trauma informed therapy

How Do I Know Which Trauma-Focused Therapy is Right for Me?

We’ve talked a lot about EMDR here in The Claibourne Journal. We’re big believers in this highly effective, evidence-based approach for treating trauma, big and small. All of our therapists are trained (or in the process of being trained) in EMDR therapy, which is proven to naturally release uncomfortable memories and negative beliefs to allow your brain to reprocess in a more objective light.

As much as we love EMDR, (which is a whole lot!) it’s far from the only therapeutic modality used to treat trauma. In one of our latest blogs, we covered the different levels of education required to become EMDR certified, and we touched briefly on some other trauma-informed modalities. We dove deeper into Accelerated Resolution Therapy (ART) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) while mentioning a few other types of trauma-centered therapies, like Acceptance and Commitment Therapy (ACT), Emotionally Focused Therapy (EFT), Exposure Therapy, Narrative Therapy, and The Progressive Approach. These are just a few of the many trauma-centered therapeutic modalities you’ll find in a counseling practice that treats those who have experienced things like PTSD, abuse, emotional neglect, bullying, and more.

With so many options available to trauma therapists, you might be wondering, how do they know which one is best for me? How does my therapist decide which type of therapy best fits my kind of trauma? That’s a great question and it’s what we’re here to talk about today. The quick answer is, there is no one-size-fits-all when it comes to any sort of therapy, whether it’s trauma-related or not. Typical therapists may have one or another that they prefer to practice, but there are so many options and the main thing to keep in mind is that there is always hope. Your experience, your story, and your memories are unique to you and your therapist will address each of these with you starting with the present and working backwards.

Window of Tolerance

The ‘window of tolerance’ is a concept that was coined by Dr. Dan Siegel in his 1999 book The Developing Mind. Most therapists learn about it, but it’s used especially by trauma therapists to describe the “optimal emotional zone” we’re all able to function in our everyday lives. Everyone has their own unique window of tolerance. The two extremes are hyper-arousal and hypo-arousal. Check out the infographic for a great visual. Ideally, we would all stay within our window of tolerance and never veer off to either extreme. But ideally, no one would ever have any trauma. Since that’s unrealistic, therapists are taught to identify their clients’ window of tolerance early.

window of tolerance infographic for trauma therapy.

The neuroscience involved in this is helpful, too. Knowing your window of tolerance helps your therapist to navigate within the bounds of your comfort zone. When we’re working within these bounds, we’re using the prefrontal cortex part of our brains. This is where we access things like logic, planning, emotional regulation, and self-control. When we’re outside of our window of tolerance, we’ve lost access to our prefrontal cortex. We’ve all been there at some point. This is when we begin to panic, make reckless decisions, or we freeze, become indecisive, and shut down.

Everyone’s window of tolerance is different. How often you’re inside or outside your window of tolerance typically depends on the level of trauma you’ve experienced. During your first few appointments, after all the housekeeping stuff has been handled, therapists will ask questions to get to know you better. These questions aren’t a test and there are no right or wrong answers. The questions are to help your therapist determine which therapeutic modality may be best suited to move forward. For some, starting with simple talk therapy, like CBT is best. Some therapists use Internal Family Systems (IFS), and others will opt for something like the Progressive Approach. Many, including our therapists here at Claibourne, choose multiple trauma-centered modalities simultaneously with an EMDR framework. It all depends on the therapist and, of course on you. In any case, your therapist will discuss the best options with you, including your window of tolerance, and goals for moving forward.

The Polyvagal Theory

The Polyvagal Theory, like the window of tolerance, provides a framework for your therapist to understand how your nervous system responds to stress and trauma. The Polyvagal Theory emphasizes our understanding of the autonomic nervous system (ANS) and its role in regulating social behavior, emotions, and physiological responses.

The ANS is a part of our peripheral nervous system that regulates involuntary physiologic processes including things like our heart rate, respiration, digestion, sexual arousal, and even sneezing, coughing, and swallowing. The Polyvagal Theory suggests that the ANS is not simply a system for regulating internal bodily functions, but also plays a crucial role in shaping social behavior and emotional experiences.

Types of Trauma-Informed Therapy

Trauma-informed therapy should be an integrative approach. Once your therapist has identified your window of tolerance, you’ll move into the counseling portion of your therapy. This is where the work begins, and your therapist begins guiding you through the process of helping you to become unstuck and healing begins. Trauma doesn’t show up as memories. It shows as reactions. So, your therapist will address what’s going on in your life now and work backward. We’ll start with the least intensive types of trauma-focused therapies, moving to the more intensive ones. Another way of putting this is to say that we’ll start with those who have a smaller window of tolerance, moving to those with a greater window of tolerance.

Mindfulness and Mindfulness-Based Cognitive Therapy

Mindfulness has been very successful in treating patients with major depressive disorder, as well as preventing relapse. It incorporates mindful breathing techniques and focuses attention on the present moment while remaining relaxed and nonjudgmental. Through mindfulness, the goal is to become less reactive and more intentional, improve focus, and reduce stress. Mindfulness is typically used in conjunction with other modalities that we’ll talk more about below, like Cognitive Behavioral Therapy and EMDR.

