Crisis and trauma psychotherapy

Crisis and trauma psychotherapy are forms of therapy that have been developed to support the processing of traumatic events and the treatment of trauma-related disorders. Crisis therapy typically focuses specifically on a single traumatic event, such as a sudden accident, the death of a loved one, or being a rape victim. Psychotherapists from other psychotherapy orientations also often have some expertise and additional training in the treatment of crises and traumatic events, and some other psychotherapists have undergone additional training in the treatment of traumatic events. 

Background 

Trauma therapy is more commonly focused on the treatment of trauma-related disorders. Internationally, there can be different theories behind the treatment, but in Finland, trauma therapy is usually based on the structural dissociation theory developed on the basis of Pierre Janet's theories. 

It is thought that repeated childhood traumatic events (e.g. domestic violence, sexual abuse or neglect) can lead to a disorder of personality development, in which the person's childhood coping mechanisms for traumatic circumstances appear in adulthood as symptoms that weaken the ability to function. 

Such early means of coping include, for example, narrowing of consciousness, self-harm, and the division of the personality into trauma-attached and trauma-separated parts. Various situations and observations reminiscent of trauma can cause those suffering from a trauma-related disorder to relive the events of the past, which makes normal life difficult in many ways. 

Especially in the most severely traumatized persons suffering from severe dissociation disorders, the personality is thought to be fragmented into parts attached to the trauma and parts separated from them. The functioning of a person suffering from dissociation disorder can vary greatly, for example, between day and night. She/he might have feeling of unreality or that the things that happen to her/him would happen to someone else and she/he suffers from memory lapses in the past and present. A person suffering from severe dissociation disorder can also hear voices that come from their own trauma background.

Focus of therapy 

Typically in Finnish crisis and trauma therapy 

• The severity level of the trauma-related disorder is assessed 
• Information is given about the consequences of traumatization
• In the first phase we learn ways to control the intrusion of vivid trauma memories into the mind as well as the over- and under-stimulation states of the body 
• Instead of fear, the development of curiosity towards body and mind reactions is supported 
• Situations and factors that trigger trauma symptoms are identified A
• Aims to combine experiences and ways of experiencing trauma-related and separate from it into a unified world of experiences 
• When it is felt that the client is ready, the trauma events are dealt 
• Deals with the reactions appearing in the therapy relationship, which are related to the traumatic childhood relationship with the parent
• In the end, we are helped to move into today's life with new skills 
• As part of trauma psychotherapy, e.g. sensorimotor trauma methods and the EMDR method. There is a separate training for the EMDR method, which psychotherapists of different orientations can attend. The method is in accordance with standard treatment recommendations in the treatment of traumatic stress disorder.

Therapy in practice 

Typical duration: In crisis therapy (single trauma event) from weeks to months, in trauma therapy several years. 

Typical frequency: 1-2 times / week 

The role of the therapist: In crisis and trauma therapy, the therapist strives to be predictable, calm and safe, but also active and sufficiently flexible. He helps to understand trauma symptoms, supports in managing trauma symptoms and alertness, and helps dissociative disorders in consolidating the fragmented world of experiences and memories into a whole experience. 

Working method: A trauma psychotherapist provides information on the effects of traumatic events on a person's mind and body function. Along with the conversation, therapy often includes various exercises, such as imagery exercises about a place of refuge, observing body sensations, and calm breathing exercises. There can also be movements or exercises that raise alertness, in which the focus is directed away from trauma memories, e.g. you may be asked to name the objects around you in order to bring focus to the present moment. 

These and other methods aim to increase the client's ability to regulate their anxiety and state of alertness. In the conversation, the aim is to become more aware of the experiences related to trauma and those that are separate from it in present life. The purpose is to reduce the unpredictable intrusive reliving of trauma memories and other trauma symptoms such as memory loses and the activation of "fight or flight" trauma reactions. 

In trauma psychotherapy, a trauma-damaged model of close relationships is often present. Domestic violence, sexual abuse or neglect caused by a parent leaves its mark on the way a person experiences the parent-child relationship and close human relationships more broadly. These distorted experiences of intimacy often show up in a relationship with a psychotherapist. In trauma therapy, we work with distrust and excessive defensiveness linked to closeness, and we work on both the longing for closeness and efforts to avoid attachment. 

The idea of ​​trauma therapy is that only when the ability to regulate trauma symptoms has been learned in the beginning can one move on to talking or writing about trauma memories with the therapist and that this exposure to trauma memories in turn reduces trauma symptoms even more. Not all traumatic events need to be dealt with, but usually the core points and distorted beliefs that have arisen in an abusive relationship with the caregiver.

The biggest differences to other psychotherapy approaches

• Focuses on crises and traumas, causes the person has developed an acute stress reaction (crisis therapy) or post-traumatic stress disorder, complex post-traumatic stress disorder or severe dissociation disorder. 

• The sessions might include more techniques and exercises than in some other orientations, as well as more information about traumatic reactions 

• Crisis therapy is rather short-term and focuses on using the threat of a traumatic event, and trauma therapy, on the other hand, is an intensive and long-term form of psychotherapy