Trauma counselling: What does working with trauma involve?

Trauma affects many people in unique and individual ways. You may be a survivor of sexual abuse, sustained violence, sexual violence or domestic abuse. You may be a survivor of trauma through the loss of a loved one in traumatic circumstances, you may have witnessed trauma and have therefore been traumatised yourself. You may have been seriously injured or indeed threatened with death.

Symptoms of trauma can be incredibly destabilising, debilitating and frightening. You may feel as if you are losing control. Nightmares and flashbacks may occur frequently, involuntarily and apparently without cause.

You may find that your body is affected involuntarily; you may freeze up, have an increased heart rate and palpitations, sweat profusely, feel both hot and cold, agitated, easily stressed or react strongly to certain things.

You may experience debilitating anxiety or panic attacks and feel as if your body is stuck in past traumatic events, making it difficult to live in the present. These experiences can feel frightening and overwhelming, but support can help you understand what is happening and develop ways of managing them.

What can working with trauma involve?

In time, you may begin to understand some of the triggers connected to your trauma, explore traumatic experiences where this feels appropriate and manageable, and develop a greater sense of ownership over your experiences. For some people, this may also involve building on their sense of self and beginning to move beyond survival towards living more fully.

You may find sexual relationships difficult, or experience problems in other relationships. You may have developed an inner critic and have negative attitudes and beliefs about yourself and others. The world may feel frightening and unsafe. You may feel shame, blame yourself, self-harm or think of suicide. You may feel isolated and have difficulty trusting others and managing everyday things.

Safety, trust and pacing

Trauma-informed counselling often places particular emphasis on safety, pacing and collaboration. A therapist working with trauma will need skills, attitudes and values such as empathy, unconditional positive regard and respect. The counsellor can help create an environment of hope and empowerment.

Alongside these, the work may include facilitating safety and self-care and helping clients develop skills that can support grounding and the management of difficult feelings and sensations.

There may also be elements of psychoeducation, helping clients to understand more about trauma and make sense of some of their responses in the context of what they have experienced.

It is a collaborative effort on behalf of both the counsellor and client. The client sets the pace of their therapy, and that is respected. Creating a genuine therapeutic relationship can help clients feel more secure and supported as the work develops.

Finding an approach that works for you

A humanistic integrative approach can be useful when working with an individual's unique experiences and finding ways that best fit them as a person in the therapeutic process, developing different skills and new ways of relating to self and others.

Change takes courage and tenacity, and change is not easy, but it can occur.

It may well be beneficial to think about ways that you can best manage your problems and issues with your counsellor, utilising a number of strategies, techniques or approaches.

Working creatively can also be valuable for some people. This might include keeping a journal, creating pictures, creative writing, working with figures, objects and sand-tray work, or experimenting with new ways of being in the therapeutic session.

The important thing is that trauma therapy is not something that should be rushed. Working collaboratively with a therapist can allow you to explore what you have experienced at a pace that feels manageable for you.