Principles of Trauma-Centered

Psychotherapy
 Immediacy
• should begin immediately in treatment and that whenever new material
arises
• it should be addressed immediately

• Once the clients have agreed to discuss the events, their anticipatory
anxiety begins to mount precipitously

• According to this principle, in the first session, after saying hello, the
therapist says, “What happened to you?” or “I understand you had a
terrible experience” or “I understand you were raped by your boyfriend a
month ago.”
Immediacy
• Trauma-centered psychotherapists will be dispassionate but clear
• They will speak about the trauma and tell the client that together they
will revisit the pain in order to get it out and that the client will feel
better as a result.
• The therapist will be optimistic but direct.
• signs of distress are signals to the therapist to inquire immediately
• about this distress rather than to wait until the narrative of the other
event is completed
 ENGAGEMENT
• the usual warm but neutral stance of the therapist in general psychotherapy may be experienced by the client as
that of a disinterested bystander
• a neutral, receptive stance places the therapist outside of the traumatic event, as if the primary means by
which what happened can be communicated to the therapist is through the words of the client
• The therapist placing himself or herself in close psychological proximity to it and asking experience-near questions

clinician demonstrates engagement in four ways:

through gaze, posture, experience-near
questioning, and affective response
• Gaze : should be animated, alive, and active. The client
should feel examined
• Emphasis is not necessarily on being warm but rather on
being interested.
• therapists should sit up in their chairs and, as the client
begins to provide details of their traumatic experience,
should sit forward just a bit more
ENGAGEMENT
• experience-near questioning. This type of questioning communicates to the client that
the therapist is actively imagining being in the scene with the client, looking around,
and asking questions about what is happening, unlike the usual form of questioning, in
which the therapist relies completely on the client to provide the details
ENGAGEMENT
CLIENT: Then he got on top of me.
THERAPIST: How heavy was he?
CLIENT: I can’t remember. Heavy.
THERAPIST: Did he press down on you?
CLIENT: Yes.
THERAPIST: Where?
CLIENT: On my neck (rubs her neck).
THERAPIST: Where were your arms?
CLIENT (beginning to get upset): My arms...I
grabbed his hands, I was choking.
THERAPIST: Sweat?
CLIENT (crying): Yes, I couldn’t get a hold. That’s
when he told me to shut up.
THERAPIST: Was there a pillow?
CLIENT: (Bursts into tears.)
THERAPIST: What about the pillow?
CLIENT (choking): It was to my left side
(gestures). I saw him look at it. I
thought he was going to suffocate me with it.
THERAPIST: That’s terrifying.
ENGAGEMENT
ENGAGEMENT
• The fourth way the therapist demonstrates engagement is through
affective response
• The therapist needs to be able to conduct the trauma inquiry
dispassionately, without showing anxiety or fear
• should not be interpreted to mean that the clinician should not show affect

• therapist should maintain a warm, compassionate tone throughout the session;

however, when the client begins to describe truly horrible aspects of his or her
traumatic experience, the therapist should not remain unaffected
EMOTIONALITY
• doing trauma-centered work, the therapist should expect the client
to become emotionally upset
• “The Developing Cultural Context of Trauma-Centered
Psychotherapy,” having the client experience a catharsis, or
become flooded, was seen as an essential element in the treatment
• It is important, from a trauma-centered perspective, to
differentiate crying from being retraumatized and to distinguish
between shouting in pain and dissociating
• It is important for the therapist to feel comfortable with high
levels of emotional expression and not to attempt to
dampen,suppress, avoid, or control them