Experiences of trauma impact a young person’s emotional and social well-being, their thinking, feelings, and behaviours, their identity, and their hopes for the future. Trauma often underpins other mental health symptoms and disorders, including depression, self-harm, eating disorders, and BPD.
Addressing and healing from the impact of traumatic memories on the mind and body is a fundamental part of the concept of mental well-being. It’s also an essential step in recovering from mental health disorders.
But since the impact of trauma is so broad and deep, healing from trauma is often not a quick or uniform process. Experiences of trauma, especially complex trauma, can disrupt and disable the same mechanisms that help us to cope and recover. These include interpersonal skills, emotional regulation, and self-belief, among others.
Sometimes, these skills need to be built before traumatic memories can be confronted. Equally, reprocessing or learning to tolerate a traumatic memory doesn’t mean emotional and social challenges will automatically resolve.
So trauma treatment requires a whole-person approach, addressing not only traumatic memories but emotional, social, and cognitive skills and well-being, which are, of course, interrelated. It requires looking at a young person as an integrated being, rather than a set of symptoms. It asks us to build solid foundations and avoid ‘rushing’ to feel better.
Understanding Trauma and Complex Trauma
Traumatic experiences are experiences that are very distressing, scary, and overwhelming. It may involve something happening to you, or witnessing or hearing about the event happening to someone else. Traumatic events can involve a threat to your life or physical integrity, but they might also constitute emotional distress, including emotional abuse, rejection, and invalidation.
Trauma can occur as a one-off event or as a continued pattern of experiences.
Complex trauma is a type of trauma involving multiple or ongoing traumatic events. Complex trauma usually consists of interpersonal traumas, involving violent, abusive, or otherwise harmful relationships between individuals or groups. This might include neglect and abuse, community violence, or war and displacement.
When we experience a traumatic event, our minds and bodies can become overwhelmed and unable to process what is happening. These unprocessed traumatic memories are stored in our brains and nervous systems, causing us to relive traumatic experiences, particularly in response to reminders of the events. They can also freeze our bodies in threat response modes, causing anxiety, hypervigilance, and mistrust in others and the surrounding world.
The effects of complex trauma are the same as those of one-off traumatic events, but with additional symptoms. Complex trauma can impact how we process social situations, regulate emotions and behaviours, and form attachments to others. When we experience complex trauma as children (known as developmental trauma), it can disrupt the development of emotional and social skills and how we perceive the world.
Social support and secure attachment relationships are key to preventing the lasting impacts of trauma, both among children and adults. With responsive care and attention, many people who experience traumatic events do not go on to develop trauma-related disorders.
Does Trauma Treatment Involve More Than Reprocessing Memories?
Core PTSD treatment modalities often centre around the exposure to and reprocessing of traumatic memories. While different approaches may rely on different underlying mechanisms, treatments like EMDR, exposure therapy, and trauma narratives aim to help trauma survivors integrate traumatic memories into the rest of their experience, find coherent narratives, and be able to hold, encounter, and accept a traumatic memory without flashbacks or intense distress.
As trauma survivors reprocess and integrate these memories, other trauma symptoms can also improve. In some cases, trauma-focused treatments may improve symptoms without preparation and groundwork, even in the case of complex trauma.
However, the broader consensus and practice around the treatment of more complex trauma, including childhood trauma, supports a longer treatment process with preparation and groundwork. Young people who have experienced trauma often lack the same emotional and social skills that are required for trauma recovery. For example, at the start of exposure or reprocessing trauma therapies, it’s common to experience intense, painful and distressing emotions. Young people who haven’t developed effective emotional regulation skills may be overwhelmed by these feelings and experience retraumatisation rather than healing.
Survivors of complex trauma may experience self-destructive feelings when trauma is being remembered, or believe that harm from trauma is permanent and incapable of healing. They may also struggle to create a non-fragmented, coherent narrative in trauma therapy, especially if they lack a coherent sense of self.
Equally, people living with complex trauma often lack close and trusting relationships and may find it hard to form intimate bonds with others. They may need more time to build a trusting relationship with the therapist and share their traumas. They may also have weaker social support systems that can support them through the intensity of confronting traumas.
What Does Building Foundations in Trauma Treatment Involve?
Building foundations in trauma treatment involves learning emotional skills and developing other psychosocial resources. These resources underpin resilience and capacity for change.
Trauma professionals often talk about three-phase trauma treatment. The first phase focuses on building individual safety, reducing some symptoms, and improving emotional, psychological, and social capacities. The second phase centres on trauma memories, while the third phase involves connecting and integrating the healing process with a person’s broader life.
This first phase of trauma treatment is alike to building foundations. It might include:
- Developing distress tolerance skills, such as grounding skills or mindfulness skills
- Developing emotional regulation capacities that focus on somatic experiences
- Developing interpersonal skills
- Strengthening social support networks, with family members or peers
- Building self-confidence and self-worth
- Building trust in the therapeutic relationship
- Discussing mistrust, guilt, and shame
- Developing mentalisation skills and identity coherence
The amount of time each individual takes to develop these resources varies from person to person. It depends on many factors, including the way trauma has impacted their development, the social support and other resources they have had access to already, and the impact of current life events on their present experience.
It’s important not to rush to ‘fix’ a trauma, but to focus on whole-person growth and resilience.
Reconnection and Integration
After the reprocessing or exposure phase of trauma treatment, therapy should continue, focusing on integrating trauma healing with different aspects of daily life. When experiences of trauma no longer dominate a person’s sense of self, emotional regulation, and interpersonal relationships, these self-aspects can grow, change, and flourish.
The reconnection phase of trauma treatment might involve reshaping how a person approaches their relationships and forms ideas about the future and their self-concept. It emphasises empowerment and continued healing and growth.
Emphasising Strengths and Empowerment
One key principle of trauma-informed care is providing person-centred treatment that encourages individuals to have agency and ownership over their lives, emphasising strengths instead of deficiencies.
These principles also apply in trauma treatment itself. Instead of reducing a person to the symptoms they are experiencing, we should focus on their personal growth, strengths, and capacities. Trauma survivors should be collaborators in their treatment process, experiencing recovery as a process of empowerment rather than distress.