Trauma

Trauma Therapy and Treatment

When starting out as a psychologist, I worked extensively with clients using standard therapies such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). It was immensely rewarding to see the progress many clients made through these evidence-based approaches. However, I began to notice that approximately 15-20 percent of my clients did not seem to experience the same level of improvement, or in some cases, didn’t benefit noticeably at all. What intrigued me further was that these individuals also exhibited patterns of behaviour in their daily lives that appeared counterproductive or even detrimental to their emotional and psychological wellbeing. These clients engaged in chronic avoidance, engaged in substance abuse, chronic procrastination, remained in relationships that were obviously harmful to them, or pushed themselves excessively in life as if this was necessary to prove their existence.

These presentations were difficult to understand and conceptualise, that was, until I learnt about the role of trauma and how adverse early life experiences affect psychological and emotional functioning. In the psychological and trauma literature, there is a great deal of interest and attention placed on what psychologist call ‘Big T’ traumas. These are defined as one off, awful, and often life-threatening experiences which result in people developing symptoms of post-traumatic stress. This includes nightmares, flashbacks, hypervigilance, negative self-concepts, and chronic avoidance. Through assessment, these symptoms can be traced back to the single incident trauma experience.

Whilst ‘Big T’ traumas have been well understood for decades, what is becoming more recognised in the trauma literature is the impact of what psychologist call ‘Little T’ traumas. These types of traumas, whilst not typically life threatening, can often have a comparable impact on people lives. Well, what exactly are ‘Little T’ traumas? Some examples include:

  • Chronic childhood neglect or physical/emotional abuse.

  • Growing up in a perfectionistic household.

  • Caregivers who were chronically demanding or guilt inducing.

  • Bullying or lack of acceptance within peer settings.

  • Ostracisation due to socio economic background.

  • Lack of trust by caregivers that you were capable to handle challenges.

  • Chronic worry and/or overshadowing by caregivers in the absence of real danger.

Together or in isolation, these experiences can have a significant impact on psychological functioning, and equally as importantly, physiological regulation. So then, what can be done to help?

Schema Therapy

Schema Therapy is a deeply supportive approach that helps people make sense of patterns in their thoughts, feelings, and behaviours that may have been shaping their lives for years. These patterns often develop early, as ways of coping with unmet emotional needs, and can quietly influence how we respond to challenges, relate to others, or care for ourselves. Rather than blaming yourself for these patterns, Schema Therapy recognises them as understandable responses to life experiences and offers a way to gently explore and transform them.

At the heart of Schema Therapy are schemas—these are like deeply held beliefs or mental “maps” about yourself, other people, and the world. They shape how you interpret situations and guide your emotional responses, often automatically. Some schemas can make you feel unworthy, unsafe, or unlovable, while others may push you to always perform, please others, or avoid conflict.

Schemas influence the way different parts of ourselves, called modes, show up in daily life. Modes are like the active “emotional states” or “coping styles” we fall into in response to stress, emotional triggers, or past experiences. Some modes are driven by strong emotions, such as sadness, fear, or shame. Others are coping modes—strategies we develop to protect ourselves from these difficult emotions. These might include avoiding situations, pushing ourselves excessively, people-pleasing, shutting down emotionally, or being highly self-critical. While these coping strategies often made sense at one point in life, over time they can feel limiting, overwhelming, or exhausting.

The goal of Schema Therapy is not to remove these parts of yourself, but to understand and work with them in a compassionate and practical way. Through therapy, you can learn to recognise when different modes are active, understand what they need, and gradually respond in ways that are healthier and more balanced. This helps you feel more in control of your life, more resilient when challenges arise, and more connected to yourself and others.

In our work together, we focus on helping you discover your own internal and innate wisdom, the part of you that can observe, understand, and respond to all parts of your experience with care. From this place, change becomes less about struggling against yourself, and more about moving forward with all aspects of who you are—gently, intentionally, and in a way that feels integrated and sustainable.

For people experiencing long‑standing emotional difficulties—such as those seen in personality disorders—research has generally shown that Schema Therapy is most often delivered over a longer period, with many clinical studies using about one to three years of regular therapy and reporting meaningful, sustained improvements in symptoms over that time frame

For less distressed individuals, or those with pre-existing coping mechanisms, research has has shown meaningful change to occur quicker, within 12-20 sessions of structured schema therapy.

Eye Movement Desensitisation and Reprocessing (EMDR)

Another approach that can be very helpful for working with trauma is Eye Movement Desensitisation and Reprocessing (EMDR). EMDR focuses on how traumatic experiences are stored in the body and the brain, and helps the nervous system process memories, current triggers, and feared future events, in a way that reduces the intensity of distressing emotions and physical reactions which arise in day to day life. Many people find that after EMDR sessions, memories and triggers that once felt overwhelming become easier to think about, and physiological symptoms such as tension, hyperarousal, or panic reduce significantly.

EMDR is particularly effective for addressing the physiological impact of trauma, helping the body and mind feel safer and more regulated. What it does less directly, however, is change the patterns of coping or the emotional “modes” that develop in response to early adversity. For example, strategies such as avoidance, overcompensation, people-pleasing, or self-criticism often arise from unmet emotional needs in childhood. While EMDR can reduce the distress linked to past experiences, these coping patterns may continue to influence daily life until they are addressed more directly in therapy.

In practice, EMDR can be a powerful part of a broader approach to trauma—helping the body feel safer and the mind less overwhelmed—while other therapeutic work, such as Schema Therapy, can support the development of more balanced ways of relating to yourself and others

EMDR is usually delivered over a shorter course of sessions compared with long-term therapies for personality patterns, often ranging from 6 to 20 sessions, depending on the intensity and number of traumatic experiences being addressed. Some people notice relief from distressing memories fairly quickly, while others benefit from a longer series of sessions to fully process deeper or multiple experiences. The pace is always tailored to your needs, helping you feel safe and supported as you work through each memory.

Whether used individually or in combination, both EMDR and Schema Therapy hare evidenced based approaches to treating trauma grown from adverse childhood experiences.