4 Reasons to Seek a PTSD Specialist



Recently I was at a networking event and was asked what I specialize in, so I said my usual spiel, “I’m a trauma therapist and adoption coach.” The therapist I was talking with said, “Well, everyone does trauma, so that’s not really a specialty.” Ahem…I beg to differ. You see, a lot of therapists do treat trauma as part of their overall practice, but that does not mean they all do it well. Don’t get me wrong. These are good therapists—well-meaning and ethical, but the reality is that Post Traumatic Stress Disorder (PTSD) requires specialized training and experience to treat effectively. A huge part of my practice has been formed by clients who have been to these good-hearted therapists who supposedly treated the trauma, but they continue to struggle, or worse, they had a terrible experience and really do not believe therapy can help. If you or someone you know fits into this category, here are some things to consider before you give up on therapy for good.


  1. Trauma brain is different than non-trauma brain.


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When someone has experienced a life or self-threatening event, they have a one in three chance of developing PTSD. The more traumas you experience, the more likely you are to develop PTSD. It’s kind of like how a small chip in your windshield is more likely to make a huge crack if it keeps getting hit with stones. Once you have PTSD, your brain does not work the same until the PTSD is healed. The trauma is stored in the “here and now”, so something reminds you of what happened and instead of it being a memory that feels distant and settled, your body starts to react as if it’s going on again. This is automatic and often unconscious.

So, imagine you were physically abused as a kid. Maybe you faired pretty well, actually, and felt you moved on with your life. Then, you’re in a car accident and almost die. Bam. Suddenly, every time you hear yelling (could be in a park or a neighbor yelling at the kids to come in for dinner), you suddenly feel like a small, helpless kid, scared, heart-racing, maybe even pain, or flashbacks of memories of the abuse or the car accident. And this happens over and over and over until you either shut down and feel numb, start numbing on purpose with unhealthy coping skills like drinking, sex, or acting out, or your body starts breaking down from all the stress (migraines, IBS, ulcers, and the like).

Now, you go into therapy, and a therapist asks you to talk about it. This triggers that same process of re-experiencing that you have been trying to avoid. So, maybe you quit therapy or maybe you think you need to progress. Therapy sometimes feels worse before it gets you better, right? While that’s true, if your brain is in trauma brain mode, you need a specialist that understands this and can teach you the skills you need to manage the trauma symptoms before you start the re-experiencing. This can be tricky and complicated because everyone’s expression of PTSD is unique. Therapists who do trauma well have gotten extensive training and ongoing supervision to develop the skills needed to maneuver through this psychological landmine.


  1. Trauma work is different.


Most therapy is client-driven meaning you come in with an issue that has come up that week and address it during the session. Maybe there is some homework to followed up on in the next session and hopefully you are looking for themes and trying to make connections, but you, as the client, are dictating what is worked on in each session. This process does not work with PTSD treatment.

Let’s face it. No one wants to revisit their worst memories. No one wants to re-experience their scariest, most awful experiences ever. And yet, all trauma work incorporates this in one fashion or another. So most of us naturally avoid it. Even therapists find themselves avoiding or changing the subject because something feels too painful or overwhelming. But a good trauma therapist is skilled in making it safe to address the issue rather than to avoid. A good trauma therapist actively guides (but does not push) you closer and closer to the bad memories and only after you build the skills needed to handle the emotions and body sensations that arise from the memory. This calls for a step-by-step process of learning to stay grounded with hard memories so that you can eventually think about the memory from a different point of view—more calmly, more objectively, and more helpfully. We call this processing and once processing is complete, the memory will be more distant, better understood, and less painful to recall.


  1. Trauma work needs a definite beginning and end.


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Because trauma work is hard, it should not last forever. Traditional psychotherapy (where you dig into new insights and work for years to uncover the unconscious reasons that cause you to do certain things) is great–but not for trauma brain. Trauma work should be short-term and have a definite beginning and ending so that you can always see the light at the end of the tunnel. Otherwise, you just get lost in the tunnel and are likely to give up. Your trauma therapist’s experience is that light at the end of the tunnel. A trauma therapist always knows exactly how far you are from the end and can give you reassurance that you are on the right path. Once trauma work is complete, you can work more loosely with any remaining issues you want to address.


  1. If you don’t use it, you lose it.


Trauma work is tough and takes special attention to details. If a therapist does not do trauma work on a regular basis—even if they have adequate training and experience—those skills get rusty. This can be pretty dangerous because people dealing with PTSD symptoms often also suffer from depression and other sometimes severe anxiety symptoms. Your therapist needs to be highly in tune to how connected you feel within the session and how high your emotions are at any moment. Many people freeze as part of the PTSD reaction. This can cause them to either numb out where they are completely out of touch with their experience even without their knowledge. It can also cause them to struggle with verbalizing how they feel. Missing the cues that tell a trauma therapist you are experiencing this might lead to flooding emotions either within the appointment or afterwards. If you are already at your breaking point, this can lead to destructive behaviors.


In summary, if you have been struggling with an experience that will not seem to let you move on and have tried to seek out therapy in the past, but it did not do the trick, do not give up! You might just need a more specialized therapist. Look for someone who has multiple trauma-specific treatment options, a wealth of training experiences, and membership to trauma-related professional organizations. And, of course, if I can do anything to help, do not hesitate to ask!


Traci W. Pirri, LCSW

Traci W. Pirri, LCSW is a top anxiety therapist, depression counselor, and adoption therapist in Austin, Texas. She is also licensed in North Carolina. She is passionate about working with people whose lives or professions have caused them to struggle, but still desire a life worth living. She helps people find the connections they want with their relationships and daily lives.

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