As someone who’s been practicing for a while, I’ve seen our view on the treatment of trauma go through substantial development. Our research, theory and treatments have all advanced considerably in the last 40 years.
And as I reflect upon this, I’m seeing 3 waves in the evolution of our outlook.
Looking back at when I first began to practice (in the late 70’s) our understanding of trauma was really quite limited. Of course we recognized the fight / flight response ever since Hans Selye introduced the notion back in the 50’s.
But our prevailing treatment option was talk therapy.
The thinking at the time was that by getting clients to talk about their traumatic event, we could “get to the bottom of” their issues and help them heal.
We were aware of the body and knew it held some power. But few practitioners used it in treatment (except the relatively few who worked with Bioenergetics, Rolfing, Feldenkrais, Rubenfeld, and to some extent Gestalt therapy).
But we were very limited in our ability to explain how body work, or for that matter, a talking treatment, affected the brain (and we had very little evidence-based research for it either). We just didn’t have much of a roadmap to guide us where we wanted to go.
That was the first wave.
Over time, researchers and clinicians started to recognize the limits of talk therapy. We realized that talking about a traumatic event held certain risks. At times, we inadvertently re-traumatized patients, especially if interventions were introduced too soon, before the patient was ready.
We also saw the memory of trauma as more often held in the right brain, the part that doesn’t really think in words.
So we began to use interventions that weren’t as dependent upon talking, interventions like guided imagery, hypnosis, EMDR, and the various forms of tapping.
And as the science surrounding the brain’s reactions to trauma became more sophisticated, clinicians grew to understand more about what was going on.
We began to realize that not everyone who experiences a traumatic event gets PTSD. In fact, most people who experience a traumatic event don’t get PTSD.
And so researchers started to develop studies to determine who did and who didn’t get PTSD. We looked for what factors might predict greater sensitivity to trauma.
And we modified our thinking to add freeze (later known as feigned death) to the fight/flight reaction.
Just adding that piece clarified our thinking about what triggers PTSD.
It also began to expand our treatment options to include sensory motor approaches.
And we started to see how more vastly intricate and multifaceted multiple trauma was compared to single incident trauma.
But I believe a third wave of trauma research and treatment innovations has just begun to crest.
And it’s only come recently.
We continue to see advances in the field of trauma therapy that are opening up more effective methods for working with trauma patients.
Because of all the research that’s been done, we are much better able to predict who gets PTSD and who doesn’t. Not only that but we’ve got a good handle on why certain people get PTSD.
And as brain science has revealed how different areas of the brain and nervous system respond to traumatic events, we don’t think so often about whether trauma is stored in the left vs right brain.
We think in terms of three parts of the brain, the pre-frontal cortex, the limbic brain and the lower, more primitive brain. And we’re much more sophisticated in thinking about which part needs our intervention.
We understand that the lower brain can command the shutdown response, totally bypassing the prefrontal cortex, totally bypassing any sense of “choice” for the patient.
And we see more clearly the part that the vagal system plays in this shutdown response.
We understand more of the role neuroception plays in feeling safe.
Knowing how the body and brain react to trauma opens the door for the third wave.
We are now beginning to use techniques like neurofeedback (based upon but a long way from the biofeedback we used years ago,) limbic system therapy, and other brain and body-oriented approaches that include a polyvagal perspective.
These are techniques I couldn’t have dreamed of when I began clinical practice.
But these are powerful tools that can offer hope to those who have been stuck in cycles of reactivity, shame, and hopelessness.
And now I’d like to hear from you:
What changes have you seen in your work with the treatment of trauma? Please leave a comment below.
Can we get the authors name added below this summary “Rethinking Trauma: The Third Wave of Trauma Treatment”, or have I missed it ?
