing, and talk therapy to help clients process traumatic experiences and regulate the nervous system.
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Yes. Many people with PTSD experience body-based symptoms or emotional reactions without clear memory of the event. This is common and can be worked through in trauma therapy.
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The length of treatment varies by person and depends on the trauma's severity, duration, and the therapy method used. Targeted modalities like EMDR and Somatic Therapy can lead to faster progress for many.
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Not necessarily. Many trauma therapies, including somatic approaches, allow for healing without retelling the entire trauma story. Safety and pacing are prioritized in effective treatment.
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Signs include reduced triggering, improved sleep, less emotional reactivity, increased body awareness, and greater capacity to engage in daily life and relationships.
Stevie Olson-Spiegel is a Licensed Therapist and Somatic Experiencing Practitioner located in Kansas City. She uses Somatic Experiencing as her main body-based trauma healing modality, as well as EMDR. As an Intuitive Eating Counselor, she uses these principles to help her clients challenge their relationship with their cultural misconceptions about their body and food.
