Three Types of Trauma Therapy
My wife is one of the most amazing people on the planet. She is smart, compassionate, and makes amazing brownies. However, my wife has one minor weakness – indecisiveness. When faced with several options, my wife wants to learn as much as possible before deciding. If forced to decide quickly, she’ll likely feel uncertain and unconfident about her choice.
If you’re a trauma survivor who’s looking to begin therapy, you may feel like my wife. There are tons of options for trauma therapy, but without the right information, it can be difficult to decide which one to pick. In this post, I’m going to describe three common types of trauma therapy to help you decide which one is best for you.
EMDR
I love EMDR. I truly believe it’s a gift that has helped me personally and as a therapist (it’s probably obvious that I’m a little biased).
EMDR stands for Eye Movement Desensitization and Reprocessing. In 1987, Dr. Francine Shapiro was walking through a park thinking about a stressful situation. She noticed that her eyes spontaneously followed cracks in the sidewalk as she was walking, and that these eye movements helped her feel less upset. Fascinated by her discovery, Dr. Shapiro began treating trauma survivors using eye movements, eventually creating EMDR as we know it today.
EMDR has eight phases: History & Treatment Planning, Preparation, Assessment, Desensitization, Installation, Body Scan, Closure, and Reevaluation. For the sake of brevity, I’m not going to explain each of these phases in this post, but you can check out a post devoted to EMDR here.
The aspect of EMDR that is most unique is the eye movements. During an EMDR session, the client thinks about a distressing memory. At the same time, they use their eyes to follow the therapist’s fingers moving quickly back and forth across their field of vision. This type of back-and-forth movement is called “bilateral stimulation” (BLS). Today, many therapists use handheld paddles that lightly buzz to apply BLS instead of eye movements.
Confused yet? If you want to get an idea of what an EMDR session looks like, you can watch this video that shows a master therapist doing an EMDR session at a live training. Just a note about the video: for the sake of time, the therapist flies through all eight phases in about one hour – it normally takes much longer to get through each phase.
We don’t understand why, but applying BLS while thinking about a traumatic memory helps it become less distressing. Some people even report that the memory “transforms” in their mind’s eye, like becoming black and white or losing its sound.
Even though we don’t understand how it works, research affirms that EMDR is effective at treating PTSD. For example, one study found that the “thinking” part of our brain is more active during an EMDR session, suggesting that EMDR helps reduce negative emotions associated with trauma.
Anecdotally, I’ve experienced the benefits of EMDR myself and have seen it work wonders with my clients. When therapists get trained in EMDR, they generally practice their new skills on other therapists at the training. The way I experience the memory I processed at my EMDR training is now completely different, and this was after a short 30-minute practice session. Honestly, I was skeptical that it was going to work going into the training, but I can attest firsthand that it does.
Internal Family Systems Therapy
When my alarm went off this morning, part of me wanted to keep hitting the snooze button until noon. Another part convinced me to get out of bed, read my Bible, workout, and come to the office.
We all are made up of different parts, and no therapy model celebrates this fact more than Internal Family Systems (IFS).
Dr. Richard Schwartz developed IFS in the 1990s while working with clients suffering from eating disorders. During his sessions, Schwartz noticed that many of his clients talked about their different “parts” feeling different ways. Using this insight, he developed a new therapy model called IFS, which quickly became one of the most popular models in the world.
To help understand this somewhat confusing model, let’s visit some of its basic assumptions:
First, IFS assumes that every person’s mind is made up of an unknowable number of parts.
There is no such thing as a “bad” part. Every part is doing the best it can to help the individual, even if this part feels unpleasant.
Parts are aware of and can interact with other parts, creating an internal system that is like a family.
There are three roles that parts can play:
Exiles are the parts that remember, feel, and carry our difficult life experiences. Because they are normally in pain, our other parts try to keep exiles out of our conscious awareness to keep us comfortable and safe.
Managers are the parts that help us stay organized and productive. They are normally logical, heady, and well put together. Managers also often block the pain of exiles. If you’ve ever felt like you needed to cry but couldn’t, you were likely experiencing a manager preventing you from doing so.
Firefighters are another protective part but are drastically different from managers. Instead of blocking exiles, this part serves to distract us when an exile is trying to make itself known. Think of firefighters like your mind’s panic button – when an exile is breaking free, firefighters jump on the scene in a last-ditch effort to distract. Common ways that firefighters distract us from exiles are panic attacks, risky sexual behaviors, and addiction.
