Traumatic experiences are having an extended cultural moment. No longer relegated to treatment settings, they’re popular conversational fodder for low-key dinner parties, celebrity interviews, and TikTok, where the #trauma tag has garnered more than a billion views. Mainstream publications like The New York Times regularly explore research related to trauma treatment, a topic once considered “inside baseball” but now more in the realm of common knowledge.
No one can deny the widespread benefits of pushing our culture to be more trauma-informed, but as trauma becomes more and more of a buzzword, some therapists worry that it’s becoming watered down in our minds. Is your client’s parking ticket really traumatizing?
To take the measure of where we stand, I spoke with trauma-treatment pioneer Babette Rothschild, who’s practiced and written on the topic for half a century. We delved into putting trauma in perspective, recent treatment trends that can cause more harm than good, and how in-demand trauma therapists can protect themselves from burnout.
Ryan Howes: In your long career in the trauma field, you’ve authored many seminal books on trauma and vicarious trauma, including The Body Remembers, Help for the Helper, and Revolutionizing Trauma Treatment. What do you think of the recent rise in trauma awareness?
Babette Rothschild: I think by focusing so much on trauma, we’re lessening the importance of all sorts of other stressful things that happen to people. Judith Herman made it very clear in the ’90s, in her book Trauma and Recovery, that if we call everything trauma, then nothing’s trauma. Still, you hear people these days saying things like, “Oh my God, selling my house was traumatic. I’ve got PTSD from that horrible real estate agent!”
Even in our field, many people I train or supervise feel that trauma should be our primary focus. When I ask them about client issues that aren’t trauma, they counter with, “My clients only have trauma.” I’ll say, “Well, wait a minute, you mean some clients don’t sometimes just have issues with their job, trouble making decisions at the grocery store, or agreeing with their spouse about childcare?”
It’s important to remember that lots of the difficulties people have with trauma may stem from other issues, particularly early attachment. In the currently popular focus on techniques, often the importance of the therapeutic relationship and other sources of support are forgotten. The literature is consistent: good contact and support in the wake of trauma is what separates people who experience trauma without long-term consequences from those who go on to develop PTSD. And we know that people can and do recover from trauma without trauma therapy.
RH: How do they recover without therapy?
Rothschild: In the same way humans have for thousands of years: they access and utilize all sorts of resources, including a support network. We as clinicians can get so focused on the trauma and processing the trauma memory, that we forget to help people develop the kind of resources that stabilize their daily life. Sometimes helping people improve their quality of life means processing trauma, but sometimes it doesn’t. People recover all the time from trauma without focusing on what it was that happened, be it recent or long past. Sometimes they recover through spirituality, family, good work, nature, friends, even (and sometimes especially) their pets. Many different things can help.
RH: And some heal by talking about it with others, particularly in therapy.
Rothschild: Yes, absolutely, sometimes that can help, though sometimes it can hurt.
Right now, everybody’s looking for a quick fix or new technique that’s going to cure trauma. But even if an intervention works for one person, nothing helps everybody. Unfortunately, therapists get so tied to their one method that when they don’t see a person benefiting from it, they assume there must be something wrong with the client, like they’re not serious enough about the work, or they’ve got secondary gains, when actually the method may not be the right fit, or the therapist isn’t a good fit.
In the 1960s, Joseph Wolpe, founder of behavior therapy, said if the therapy isn’t working, look to the method and the application of the method: don’t look to the client. I’ve always said that therapists should be trained in several different approaches so they can fit the therapy to the client, not the other way around. With all this focus on methodology, the unique needs of the individual often get lost.
RH: It’s interesting to me how people who develop therapy approaches and theories are often much less rigid about them than some of us who adopt them.
Rothschild: I wouldn’t say that’s true of everybody who’s an originator, but it’s true of a lot of them. In my preface for Revolutionizing Trauma Treatment, I write about three meta- studies that looked at outcomes for several different trauma therapy methods. They found that no method stood above any other or helped more than 50 percent of people.
When a trauma method doesn’t work, too often the client gets blamed in some way. In that same book, I have a case where a mother came to me because her young daughter had early trauma. She’d been to three trauma therapists trained in three of the best-known methods. But each of those therapists had fired the kid from therapy after a few sessions. All of them said some variation of: “I can’t do any ‘real work’ with your daughter because she dissociates too much.” I can’t tell you how angry I was!
