Trauma therapy

What is trauma therapy?

Trauma therapy is not a single model but an umbrella term for specialist psychological approaches designed to help people who have been affected by traumatic experiences. What sets trauma therapy apart from general psychological support is its focus on how traumatic memories are stored in the brain and body, and its use of specific techniques to help process those memories safely.

Traumatic events overwhelm the brain’s normal processing mechanisms. When this happens, memories can remain vivid, fragmented and easily triggered, as if the danger is still present. This can lead to a range of difficulties including flashbacks, nightmares, hypervigilance, emotional numbness, avoidance, and persistent feelings of shame, guilt or fear. You may find that certain sounds, smells or situations catapult you back to the moment of the trauma, or that you feel permanently on edge without being able to switch off. These responses are not signs of weakness. They are your brain’s way of trying to protect you from a threat it has not yet been able to file away as being in the past.

It is also important to understand that trauma is not defined solely by the event itself, but by the impact it has on you. Two people can experience the same event and respond very differently. What matters is how the experience has affected your sense of safety, your ability to function and your view of yourself and the world.

Our psychologists draw on a range of evidence-based trauma therapies depending on your specific needs. These include EMDR, trauma-focused CBT, compassion-focused approaches, and integrative methods for complex trauma. The choice of approach is guided by the nature of your experiences, your current symptoms, your preferences and what the research evidence supports.

All of our trauma work is delivered within a phase-based framework. This means we prioritise safety and stabilisation before moving into processing work, ensuring you feel resourced and in control throughout. This phased approach is widely used in trauma therapy and is particularly important for people who have experienced complex or prolonged trauma.

When it helps

Trauma therapy is appropriate for a wide range of trauma-related difficulties, including:

• Post-traumatic stress disorder (PTSD)
• Complex PTSD arising from prolonged or repeated trauma
• Childhood abuse, neglect or adversity
• Sexual violence and assault
• Domestic abuse
• Medical trauma, including birth trauma
• Accidents and physical injury
• Bereavement following sudden or violent death
• Witnessing traumatic events
• Institutional or organisational trauma
• Moral injury

You do not need a formal diagnosis to benefit from trauma therapy. If past experiences continue to affect your daily life, relationships or sense of self, specialist support can help.

It is also worth considering trauma therapy if you notice that your emotional responses feel out of proportion to current situations. A disproportionate reaction to a relatively minor event, such as snapping at a partner over something small or feeling intense panic in a safe environment, can be a sign that unprocessed trauma is being triggered. Similarly, persistent low self-esteem, difficulty trusting others, emotional numbness, or a tendency to disconnect from your body may all have roots in traumatic experience.

Some people are uncertain whether what they experienced “counts” as trauma. It is common to minimise your own experiences, particularly if others seem to have been through worse. Trauma therapy does not require your experience to meet a particular threshold. If it has left a lasting impact on how you feel and function, it deserves attention.

What to expect

Trauma therapy begins with a thorough assessment to understand your experiences, current difficulties and goals for therapy. Your psychologist will take time to understand what has happened to you and how it is affecting you now, at a pace that feels manageable. You will never be pressured to share more than you are comfortable with, particularly in the early stages.

Phase one: Safety and stabilisation. The first phase of therapy focuses on building safety and stabilisation. This may involve developing grounding techniques that bring you back to the present when you feel triggered, emotional regulation skills to help you manage intense feelings without becoming overwhelmed, and psychoeducation about how trauma affects the brain and body. Understanding why you respond the way you do can itself be a powerful intervention. For some people, this phase alone brings significant relief, as they develop tools to manage symptoms that may have felt uncontrollable.

Common stabilisation techniques include:

• Grounding exercises, using your senses to anchor yourself in the present moment. Your psychologist might guide you through noticing five things you can see, four you can hear, three you can touch, and so on.
• Breathing techniques, such as slow diaphragmatic breathing, which directly calms the nervous system.
• Safe place imagery, developing a detailed mental image of a place where you feel completely safe, which you can return to when you feel overwhelmed.
• Containment exercises, learning to mentally “put away” distressing material between sessions so that it does not intrude on your daily life.

Phase two: Processing. When you are ready, and only with your agreement, therapy moves into processing specific traumatic memories. The method used will depend on the approach best suited to your needs. EMDR uses bilateral stimulation to help the brain reprocess stuck memories. Trauma-focused CBT uses structured techniques to work through the trauma narrative and challenge unhelpful beliefs that have developed. Compassion-focused approaches help address the shame and self-blame that often accompany trauma.