A GOOD Feldenkrais teacher may be part of the solution
Ruth, thank you so much! As a Neurofeedback provider for the last 14 years and a psychotherapist for many years prior to that, we are now enabled to help so many more people then ever before. There are many tools that we use, biofeedback and Neurofeedback, many types of both. We must treat the entire person (body,mind, and spirit) if we are to help with the trauma that lives in the body.
Occupational Therapists have been aware of these ideas and using them for years within their practice as their trainig incorporates Sensory Intergration and Sensory Processing as well as the paradigm of Person Environment Occupation
As OTs we definitely have a lot to add to the world of trauma treatment though I do think as a profession we need to start considering our own untreated trauma as relevant to the picture and incorporating personal healing into training.
As the third wave arrives, it seems to bring reinvented and combinations of first and second waves with its new knowledge. One example is Accelerated Resolution Therapy. I’m so thankful to have this amazingly effective tool. Seeing positive results is so very rewarding.
One therapy I have recently come across is from Gary Craig, founder of EFT. It is called the Unseen Therapist and is a very gentle approach. I am using it on myself along with meditation, hypnosis, EMDR (with a counselor), diet, exercise, qi gong, and daily doses of comedy to heal from CPTSD developed as a child. So far, I am impressed with how it shifts stuck “stuff.”
When I mentioned this therapy to my counselor, she said it overlaps a few modalities, including NLP and energy work, and sounded very promising.
I’d be interested to know if anyone has seen it in action.
I keep saying this but…nothing so far! I should write books about this because of the gamut of my experience unwinding my own trauma (with lots of different kinds of help from therapists of all kinds).
Yes these waves happened, but all of the bits and pieces from yesteryear still help and I think they would be maximized if used in tandem.
~~~Talk therapy is important because of its acknowledgment of the vulnerability and confusion trauma leaves you with. And talk therapy make you feel seen, if its well done. It also resocializes clients to feel better about themselves.
~~~Body centered therapies are amazing sources to reach toward *mindfulness*…actually feeling and perceiving what happens moment to moment. EMDR, Holographic memory release, Hypnosis, Journaling, Listening to Affirmations makes the blanked-out moments come back, sometimes in full color. You don’t feel like such a flake–you know more and more about what happened.
~~~Understanding the INTERPLAY OR LACK of interplay between the hindbrain, the social brain, and the prefrontal cortex makes the missing puzzle pieces of the traumatized brain explicable, and gives us a sense of grounding and acceptability….acknowledgment that we are NOT CRAZY. It’s a physical brain and body functioning as best it can.
We’ve come a long way from thinking there is something *wrong* with a traumatized war veteran or a hysterical woman, molested as a child. TRAUMA, whether it’s generational (in our DNA), or it happened in utero (like the cord causing blue-baby), or it happens later in life; Trauma is the cause of human suffering. It has been a greatly de-stigmatizing journey.
I completely agree with you, and would like to add one more point.
The response to trauma can also result in/create PTSD. When it is denied, and the victim is repeatedly blamed, shamed, and put down, PTSD symptoms become apparent. This can be seen through women and men who have gone through repeat denial and exposure to trauma in the Canadian RCMP, military, and those in closed religious environments. I’m sure there are more sectors of society that engage in this. This is constant re-victimization. I think this also needs to be acknowledged as it is also a factor in the development of PTSD and complex PTSD.
Trauma also leaves it’s impact in our cells. Body work also helps depending on severity of the traumatic response.
Our response to victims (even over time) as a society and culture matters tremendously. We can empower or dis-empower through our attitudes and talk. Repeat dis-empowerment is also traumatizing (re-victimization).
As an EMDR therapist I have seen many, many times how trauma will be cleared completely and the client will have a totally different life.
EMDR has been researched and is the treatment of choice for PTSD. The research is on-going and we learn more every day.
