Trauma and PTSD Therapists in Oregon

Photo of Myles Buchanan, Professional Counselor Associate in Oregon
Myles Buchanan
Professional Counselor Associate, MA, MFA
Verified Verified
Portland, OR 97202  (Online Only)
I use a person-centered, trauma-informed, and inclusive approach to offer therapy customized to your unique needs, background, culture, and neurology.
It's not about forcing yourself to change, but rather accepting yourself as you are, and then exploring. I can help you do this. I support people experiencing post-traumatic stress, anxiety, depression, and other mental health concerns, as they rediscover their own powerful wisdom and learn to trust themselves. In particular, I often support people in building self-esteem, overcoming social anxiety, creating stronger boundaries, creating the relationships they want, and giving themselves permission to be who they truly are.
I use a person-centered, trauma-informed, and inclusive approach to offer therapy customized to your unique needs, background, culture, and neurology.
It's not about forcing yourself to change, but rather accepting yourself as you are, and then exploring. I can help you do this. I support people experiencing post-traumatic stress, anxiety, depression, and other mental health concerns, as they rediscover their own powerful wisdom and learn to trust themselves. In particular, I often support people in building self-esteem, overcoming social anxiety, creating stronger boundaries, creating the relationships they want, and giving themselves permission to be who they truly are.
(503) 852-9077 View (503) 852-9077
Photo of Dr. Nicole La Verne, Licensed Professional Counselor in Oregon
Dr. Nicole La Verne
Licensed Professional Counselor, PsyD, LPC, MAC, CADCIII, ACS
Verified Verified
Lake Oswego, OR 97035
I use a client-centered, trauma informed approach when working with people.
Is life becoming challenging, overwhelming, confusing, unfair, and more? I understand! I have over 28 years of experience supporting people struggling with a variety of issues - depression, anxiety, addiction, trauma & PTSD, grief & loss, life changes, abuse, and more. I personally and professionally understand the dynamics that accompany many of these life challenges.
I use a client-centered, trauma informed approach when working with people.
Is life becoming challenging, overwhelming, confusing, unfair, and more? I understand! I have over 28 years of experience supporting people struggling with a variety of issues - depression, anxiety, addiction, trauma & PTSD, grief & loss, life changes, abuse, and more. I personally and professionally understand the dynamics that accompany many of these life challenges.
(503) 342-7764 View (503) 342-7764
Photo of Steven Orr, Licensed Professional Counselor in Oregon
Steven Orr
Licensed Professional Counselor, LPC
Verified Verified
Eugene, OR 97401
I strive to create a safe supportive environment where clients have the freedom to explore the issues and situational challenges they face. I have strong history of working with trauma, PTSD, and mood disorders, within a creative, insightful, format. I understand the sensitivities involved with personal struggle and have a variety of useful tools at my disposal to bring light to the dark places.
I strive to create a safe supportive environment where clients have the freedom to explore the issues and situational challenges they face. I have strong history of working with trauma, PTSD, and mood disorders, within a creative, insightful, format. I understand the sensitivities involved with personal struggle and have a variety of useful tools at my disposal to bring light to the dark places.
(971) 407-5674 View (971) 407-5674
Photo of Todd Dennis, Clinical Social Work/Therapist in Oregon
Todd Dennis
Clinical Social Work/Therapist, LCSW
Verified Verified
Eugene, OR 97401
Certifications include Cognitive Processing Therapy for Trauma (CPT-PTSD), Cognitive Behavioral Therapy (CBT), and Integrative Behavioral Couples Therapy (IBCT).
Do you avoid or sabotage your potential to create a fulfilling life? Is the contemplation of change overwhelming? Witnessing positive change continues to be the most rewarding part of my twenty eight years in clinical practice. I prioritize the development of an emotionally safe, strong and trusting therapeutic relationship. Our work will focus on recognizing and changing the patterns and beliefs that limit your ability to achieve an enriched and fulfilling life. I will assist you in developing the skills to better manage emotions, improve interpersonal relationships, modify unhelpful thinking, and enhance personal wellness.
Certifications include Cognitive Processing Therapy for Trauma (CPT-PTSD), Cognitive Behavioral Therapy (CBT), and Integrative Behavioral Couples Therapy (IBCT).
Do you avoid or sabotage your potential to create a fulfilling life? Is the contemplation of change overwhelming? Witnessing positive change continues to be the most rewarding part of my twenty eight years in clinical practice. I prioritize the development of an emotionally safe, strong and trusting therapeutic relationship. Our work will focus on recognizing and changing the patterns and beliefs that limit your ability to achieve an enriched and fulfilling life. I will assist you in developing the skills to better manage emotions, improve interpersonal relationships, modify unhelpful thinking, and enhance personal wellness.
