Why CBT Alone Is Not a Trauma-Informed Approach

Despite the fact that more agencies and mental health organizations are attempting to be "trauma-informed," when CBT (Cognitive Behavioral Therapy) is the only treatment paradigm used, it's disingenuous to say that they are truly approaching clients from a trauma-informed perspective.

Steps towards de-pathologizing clients' issues and lessening their sense of shame

We are who we are in spite of and because of where we come from. Clients' earliest attachment experiences profoundly impact their subsequent thoughts, emotions, and behavioral choices. These experiences shape and inform their core sense of self and the inner monologue that guides them throughout life.

When therapists only focus on re-framing negative or distorted cognitions or give clients a formulaic approach to changing their behavior without exploring the underpinning of those beliefs or self-destructive choices, it's as if they are building a house on sand rather than a foundation of concrete. Helping clients to "connect the dots" between past experiences, formative relationships, and current struggles is essential. It helps clients make sense of their pain. It can be the first step towards de-pathologizing their issues and lessening their sense of shame.

Building the bridge between the past and the present gives clients the opportunity to recognize that some of their deeply held "truths" were never actually their own thoughts. It's powerful and freeing for clients to process the fact that their beliefs were imposed upon them by caretakers they loved and trusted, and therefore the messages were never challenged.

Doing deeper, family-of-origin work gives clients the opportunity to re-examine, re-evaluate, and potentially let go of thoughts that have never been accurate or served them well. When clients are given the chance to safely identify and explore the origins of their negative thinking, self-effacing beliefs, or self-destructive behaviors the process of cognitive re-framing and the ability to embrace new behaviors will certainly be a more organic, authentic, and effective endeavor.

Additionally, our newest understanding of the brain corroborates the fact that trauma is not stored in Broca's area — the part of the brain responsible for language. As "trauma-informed" therapists, we must weave right-brain based, expressive modalities into the work. In this way, the deepest healing can occur. Simply "talking" about the issues that clients bring into therapy is not enough. Although there is absolutely a place to address negative, inaccurate beliefs and behaviors that are unsafe or promote shame, if therapy doesn't take into consideration clients' histories, their affective states, and the somatization of their trauma, then we are putting a band-aid on something that requires surgery.

In a world where we have become conditioned to expect and demand immediate, instantaneous results and quick-fix approaches, CBT can seem very appealing. It's certainly still being promoted by insurance companies and, shockingly, the paradigm of choice in many mental health graduate programs. We are doing clients a terrible disservice when all we offer them is a "here and now" approach.

Helping clients to access, unpack, and heal from powerful childhood wounds is essential. It requires a therapeutic context that is safe and trusting. It means taking the time to resource clients with affect regulation skills and respecting the pace that clients establish so safety is always preserved. It means honoring the uniqueness of every client and incorporating a variety of treatment modalities that resonate with each person. It means taking the time to build a secure attachment, and safely reconnecting the client to their autobiography so their thoughts and feelings make sense. If we do anything less, we cannot call ourselves "trauma-informed" clinicians.