How Do Clinical Psychologists Treat Patients With Trauma Histories Effectively?
Psychologist Brief
How Do Clinical Psychologists Treat Patients With Trauma Histories Effectively?
Imagine a world where trauma can be treated effectively without causing additional harm. This is the reality for many patients under the care of experts such as an Owner and Clinical Director and a Ph.D. Clinical Psychologist. In this article, the first insight shared by these professionals focuses on teaching the Window of Tolerance. The last of the five insights emphasizes the importance of focusing on present moment pain.
- Teaching Window of Tolerance
- Guiding Through Resourcing Exercises
- Measured, Empathetic Approach
- Building Emotional Stability Skills
- Focusing on Present Moment Pain
Teaching Window of Tolerance
As a trauma and PTSD therapist, I have successfully treated many clients with histories of trauma by using a trauma-informed and client-centered approach. One key intervention I use early in therapy is teaching clients about the Window of Tolerance. Together, we explore their nervous system's tendencies toward hypo- or hyperarousal and identify personal indicators of dysregulation. For example, one client I worked with noticed shallow breathing and clenched fists were early signs of hyperarousal. We developed grounding practices, such as deep belly breathing and sensory engagement, to help them return to their Window of Tolerance.
We also created a self-care plan tailored to their needs, encouraging activities that support nervous system regulation. After establishing these foundational tools, we began trauma processing. Because the client had resources to manage distress, they felt more confident navigating the emotional intensity of processing. This structured, collaborative approach allowed the client to process traumatic memories without becoming retraumatized and build resilience in their daily life.
Guiding Through Resourcing Exercises
As a licensed counselor who specializes in trauma, I ensure clients don't get re-traumatized when treating trauma by guiding them through numerous resourcing exercises. Through these exercises, I can gauge their ability to connect to tools that allow them to shift nervous system states. Moving forward, if additional resourcing is necessary, we do that to ensure emotional safety before processing trauma. Once safety is established, I use EMDR and target a memory called a 'bee sting,' meaning it is not a large T trauma. This is another safety strategy used to test the state of their nervous system. It gives me information again if they can shift nervous system states. If they can tolerate the bee sting processing, we then move to a traumatic memory that is causing them distress using EMDR therapy. When processing, clients are stopped periodically to check their level of tolerance. Addressing trauma is unpleasant but it's imperative to ensure clients stay inside their window of tolerance, with just the right amount of distress, in order to access the memory and help move it from short-term memory to long-term memory. If the client becomes too distressed when processing and gets outside their window of tolerance, we stop processing and do grounding exercises and use the tools taught in session to return to a calmer state.
Measured, Empathetic Approach
One of the most rewarding cases I've worked on involved a patient who came to The Alignment Studio with chronic back pain and a history of physical trauma from a car accident years prior. The patient was understandably apprehensive about treatment, as they had previously undergone therapy that left them feeling both physically and emotionally triggered. Drawing on my many years of experience and training, I took a measured, empathetic approach to ensure they felt safe and understood throughout the process. My first step was to conduct a thorough assessment, focusing not just on the physical issues but also on understanding their emotional and psychological concerns. I explained every step of the treatment plan, offering reassurance and maintaining open communication to establish trust.
We started with gentle manual therapy techniques designed to reduce muscle tension and improve mobility without causing discomfort. I then integrated tailored clinical Pilates exercises, which allowed the patient to regain strength and confidence in their body gradually. By focusing on postural alignment and movement patterns, we addressed the root causes of their pain while avoiding any triggering elements of their previous trauma. Over several months, the patient not only became pain-free but also reported a significant improvement in their overall well-being and a renewed sense of control over their physical health. This outcome highlighted the importance of combining technical expertise with compassion and clear communication, a philosophy I prioritize at The Alignment Studio.
Building Emotional Stability Skills
The key is to focus on a carefully paced approach that puts a patient in control of their healing journey. Rather than diving directly into traumatic memories, we might begin by building what we call "emotional stability skills" - techniques for managing overwhelming feelings and staying grounded in the present moment.
When working with patients, we first establish a foundation of safety in the therapy room. This means letting them set boundaries about what they're ready to discuss and teaching them tools like controlled breathing or sensory grounding before approaching difficult memories. We call this the "safety first" approach.
A crucial part of avoiding re-traumatization is working at the edge of what's tolerable - helping clients process their experiences without becoming overwhelmed. This might mean focusing initially on building strength through discussing times they've shown resilience, rather than the trauma itself. The brain needs to feel safe before it can begin processing difficult experiences.
We know that trauma lives in both the mind and body. Modern treatment approaches respect this by incorporating both cognitive techniques and body-based awareness, allowing clients to heal without being re-traumatized by their own memories.
Focusing on Present Moment Pain
There's no need to retraumatize our patients by getting them to focus on the horrific memories of the past because the real problem only exists in the present moment. The past is mostly irrelevant to the real healing.
I am currently working with a client who comes from a background of sexual abuse that was ritualized in a religious context. She experiences flashbacks that come with a strong visceral response and physical pain.
We are seeing immense progress by turning her attention to the visceral response directly and learning how to feel and process that emotional energy without fear. The memory involved with the flashback isn't important. The problem is the pain that comes along with the flashback, so we need to focus on handling the pain directly.
Imagine that you sprained your ankle 20 years ago but never let it heal properly. So, you developed a way of walking that helped you avoid putting pressure onto the wounded muscles. This new gait allowed you to get by, but the actual damage never got repaired and now, when you put pressure back onto the old, unused muscles, it causes pain.
Now, if you went to a physical therapist, it's not relevant how you sprained your ankle. Whether you did it playing volleyball or by slipping down the stairs doesn't matter. What matters is developing a slow and steady process of learning how to put weight back onto the atrophied muscles and doing exercises that will help to build those muscles back up.
That's how we need to confront our trauma as well.
In fact, the trauma is like a 500-pound weight of emotional distress and right now, the traumatized client's emotional muscle can barely handle 10 pounds. So, why would we focus on such a heavy weight anyway? Trying to lift something that big will only cause more damage until we build the strength to do it properly.
Our trauma presents itself to us every single day as our triggers, emotional responses, and defense mechanisms. Rather than focusing on the memories that created these responses, we should focus on building the strength and skills to handle the responses directly. By bringing ourselves back into the moment and developing the strength to process our triggers without fear, we build the muscles which will allow us to get closer to the buried trauma naturally.
It's not a process of drilling into the past... It's a process of excavation. Start with the pain in the moment and we'll uncover what's been buried naturally when the patient is ready to discover it.