(541) 636-9383 View (541) 636-9383
Photo of Ritual Therapy, Professional Counselor Associate in Oregon
Ritual Therapy
Professional Counselor Associate, MA
Verified Verified
Portland, OR 97213
I work with individuals to address struggles with communication, anxiety, panic, relationship problems, codependency, trauma, and PTSD.
Do you find yourself simultaneously feeling too much and not enough? Do you feel broken? Stuck? Have you ever asked yourself, “Why can’t I just be normal,” or “What is wrong with me?” Maybe you act in ways that don’t feel true to yourself for fear of rejection or abandonment, and perhaps you even end up in unhealthy or one-sided relationships. I believe that just by coming to this page there is something fundamentally “right,” not “wrong" with you. Being a human is complicated, messy, and can be painful, but I feel honored to have the opportunity to support you through these challenges in a way that fosters healing and growth.
I work with individuals to address struggles with communication, anxiety, panic, relationship problems, codependency, trauma, and PTSD.
Do you find yourself simultaneously feeling too much and not enough? Do you feel broken? Stuck? Have you ever asked yourself, “Why can’t I just be normal,” or “What is wrong with me?” Maybe you act in ways that don’t feel true to yourself for fear of rejection or abandonment, and perhaps you even end up in unhealthy or one-sided relationships. I believe that just by coming to this page there is something fundamentally “right,” not “wrong" with you. Being a human is complicated, messy, and can be painful, but I feel honored to have the opportunity to support you through these challenges in a way that fosters healing and growth.
(503) 461-2628 View (503) 461-2628
Photo of Angela Arndt Telehealth Provider, Licensed Professional Counselor in Oregon
Angela Arndt Telehealth Provider
Licensed Professional Counselor, MS, LPC, NCC
Verified Verified
1 Endorsed
Bend, OR 97702  (Online Only)
I love helping young adults (18+) who are struggling with anxiety, anger, depression, trauma, loneliness, feelings of worthlessness, and shame. I also help college students. Mental health problems can negatively impact many areas of a college student's life including academic performance, quality of life, physical health, satisfaction with the college experience, and relationships with friends and family members. I offer compassionate and non-judgmental therapy to help you make desired changes in your life and I work to help you understand yourself better. Email me for help.
I love helping young adults (18+) who are struggling with anxiety, anger, depression, trauma, loneliness, feelings of worthlessness, and shame. I also help college students. Mental health problems can negatively impact many areas of a college student's life including academic performance, quality of life, physical health, satisfaction with the college experience, and relationships with friends and family members. I offer compassionate and non-judgmental therapy to help you make desired changes in your life and I work to help you understand yourself better. Email me for help.
(458) 202-2482 View (458) 202-2482
Photo of Candyce Monteleone, Licensed Professional Counselor in Oregon
Candyce Monteleone
Licensed Professional Counselor, MA, LPC, PMH-C
Verified Verified
Lake Oswego, OR 97035
I provide holistic and trauma-informed counseling to adults struggling with depression, anxiety, stress, traumatic experiences, life transitions, and perinatal mood and anxiety disorders. Some evidence-based modalities I may use in therapy include Strengths-Based Therapy, Interpersonal Psychotherapy, Acceptance and Commitment Therapy, and attachment-focused EMDR.
I provide holistic and trauma-informed counseling to adults struggling with depression, anxiety, stress, traumatic experiences, life transitions, and perinatal mood and anxiety disorders. Some evidence-based modalities I may use in therapy include Strengths-Based Therapy, Interpersonal Psychotherapy, Acceptance and Commitment Therapy, and attachment-focused EMDR.
(971) 306-4467 View (971) 306-4467
Photo of Monica Gabaldon, Clinical Social Work/Therapist in Oregon
Monica Gabaldon
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
2 Endorsed
Portland, OR 97219  (Online Only)
I use a gentle, strength based, trauma informed approach to help bring about awareness, meaning and solutions to life's challenges.
Virtual Only. I accept all medicaids/OHP except PacificSource at this time. Hello & welcome! As a Licensed Clinical Social Worker, I am passionate about helping women work through past/current traumas, anxiety and depression. Together, we will work through any obstacles you may be having and explore self-defeating thoughts that are keeping you stuck from living the life you want.
I use a gentle, strength based, trauma informed approach to help bring about awareness, meaning and solutions to life's challenges.
Virtual Only. I accept all medicaids/OHP except PacificSource at this time. Hello & welcome! As a Licensed Clinical Social Worker, I am passionate about helping women work through past/current traumas, anxiety and depression. Together, we will work through any obstacles you may be having and explore self-defeating thoughts that are keeping you stuck from living the life you want.
