What is trauma-focused therapy?
Trauma-focused therapy aims to help individuals who have experienced traumatic events, in childhood in particular. It’s usually intended for children and adolescents, and sometimes their families as well. A trauma-informed approach to mental health care embraces an understanding of the emotional, neurological, psychological, social, and biological effects of trauma. Trauma-informed therapists help promote healing by providing mental health services and treatment tailored to each individual's trauma history.
What is trauma?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines trauma as “exposure to actual or threatened events involving death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the events;
- Witnessing the events in person as they occur to others; or
- Experiencing repeated or extreme exposure to adverse details of the events."
Trauma can come about after someone experiences physical, emotional, or psychological danger or harm. Even being close to or witnessing these sorts of experiences can lead to the development of trauma and related mental health responses.
Common examples of potentially traumatic experiences may include:
- Childhood neglect
- Sudden separation from a loved one
- Natural disasters
- Poverty and food insecurity
- Violence in one's community
- Living with someone who experiences unmanaged substance use and/or mental health disorders
- Experiences of sexual, emotional, or physical abuse. *
*If you or someone you know is experiencing abuse in any form, you can contact The National Domestic Violence Hotline at 1-800-799-SAFE (7233) for immediate support, advice, and assistance.
Another resource is the Crisis Text Line, which can connect anyone in crisis with a crisis counselor; text “HELLO” to 741741 from the U.S. anytime, day or night.
What are the potential effects of trauma?
Regardless of the type or cause, trauma can be a pervasive problem that can have both short- and long-term effects on a person’s functioning and/or emotional, physical, or social well-being. Trauma-informed care focuses on addressing these potential effects of a past traumatic event, which may include but are not limited to:
- Shock and denial
- Unpredictable emotions
- Flashbacks and nightmares
- An inability to feel comfortable
- Physical symptoms like stomach aches and headaches
- Exhaustion and fatigue
- Difficulty concentrating
- Risky behavior, such as substance misuse
The toll that trauma takes on an individual’s well-being can be significant. However, people who have had traumatic experiences can also be highly resilient and may develop a sense of perseverance and strength in the face of challenges with the right support. Healing from trauma and living a fulfilling life can be possible with the help of a trauma-informed approach to therapy. See below for distinctions between the effects an individual may experience during childhood and adulthood after experiencing trauma at a young age.
Potential effects of trauma during childhood
Childhood trauma is often referred to as an “adverse childhood experience,” or ACE. An ACE can have serious long-term effects on the developing brain of a child. Trauma can negatively impact areas of the brain responsible for certain cognitive functions, such as emotional control and short-term memory. During times of stress, the body also releases the hormones cortisol and adrenaline, and repeated or prolonged exposure to these hormones can be associated with poor brain development in early childhood. Other ways that post-traumatic stress can impact the brain and even DNA in childhood and beyond are suspected but not yet fully understood.
Research also suggests that the more a child is exposed to stress and trauma, the greater their risk of experiencing trauma-based chronic health conditions and risky behaviors later in life. Childhood PTSD (childhood post-traumatic stress disorder) is an example of a diagnosable mental health condition and stress disorder that could occur in some children who have had an ACE. There are various types of therapy that may be used to help a child recover from trauma depending on the type of experience, from trauma-focused therapy to reunification therapy.
Potential effects of childhood trauma in adulthood
Adults who experienced trauma during childhood may also experience negative effects. These adults may find it particularly challenging to respond to life’s experiences and might be more likely to live with depression, anxiety, and problems with emotional control. This can affect functioning at school and work, relationships, and physical, emotional, and mental well-being. They can also be at risk for post-traumatic stress disorder (PTSD), substance use disorders, risky behaviors, and other health challenges.
How trauma-focused therapy works
Trauma-focused therapy is typically conducted by trauma-informed therapists who understand the effects of trauma and utilize therapeutic tools to address thoughts, behaviors, and feelings that may occur as a result of it. These therapists usually undergo specialized training and follow certain evidence-based practices to ensure that they provide effective post-traumatic support for their clients.
Trauma-focused therapy takes into account the potential effects of a past trauma(s) when administering therapeutic treatment to a child or adolescent. It was originally designed to help those who had experienced sexual abuse, but it has since been expanded to support children and teens who have experienced any number of traumatic situations. It’s a shorter-term type of therapy and is usually done with a parent or caregiver present. There are typically three phases of trauma-focused therapy.
The first part of trauma therapy is usually helping the child and their parent(s) understand what normal reactions to trauma can look like, which may help increase understanding in the parents and reduce feelings of guilt in the child. Next, the therapist may help the child learn to get comfortable identifying and expressing their emotions. Then, they can teach them relaxation techniques for calming distress that may arise. After that, the cognitive behavioral therapy portion usually begins, which aims to help adolescents in particular learn to identify and shift distorted thoughts about the experience or themselves.
Trauma narrative and processing
In this phase, the therapist will gently and gradually encourage the child to speak about what they experienced. The aim is to help teach them “mastery” of the experience and its effects on them rather than avoidance. It can also offer the therapist the chance to catch any further instances of distorted thinking the child may hold about the event.
Integration and consolidation
Gradual, controlled exposure to innocuous triggers may take place in this stage. The rest of this phase is usually about safety education for the future. In addition to the healthy coping techniques learned in previous sessions, the child will also typically learn information to help keep themselves safe in the future during this part. Discussions on healthy sexuality, bullying prevention, and family communication could all occur at this time, depending on the situation.
Seeking out therapy for trauma
"Is therapy right for me if I’ve experienced trauma?" The way people choose to move through the trauma they’ve experienced is individual and up to them. However, many people find engaging in some form of trauma-focused therapy to be beneficial.
Although trauma-informed therapy in particular is often discussed in reference to children, there are various forms that are geared toward adults as well, from dialectical behavior therapy (DBT) to eye movement desensitization and reprocessing (EMDR) therapy. A therapist who is trained in these types of modalities can generally offer a nonjudgmental, welcoming space where the individual can freely express and process their emotions and learn techniques for managing distress and moving forward toward healing.
Those who prefer to meet with a therapist to address trauma face to face can contact their insurance company for a list of in-network providers or ask their primary care doctor for a referral. Those who would prefer to meet with someone from the comfort of their own home might consider online therapy. With a platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or in-app messaging. If your child aged 13–19 has experienced trauma, TeenCounseling can offer the same services with parental consent. Research suggests that online therapy can be as effective as in-person sessions for addressing post-traumatic stress disorder and similar conditions in many cases, so it may be worth exploring if you prefer this format.
Experiencing or witnessing trauma during childhood can cause a number of short- and long-term effects. If your child has been through a traumatic experience, trauma-focused therapy could help them on the path to healing. If you’ve experienced trauma in the past, some form of trauma-sensitive therapy could also be helpful for you. There are both in-person and online options and resources available for this type of care.
Frequently Asked Questions
What is a trauma-informed approach in therapy?
What are the 5 principles of trauma-informed practice?
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What are the 3 R's of trauma?
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What are the four C's of trauma-informed care?
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