RH: It’s as if they were saying, “I can’t do trauma work with your daughter because she’s showing trauma symptoms.”
Rothschild: Exactly! Dissociation is a major symptom of trauma. You can do plenty to help somebody with dissociation without having to touch the trauma memories. But those therapists thought the only real work was processing trauma memories. They didn’t have any other tools.
RH: Ultimately, you’re advocating for trauma therapists to have a variety of tools in their toolbox?
Rothschild: I recommend each therapist should only choose tools that suit them, but, yes, they should have a variety, so that they’re flexible enough to be able to look at the individual, talk with them about their situation and preferences, and negotiate together. This way the client’s a full partner in the process.
In practice, I might go about this by saying to a client, “Here’s what EMDR looks like. Does that appeal? Here’s what a somatic intervention might look like. Does that appeal? Here’s what cognitive behavioral exposure therapy looks like. Let’s talk about what might be best for you. But even before we get that far, are you ready to process a trauma memory? Do you feel you have the capacity for it? Are you able to manage the increased stress and dysregulation that’s going to happen when we open that Pandora’s box?”
It’s important to remember that when you do open Pandora’s box, the client will likely get more unstable and become more dysregulated, not because anyone is doing anything wrong, but because that is what happens when someone connects to their unresolved trauma memories. When you apply phase-oriented treatment as proposed by Pierre Janet, Judith Herman, and others, focusing on stabilization and safety first, processing memories becomes way easier, briefer, and you have fewer problems between sessions.
RH: So establishing community or a support system should come before the trauma treatment?
Rothschild: Yes, alongside building up stabilization and safety. Here’s how I put it to my groups. “Do you know there are 168 hours in a week, and the average therapist sees their average client for only one? What happens in those other 167 hours? That is why helping a client develop a network, increasing their access to contact and support, is so important. No therapist or therapy can be enough support, for any client.”
But people will still say, “Oh, yeah, I do that phase-oriented stuff. The stabilization and safety. We do a few minutes of grounding, and I have them think of a safe place, and then we start processing the trauma memory.”
Well, that’s not building stabilization and safety in the client’s life. If you take a person without adequate support and go straight to processing trauma memories, you get more isolation, more dysregulation. You can end up with people trying to process their trauma for years and years because they don’t have the internal and external resources and structure for actually resolving it.
First, help clients get stable and safe in their daily life. That doesn’t necessarily mean they’re symptom free, but they can go to work or school or manage the house and have a support system: friends, family, church, whatever. Sometimes those clients say, “You know what? My life’s going much better. I don’t want to dig around in that stuff.” I say, “Great, go live your life.” The important thing is that their life quality is improved. I care about processing memories only when that’s going to improve their quality of life.
I’d like to clarify something important here: helping a traumatized client stabilize, manage their symptoms, be safe, and build network and other resources is all trauma treatment, and as far as I’m concerned, it’s perhaps the most important part. Too many therapists think working with the memories is the only trauma treatment that counts, which risks the kind of situation that happened to the girl with the dissociation I mentioned before.
It’s a myth that our clients must process their trauma memories to recover a good quality of life. I demonstrate this in my trainings by polling the audience of therapists. “Everybody put up your hand if you have trauma in your background.” Most everybody puts up their hand because as trauma therapists, we’re a field of wounded healers, right? Then I say, “Keep your hand up if you haven’t processed all your traumas.” A bunch of hands come down. Then, “Keep your hand up if you have trauma in your background, you haven’t processed all your trauma, and you have a relatively good quality of life.” More hands come up again. And then I ask the audience to look around, because now, between two thirds and four fifths of hands are still up in the air, indicating a majority of the therapists present have unresolved trauma in their backgrounds and yet have a good quality of life. Finally, I say, “Now tell me why we’re pitching to our clients that they must process all their trauma memories when we as professionals know ourselves, personally, that it’s not always necessary for recovering and pursuing a good quality of life?”
