Trauma-informed Psychotherapy should make its comeback

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The current paradigm of psychiatric treatment is best described as "biomedical psychiatry." It's been the major force in treatment for the mentally ill for about half a century. It's replaced the earlier method (often called Freudian for its founder and those who learned from his, such as Jung) which is best described as "psycotherapy" - the term Freud himself used. The difference is in the reliance on medication as the primary treatment method for disorders versus the therapeutic approach of earlier times.

Increasingly, however, evidence is beginning to show that a large number of mental disorders are caused by unresolved traumatic stress, not chemical imbalances or discrepancies as was often believed the norm just a few decades ago. This reversal of thought, though slow, is coming about as what little evidence there is to show physical causes for mental disorders dwindles.

Trauma specialist Bessel Van der Kolk says that "pharmacotherapy" (his term for biomedical psychiatry) has developed towards controlling some of the neurochemical abnormalities "caused by trauma, but they obviously are not capable of correcting the imbalance." What's more, the continued use of pharmaceuticals to treat ailments that are not based on physical problems has long term negatives such as chronic disease (via Robert Whitaker).

Along with the expansion and innovation that has come with pharmacology, however, has been a greater understanding of the basis of trauma and how we humans naturally heal from it, giving new insight into how the intuitions of Freud and Jung were correct. Our understanding of neurobiology has grown significantly, enough so that we more fully understand the processes behind trauma's effects the healing that can come afterward.

One key to this understanding is what's commonly termed as the "fight or flight reaction." During traumatic events, the frontal lobe disconnects itself from the body to allow the survival response to be unimpeded for maximum reaction. This lessens reaction time and thus heightens the chance of survival. This disconnect interrupts the normal narrative of memory that is created, leaving a "blank" or gap in our memory of events.

This gap is eventually filled as we relive the trauma through flashbacks, which serve as a re-integration of memory to create integration in our minds. If the trauma is too intense, long-lasting, or otherwise too much for us to easily integrate, it can result in mental disorder.

Psychotherapy aims to treat these disorders by guiding the patient back towards reintegrating those memories and finding coherency, thus "dealing" with the trauma naturally, over time. Several newer approaches to this method are making progress.

The goal is to allow the patient to slowly, steadily, and safely relive the trauma, portion by portion, in such a way that memories shuffle into place until a whole is finally found. The body then naturally ceases to replay the trauma and, with time, the disorder associated with it decreases or dissipates.

Of course, not all trauma can be dealt with in this way and prolonged or acute trauma may never be fully recovered from, but evidence mounts that this approach is a more likely long-term solution for most patients than does pharma alone.

Approaches such as attachment theory are paving the way towards new healing.

 
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