Trauma Therapy vs Regular Talk Therapy: What is the difference?

In my consultations or intake appointments, I will sometimes ask clients if they have ever done any trauma work with previous therapists. I typically get a baffled look in response, which has prompted me to write about the key differences between trauma work and traditional talk therapy.  

As a clinician, I think of talk therapy as modalities that broadly fall into four categories, cognitive/behavioral, psychodynamic, humanistic, and integrative. My work is centered around ACT, or Acceptance and Commitment Therapy, which falls under the umbrella of cognitive/behavioral therapy (not to be confused with CBT). I also appreciate facets of the humanistic framework, focusing on growth, personal responsibility, and self-actualization, which blend very well with the tenets of ACT. What all these categories have in common is that they target thoughts and behaviors that are going on in your present life, which (hopefully) leads to cognitive restructuring, insight, and coping skill development.  

Trauma work is typically going to be a bottom-up approach that addresses your body’s response to a traumatic event. This is an appropriate approach if you are experiencing flashbacks and chronic dysregulation. Trauma focused therapy will help you reprocess traumatic memories and integrate your body-mind connection.  

 Before I get too much farther, I want to emphasize that you can experience trauma even if it doesn’t feel like a “big” trauma. In recent years, we have started to refer to trauma as big T and little T trauma. Big-T trauma includes experiences such as sexual assault, physical abuse, or severe accidents that often lead to a full diagnosis of complex PTSD. Small-t traumas, on the other hand, are less pivotal but still impactful moments, such as witnessing an accident, losing a job, or other stressful life events. Small-t traumas are more likely to not meet the full criteria for complex PTSD but do cause unpleasant symptoms.  

There are many therapeutic approaches tailored to working with trauma, including Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, somatic-based therapy, Internal Family Systems (IFS), Prolonged Exposure, Narrative Therapy, Acceptance and Commitment Therapy (ACT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Processing Therapy (CPT), Accelerated Resolution Therapy (ART), and others.  

Trauma work can be tough for many reasons. For most clients, there is a resistance to going back in time and reopening a proverbial bag of big, uncomfortable feelings. That is totally valid. My experience, both personally and clinically, has repeatedly shown me that experiences and situations that remind us of past trauma will continue to follow us until we are able to make some peace with them.  

I like to think of trauma as a tree. Difficult experiences in childhood or adolescence are like the roots. You might come to therapy for the first time in your 30s and say, “I haven’t experienced any trauma since my childhood and teen years, so it’s irrelevant to my treatment.” Similarly, your tree may look healthy and strong, but unseen, there may be holes where water can get in, or the beginnings of a blight forming. 

As we engage in therapy and explore your present concerns, beliefs, and symptoms, you may find yourself repeatedly pulled back in time. Unresolved experiences from your past often show up in big and small ways, especially during tough times. It’s difficult, if not impossible, to flourish fully into a strong, thriving tree if the roots beneath the ground remain damaged. 

I recommend EMDR for many clients who are dealing with both small and big-T trauma. This is because it works! It is also pretty fast, especially compared to talk therapy. When I incorporate EMDR into a session with a neurodivergent client, there are some key ways to make sure that it is an affirming process.  

First, I think that fully exploring sensory needs around bilateral stimulation protocol and outside distractions can significantly help a client have a more comfortable, productive experience. My second thought, and perhaps the most important, is a commitment to flexibility during the EMDR process. This might seem like a given. However, EMDR is very protocol oriented, meaning that it is really the opposite of flexible in many ways. Flexibility is important because of the differences in how neurodivergent clients brains work. There might be communication differences at play, or someone who needs shorter or longer sessions, such as intensives, depending on their window of tolerance.  

It is important to note EMDR will not heal or change your neurodivergence, but it can help with many of the issues that my neurodivergent, Autistic, and ADHD clients deal with. Things like low self-esteem, anxiety and depression, trauma, and feelings around not fitting in or being misunderstood are all things that EMDR can address. Most of my clients have experienced some degree of trauma. I believe that being neurodivergent in a neurotypical world can be traumatic in itself, due to marginalization, isolation, bullying, and it's even worse for BIPOC clients.  

If you are considering neurodivergent-affirming EMDR and have , please reach out to me to set up a consultation appointment chudson@wellspacetherapy.org.