This horrifies a lot of people. Nonetheless, we have centuries and centuries of examples before psychotherapy or trauma therapy ever came into being. We all know people who have recovered from trauma without therapy and gone on to live valuable, productive, good lives. An example from my practice: A woman I worked with was gang raped as a teen. She had amazing support in the wake of the rape, and completely recovered. No therapy, no rape crisis center, no pastoral counseling, nothing but good, consistent, contact and support. I was glad she came to me because a different therapist might’ve said, “Well, you absolutely have to process that trauma.” And I think that could have done tremendous damage.
RH: What other mistakes are we making with trauma clients?
Rothschild: As a field, we have a magnetic pull toward early trauma. Let’s say a man experiences a recent stressful or traumatic incident that triggers an old trauma, and he goes to a therapist. A common scenario in that case would be the therapist ignoring the recent incident and zeroing in on the earlier trauma. That often results in the client becoming further dysregulated. This is a common scenario because most of us were not taught to ask a valuable old-school question: “Why now? What was the precipitating incident that brought you to therapy at this time?” The precipitating incident may have triggered a connection to the earlier trauma, but nonetheless deserves (and usually needs) attention of its own.
My analogy for this is you cut yourself and you’re bleeding profusely from a gash in your arm. You go to the emergency room, and the ER doctor says, “Wow, that’s really a lot of blood. Wait a minute. What’s that scar? Is that scar on your shoulder bothering you? I can remove it. You want me to remove that scar?” And meanwhile, you bleed to death. In the therapy situation, it can be the therapist, the client, or both who are more interested in the old scar than in the currently bleeding wound. However, paying attention to the bleeding wound first will almost always make dealing with the scar much easier, and even sometimes no longer necessary.
RH: You wrote the book Help for the Helper. What’s your message for therapists dealing with vicarious trauma and compassion fatigue?
Rothschild: The airlines have it down: “Put on your own oxygen mask first.” That is, make sure to take care of yourself so that you’ll continue to be able to care for others. But how do you do that? In large part by managing your health and your time off and learning how to regulate your empathy so you’re not over-resonating with clients and putting yourself at risk.
Of course, that gets harder when we’re living through a traumatizing time with clients, as happened with covid or is happening now in Ukraine, Maui, Morocco, and other areas experiencing war or natural disasters. How do you manage your own stress and trauma from the situation as you’re helping clients with the same? For the last couple of years, I’ve been offering free trainings for therapists in Ukraine—all volunteer, including sponsor, hosts, and translators. This year, we trained 3,000 professionals with two days of trauma training along with one day focused on self-care issues, which includes learning to reduce empathy with their clients.
RH: The phrase “reduce empathy with their clients” stands out to me because we’re always told to be more empathic.
Rothschild: It’s a double-edged sword. Empathy is our most valuable tool, but it’s also the basis for our greatest professional risk factors: vicarious trauma, compassion fatigue, and burnout.
I teach therapists to learn to have enough empathy to help them get a feel for their client, but also allow them to sit back in their own chair. By this I mean, if your “empathy dial” is turned way up, it’s like you’re sitting on the client’s lap which doesn’t do either of you much good. You can be much more helpful if you stay in your own chair, feeling it support your back and your bum, because that’s the place from which you can think clearly and offer the best care.
HEADSHOT PHOTO © PAULA HEARTLAND
A digital seminar by Babette Rothschild
Babette Rothschild, MSW, has been a psychotherapist and body psychotherapist since 1976 and a teacher and trainer since 1992. She is the author of seven books, (translated into more than a eighteen languages including Danish, German, French, Spanish, and Japanese) all published by WW Norton. Revolutionizing Trauma Treatment (2017, 2021); her classic bestseller, The Body Remembers (2000); The Body Remembers CASEBOOK (2003); Help for the Helper (Revised and Expanded 2022); 8 Keys to Safe Trauma Recovery (2010) and 8 Keys to Safe Trauma Recovery WORKBOOK (2022); and Trauma Essential (2010). She is the Series Editor of the WW Norton 8 Keys to Mental Health Series (20 titles and growing!). After living and working for 9 years in Copenhagen, Denmark she returned to her native Los Angeles. There she is writing her next books while she continues to lecture, train, and supervise professional psychotherapists worldwide. For more information, visit her website: www.trauma.cc