Talk Therapy
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The treatments that work best for PTSD are trauma-focused psychotherapies (or, talk therapies). “Trauma-focused” means that the therapy focuses on your memory of the traumatic event or what it means to you. There are other talk therapies that do not focus on your trauma. Learn about the research for different talk therapies and what you can expect in treatment.
Most of the therapies below last for 3 to 4 months. Then, if you still have symptoms, you and your therapist can talk about ways to manage them using skills you learned in treatment.
Trauma-Focused Talk Therapies for PTSD
- Cognitive Processing Therapy (CPT)
CPT teaches you how change the upsetting thoughts and feelings you have had since your trauma. - Prolonged Exposure (PE)
PE teaches you to gradually approach trauma-related memories, feelings and situations that you have been avoiding since your trauma. - Eye Movement Desensitization and Reprocessing (EMDR)
EMDR helps you process and make sense of your trauma while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone). - Written Exposure Therapy (WET)
WET helps you find new ways to think about your trauma and its meaning through writing assignments you complete during sessions. This is a brief, 5-session therapy.
Other Talk Therapies for PTSD
- Stress Inoculation Training (SIT)
SIT teaches coping skills to help you find new ways to manage PTSD symptoms or other stress in your life. - Present-Centered Therapy (PCT)
PCT focuses on learning how to deal with current life problems related to your traumatic experience or PTSD symptoms in ways that are adaptive.
Which PTSD Treatment Is Best for You?
No one treatment is right for everyone. Learn about effective treatment options with PTSD Treatment Decision Aid. You can read about different treatments, hear advice from people who have been through these treatments, and watch videos of providers explaining how the treatments work. You can also build a chart to compare the treatments you like the most and print a personalized summary that lists your symptoms, treatment preferences, and questions to share with your provider.
I know the title of this article may sound a bit odd coming from a psychotherapist, but let me explain. This is one of the least known aspects for most therapists and clients when it comes to working with trauma. Now I am not saying we don’t talk and discuss things as part of therapy, but it is not sufficient to resolve trauma.
I regularly work with clients who have been through years,and sometimes decades, of therapy who have made progress and accumulated agreat deal of knowledge, but they still struggle with symptoms related to theirtrauma, such as anxiety, depression, and relationships issues.
What they have not yet experienced is how to release traumafrom their body, which is held in what is referred to as our implicit memorysystem. This part of the brain has no sense of time and cannot differentiatebetween people, time, and place. Furthermore, it cannot be accessed andresolved by talking about what occurred.
People will frequently discuss events that were traumatic and have little to no emotion as they talk about them. Some recognize their lack of emotion is out of place. Others believe these events had only minimal impact due to their lack of reaction to them. In both cases their absence of feeling is due to a process known as dissociation.
When our nervous system becomes overwhelmed energetically, we either reach for someone safe, fight or flee, or go into a primitive freeze response as a last line of defense. In early life, it doesn’t take much to trigger a freeze reaction. Our lower brain triggers a neurological response that splits off the energy we cannot handle low and right in the brain to prevent the upper brain from being damaged by the chemical, electrical energy that is rushing through our nervous system.
This reaction is highly adaptive and helps us survive overwhelming physical and emotional experiences. However, these events are now held in our implicit memory system, which again has no sense of time or way to distinguish between past and present.
Moreover, when it is not activated you may not even realize it is there or believe it is in the past and does not affect you now. This part of the brain just stores things as a feeling; it does not typically come with words or images. When experiencing this type of memory, you rarely realize you are having a memory.
Until recently, most of the approaches in therapy were focused on helping you contain your reactions or challenge them rationally. But if you struggle with PTSD (Post Traumatic Stress Disorder), you are aware these strategies do not work when you are highly triggered, nor do they resolve the underlying trauma.
In order to resolve the trauma and manifesting symptomsrequires accessing the implicit memory and then allowing the energy to movethrough your nervous system and discharge. This cannot be achieved by justhaving a conversation. The implicit memory is not stored in the cognitive partof your brain.
