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Understanding the Long Shadow of Trauma

Cognitive processing therapy helps make sense of the impact of past trauma.

The experience of chronic trauma as a child can have long-term consequences, casting a long shadow far into adulthood. While many people heal and go on to live happy and healthy lives, many others struggle to find peace. When abuse started early in life, it can be particularly difficult for a person to understand how these experiences have impacted them. There may be a sense that “something is not right” or “I don’t function as well as other people,” but difficulties in putting a finer point on it since the person might not have memories of a life before abuse.

Lewis Burrows/Pexels
Source: Lewis Burrows/Pexels

Cognitive processing therapy (CPT) is an evidence-based treatment for PTSD that offers guidance for people trying to make sense of the impact of past trauma (Resick, Monson, and Chard, 2017). CPT highlights five key themes that are relevant for many people who have experienced trauma: safety, trust, power/control, esteem, and intimacy. In each of these areas, people may find that they hold unhelpful beliefs or assumptions about themselves, other people, and the world. CPT helps the individual identify these beliefs and assumptions, and trade them in for ones that are both more helpful and accurate. The best way to do this is with a therapist who is trained in providing cognitive processing therapy.

Many people who experience trauma find that their basic sense of safety in the world has been altered. This can be quite clear in the case of a person who has survived a traumatic car accident, whereas individuals growing up in an abusive home may find it difficult to articulate. When a person grows up in an unsafe environment, where the threat of violence is pervasive, there is little opportunity to establish a sense of safety in the world at all. Such an individual might go into adulthood assuming they are never safe, that it is normal to never feel safe, and that vigilance to potential threat is the only way to live. They might find themselves feeling unsafe even in the home they have created, be it a solitary apartment or a family with a spouse and children.

Trust is also frequently influenced by trauma. Much like safety, if a person grows up never able to fully trust their caregivers then they might continue having difficulty with trusting attachment figures in adulthood. This commonly comes out with romantic partners, but could also show up with friends or even work colleagues or supervisors. People might blame themselves for their past trauma, leading to an inability to trust their own judgment. This can lead to difficulties with decision-making and chronic self-doubt.

Individuals may also have difficulties in the areas of power and control. They may have felt helpless in their childhood home, and carry that feeling with them throughout life. Such a person may always feel that the world is against them and that they are helpless against more powerful forces or people as they were when they were young. Since being abused and controlled may be familiar, it is possible that they have ended up in relationships that replicate this dynamic. Alternatively, they might attempt to push away helpless feelings by establishing a rigid set of controls in their adult lives. They might be overly meticulous or perfectionistic. Some people may find themselves tempted to micro-manage or even to dominate others in order to maintain a feeling of control.

In cognitive processing therapy, the domain of esteem relates both to self-esteem and esteem for others. Individuals with trauma might have developed a belief that they are bad, deserving of poor treatment, or somehow broken. Alternately, there may be a belief that everyone else is bad, that all people are potential abusers and thus unworthy of holding in positive regard. There might be assumptions that everyone else is selfish or uncaring, particularly if there were family or bystanders aware that they were being abused and nobody did anything to protect them.

Intimacy can be influenced in several ways as a result of trauma. People might have difficulty with self-intimacy, meaning the ability to self-soothe and cope adequately with the stressors of life. Self-intimacy also involves getting to know and appreciate oneself, knowing one’s own likes and dislikes, and being willing to engage in self-reflection. Intimacy also involves emotional intimacy with friends and family, being willing to open up and share one’s private thoughts and feelings, and it may also mean sexual closeness. When it comes to intimacy with others, there may be problems with staying too distant or being too quick to get involved. A person may overshare or become sexually intimate too soon, or they might never allow anyone close at all.

The impact of trauma is individual and unique. These examples are just the beginning, and reflect common but not universal responses. Some people may find different life domains affected, while others may only relate to one or two of the themes listed above. In CPT, each person engages in their own personal reflective process on these and other themes in order to understand whether and how they have been influenced by their past trauma. Throughout treatment, individuals are provided other tools, education, and support to begin to make the changes needed to improve their lives.

With time, practice, and a good CPT therapist, old beliefs and assumptions can be changed. Often, such work involves changing pithy but false beliefs such as “I can’t trust anyone” or “the world is unsafe” to more nuanced statements that take into account probabilities and contingencies. “I can’t trust anyone” might become “Sometimes people are trustworthy and sometimes they are not, and I am continuing to learn how to tell the difference.” Similarly, a belief that the world is entirely unsafe might yield to an understanding that there are some things about life that are safe, and some that aren’t, and we can’t always tell the difference. Life can change dramatically once a person truly internalizes these new thoughts and beliefs. In shining a light on the long shadow of trauma, a whole new outlook can be revealed.

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Resick, P.A., Monson, C.M., & Chard, K.M. (2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. New York & London: Guilford Press.