Psychoeducation in Trauma-Focused Psychotherapy

Psychoeducation.

Source: Dr. Odelya Gertel Kraybill Expressive Trauma Integration™

In a recent post, Stop Focusing on Pathology, I introduced five basic principles of trauma-focused psychotherapy.

In this post, I will elaborate on the first of those principles: psychoeducation.

In its broadest form, psychoeducation is providing information about mental health processes and services. When dealing with trauma, psychoeducation should inform about the emotional, cognitive, physical, spiritual, and social effects of trauma on survivors and families (individual trauma) and communities (communal trauma).

The first step in doing psychoeducation about trauma is to provide people affected by trauma with a definition of trauma that illuminates things essential to responding to it. Currently, I work with this definition:

Trauma is an experience that shocks all systems of wellness (emotional, cognitive, physical, spiritual, social), and fragments a survivor’s self-regulation and internal narrative of the past, present, and future.

Because this kind of injury is so common, so pervasive in impact, so easy to misdiagnose, and so complex to properly treat, it is essential that everyone, including children (as young as 4), teens, and adults, have a basic understanding of trauma and its impacts.

Psychoeducation without additional intervention has been found to increase the quality of life after trauma among trauma survivors (Phipps et al., 2007). Without this understanding, survivors typically feel that something is wrong with them, that they are broken and need to be "fixed."

Psychoeducation enables survivors to recognize that they are not broken; rather they are experiencing a predictable set of symptoms, a normal response to an abnormal situation. These symptoms can be difficult to live with but they evolved to assist human survival and are easier to manage when understood in this light.

Psychoeducation is also important to help survivors recognize strategies required to sustain the progress achieved in therapy. Trauma integration is not a simple matter of healing and moving on. Survivors need to keep certain routines to maintain or improve their quality of life.

Psychoeducation helps clients understand that a lot of what they are experiencing are biological mechanisms designed to enable personal survival (read more in this post).

True, the symptoms are probably not comfortable. Often they are devastating for the quality of life for survivors. But recognizing that resourcefulness is the core positive purpose of the symptoms helps survivors to reclaim confidence in themselves and the possibility of meaningful life after trauma. Their task is not to escape from or eliminate some destructive part of themselves; rather it is to bring into balance a misaligned inner mechanism whose core function is positive.

An unconscious choice to stay alive lies behind trauma symptoms. Survivors respond to therapy better when they revise their view of the symptoms, recognizing that their debilitating responses are testimony to an unconscious choice to stay alive. A new lens enables them to recognize a powerful commitment to life at the heart of responses that seemed to be driving them away from life. This recognition allows the burden of shame, guilt, self-loathing, and coulda/shoulda/woulda to shift, away from despair and towards recognition of life resources.

When this happens, the work of the therapist is to then help clients figure out how to redirect the overactive survival responses (symptoms) when they occur. They contain enormous energy that can be guided in a useful direction, towards receiving attunement from another human being, experiencing co-regulation, and eventually self-regulation (more info on this approach here).