Beyond “What Happened”: Trauma Counseling and the Importance of Pre-Treatment Work
Trauma counseling often begins with a simple yet profound question: “What happened?” However, as I’ve learned through Dr. Janina Fisher’s course, effective trauma treatment requires going far beyond recounting events. Understanding the neurobiological underpinnings of trauma is a critical first step in helping clients navigate the complexities of their symptoms, not just their memories.
This insight fills a significant gap I encountered during my earlier EMDR training. While my instructor emphasized the need for clients to achieve relative stability before initiating eye movement desensitization, I often felt unclear about how best to support clients in reaching that stage. Dr. Fisher’s structured approach to pre-treatment work—grounded in neuroscience and somatic awareness—offers a practical roadmap for clinicians like myself.
The Neurobiology of Trauma
Trauma changes the way our brain functions, locking us into survival mode. Understanding the roles of key brain structures—the amygdala, hippocampus, and prefrontal cortex—illuminates why trauma manifests as symptoms rather than discrete memories.
- Amygdala: This is the brain’s alarm system, responsible for processing emotional reactions like fear and anxiety. Trauma can leave the amygdala overactivated, constantly signaling danger even in safe situations.
- Hippocampus: Responsible for forming and retrieving memories, the hippocampus often struggles under trauma. This results in fragmented or intrusive memories that are difficult to process.
- Prefrontal Cortex: This part of the brain governs decision-making and self-regulation. Trauma disrupts its ability to operate effectively, leaving clients reactive and overwhelmed.
For example, consider a scenario where someone doesn’t receive a text reply. For a trauma survivor, this minor incident might trigger unresolved feelings of abandonment from past relationships or childhood experiences. Their amygdala flares up, signaling danger, and they spiral into fear, sadness, and compulsive behaviors like repeatedly checking their phone. Despite rationally knowing the situation isn’t dire, their brain remains stuck in a reactive loop(Fisher, 2021).
The Body Remembers
Trauma isn’t just stored in the brain—it resides in the body. The phrase “the body keeps the score” rings especially true for trauma survivors, whose physical responses often include chronic muscle tension, altered breathing patterns, and unexplained pain. These somatic symptoms reflect the body’s ongoing attempts to process unresolved trauma
Dr. Fisher’s Approach: Building Safety and Awareness
Dr. Fisher advocates for a foundational approach to trauma treatment that focuses on creating safety and integrating mind and body. Her methods address the “survival brain” by calming the amygdala and fostering a sense of security (Fisher, 2021).
Key Elements of the Approach:
- Recognizing Triggers: Helping clients identify and understand their triggers is a crucial first step. This shifts their focus from reactive behavior to self-awareness.
- Mindfulness Practices: Introducing mindfulness allows clients to observe their thoughts and bodily sensations without judgment. This opens the door for memories stored in the amygdala and hippocampus to flow naturally, reducing their intensity.
- Somatic Awareness: Trauma-informed yoga, breathing exercises, and grounding techniques can release tension stored in the body and re-establish a connection to the present moment.
- Prefrontal Cortex Activation: As clients develop emotional regulation skills and somatic safety, the prefrontal cortex regains functionality, enabling them to process trauma more effectively.
Application in Practice
For clinicians, this approach offers a pathway to help clients move out of the hypervigilant state often caused by trauma. By working with both the mind and body, we can help them lay the groundwork for deeper therapeutic work, such as EMDR or cognitive processing therapy.
A Call for Cultural Competency
Cultural considerations are essential in this work. Trauma manifests differently across communities, and factors like systemic oppression, family dynamics, and cultural stigmas around mental health shape clients’ experiences. Tailoring trauma treatment to account for these nuances is vital for fostering trust and efficacy.
Conclusion
Understanding the neurobiology of trauma transforms how we approach therapy. Rather than focusing solely on the question “What happened?” we can help clients address the lingering effects of trauma stored in their bodies and minds. By creating safety, integrating mindfulness, and fostering awareness of the brain’s survival mechanisms, we empower clients to move toward healing—one step at a time.
Dr. Fisher’s course has given me a renewed perspective on trauma treatment and the tools to approach this critical pre-treatment phase with greater confidence and compassion.