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Photo of Dr. Kimberly Christensen, Marriage & Family Therapist in Oregon
Dr. Kimberly Christensen
Marriage & Family Therapist, PhD, LMFT
Verified Verified
4 Endorsed
Portland, OR 97209
Somatic therapy emphasizes the deep link between body and mind, recognizing our bodies as storages of emotional history and trauma.
Welcome! If you find yourself navigating through this platform, it's likely because you're seeking a guiding light to illuminate your path toward positive change. With over 12 years of dedicated experience in the field of psychology, I specialize in somatic and depth psychotherapy, emphasizing trauma-informed care. My approach is rooted in the profound belief that your journey to healing should not only be transformative but deeply attuned to the specificities of your individual experiences.
Somatic therapy emphasizes the deep link between body and mind, recognizing our bodies as storages of emotional history and trauma.
Welcome! If you find yourself navigating through this platform, it's likely because you're seeking a guiding light to illuminate your path toward positive change. With over 12 years of dedicated experience in the field of psychology, I specialize in somatic and depth psychotherapy, emphasizing trauma-informed care. My approach is rooted in the profound belief that your journey to healing should not only be transformative but deeply attuned to the specificities of your individual experiences.
(503) 486-8662 View (503) 486-8662
Photo of Hannah Boley, Clinical Social Work Associate in Oregon
Hannah Boley
Clinical Social Work Associate, MSW
Verified Verified
Grants Pass, OR 97526
I have experience working with anxiety/panic, depression, coping skills, self-esteem, stress, life transitions, and PTSD, with LGBTQIA+ and diverse cultural backgrounds.
Life can be difficult! But you don’t have to do it alone. Gen Z- you are in the driver's seat here and I am here to sit beside you, to help you navigate the twists and turns along your journey. With empathy and understanding, we can explore life struggles, anxiety, depression, past hurt, future goals, and more. I hold a safe space for you to process anything that life throws your way. My experience working with youth in various settings of teaching, counseling, and telehealth, has given me an understanding that Gen Z has their own set of challenges to navigate, different from other generations.
I have experience working with anxiety/panic, depression, coping skills, self-esteem, stress, life transitions, and PTSD, with LGBTQIA+ and diverse cultural backgrounds.
Life can be difficult! But you don’t have to do it alone. Gen Z- you are in the driver's seat here and I am here to sit beside you, to help you navigate the twists and turns along your journey. With empathy and understanding, we can explore life struggles, anxiety, depression, past hurt, future goals, and more. I hold a safe space for you to process anything that life throws your way. My experience working with youth in various settings of teaching, counseling, and telehealth, has given me an understanding that Gen Z has their own set of challenges to navigate, different from other generations.
(458) 213-4331 View (458) 213-4331
Photo of Jared Utterback, Marriage & Family Therapist in Oregon
Jared Utterback
Marriage & Family Therapist, LMFT
Verified Verified
Bend, OR 97702
Waitlist for new clients
EMDR through the Personal Transformation Institute and use EMDR to work with clients who have endured past trauma.
I believe that every person is created in the image of God, is uniquely designed and can obtain optimum mental health if they are willing to put forth the effort. I utilize many methods of counseling including a client-centered talk therapy approach, family systems theory, cognitive behavioral therapy, and EMDR.
EMDR through the Personal Transformation Institute and use EMDR to work with clients who have endured past trauma.
I believe that every person is created in the image of God, is uniquely designed and can obtain optimum mental health if they are willing to put forth the effort. I utilize many methods of counseling including a client-centered talk therapy approach, family systems theory, cognitive behavioral therapy, and EMDR.
(458) 216-5779 View (458) 216-5779
Photo of Ariel Yabek, Marriage & Family Therapist in Oregon
Ariel Yabek
Marriage & Family Therapist, MA, LMFT
Verified Verified
1 Endorsed
Eugene, OR 97405
Apologies, my practice is full. I support clients in addressing issues related to identity, relationship and belonging. My work is anchored in a Relational model of care whose aim is to support the development and maintenance of mutually beneficial and sustainable relationships. I work with clients to identify and cultivate resources, supports and protective factors so they may feel increasingly more secure navigating life. My work with clients reflects my values of transparency, respect and courage. Much of my work focuses on resolving trauma wounding, with highly effective models of care such as EMDR and Internal Family Systems.
Apologies, my practice is full. I support clients in addressing issues related to identity, relationship and belonging. My work is anchored in a Relational model of care whose aim is to support the development and maintenance of mutually beneficial and sustainable relationships. I work with clients to identify and cultivate resources, supports and protective factors so they may feel increasingly more secure navigating life. My work with clients reflects my values of transparency, respect and courage. Much of my work focuses on resolving trauma wounding, with highly effective models of care such as EMDR and Internal Family Systems.
