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  What kind of Counselling Approaches are there?

Trauma Counseling Approaches

There are many trauma counseling approaches and techniques available to address the symptoms of PTSD. Choosing which is the most appropriate might seem confusing.

When selecting a therapist to assist you, they will, hopefully, be trained in a number of approaches so that they can select the approach that is the best fit for you. That choice is will often dependent on your particular struggles. Presenting a clear and honest description of what you are experiencing will help the counselor treat you with interventions which are the best fit for your needs.

Although there are many types of approaches, many are derived from Cognitive Behavioral Therapy and Reciprocal Inhibition.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is probably the most used, intensively researched, and consistently effective treatments for the symptoms of posttraumatic stress currently used by clinicians that treat trauma survivors. CBT Trauma Therapy combines the aspects of Behavioral Therapy (BT) and Cognitive Therapy (CT) so it includes explicit, observable, as well as the implicit and internal behaviors.

One essential feature of CBT is addressing the distorted cognitions (thoughts) that are negatively impacting your life, limiting your activities, outlets and life pleasures. These include:

  1. Identifying distorted beliefs
  2. Identifying the root of the distortion (when did the belief first surface; what happened at that time?)
  3. Extinguish the old belief (often through various exposure and/or challenging exercises)
  4. Develop new more adaptive and intentional schemas or belief systems (i.e., I am doing my best)

Reciprocal Inhibition

Another essential element of CBT is Reciprocal Inhibition; a theoretical approach developed by Joseph Wolpe in 1958.

Reciprocal inhibition was used to explain and direct the treatment of anxiety and phobia symptoms and most recently post-traumatic stress. The theory of reciprocal inhibition holds that when exposure to an anxiety-provoking stimulus is paired with the relaxation response (i.e., the individual is able to keep the muscles in their body relaxed) and the individual is able to maintain this relaxation, then over time fear-provoking stimulus (such as reminders of a trauma) are eventually extinguished through consistent exposure while feeling safe and/or calm.

Reciprocal inhibition, the pairing of exposure and relaxation, is at the heart of all Behavior Therapy with symptoms of anxiety. Some Behavioral Therapies (e.g. in vivo exposure or flooding) begin with exposure and push their way through the anxiety, hopefully to a point where you can become relaxed in the face of exposure. However, these techniques have the potential of re-traumatizing some people especially when you are not able to fully maintain relaxation throughout the exposure exercise and as well if there is insufficient time to resolve or get used to the trauma memory. This would leave the trauma memory recovery work incomplete. It is not until relaxation occurs in the face of exposure to a trauma memory that symptoms subside. It is our opinion that relaxation is a necessary ingredient to symptom resolution and better learned before and experienced during exposure than experienced after the process of being overwhelmed by anxiety, panic or post-trauma response.

Thus, we identify reciprocal inhibition as a "necessary ingredient" in effective treatments of PTSD. Working with your trauma therapist, you will learn techniques to help approach and confront your traumatic history when you are ready. You will also learn techniques for developing and maintaining a relaxation response during the stabilization stage of your treatment as well as during the trauma memory processing portion of recovery. A skilled traumatologist will help you navigate this journey.