When “trauma therapists” aren’t especially trauma informed.

I recently saw someone who represented himself as an experienced trauma therapist say, “avoidance never works” in the treatment of trauma. 

It was in the context of him dismissing a grounding technique as “avoidant”— which it wasn’t. 

He seemed to think that the point of the grounding technique was to distract from or avoid the pain of an emotional flashback (though, in fairness, he didn’t seem to know what an emotional flashback was, either). 

Grounding isn’t about “avoiding” anything— it’s about using environmental cues, starting with our senses, to impress upon our nervous system that we are not “back there, back then,” but rather right here, right now, and relatively safe. 

That notwithstanding, I was surprised that a supposedly experienced trauma therapist would claim that “avoidance never works” (in fact, elsewhere in the conversation, he advised confronting trauma memories “head on”). 

It’s true that if avoidance is ALL we do in trauma recovery, it’s not really recovery. Trauma recovery is actually the literal opposite of avoidance— it’s accepting that we NEED structured trauma recovery; that we WERE abused, neglected, or otherwise traumatized; that we CAN’T just go on like we were. 

But it’s also true that we’re not ready, at every moment or point in our recovery, to confront certain feelings or memories. 

Effective treatment for trauma proceeds in three stages. In the first stage we don’t do ANY trauma “processing” or other exposure-based work; we focus ONLY on safety, stability, and coping skills and tools. 

The reason we don’t f*ck with meeting trauma memories “head on” in Stage One is because we’re usually not stable or safe enough at that point to tolerate that work.

Many people who get into trauma recovery are frustrated to learn that we can’t just jump right into confronting or working through our traumatic memories and feelings— but we first have to develop what I call emotional “cardio” for the fight ahead. 

If you were a professional fighter, and I, as a coach, put you RIGHT in the ring to fight a big, scary opponent, WITHOUT any skill-building or endurance training, you probably wouldn’t have much of a realistic chance to win, would you? 

That’s what Stage One trauma work is: skill-building and emotional cardio. 

In order to DO that skill-building and endurance training that will give you your best chance to succeed when you DO move on to trauma processing in Stage Two, you’d better BELIEVE we’re going to avoid some things. 

Important skills in Stage One trauma work are containment and pacing. “Containment” is all about learning to intentionally, intelligently compartmentalize memories and feelings until we’re ready to deal with them; “pacing” is all about tapping the brake and only dealing with the piece of work you can realistically manage. 

Technically speaking, both of these skills are about “avoiding” certain feelings, memories, and other sensations. They are the opposite of meeting feelings and memories “head on,” as this supposedly “experienced” therapist was advocating (remember, “avoidance never works!”). 

Unfortunately, there really is a subset of therapists who think that exposure and cognitive therapy are the only effective ways to work with trauma. The Veterans Administration famously endorses two treatment protocols, prolonged exposure (PE) and cognitive processing therapy (CPT), in work with traumatized veterans. 

Exposure and cognitive therapy can play a role in trauma recovery. 

But dissociation throws a wrench into both of those modalities. 

You can’t “confront” a feeling or memory if a survivor isn’t there to work through it— if they’ve been triggered and are mentally taking a Parisian vacation while their body remains in your office. 

That’s why we make the distinction between paced, skills-based work in Stage One, when survivors are prone to be overwhelmed, dissociative, and not-infrequently suicidal; and Stage Two, when survivors have acquired sufficient skill, endurance, and stability to actually DO the exposure and processing work that this guy seemed to think you could do at any ol’ time. 

All of which leads me to say: we sometimes hear that it’s not important to be “trauma informed;” that anybody with a mental health degree or license is probably trauma informed, by definition. 

But here was a guy whose literal job was to work with trauma— and he was missing a large, pretty basic piece of the conceptual puzzle. 

We, the trauma treatment and recovery community, have a LONG way to go in helping the culture become meaningfully trauma informed.