When a new client asks “how long is therapy going to take?” I know that they are eager to feel better, heal, and move forward. They want to pour out all the details of their story within that first session because they expect this to speed up the process of healing. But, we are dealing with deep emotional pain, trauma – pain that requires slowing down and taking the healing process one step at a time. I wish we could help everyone achieve healing instantly. But the truth is, healing trauma takes different amounts of time for different people. And diving right into the deep end, to face your deepest hurts isn’t usually the best approach to achieve long term change. Healing takes time to explore and own your strengths and develop an awareness of the many different parts or perspectives you have, and how they work together as an attempt to help or protect you that you may not know now.
As a trauma-informed therapist, I would like to share some of my insights into how long therapy takes to heal trauma and explain why doing it right—slowly, and with a trauma-informed approach—is worth it, even if you don’t think you have trauma.
The Understandable Desire for a Quick Fix
Many people who’ve experienced trauma have spent their lives trying to feel less bad. They have often desperately tried anything they can think of to stop feeling the pain, fear, and sadness they experience. This could lead to using coping mechanisms like drugs and alcohol, self-harm, food, or sex to try and make themselves feel less bad. Reaching for answers outside themselves to manage feelings seems to “help” for the short term.
But for the long term, the only way to feel less badly is from the inside. Relief comes from being able to process the feelings within your body (with a bottom-up approach) and move towards healing. It’s not easy. But it’s worth it. When it comes to healing trauma, quick fixes usually don’t work. Here is why trauma-informed therapy does.
Why I Advise Against Diving Into the Details In the First Session
You are looking for relief when you decide to come to therapy. You want to feel better. That’s understandable and possible!
“The first goal of trauma recovery should and must be to improve your quality of life on a daily basis.”
― Babette Rothschild
You may think the fastest path to relief is to completely share all the details of your trauma right away. The quicker you share the trauma, the faster you can heal trauma, right? This is not true.
You can share the details about your trauma with every new therapist (or person) you meet. But this doesn’t bring you closer to healing, because prior to healing, trauma will shape the way you see it and the way you tell it. Until you have processed it, the story of your experience will come from a mindset shaped by the trauma itself. These are:
1) A dissociated state: You can tell your story matter-of-factly from a state where you are not fully present and inside your body. The coping skill you have used to handle this trauma inside yourself is avoidance. The only way to tell the story or recount the trauma is without any feelings, as though it happened to someone else, which perpetuates a cycle of dissociation and trauma.
2) A triggered state: A way in which you are reliving the trauma and feeling badly, as you tell the story – living in a body memory or flashback. You are then living in that pain again without a healing resolution.
Neither of these states brings you closer to healing.
How to Work With Trauma At a Safe Pace
Sharing the details of your trauma with a brand new therapist is like ripping off a bandage to show a doctor a raw, unhealed injury. If you tear off a scab before the wound has healed, you’ll find yourself bleeding all over again.
Likewise, you need a safe relationship and a trained, trauma-informed therapist to work with emotional or psychological trauma. If you don’t, and you don’t yet have the skills to stay present you will be unable to recognize that you are safe in the present moment and that the trauma is no longer happening to you. You may be unable to avoid feeling a fight-flight amygdala response.
Each time a person tells their story from an unsafe place, that person risks reliving the trauma. They risk strengthening the nervous system response to stay prepared for danger – reinforcing the need to live in the fight, flight, or freeze mode.
Safety and Stability First
In our work with clients, before we discuss the details of your trauma, you will feel stable and safe in and out of our office.
Before we focus on the details of your experience, we have to develop ways for you to feel safe and stable in your current world. We will further help you develop your resources and stability and increase your healthy coping skills.
For example, we use imagery to develop new ways to respond when you feel triggered. We may develop a “container” of sorts that you’ll use—both in and out of the office. It’s an imaginary box to hold feelings and memories. It’s a way to hold your emotions, contain them until you are in a safe place or trusted relationship, sort through the pain and not be alone. You can think of it as a shoebox with index cards in it, to organize your thoughts and responses. The next time we meet, we can take them out to process them slowly, one by one.
A stronger sense of stability comes from having a safe space to hold feelings until you are ready to process them. This allows you to develop the ability to tolerate your current day feelings and know that you’re safe.
