“Perhaps there was no more detrimental consequence of our childhood abandonment than being forced to habitually hide our authentic selves. Many of us come out of childhood believing that what we have to say is as uninteresting to others as it was to our parents.”
Sam works extensively with trauma, including PTSD and complex developmental trauma. Trauma often shows up in ways we don't immediately associate with our traumatic experiences — in how we see ourselves, other people, and the world. Life often seems to get smaller after trauma, because we feel worse about things and avoid situations that will bring up painful feelings. We avoid obvious triggers, like the place that something bad happened, but often we start avoiding situations like trusting others or saying “no” to loved ones because of things we started to believe after the trauma.
Working with Sam to address trauma is a collaborative process, and something we would approach carefully together. Sometimes clients come in with a clear idea of what they need and a desire to jump right in, but often it is a much more gentle exploration of things that have happened in the past and developing a shared understanding of how they effect you in the present. You can expect to be supported and go at your own pace, and work with Sam to choose a treatment approach that works best for you.
Cognitive Processing Therapy
CPT is a cognitive behavioral therapy that operates from a scientific understanding of trauma, and intuitively makes sense to anyone who has experienced PTSD. When PTSD is triggered our brains are responding as if we are experiencing a whole new traumatic event — many people get flashbacks, panic attacks, nightmares, or an intense sense of danger even years after a traumatic event. Trying to avoid those experiences and make sense of why the traumatic event happened to us can leave us leading deeply compromised lives. We often end up unable to enjoy things that we used to, and telling ourselves (sometimes unconsciously) overly negative things about ourselves, other people, and the world in general.
CPT focuses on developing a clear understanding of what it is you are telling yourself, and changing that inner narrative. The focus is on things you consciously and unconsciously started to believe after the traumatic experiences, so we don’t necessarily have to talk about all the details of the experiences at all. As you shift the things you think and believe, you will find that you start to feel and behave differently as well.
CPT involves 12 structured sessions with a significant amount of homework between sessions. You will develop an understanding of how PTSD effects you, the mostly unconscious things you’ve been telling yourself since the traumatic events, and start practicing new thoughts and beliefs that are more realistic and nuanced. The goal is not to develop very positive thoughts or feelings about your trauma, but to settle into a more reasonable and accurate view of the world so that you can move on with your life.
Sam was trained in CPT by Dr. Kathleen Chard, one of the treatment’s co-developers. Here is a firsthand account of one person’s experience with an intensive course of CPT.
Cognitive Processing Therapy vs. EMDR
Over the past several years, EMDR (Eye Movement Desensitization and Reprocessing) has received a lot of attention. EMDR is effective and well established, and it is one of three trauma-focused therapies (including CPT and Prolonged Exposure) that are generally considered ‘gold standard’ PTSD treatments. If you are already aware of your treatment options for PTSD and you are seeking EMDR specifically, there are numerous local providers who offer EMDR. If you are not fully aware of your treatment options for PTSD, it may be worth considering CPT as an alternative to EMDR.
The practical difference between the two is in what is involved for the client. EMDR and Prolonged Exposure both have you bring the traumatic memory to mind and stay with it during the session; in that sense both involve a form of revisiting the experience and developing your ability to tolerate it, eventually ‘desensitizing’ yourself through exposure. Some EMDR proponents would argue that there is a ‘reprocessing’ element associated with the eye movements, though studies comparing EMDR with and without the eye movements indicate they have minimal effect, and that the exposure accounts for the efficacy of the therapy. CPT is not an exposure therapy. Rather than returning to the details of what happened, CPT gets at the thoughts and beliefs that resulted from the event. You change how you feel by re-evaluating those beliefs without having to walk back through the memories themselves in a detailed or repeated way.
CPT involves regular homework, mostly in the form of daily worksheets that take 5–15 minutes between sessions, and EMDR does not. EMDR is a clinician-led process that happens within the session itself. While the homework requires commitment and diligence, the advantage is that clients develop tools that they can use for the rest of their lives.
If you’d like to compare the options for yourself, the VA’s National Center for PTSD offers a free, plain-language PTSD Treatment Decision Aid that walks through each treatment side by side.
Psychodynamic Therapy
Psychodynamic therapy is a very different experience than CPT. It is a relatively unstructured and relationship-based approach based on developing insight into unresolved inner conflicts and developing an authentic relationship between therapist and client within the frame of therapy. Psychodynamic treatment sees the therapist-client relationship as the primary mechanism of change, and tends to focus on childhood experiences, relationships, dreams, attachment with caregivers and other forms of meaning-making rather than present-day PTSD symptoms.
Therapy will often address transference and countertransference, or the tendency for a client’s longstanding relational patterns to show up in the therapeutic relationship itself and provide both insight and an opportunity to try something new. The therapist-client relationship can be an opportunity for a corrective emotional experience — an opportunity to positively experience things like vulnerability and connection that went terribly wrong in the past. Psychodynamic therapy is often helpful for people whose trauma is more complex or developmental in nature, i.e. in situations in which a caregiver was involved and/or the experiences happened during childhood when we are developing our models for attachment and our most basic feelings about ourselves.
Treatment is not time-bound and does not stick to any set pace or agenda. It is common for psychodynamic treatment to stretch over a period of months or years, not weeks.