Writing a book is a great way to clarify your thoughts. I am now halfway through my new self-help book, on healing childhood trauma, and – after many head-scratching years – it has finally given me clarity on what to call my approach to therapy. One of the USPs of this book is the idea that, especially when we are trying to heal from complex problems like the impact of childhood trauma, using a one-size-fits-all approach to therapy isn’t always helpful. In my opinion, if you’re in need of therapy for any reason, you deserve to find someone who respects you as an individual, rather than trying to round-peg-into-square-hole you into a somewhat rigid idea of how therapy should look for everyone.
That’s why I have fused all the wonderful therapy models I have learned over the last 30 years into a unified approach called integrative trauma therapy. I have drawn from cutting-edge, highly effective models such as:
Aaron Beck’s cognitive therapy
Jeffrey Young’s schema therapy
Richard Schwartz’s internal family systems
Stephen Porges’ polyvagal-informed therapy
Janina Fisher’s trauma-informed stabilisation treatment
Paul Gilbert’s compassion-focused therapy
Kristin Neff & Chris Germer’s mindful self-compassion
These are all wonderful approaches to healing in their own right – and I have many brilliant colleagues who offer them in a pure way to their clients, which works beautifully for them and those they help. But that’s just not the way my brain works – I’m naturally integrative and, although I see great wisdom in every form of therapy, there are aspects of each that don’t seem so helpful. And, more importantly, I don’t think that any one model is enough for people with the most complex, hard-to-treat problems.
Here are some of the key principles of integrative trauma therapy, as well as the ways in which I think it will help you, if you’re struggling with the legacy of trauma in your life.
All good therapy should be trauma-informed
We know beyond doubt, from decades of research into the roots of mental-health problems, that childhood trauma is a causal factor in most, if not all of them. I have written before in these posts about the groundbreaking Adverse Childhood Experiences study, which was a vital piece of research showing how common ACEs were – among the middle-income Americans who participated in the original study, let alone those living in poverty, or other tough environments in which to be a child. These ACEs include experiencing physical, emotional or sexual abuse; having one or more parents with substance-abuse issues, and witnessing domestic violence. A heartbreakingly large number of kids must endure these problems, in the US and around the world.
This research also showed a strong link between the number of ACEs we experience as a child and our vulnerability to a wide range of physical and mental-health problems as adults. In my opinion, any therapy which is not trauma-informed is at best unhelpful and, for trauma survivors, can be downright harmful. That’s why my approach is based on the tried-and-tested three phases of trauma treatment, because so many of my clients were traumatised by their painful childhoods. Phase one involves psychoeducation, about key ideas like trauma, attachment, core developmental needs, schemas and parts, a little brain science and the crucial role of the nervous system in trauma healing.
This first phase also involves practical, experiential exercises to help calm and soothe people’s dysregulated nervous systems – using all my practices on Insight Timer – before phase two, which is processing trauma memories. Schema therapy’s imagery rescripting is great for this, as is IFS and EMDR, which I don’t offer but many colleagues do. And phase three is all about integration, of all this healing, transformative knowledge into your life, as well as integrating every aspect of your internal system using parts-based therapy.
Therapy needs to be a unique blend, just for you
I often say to my supervisees that not only should we create a unique therapeutic recipe for each client, our guiding principle should be: ‘What does this person need at this moment in this session?’ Although we all need goals, and an overarching idea of how therapy should look over time and what we are trying to achieve, these principles should be flexible, not fixed. As someone who specialises in complex trauma, I have learned that the more trauma someone’s system holds, the more flexible we therapists need to be. That’s because the techniques and approaches that work well for someone who is fairly high-functioning and only experienced mild trauma/neglect in childhood, just do not work with more traumatised folk.
It also makes me a little sad when I see devotees of model X saying model Y is deeply flawed, or that anyone not adhering to every principle of model X – as if it were some kind of religion – is somehow being disloyal to the model, or doing therapy badly. Why can’t we draw on all the wisdom, richness and depth of the many great approaches to therapy available to us? That’s why I think integration is key, depending on what works best for us, as an individual therapist, and you, as individual clients. The tricky bit, of course, is integrating in a way that is organic, coherent and powerful, rather than bitty, eclectic and confusing for clients. That only comes with a great deal of practice, experience and trial and error to see what works best (after 30 years in the personal development world, I’m still learning from my mistakes every day! Ask me in another 30 and I may have it all figured out).
All of this means that, as a client, please do not be afraid to shop around. Finding the right person for you, who feels like a good fit, is so important – whatever kind of therapy you choose. I hope that person is flexible enough to adapt what they are doing to suit you. Also make sure they are accredited, properly trained and can explain their approach/answer any questions you may have – if it’s too vague, or doesn’t feel right for you (listen to your gut on this, because your gut has wisdom that your brain does not) keep looking until you find the right healer for you.
Therapy is all about love
All therapy is based on attachment, whether that’s explicit (as in schema therapy) or not (in modalities like CBT). Humans are hard-wired to attach to other humans, it’s fundamental to our being. We rely on others to survive, as helpless infants. And we continue to rely on others in so many ways for every second of our lives, which is why loneliness is so painful – and even life-threatening – for millions of people in our fragmented, isolating, unnaturally hi-tech and urban existence. So, of course, therapy is about being in relationship too. One of the reasons I love schema therapy is the richness of its attachment-based approach to the therapeutic process. Creating ‘earned secure attachment’ with my clients is my number-one goal.
In fact, I think that as therapists, we should love our clients. And of course that doesn’t mean we should date them, or do anything inappropriate. It’s just that everyone needs love – our inner children crave it above all else. And many of the people who see me for therapy have never had love, or at least never had love that wasn’t in some way hurtful, disappointing or neglectful. So I am as warm, kind, compassionate, involved, attuned, respectful and praising as I can be. I have a principle that I am as warm as my clients will let me be, because again for those with a big trauma history, receiving love is often hard, or even threatening. So I go easy, step by tentative step, until they can learn to let it in, even a little.
The other kind of love we need to foster in therapy is internal, from your wise, kind, patient, nurturing Compassionate Self to the hurt parts of you, especially the wounded little boy or girl inside. IFS is great at helping you build this inner relationship, which is why it’s my favourite of these many different models. It embodies the warmth, kindness and downright good-heartedness of its founder, Richard Schwartz, with a non-judgemental, non-pathologising ethos that I and my clients love. The key point here is that it’s not either/or – attachment with your therapist or your Compassionate Self, inner or outer. It’s both/and, because we need both inner and outer connections, understanding and love, to thrive as humans.
If you would like to know more about integrative trauma therapy, here is a guide to some other key principles. I will also keep posting about techniques and ideas you might find helpful. And, of course, watch this space for my book! It’s coming together nicely, so I can’t wait for you to read it.
Love,
Dan ❤️