“The paradox of trauma is that it has the power to destroy but also the power to transform and resurrect.” Peter A Levine

Different Forms of Trauma

  • Post Traumatic Stress Disorder (PTSD)

    Post Traumatic Stress can be a normal response to an abnormal or life-threatening event such as an accident or attack. Sometimes people then find that their beliefs are challenged, maybe about themselves and their safety or about how they feel about other people. The event might be re-experienced with intrusive imagery or nightmares replaying what happened. Understandably, with post-traumatic stress you may feel on edge and might notice strong emotions and changes in behaviour. To start with, this is a healthy adjustment process after a shock. It becomes a problem if it persists and starts to impact your life negatively. Because the trauma feels so unmanageable and overwhelming there is usually strong urge to block the memory out and avoid reminders to cope. Trauma therapies aim to make a safe space to work through traumatic experiences and process them so that they don’t continue to have this emotional impact. Both CBT and EMDR are NICE-recommended PTSD treatments.

    Trauma-focussed CBT starts with teaching calming strategies and understanding the trauma and how it has impacted. It then aims to tell the story and challenge and update the linked trauma beliefs. Lastly the aim is to engage with life again and build confidence in your ability to cope and overcome the past and focus on the present. After recovering from trauma, people often report increased self-confidence and understanding, and this positive change has been named post-traumatic growth.

    EMDR can also start with building positive resources first, if needed. It then uses ‘bilateral stimulation’ (eg eye movements, sounds or tapping on two sides) to distract you while working through difficult material imaginally. Processing the bad experience then allows you to find ways to resolve it and feel stronger. People sometimes compare the experience to intentionally dreaming when awake and can find unexpected positives and solutions.

  • Complex Trauma / Complex PTSD

    Complex PTSD is increasingly recognised and is common when people have had abusive or neglectful childhoods or have had violent or controlling partners. It also arises from other situations where people experience repeated traumas they can’t escape such as war or slavery. In addition to the PTSD symptoms above, Complex PTSD also includes: long-term negative beliefs about self, lots of difficulty managing emotions and severe problems making or keeping relationships. Sometimes people can ‘dissociate’ which is a fairly common protective response to repeated severe trauma, where people lose connection to themselves or reality. It can help at the time as a defence to minimise the impact of the trauma. But it can become a problem later when it becomes an involuntary response at other times.

    The same treatment approaches also work to treat Complex PTSD – in fact a large meta-analysis of 130 studies showed talking therapies for adult PTSD work as well for multiple traumas as single ones (Hoppen 2024), which backs up what we know from clinical practice. However it may be that more time is needed for therapy. Initially this could be to understand trauma impacts and timescales and to stabilise with work on managing emotions. You might also want to process multiple trauma experiences. If there are several similar ones you don’t usually have to process them all as processing a significant one well can ‘generalise’ to the others. To choose targets, you and your therapist would be guided by what bothers you and is re-experienced now and the positive changes you want to make.

  • Traumatic Grief

    Grief is a natural process of feeling intense loss and sadness. Usually this is after a death but we can also experience grief after other losses, like a relationship breakdown or a job ending, especially if these are things that were important to your identity and the loss happened in an unplanned way and leaves you feeling unmoored.

    Usually grief starts to improve and adapt with time as part of our natural healing ability. However when the grieving process gets stuck or perhaps the level of sadness, anger, guilt or self-blame has become unmanageable, then therapy can help with this.

    CBT might help in terms of telling the story of the loss to help understand it and put it in context. It can address self-blame and loss of trust or self-confidence. You might value the space to reflect and develop different meanings about a loss and consider how to grow around it in ways that are important to you now. Alternatively, EMDR might be a less structured and more direct way of working with whatever is coming up for you. All the therapies could help with focussing on rebuilding and developing meaning around difficult experience.

Personality Difficulty / Disorder

We can all have difficulties with our personalities sometimes and historically ‘Personality Disorder’ has been seen as a stimatising diagnosis. However, some people have embraced and reclaimed it, as it has opened doors for effective treatments. Although it’s implied as something long-term, people can make major changes in their lives and recover to the extent they no longer meet this diagnosis.   There’s often a big overlap between Complex PTSD and Personality Difficulties/Disorder (particularly Personality Disorder diagnoses such as Borderline also known as Emotionally Unstable). This is likely because severe adversity in childhood can impact on personality development and limit chances to learn healthier coping skills. Some differences that might suggest a Personality Difficulty approach (rather than Complex PTSD) might be where someone experiences more instability around their sense of self. This might result in dangerously impulsive behaviour, extreme mood swings and severe attachment and relationship problems e.g. intensively seeking relationships but fearing abandonment. The newer international (ICD11) diagnosis for personality disorder has removed some of the old categories (such as Borderline, Narcissistic and Avoidant) to have a broader categorisation that focuses more on the severity of difficulties. It also uses Costa and McCrae’s extensive research on universal personality structures across the world to locate 5 areas of personality problems. This includes difficulties with social and emotional functioning, rigid standards for self or others, disinhibition and detachment. Swales (2022) provides an excellent interpretation of this and other great reading is the Consensus Statement advocating for better understanding and treatment for people diagnosed with Personality Disorder.   There’s considerable debate about the (un)helpfulness of this diagnosis and where there’s obvious trauma and reexperiencing it would make sense to treat that, if wanted. Although this obviously depends on whether someone feels ready and has enough stability in their life to do an intensive therapy . A specialist service might be needed if there are considerable risks and the timing needs to be considered carefully.

DBT is often the recommended treatment for Personality Disorder, particularly where there are risky or self-harming behaviours. It has had good treatment outcomes for young women in particular, according to NICE.   CBT for Personality is another approach which focuses more on the belief systems that have formed and understanding and changing these to something more helpful.   CAT’s relational focus can make it a really valuable way of working on this key area of difficulty, developing understanding of patterns and responses.   ACT and Mindfulness also has a lot to offer around learning to manage and step back from difficult experience and focussing on the life you want to build.