There are many well-meaning individuals in the helpingprofession who create a safe environment, listen empathically, and providesupport. And, yes, this has tremendous impact and can help heal trauma at acertain level. However, until the trauma is fully cleared from the body, itwill continue to surface and impact your life negatively.
A great resource if you would like to learn more about this process is Bessel Van Der Kolk’s book, The Body Keeps the Score. This will give you a much deeper understanding of the concepts I have been discussing. In addition, when you obtain assistance from a trauma specialist like myself, it will be a huge asset to you in your therapy.
One of the most meaningful parts of my job is helping peoplerelease trauma rapidly they have been carrying around for years. In thebeginning of our work, I hear statements like, “It’s too late for me,” or,“I’ve been through too much.” No matter what you’ve been through or the amount,you can completely heal from anything. Thousands of clients I have work withwould back me up on this statement.
My final piece of advice is to look for someone who uses experiential therapies, such as:
- AEDP,
- EMDR,
- Somatic Experiencing,
- Brainspotting,
- Internal Family Systems,
- Sensorimotor Psychotherapy,
- or similar experiential therapies.
Remember, it takes more than just talking about what happened to heal from it. It will take processing your emotions related to these events and releasing them from your nervous system, but it will be well worth it.
If you have any questions, would like more information about this topic, or are interested in scheduling a session, contact me.
It can be frustrating if you’ve worked on your trauma in traditional talk therapy for months, or even years, just to find only temporary relief. What talk therapy does in the case of trauma is simply talk the ghosts of the traumatic memory into different rooms of your brain. When a trigger comes up, however, and you accidentally find yourself opening the door to one or many of the rooms you had locked these ghosts into, you then have to convince them to return. Symptoms that come up such as PTSD, depression, anxiety, addiction, eating disorders, etc., are really present day triggers of trauma. As long as those ghosts of your past are still locked into those rooms of your mind, symptoms are going to persist. It takes a lot of energy to keep track of where traumatic memories are stored and stay away from those places at all times, and is something you won’t be able to maintain long-term. EMDR therapy works to completely get rid of those ghosts so there is no chance of them jumping back out at you. So why does talk therapy work, but not in the case of trauma?
- Talk therapy can provide some temporary relief; however, it is merely the Band-Aid that is being placed over the cut. EMDR is able to access the memory networks of the brain directly to clean out any blocks that may be preventing the brain from healing and correctly processing the traumatic memory. Rather than just covering up the cut for periods of time, it works to clean it out to allow for healing on its own. Talk therapy leaves out this initial step of cleaning out the cut, therefore can lead to further infection and improper healing.
- Every time you tell a story a new memory is made. Talk therapy forces you to reiterate the event which can be retraumatizing in some cases. If you are constantly being prompted to rehash traumatic details and remember the story, each time you do your brain is going to store a new memory of this traumatic event. EMDR does not require you to make new memories of the event because, rather than encouraging narration of the details, it directly accesses the original memory in the brain. EMDR simply edits the original memory in a way that allows it to be stored in its proper place.
- The brain organizes information different than the intellect does. All the insight in the world will not change the body’s natural response to trauma. Intellect does not necessarily prevent triggers and does not guarantee change. Talk therapy aims to change the maladaptive thoughts and negative beliefs associated with the trauma without really processing the state specific images, emotions, and body sensations which accompany trauma recall. Trauma is stored in the right side of the brain apart from narrative memory. As trauma is processed through EMDR in a holistic manner and moves over into verbal memory, positive beliefs spontaneously arise and strengthen as a result. This is not the case in talk therapy, as positive cognitions are often forced upon the memory like trying to fit a square piece into a circular shape. It doesn’t fit as long as that memory is still “frozen in time” with the attached images, emotions, and body sensations.
With EMDR therapy you are always in control of the process. You already survived the worst part, and all EMDR does is remove the obstacles so your brain is allowed to do what it naturally does anyways. Your brain is constantly working to resolve traumatic memories, so it is just a matter of cleaning out the cut and allowing the healing to happen.
Chelsea Crow is a Marriage and Family Therapist Registered Intern, Professional Clinical Counselor Registered Intern, is trained in EMDR and specializes in trauma. For more information or to schedule an appointment with Chelsea, please call 949.484.5008.
