Why do people come for therapy?

What do we understand by the term: Trauma?

The term trauma is widely used in the media and most of us have heard stories of people traumatised by horrific events and suffering with conditions such as PTSD (Post Traumatic Stress Disorder).

In this article I hope to explain what psychological trauma is, how it happens and what we can do about it.

So what is trauma?

In the physical realm we know that the human body has a protective skin. Our skin is tough enough to get us through most day to day situations, but occasionally something happens that breaks through our skin. We call it an injury, medical doctors often call it a trauma. Typically this results in a wound which needs to heal. Occasionally we are left with a scar, and depending on the severity of the injury we may even be left with permanent damage.

This description can serve as an analogy to our psychological realm, where we have a mental system that allows us to engage constructively with the world and protects us from unwanted intrusion. Some (including myself) believe that this psychological protective ‘skin’ is optimally formed in loving interactions with our caregivers during our development through childhood.

However, events can occur that break through this protective psychological ‘skin’ or maybe prevent it from forming correctly in the first place. Psychotherapists call this a trauma. A trauma leaves a psychological wound that needs to heal. Occasionally we are left with a metaphorical ‘scar’ which can affect the way we see and understand the world. Fortunately humans are blessed with an innate capacity to heal, both physically and mentally.

What type of events can cause psychological trauma?

One way of looking at traumatic events is the concept of “too much coming in”, or things happening that break through our ability to protect ourselves. This could include violence, aggression, sexual abuse, loud noises, explosions, war, medical procedures, accidents, natural disasters, horrific images and stories. This list is not exhaustive as it is not possible to predict what events will be traumatic to any particular individual. One factor may be how well formed their ‘psychological skin’ is at the time of the incident. This may explain why a group who experience the same event at the same time can all have differing reactions to it.

One theory describes an exacerbating reason that may explain why an event can become traumatic. This is our ability to mobilise (or not) in accordance with our natural bodily responses to danger. In my article on fear I describe the ‘stress response’ (sometime called our fight/flight response). If the circumstances of the event did not allow us to respond in the way our natural instincts wanted us to, then that may have the effect of intensifying the trauma.

What are the effects of trauma?

Trauma can affect our memory, and not simply in the sense of remembering historical events. One function of our memory is to teach us what is good for us, and what is bad. We learn by experience more powerfully than by instruction. Recently on a nature walk, I saw a loving father instructing his young son what a stinging nettle looks like. I couldn’t help thinking that the boy will probably have a more powerful learning experience the first time he touches one.

A trauma can affect our memory by changing the natural setting of our warning alert system, rather like changing the sensitivity of a smoke alarm. Too sensitive and the alarm is constantly being triggered by benign events, too insensitive and the alarm may miss potentially important signals. Trauma sufferers can experience both these effects, and it can be very disturbing and unsettling, especially if it’s all happening out of conscious awareness. In their attempts to self regulate, they may find themselves plagued with unwanted bodily sensations or drawn to partake in risky behaviours or addictions.

What can we do about it?

As I mentioned earlier, the mind/body has a natural predisposition to heal but usually requires the right external circumstances to support the healing. Rather like a broken bone needs to be held in place and kept still and protected in order to heal well, our psychological wounds need an appropriate environment in which to heal well.

Typically this will be a place of safety, respect, openness and encouragement. This is what a psychotherapist seeks to co-create with their client. The therapist needs to keep in mind that traumas that were perpetrated to the client, especially by a person in a position of power or trust, can make the re-establishment of trust very difficult for the client. It is important that the client feels that they have control over the pace and depth of the evolving therapeutic alliance.


We have been looking at trauma from the perspective of ‘too much coming in’. There is another, slightly more subtle but no less devastating kind of trauma which is characterised by ‘not enough coming in’. Perhaps if I use the word neglect it will become more clear.

This kind of trauma is becoming known as complex trauma and will be the subject of a future article.

And by the way, you don't need to wait for a crisis.

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