In addition to exiles, managers, and firefighters, every person also has a Self. The Self is perhaps one of the most difficult concepts in IFS to understand. It isn’t a part but is “the seat of consciousness and what each person is at the core.” The Self observes other parts – it is the “inner I” every person has inside of them.
There are eight adjectives that describe Self: confidence, calmness, creativity, clarity, curiosity, courage, compassion, and connectedness. Ideally, the Self is the one leading the person throughout life.
The overall goal of IFS is for the Self to manage and lead a person’s other parts so their internal system is in a state of harmony. This is accomplished by gaining the trust of parts, convincing them to let the Self lead, and unburdening exiles from the pain they are carrying.
Prolonged Exposure Therapy
I started rock climbing in 2021. The first time I went climbing, I made it up a 10’ wall and was shaking the entire time. Slowly but surely, I started climbing higher and higher. Now, several years later, I can scale a 50’ wall without giving it a second thought.
What changed?
My brain went through a process called habituation. Habituation is a way to describe how the brain can become used to something it previously perceived as dangerous.
As I learned to trust that my rope and harness would keep me safe from falling, my brain stopped sending distress signals to the rest of my body. My legs stopped shaking, my breathing slowed down, and my palms stopped sweating.
What does this have to do with trauma therapy?
One of the hallmarks of PTSD is an overactive nervous system. Essentially, a brain that has been through trauma will sometimes stay stuck in fight, flight, or freeze mode. When stuck in this state, the body is flooded with stress hormones in preparation for danger.
It feels awful to be in fight, flight, or freeze, so we commonly avoid the triggers that make us feel that way. However, in doing so, we reaffirm to the brain that the trigger is dangerous so that the next time we encounter that trigger, our brain responds even more rapidly.
The awesome thing about exposure therapy is that it breaks this cycle. By intentionally exposing survivors to their triggers, exposure therapy allows their brains to habituate to these triggers, stopping their brain from going into fight, flight, or freeze.
Once the survivor habituates to the trigger, their brain no longer perceives it as dangerous and the trigger doesn’t send them into fight, flight, or freeze anymore.
Of course, it can be scary to expose yourself to reminders of your trauma. Exposure therapy generally starts small, allowing you to habituate to the least upsetting triggers before confronting the scarier ones.
There are lots of ways to participate in exposures. They can be “in vivo” (being exposed to the trigger) or “in vitro” (picturing the trigger in your mind’s eye). Both are highly effective.
One common type of exposure is called narrative exposure. During this exposure, the survivor shares the story of their trauma in detail again and again until their brain habituates to it. You can check out an example of a narrative exposure here.
Which Trauma Therapy Model is Best?
There are lots of factors to consider when deciding which trauma treatment to use. Your worldview, the type of trauma you experienced, and your personality will all affect how you respond to each model.
One of the most important factors for successful therapy is client buy-in. It’s going to be much less likely that therapy is effective if you don’t believe that therapy can help you. When weighing your options, try to notice how you respond to each model. Which one fits best with your worldview? Which makes the most sense to you or feels like it would be the most helpful?
If research is important to you when deciding, you can click here to view the American Psychological Association’s (APA) treatment recommendations for PTSD.
Here are my thoughts on when it’s best to use EMDR, IFS, and exposure therapy.
EMDR: I’ve had the most luck with EMDR when treating a single incident trauma, like a car accident or natural disaster. It’s still been helpful when treating complex trauma (trauma that was repeated), but it takes more time than treating a single incident trauma. It’s also helpful if the survivor has clear, distinct memories about their trauma so we know what to target.
IFS: I’ve found that IFS is most helpful when treating interpersonal trauma, like a parent who was neglectful or a childhood bully. Some people have a tough time buying into the idea that we are all made up of multiple “parts,” whereas others really resonate with this model. It’s also not on the APA’s treatment recommendations for PTSD, but research is showing that it’s an effective trauma treatment model.
Prolonged Exposure Therapy: I was skeptical of exposure therapy before I was trained in it. However, I can attest to its effectiveness, as it’s helped me overcome some of my own fears. Some of my clients have reported that they like exposure therapy because they can feel themselves getting less anxious in the moment. Like EMDR, I’ve found that it’s most helpful with single incident trauma.
How to Get Started
These are only some of the therapies available for treating trauma. If you’re considering trauma therapy, reach out to a therapist and ask what type of therapy they use. They should be able to explain your treatment options. Shop around until you find someone who feels like they’ll be a good fit.
If you’re interested in hiring a trauma therapist, I’d love to have a conversation with you. You can click here to contact me and learn more about my approach to trauma therapy.
