Trauma Counseling for Family Crisis: A Treatment Guide

Introduction

When it comes to providing counseling for clients dealing with a family crisis — such as domestic violence, sexual assault, substance abuse, personal loss, or disaster — it is important for counselors to understand the role that trauma-centered treatment can play. Trauma can prevent clients from processing their problems in a positive way, so it is helpful if a counselor can empower the client to address the trauma in order to move past it. This paper provides an explanation of a course of treatment for a trauma counselor dealing with family crisis.

Understanding Trauma and Its Effects

Trauma affects different people in different ways. Some people who are traumatized by an event try to self-medicate and end up abusing drugs or alcohol. Others may not realize they are traumatized at all, but may engage in the same traumatizing behavior that led them to be traumatized in the first place — such as in cases of sexual abuse (Groth & Burgess, 1979). Trauma is an underlying problem that affects the cognition and emotions of the individual. For a counselor to help in a family crisis, understanding how to treat trauma is crucial.

To address trauma, one of the most important steps a counselor can take is to promote mindfulness with the client (Scott, 2014). Mindfulness is a concept found across cultures in meditation and contemplative practice. Mindfulness promotes self-awareness, understanding, self-discovery, self-control, and the individual's ability to come to terms with trauma (Shim, Goodill & Bradt, 2019).

Core Treatment Approaches: CBT and PET

It is also important to recognize that there is no one-size-fits-all course of treatment when it comes to healing trauma. Every client may respond differently, so the counselor must determine which course is most likely to work based on the client's own willingness to engage with a particular type of treatment. Cognitive Behavioral Therapy (CBT) is a common course of treatment for trauma clients. Prolonged Exposure Therapy (PET) is another common approach. Some newer courses of treatment now in use include drama therapy and body movement trauma treatment, such as dance and yoga. The key to implementing trauma-focused treatment is to remember that these approaches work because they are "treatment approaches fostering safety, trustworthiness, choice, collaboration and empowerment" (Giordano et al., 2016, p. 61). They help clients learn to better manage their thoughts and feelings, identify triggers, process emotions, process traumatic memories, and create positive conceptualizations of themselves (Giordano et al., 2016, p. 62).

Treating trauma does not have to be confined to one course of treatment. On the contrary, it is often helpful to combine treatments. For instance, dance or yoga therapy could be combined with CBT, PET, or both. As long as mindfulness and resiliency are promoted, the course of treatment can be approached creatively as the counselor and client work together to find what is appropriate. In most cases, beginning with CBT and PET and supplementing these primary treatments with an approach like yoga or dance therapy can be sufficient (Sajnani et al., 2019).

CBT is not about directing the client's attention toward the past, but rather toward the current situation, the current environment, and the current triggers the client can identify. In this respect, it is more a treatment oriented toward managing the effects of trauma than toward having the client confront the trauma directly. The origins of the trauma are largely irrelevant within CBT. Psychoanalysis might be used to bring the trauma to consciousness, but in CBT the main goal is to identify which thoughts, feelings, environments, and situations trigger a loss of control in the client. The goal is to identify these triggers and to implement behaviors and thinking habits that allow the client to overcome or cope with triggering situations as they arise.

CBT also involves identifying positive habits or goals the client would like to develop and setting about implementing a course of action to facilitate those goals. It is a goal-oriented course of treatment. Its purpose is to enable the client to take back control and ownership of his life, little by little, step by step. It works because its underlying purpose is to get the client to address "automatic thoughts and core beliefs" that affect behavior (Beck et al., 2004, p. 265). By cultivating a habit of positive thoughts and feelings and learning to reject negative or triggering ones, the client gains a pathway through which to overcome the trauma (Robertson, 2010).

To facilitate the CBT process, it is also helpful to augment the course of treatment by pairing it with another approach, such as PET. Like CBT, PET also assists the client in addressing unwanted thoughts and feelings — but the goal of PET is to help the client re-engage with life in a meaningful way. Rather than focusing primarily on overcoming triggering thoughts and feelings, the client is encouraged to talk about the trauma he has experienced. By talking about it and sharing it, the trauma is processed and the person is no longer consumed by fear of it. By bringing it into the open, the person is able to step out from under its shadow. This can be especially helpful for people who feel there is a stigma attached to trauma or to conditions such as PTSD. They may feel ashamed of requiring counseling or treatment. They should not feel ashamed, however, and a counselor applying PET can help the client surface those feelings so they can be properly addressed.

Both approaches are important to a trauma-focused course of treatment. CBT enables the client to reshape his life by developing new, positive habits and ways of thinking so that old negative behaviors and thoughts are overcome — enabling the client to develop a new way of being. PET enables the client to tell his own story and share his own experience, which can be eye-opening both for the client and for others, particularly in a family counseling session (though it does not require such a setting to be effective). The value of PET is that revisiting the trauma in a controlled environment allows the client to process it without the risk of being overwhelmed by it.

Conclusion

Dealing with trauma is painful for many clients and families, but a course of treatment that a trauma counselor can pursue is to use Cognitive Behavioral Therapy and Prolonged Exposure Therapy — both to help the client overcome negative thoughts and to help the client process the trauma. The supplemental support of a secondary course of treatment, such as drama therapy or dance or yoga therapy, can further benefit the client by providing opportunities to develop self-control, self-awareness, mindfulness, and the confidence that the overall course of treatment will have a positive effect in the end.