I call upon my intuition to allow me to feel my client’s traumatized tissue in my own body. I then rest my attention and perception in the trauamtized tissue. Of course, when my attention contacts the traumatized tissue, it starts to open and the emotional pain starts to move. I allow this pain to move through my body. My client is simply relaxed and notices that her occiput, let’s say, feels more open, that she feels lighter. Clients feel so much less frightened of the trauma as they feel it gently release in their own bodies. I often will use Tapping or another energy psychology modality on my own body while resting awareness in the tissue of my client’s body. I developed this way of working (with myself as my first client!) when I was isolated for the world for many years as a result of Environmental Illness. I credit and thank NICABM for teaching me the importance of safety in the healing of trauma. This is the core of what I am trying to provide when resting intuitively in the traumatized tissue of my client’s body.
effectiveness of sand tray work
I have been a therapist for almost 20 years and the growth in learning about the brain, where and how trauma is stored and now, how to access it and go from dysregulation to regulation with Brainspotting therapy. Simply magical at times! ?
The client does not have to relive the trauma, does not have to speak about any details if they choose not to. Client led. I just love this therapeutic modality ??
I could not agree more Jacqui. Brainspotting has allowed so many of my clients to access and process their trauma without having to be re-traumatized in the process. What a gift!
Great summary, Ruth, but there has also perhaps been a downside; a loss? It was a feminist issue to recognise childhood sexual abuse: the Courage to Heal – and it was framed as most perpetrators are male and most survivors are female. Sad the awareness of power issues has fallen by the wayside, apart from METOO#. Naming and challenging ‘Power over’ and striving to work for power with was feminism’s and humanism’s approach to therapy – less emphasis on the expert therapist doing stuff to the hapless victim. There was Judith Herman’s identification of trauma and its 3 stages of treatment back from 1982 and Healing tasks James Kepner’s 1985 brilliant Gestalt approach too. Both preceded Babette Rothschild’s ‘learn to put the brakes on before you put your foot on the gas’ – and learn how to help a client ground and centre before reliving the trauma (The Body Remembers). Kepner and Herman also focused on the importance of purpose and community as the consolidating part of trauma therapy – have to become part of something bigger than your traumatic experience to fully heal. Maybe we need to add a WETOO# trauma healing process?
I agree with you around the power issue, and the importance of purpose and community in the healing process. When we heal, we reclaim ourselves and our being that is much bigger than the trauma that impacted our lives.
As a survivor/victim who had PTSD and C-PTSD with dissociative symptomology, the most frustrating talk around identifying what happens during trauma and it’s aftermath in PTSD, is the piece around PTSD leaving the victim with lifelong sensitivity, etc. to adverse experiences, as if they have somehow also become deficient in that way as well. This is also dis-empowering. People heal, and learn effective methods to deal with and cope with traumatic stress. I have used these in my life, and have been through enough trauma in the last few years to create full blown PTSD even if I’d never experienced trauma in life. It didn’t develop because of the work I’d done in my life around trauma, and the fact that I was aware of what trauma symptoms look like, and knew how to reduce it’s impact in my life. The work I has been a huge resource and asset.
People heal from childhood and adult trauma – even severe trauma. I think the most frustrating piece is when people talk the talk that the impacts are lifelong, and leave me limited and somehow deficient. If we don’t respond in the prescribed time, then somehow that is also an indication of something else. It took me years to heal inside – to heal my heart and my mind/brain from the repeat trauma and the response to it – the aftermath. I’m grateful that my heart no longer carries all of that pain. It was overwhelming. I have been at a place where I would have rather been dead that feel how I felt inside. I’m telling you that wounds heal – even extreme ones, and that scars are simply indications of injury and healing having happened. I healed.
I am an advocate for trauma informed awareness and practice in our social institutions, and have taught for many years. Our attitudes and recognition of trauma are critically important in offsetting the impacts or worsening the impacts.
