Drs. Dietrich, McLean & Associates -
Not all traumas are the same;
not all trauma training is the same
If you have been traumatized, it is important to know what to look for in a trauma therapist and trauma treatment. Not all training is the same, and not all treatments for trauma are the same. Traumatic events as defined by the Diagnostic and Statistical Manual of Mental Disorders (such as combat, rape, sexual abuse, and so forth) differ from "small-t" traumas, such as loss of job. Treatment for severe traumatic events requires specialized training.
Therapists have wide differences in terms of the training they have had for treating trauma. It can vary from taking a weekend or two of a specific technique such as EMDR, to those who have been extensively trained in a variety of approaches for trauma and who regularly keep their training up-to-date.
Single-Incident Traumatic Events
For individuals who have had fairly normal childhoods and who have experienced a single-event trauma as an adult, treatment is usually fairly straightforward. The most researched and empirically validated treatments for single-incident traumas are Cognitive Behavioural Therapy or Eye Movement Desensitization and Processing. When there are no pre-existing or co-existing difficulties to the single traumatic event, treatment tends to proceed quickly with excellent results.
Chronic or Developmental (Childhood) Traumatic Events
When individuals have experienced traumas during formative development (e.g., childhood and adolescence), or who have been repeatedly or chronically traumatized, treatment becomes much more complex, and treating clinicians should be highly trained to work with these individuals and the symptom picture that they often present with (e.g., posttraumatic stress, depression, anxiety, substance-related disorders, dissociative disorders, relationship problems, problems with identity, sexual problems, anger issues, and so forth).
It is often important that treatment is provided for the underlying basis of the symptoms (early trauma), rather than focusing solely on the symptoms or manifest pathology. Often these symptoms are the ways in which persons who have been traumatized during developmental periods have learned to cope. Treating the symptoms and ignoring the underlying origins, or overpathologizing the patients without recognizing the impact of the developmental trauma, may be counterproductive and result in iatrogenesis. These individuals may get worse when not receiving expert treatment.
When seeking therapy for these types of traumatic events, things you may want to look out for include the following:
  • What level (breadth and depth) of supervised training in trauma has the clinician received? Have they simply taken a couple of courses in a specific technique, or are they trained more extensively (breadth and depth)?
  • How much continuing education specific to trauma have they received? When did they last attend such a training session?
  • What is their interpersonal style?
  • What treatment approaches do they use? Are they limited to one approach, or do they have several options available to them? Patients are different, and what works for one patient may not work for another.
  • What is their understanding of phases of treatment for treating complex trauma? If they do not know the answer to this, you may wish to explore additional options.
  • Do they use empirically validated treatment approaches? Or do they practice using techniques that are not accepted by the wider scientific community? A caveat: if patients do not respond to validated treatment approaches, then there may be approaches that have not yet been validated that may help. In accordance with the Code of Conduct of the College of Psychologists of British Columbia, the first line of treatment should be with empirically validated approaches.
Although there are no guarantees that you are choosing the right therapist for the problems that you are experiencing, the more knowledge you have, the more likely you will find an appropriately trained therapist.
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