Processing work is carefully paced and your psychologist will regularly check that you feel safe and in control. You will not be asked to recount every detail of what happened if that does not feel right. Different approaches have different requirements in terms of how much verbal detail is needed, and your psychologist will explain this clearly.

Phase three: Consolidation and reconnection. The final phase focuses on consolidation and reconnection, helping you integrate your experiences, strengthen your sense of self and build the life you want to live. This may involve working on relationships, rebuilding confidence, reconnecting with activities and people you have been avoiding, and developing a relapse prevention plan.

The total length of therapy varies considerably. Single-incident trauma may require 8 to 12 sessions, while complex trauma typically benefits from longer-term work of 20 sessions or more.

The evidence for trauma therapy

Trauma-focused therapies have the strongest research evidence for PTSD. NICE recommends trauma-focused CBT for adults with PTSD, and EMDR for adults with PTSD after non-combat trauma. Both approaches are well supported by randomised controlled trials.

For complex PTSD, which was formally recognised by the World Health Organization in the ICD-11 diagnostic system, many clinicians use a phased approach, with stabilisation before processing, and this is the framework used by our psychologists. NICE guidance suggests allowing more time and building trust for people with complex PTSD. Research into how best to treat complex PTSD is still developing, but early evidence for therapies adapted for complex trauma is encouraging.

The evidence also highlights the importance of the therapeutic relationship in trauma work. Feeling safe with your therapist is not just a nice-to-have. It is a prerequisite for effective trauma processing. Research suggests that the quality of the therapeutic alliance is linked to how well trauma therapy goes.

Online delivery of trauma therapy has been studied more since 2020, and research on online trauma-focused CBT and EMDR has been encouraging. For some trauma survivors, accessing therapy from their own home actually reduces barriers to engagement, as it avoids the stress of travelling to an unfamiliar clinical setting and allows them to access their coping strategies in a familiar environment.

Trauma therapy at The Online Psychologists

At The Online Psychologists, trauma therapy is delivered by those of our HCPC-registered clinical psychologists who have specialist training and experience in trauma-focused approaches. Between them, they offer EMDR, trauma-focused CBT and compassion-focused therapy, so we can match you with someone whose approach fits your needs.

Our matching process takes particular care with trauma presentations. We consider not only the type of trauma you have experienced, but also any co-occurring difficulties such as depression, anxiety or low self-esteem, so that you are paired with a psychologist who has relevant experience across all areas of your presentation. For specialist needs, such as birth trauma or complex childhood adversity, we will match you with a psychologist who has specific expertise in that area.

Sessions are typically 50 to 60 minutes. During active processing, some of our psychologists can offer longer sessions of 60 to 90 minutes by arrangement. Sessions are usually weekly, though your psychologist will adjust the frequency based on your needs and where you are in the treatment process.

Many people find that online trauma therapy offers advantages they did not expect. You can access therapy from a space where you already feel safe, you do not have to manage the experience of travelling home after an emotionally intense session, and you have immediate access to your grounding tools and coping strategies in the environment where you spend most of your time.

Frequently asked questions

Do I need a PTSD diagnosis to access trauma therapy? No. You do not need a formal diagnosis to benefit from trauma therapy. If past experiences are affecting your daily life, relationships, mood or sense of self, trauma-informed support can help. Your psychologist will carry out a thorough assessment to understand your difficulties and recommend the most appropriate approach.

What if I cannot remember everything that happened? This is very common with traumatic experiences. Trauma can disrupt the way memories are stored, leaving them fragmented or incomplete. You do not need to have a clear, chronological narrative of what happened for trauma therapy to help. Approaches like EMDR can work with fragments of memory, sensory impressions and body sensations, and your psychologist will adapt the approach to what is available.

Will I be forced to talk about what happened in detail? No. Your psychologist will never force you to share more than you are comfortable with. Different approaches require different levels of verbal detail, and your psychologist will explain what is involved and give you choice about how to proceed. EMDR, for example, does not require you to provide a detailed verbal account of the traumatic event.

Can trauma therapy make things worse? It is normal to experience some temporary increases in distress during trauma processing, as you are engaging with material that your mind has been working hard to avoid. However, this is carefully managed by your psychologist, and the phased approach ensures you have adequate coping skills before any processing begins. Research on trauma-focused therapies suggests that short-term increases in distress during processing usually settle, and that these therapies help many people with PTSD.