I may be misunderstanding your “wetoo” healingtrauma comment, but I am stating that healing happens, and “metoo” in terms of healing. This is not to diminish those who have not healed. I would never do that. I think that increased trauma awareness and the broad scope needs to include more opportunities for people to access services, especially those who cannot afford it. Therapy is very expensive. I was lucky enough to have this resource in my life, and a therapist who was committed even when I couldn’t afford it. I’m grateful for this in my life.
I also became aware of how the impacts show up in our lives, so that long after therapy when I went to purchase my first home, I only wanted a bungalow style house as this affected my sense of safety. I’d never even thought about that. It was simply another “oh” (with a laugh, not more pain) awareness for me. Once I realized that, I was able to understand, and make that choice with understanding.
As therapists, I’m asking you to avoid the pathologization talk for trauma survivors. It is dis-empowering and can become how they are perceived and defined. Understand that it is something that happened to them, not something innate within them. Be aware of the associated connotations used in descriptive language in observations of those we are working with who have been traumatized (eg. reacting vs responding). As survivors, we demonstrate resiliency over and over and over again. Listening to resiliency talk, and resiliency being defined as “bounce back” is sometimes irritating. Sometimes it seems to be defined by those who have experienced little t traumas. Our talk really matters. PTSD is a response or a condition created by traumatic experiences. It is not a disease.
As therapists, I think we need to educate others about trauma, resiliency, and healing. I think we need to join with the “metoo” movement the “wetoo” traumahealing, and advocate for healing resources available affordably.
The MeToo movement has made it acceptable to state what happened without shame or blame, and for people to see the vast scope and breadth of sexualized violence.
As a therapist, the greatest gift I can give another survivor who has been through trauma is their life, being, and dignity back. There should never be any shame in needing to healing work or having engaging in that. I love the idea of wetoohealingtrauma but without it contrasting with metoo. I’m starting this today on my own facebook page.
MeTooandHealingtrauma…(with a descriptive word attached around that process).
“WeToo&supportingtraumahealing” might be a good hashtag for therapists and survivors in this work alike.
correction: “The work I has been a huge resource and asset.” should be “the work I did has been a huge resource and asset”.
Yes, Yes, Yes. Thank you for the concise history. So important for clients to know and for people to understand!
I find this article very informative. Over the past 3 decades I have read thousands of articles and books on the effects of trauma and the how clinicians have attempted to understand and treat it. It seemed to me that while certain behaviours and thought patterns were understood to be related to trauma, there was no recognition of how or why this was so. Seeking to understand my own response to trauma, I felt frustrated and, at times, very afraid. The knowledge now, of the part the lower brain plays in shutting down conscious response, and the much deeper understanding of how the physical body reacts to this, resonates very clearly with me, giving me a greater awareness of what is happening in my own mind and body.
I am Proof, that verbalizing childhood trama, reversed and destroyed 2 years of Paranoid Schizophrenia.
At 13, the abuses I carried in my brain, we’re Extensive. Extensive enough, to where I had an old Hag, whispering and Sometimes shouting in my ears, or so that is what I thot at that age. I soon learned lol, “It Was All In My Head!”
**She was a vicious female.**
Complete Negativity! Every word was ment to Destroy what very little confidence,
I had left.
Was sent to Los Palmas Sch. For Girls @14yrs.old.
Extensive Groups, One on one with Councilor, Wednesdays were Groups with a Psychiatrist, who would also attend Most of our Marathon Groups-
(in jammies or comfy clothes,with pillows and Blankets and an unspoken promise that if there is Still one of us in pain, We were *In For The Long Haul* Even If it took All night.)
More of these kind of Places Should Become a Priority!
Meds? HELL, WE JUST NEEDED TO BE HEARD! AND THIS IS HOW WE BEGAN TO HEAL!!
Mrs. *J.J.* Jinx Torres
Sounds interesting. Good concept, I’m interested in learning more
I have been having some breakthroughs with people stuck in childhood trauma using EFT/Tapping while going back and re processing the event. I add inner child and loving parent to the narrative. This is EMDR like. Also use zTapping while meditation.