Trauma-Informed Practice in Psychodynamic Psychotherapy

A shift in the understanding of trauma became prevalent in the 1960s and 1970s, when mental health practitioners realized that a large number of veterans returning from the Vietnam War, struggled with symptoms including emotional numbing, guilt, and feelings of blame. The presenting symptoms in the veterans became what is now known as post-traumatic stress disorder (PTSD). PTSD commonly results from exposure to discrete traumatic events, such as motor vehicle crashes, natural disasters, or the unexpected death of a loved one. In 1992, psychiatrist Judith Herman discussed in her work, Trauma and Recovery, another and more severe condition known as complex PTSD. Complex PTSD emerges when one is exposed to prolonged trauma, such as chronic child abuse or ongoing interpersonal violence. Although complex PTSD is not recognized as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), individuals with complex PTSD frequently meet diagnostic criteria for PTSD, in addition to exhibiting symptoms such as difficulty regulating affect and impulses, dissociation, aggression and anger management problems, and social avoidance (Alessi & Kahn, 2017).

The increased understanding of trauma also led to a better understanding of how events that do not qualify as traumatic in accordance with the DSM, can still have negative psychological impact. Such events can include the ending of a relationship, financial difficulties, or the unexpected death of a loved one (Alessi & Kahn, 2017). These “non-traumatic” events can cause enough emotional distress that those who experience the events often seek out mental health services such as psychotherapy. Therefore, it is essential that trauma-informed psychotherapists are apprised and knowledgeable in trauma-informed practice.

Trauma-Informed Practice

The notion of trauma-informed practice gained prevalence in the 2010s and 2020s. Trauma-informed psychotherapists incorporate trauma-informed care by adopting the following:

• Recognizing that the symptoms their patients present serve as attempts at coping with the impact of traumatic events.

• Viewing healing from trauma as a primary therapy goal.

• Encouraging patient control over their therapy and healing.

• Placing emphasis on patient-therapist collaboration and the therapeutic relationship.

• Providing and cultivating a therapeutic space of safety, respect, and acceptance.

• Emphasizing adaptation over symptoms, and resilience over pathology.

• Minimizing the potential for retraumatization.

• Considering the cultural context of a patient’s life experiences.

In addition to the aforementioned points, it is recommended that trauma-informed psychotherapists monitor and reflect on their own feelings and responses to patients, as it enables them to identify when patients should be encouraged to express traumatic material, and when they should provide empathy and contain the material.

When trauma-informed psychotherapists begin treatment with patients, it is critical that they establish a strong therapeutic relationship, as a positive therapeutic relationship facilitates relational and internal safety. Internal safety allows patients to acquire the skills of managing strong emotions without becoming overwhelmed, refraining from self-destructive behaviour, or shutting down (as cited in Alessi & Kahn, 2017).

The therapeutic relationship is a key catalyst that promotes healing in most approaches to psychotherapy, however, it is especially salient in psychodynamic psychotherapy due to the nature of the approach and its theoretical underpinnings. In fact, there is a high degree of alignment between psychodynamic psychotherapy and trauma-informed practice.

Trauma-Informed Practice within Psychodynamic Psychotherapy

Psychodynamic psychotherapy is a therapeutic approach focused on understanding how early-life experiences, attachment patterns, and unconscious motivations shape current behaviour and personality. It operates on the following core principles:

1. It explores how early relationships and attachment history influence a patient's current struggles.

2. It uses the relationship between the psychotherapist and patient as a primary tool for healing.

3. It helps patients identify patterns or behaviours that may be serving as symbolic, unconscious protections against past pain.

4. It aims to help patients develop a more cohesive sense of self by processing traumatic experiences at a tolerable pace.

When considering the core principles of psychodynamic psychotherapy and the key characteristics of trauma-informed practice, four prominent factors demonstrate how the psychodynamic approach is particularly effective within a trauma-informed framework. First, trauma-informed care recognizes that trauma often stems from early attachment injuries. Psychodynamic psychotherapy inherently focuses on how early-life and life experiences and relationship dynamics shape current personality and behaviours, which helps psychotherapists understand the root cause of a patient's struggles. Second, the relationship between psychotherapist and patient is essential to both approaches. Psychodynamic psychotherapy uses techniques such as transference analysis (where a patient projects past relationship dynamics onto the psychotherapist) to work through unprocessed trauma within a safe, controlled environment. Developing a safe environment cultivates trust and safety, which are essential for trauma-informed practice. Third, psychodynamic psychotherapy helps patients gain insight into unconscious motivations, where behavioural patterns serve as symbolic protections against past pain. By identifying these patterns, patients can shift from maladaptive coping strategies toward healthier forms of self-expression and affect regulation. Lastly, for patients whose trauma history has led to fragmented identities or personality structures, psychodynamic psychotherapy supports the development of a more cohesive sense of self. It provides the space to explore "unheard stories" and process them in a way that is tolerable for the patient, upholding the trauma-informed priority of ensuring patients are not retraumatized.

References

Alessi, E. J., & Kahn, S. (2017). Using psychodynamic interventions to engage in trauma-informed practice. Journal of Social Work Practice, 33(1), 27–39. https://doi.org/10.1080/02650533.2017.1400959