What Exactly Does"Doing Trauma Work" Even Mean?
A simplified, no-jargon guide for therapists mystified by this elusive term
When I was a training therapist, I sat in supervision groups listening to more experienced clinicians discuss “trauma work” as if it were some distinct and almost secret modality. At the time, the term felt technical and gated, packaged as if a therapist graduates from doing “regular therapy” before being able to offer this "othered” serious kind of work.
But therapy doesn’t sit in this sealed box. It is not “underneath” other problems. Rather, it is ever-present in how someone sees themselves, how safe the world feels, how the body interprets and responds to stress, and which strategies are used to cope, avoid, or connect with others.
Therefore, even if you don’t realize it, you are doing trauma work with patients. So, you need to be deliberate with how you’re engaging in it.
Almost 15 years later, I will share what I now know: there is no particular, single thing called trauma work. Trauma work starts immediately. Trauma-focused care is a nuanced lens, rather than a separate category. It’s not “this is depression,” and “that is anxiety,” and trauma is in a deeper fold, just waiting to be processed.
And so this is what I’d like to share with clinicians who still feel mystified by the mysterious phrasing “trauma work.”
Building a Trauma-Focused Framework
This article, like all my articles and books, is intended to be foundational.
It is not rooted in one specific modality or population. I aim to “go broad” to encompass the main strokes. My readers work with all types of people and in all types of settings- my hope is there is something for everyone to glean.
That said, use your own discretion and consider that my reflections may not be indicative of your own clinical experiences or particular modes of treatment. In other words, take what you need and feel free to reach out if something feels utterly off.
Understand That Trauma Work Starts From the Get-Go
Despite how trendy modalities want to package their training, there is not one specific moment where therapy suddenly shifts into “trauma work.”
All therapy is contextual; trauma work starts the first time we sit with someone. That’s because, from the onset, we, as therapists, are being evaluated. The trauma, therefore, speaks to us both verbally and non-verbally.
From the beginning, the patient is assessing: Is this person safe? Can I trust this person with my feelings or needs or longings? How do I balance the shame I feel with the desire to be witnessed and understood? What if I lean all the way in, and they abandon me?
For many people with trauma histories, safety has been deeply compromised. They are inherently hypervigilant trusting others, and this apprehension unfolds into the treatment.
In other cases, there is such a frantic desire to experience relief that they want to share everything. That feels urgent and acute- the need to “release” feels omnipresent, both to them and to us.
And in some cases, it’s a combination of both: the longing to be seen and the terror of actually being seen.
And so, you are “doing” trauma work by modulating your own presence first. Do not overlook that the extraordinary gift of attunement itself can be a corrective emotional experience. Many patients can feel this as early as the first session, and they should certainly start feeling it within a few sessions.
Even if they don’t feel safe yet (and the safety often does take a good amount of time), there should be a developing felt sense within the patient’s inner monologue that sounds like: “Even if I’m afraid or insecure or feeling extremely discouraged sharing my stuff, maybe this person can help me. Something about them feels somewhat trustworthy. They feel like they know what they’re doing. And it feels okay (or even pretty good) talking to them.”
Trauma is Not Separate From Other Presenting Concerns
A common clinical error is assuming trauma exists in its own distinct category.
It doesn’t. A trauma-focused therapist operates under the framework that trauma fundamentally impacts how a person perceives themselves and the world around them.
Trauma can erode internal and external safety, making it hard to feel settled. This painful lack of feeling settled can lead to avoidance behaviors or the ongoing need to repeat the same behaviors, hoping for a different outcome.
Therapists can theorize that many compulsive tendencies are ways to manage trauma symptoms and maintain a sense of safety in the world. Therapists can also conceptualize that trauma exacerbates other symptoms, including anxiety and depression.
And so, despite how modern treatment plans are packaged, you do not treat one without the other. Neither the body nor the psyche knows “what is depression” versus “what is ADHD” versus “what is emotional neglect.”
The same is true for therapists. You can’t treat anything in isolation because all symptoms overlap and reinforce one another- that’s why changing one way of being can and does often impact the entire system.
Trauma Pacing Requires Striking the Right Balance
Pacing matters in all courses of psychotherapy. Move too quickly, and you risk overwhelming the person, pushing them into the dysregulation, shutdown, or damaging reeactments that often reinforce why they’re in therapy. But if you move too slowly, it feels like nothing is happening.
Both are problematic.
Therefore, the work lives in the tense space between:
Sitting with what feels painful right in the here and now.
Moving toward what has been avoided or what feels intolerable.
The gap between these two states can be quite long, and readiness is often built through ongoing safety and repetition. We strive to meet people where they are, but we hold onto hope regarding where they can be.