New coping skills and abilities to hold difficult feelings don’t happen in the first five minutes of therapy. This growth happens by building a trusting therapeutic relationship and then building safety within yourself. Then you can better handle the emotions that may come forth when you think about and share your painful story.
You are able to know that you are safe currently and can hold that dual awareness with the painful story of your past. In therapy, you learn to develop a larger window of tolerance of emotions, where the feelings are bearable so that you can share your story in a way that promotes healing.
“Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.”
― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Safety Includes the Time Between Sessions
But what if you feel safe with your therapist right away?
What if you feel safe enough with me (or any therapist), that you feel safe telling all the details in a first session? I would ask you: What if you don’t know yet how to tolerate those feelings outside the therapy office? And once you leave the session, do you need to have to drink, use, cut, or do something else in order to avoid a constant state of overwhelm?
There is danger in facing too much too soon because that emotional pain you allowed yourself to feel in the therapy office feels so similar to the pain of the past. It doesn’t yet have a safe place to live in your present life. Before we can begin to process the trauma, we need to help you be safe in the moment, and safe in your current life, so that a new ending to your story can emerge.
“No recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. The therapist’s job is not just to be a witness to this process but to teach the patient how.”
― Janina Fisher
So, How Long Will Therapy Take?
We need to understand your history, your strengths, your resources for support and your current situation. Is this a single incident trauma (which can potentially be resolved quickly through EMDR? Or, are you facing complex developmental trauma? Are you experiencing ongoing abuse in which you are still living with the abuser? Do you have a fairly secure foundation and support system, or do we need to work to build these?
The point is, how long therapy takes is less important than the quality of our relationship and support. Can you learn to have a more secure foundation, Can you develop relationships outside of therapy that will support your healing? What matters more is to work with you and the experiences you bring—from a place of safety and stabilization. This is how true healing can occur. And I can’t think of a better way to spend our time!
It Takes Time to Heal Trauma
It’s worth the time! You’re spending it anyway.
Many people spend thousands of dollars and years and years trying to feel less badly, anyway they can—using drugs, alcohol, eating disorders, sex or pornography or anything else that will help them avoid feeling bad—trying to live with memories, feelings, and stress that is unlivable. They do what they can to cope because they’d rather feel anything besides the pain, the fear and the sadness.
In our practice, we understand that the weight of your emotional pain is huge. We respect that pain. And we move through it, one step at a time, in a way that we both know you can handle.
- Flashback Halting Guide: 10 Tips to Halt Flashbacks for Yourself or a Loved One
- What You Need to Know About EMDR and Trauma
- Fuzzy Slippers: How to Do Self-Care as a Trauma Survivor
- Why You Need a Trauma-Informed Therapist, Even if You Don’t Think You Have TRAUMA
- Using ‘Big T’ and ‘Little T’ for Trauma Can Be a Big Mistake
Robyn is a Licensed Marriage and Family Therapist with 20+ years of experience providing psychotherapy, as well as the founder and clinical director of a private practice, Brickel and Associates, LLC in Old Town, Alexandria, Virginia. She and her team bring a strengths-based, trauma-informed, systems approach to the treatment of individuals (adolescents and adults), couples and families. She specializes in trauma (including attachment trauma) and the use of dissociative mechanisms; such as: self-harm, eating disorders and addictions. She also approaches treatment of perinatal mental health from a trauma-informed lens.
Robyn also guides clients and clinicians who wish to better understand the impact of trauma on mental health and relationships. She has a wide range of post graduate trauma and addictions education and is trained in numerous relational models of practice, including Emotionally Focused Couple Therapy (EFT), the Psychobiological Approach to Couple Therapy (PACT), and Imago therapy. She is a trained Sensorimotor Psychotherapist and is a Certified EMDRIA therapist and Approved Consultant. Utilizing all of these tools, along with mindfulness and ego state work to provide the best care to her clients. She prides herself in always learning and expanding her knowledge on a daily basis about the intricacies of treating complex trauma and trauma’s impact on perinatal distress.
She frequently shares insights, resources and links to mental health news on Facebook and Twitter as well as in her blog at BrickelandAssociates.com