Narrative Therapy

Narrative therapy, as its name suggests, is based on the idea that individuals interpret their experiences through the lens of stories that people construct about their lives, which shape their identity, beliefs, and behaviors. In narrative therapy, the therapist collaborates with the client to explore and understand the dominant narratives that influence their lives. These narratives may include patterns of thinking, problem-solving strategies, and interpretations of past events. It emphasizes the importance of individual agency, creativity, and the ability to rewrite one’s life story in a way that aligns with personal values and goals.

Cognitive Behavioral Therapy (CBT) and Trauma-Focused Cognitive Behavioral Therapy (CF-CBT)

CBT is the original talk therapy. It’s what most people think of when they think of therapy. You go into your therapist’s office, sit in a comfy chair, and talk to them. To put a textbook definition to it, the therapist will help you become aware of negative thinking loops so that you can respond to situations in a better way by learning to cope with stressful situations. It can be used for things like anxiety, depression, addiction, and so much more.

Trauma-Focused CBT as you may have guessed is the trauma-sensitive approach to cognitive behavioral therapy. It was first developed to treat children who were victims of sexual abuse. This modality has now expanded to meet the needs of children, adolescents, and adults who have experienced all forms of abuse, PTSD, depression, or anxiety.

Acceptance and Commitment Therapy

ACT is a different type of CBT based on the notion that suffering is a normal and unavoidable part of human experience, and it emphasizes acceptance of these experiences rather than attempting to eliminate them. Therapists guide clients to accept their thoughts and feelings and commit to behavior changes with the idea and goal of their overall emotional and psychological flexibility being increased in the end.

Somatic Experience Therapy

somatic therapySometimes referred to as Somatic Experiencing, this fairly new trauma-focused therapy modality focuses on the body’s physical response to trauma and helps clients process trauma through bodily sensations. While research is still being done daily to bring this modality into the mainstream, it’s been compared to Mindfulness, but for the body. While Mindfulness encourages any feeling and emotion to come without judgment, Somatic Therapy urges us to focus on bodily sensations as they’re happening. The therapist will then help to release these “pent-up” emotions using anything from breathwork or dance to hypnosis or even things like acupuncture.

Internal Family Systems (IFS)

IFS helps clients explore and heal internal parts of themselves that are affected by trauma using techniques like guided imagery and parts work. It’s a type of talk therapy that addresses sub-personalities that we may have created from wounded parts and painful emotions such as anger and shame, including the parts of the person who tries to protect those wounded parts from further pain. As you would imagine, this can get deep. These sub-personalities are often in conflict with one another and one’s core sense of self.

It’s important to note that the “parts of self” or sub-personalities are not to be confused with dissociative identity disorder (multiple personality disorder). The easiest way to explain sub-personalities/parts of self is to ask anyone about how they act around their friends versus how they act around their grandma. Most people present themselves differently in different situations. In other words, they present different parts of themselves. IFS helps to identify these and helps to heal the wounded parts that have experienced trauma.

Accelerated Resolution Therapy (ART)

We’ve already touched on this in a recent blog, but we wanted to be thorough here. ART is similar to EMDR in that it uses rapid eye movements, but in addition, is referred to as a Voluntary Image Replacement therapy for traumatic memories. It aims to work a bit more quickly than other modalities. Its goal is to help clients achieve relief and benefits within one to five sessions by rapidly desensitizing traumatic memories and promoting positive changes in emotions and behaviors. This evidence-based treatment modality has been shown to support people recovering from trauma and experiencing anxiety, depression, OCD, PTSD, addictions/substance abuse, and more.

Prolonged Exposure Therapy (PE)

Getting into the slightly more intensive trauma therapies now, PE involves repeated and gradual exposure to trauma memories and reminders. This trauma-focused modality should only be used once your window of tolerance has been established as being wide open and you and your therapist both feel you’re ready. In a PE session, the therapist will guide you through telling the story of your traumatic experience in detail. What did you see? What did you hear? What did you feel? You’ll process it all in the safety and confines of your therapy session. The therapist may have you list your “exposure hierarchy”. This is the list of things that you’ve avoided because of the stress your trauma has caused you.

The idea is to teach your brain that when you experience these fears, stresses, and anxieties the trauma will not come with it. We’ve all heard of Pavlov’s Theory. As a reminder, it’s how dogs are trained. They hear a bell; they get a treat. It’s learning by association. Trauma has essentially trained your brain into believing that every time a traumatic trigger occurs, your body should respond with panic and all the terrible feelings that go along with it. The goal of PE is to do the opposite. When you retell your trauma over and over and realize that the terrible things don’t happen, that’s a success.

Healing from Trauma is Not Linear

healthy coping skills and therapy supports wellbeing

Some types of trauma-centered therapy are a bit more intensive, while others foster a bit more of a gradual approach. There is no one-size-fits-all all. Using evidence-based and neuroscience-backed tools like the window of tolerance and the Polyvagal Theory, a good therapist will work with you to determine which modalities are the best options for you. Unfortunately, time does not heal all. We wish this were true. Your stress response to trauma is a natural human response for protection in actual situations that require it. This is a good thing that protects you when you need it! But when a traumatic event occurs, this system stays on high alert. That’s where trauma therapy comes in. That’s where we can help. There is hope. Get connected with one of our trauma-informed therapists today.

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Monday – Friday | 9am – 5pm
10613 N Hayden Rd, Ste J-100
& 10617 N Hayden Rd, Ste B-100
Scottsdale, AZ 85260

(Note we have 2 suites. Please check with your therapist to confirm where to go!)

Counselors in Haden Park Area