(541) 204-2705 View (541) 204-2705
Photo of Dr. Thaen Saelee, Psychologist in Oregon
Dr. Thaen Saelee
Psychologist, PsyD, EMDR
Verified Verified
2 Endorsed
Roseburg, OR 97471  (Online Only)
Waitlist for new clients
My speciality is trauma work.
I'm an eclectic therapist trained in many evidence-based, holistic, and indigenous healing practices from my professional and lived experiences. With a wide ranging tool box, I’ve been successful in treating individuals with symptoms of trauma, anxiety, depression, grief, life stressors, identity concerns, family issues and addictive behaviors. I have been a counselor for over 14 years and identify as a third-culture psychologist. I see race-based and systemic trauma and work with individuals who identify with these communities. I'm neurodivergent and LGBTQI affirming therapist.
My speciality is trauma work.
I'm an eclectic therapist trained in many evidence-based, holistic, and indigenous healing practices from my professional and lived experiences. With a wide ranging tool box, I’ve been successful in treating individuals with symptoms of trauma, anxiety, depression, grief, life stressors, identity concerns, family issues and addictive behaviors. I have been a counselor for over 14 years and identify as a third-culture psychologist. I see race-based and systemic trauma and work with individuals who identify with these communities. I'm neurodivergent and LGBTQI affirming therapist.
(458) 237-4979 View (458) 237-4979
Photo of Robyn Gibbs, Clinical Social Work/Therapist in Oregon
Robyn Gibbs
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Eugene, OR 97401  (Online Only)
Are you seeking support coping with a difficult time in your life, adjusting to changes, healing from trauma, dealing with a difficult work situation, balancing responsibilities, or grieving a loss? Do you want to create fulfilling relationships in which your needs are met? Have you found that your coping strategies are not working as well as they used to? Maybe you feel limited in some way and want to break free. Allow me to offer you a safe space to explore your struggles and assist in creating a healing path. I will listen to you and place great value on understanding your unique needs.
Are you seeking support coping with a difficult time in your life, adjusting to changes, healing from trauma, dealing with a difficult work situation, balancing responsibilities, or grieving a loss? Do you want to create fulfilling relationships in which your needs are met? Have you found that your coping strategies are not working as well as they used to? Maybe you feel limited in some way and want to break free. Allow me to offer you a safe space to explore your struggles and assist in creating a healing path. I will listen to you and place great value on understanding your unique needs.
(458) 215-1657 View (458) 215-1657
Photo of Lucy Sherman, Licensed Professional Counselor in Oregon
Lucy Sherman
Licensed Professional Counselor, LPC, MS, NCC, CRC
Verified Verified
5 Endorsed
Portland, OR 97211
Hey! I’m Lucy (She/Her), I help clients process complex trauma and sexual trauma through EMDR and creative expression. I imagine trauma is coming up that you thought was worked through but now you are realizing that you are not trusting yourself or others and your body is stuck responding as it did in the past even though things are different now. I work with sensitive souls who have felt like a burden for having needs and feel they are not enough and too much at the same time. Through our work you can build trust with yourself, your body and find relief from past trauma through 50 min, EMDR Intensives and/ or extended sessions.
Hey! I’m Lucy (She/Her), I help clients process complex trauma and sexual trauma through EMDR and creative expression. I imagine trauma is coming up that you thought was worked through but now you are realizing that you are not trusting yourself or others and your body is stuck responding as it did in the past even though things are different now. I work with sensitive souls who have felt like a burden for having needs and feel they are not enough and too much at the same time. Through our work you can build trust with yourself, your body and find relief from past trauma through 50 min, EMDR Intensives and/ or extended sessions.
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Photo of Emily A Pyle, Licensed Professional Counselor in Oregon
Emily A Pyle
Licensed Professional Counselor, LPC
Verified Verified
Eugene, OR 97401
Waitlist for new clients
My training in Western psychotherapy gives me a deep understanding of the brain processes behind depression, anxiety, shame, addiction, PTSD, and relationship problems.
However you are feeling at this moment, you have deep, natural sources of resilience inside you. My job as a therapist is to help you tap into the resources of your mind, body, and spirit, so that you can take charge of your own healing and growth. Often, the feelings, thoughts, and behaviors causing us the most difficulty right now have their roots in old coping strategies that once helped us to survive and care for ourselves. If you are struggling or stuck now, it may be because you are ready to let go of these old patterns and find new ways of being.
My training in Western psychotherapy gives me a deep understanding of the brain processes behind depression, anxiety, shame, addiction, PTSD, and relationship problems.
However you are feeling at this moment, you have deep, natural sources of resilience inside you. My job as a therapist is to help you tap into the resources of your mind, body, and spirit, so that you can take charge of your own healing and growth. Often, the feelings, thoughts, and behaviors causing us the most difficulty right now have their roots in old coping strategies that once helped us to survive and care for ourselves. If you are struggling or stuck now, it may be because you are ready to let go of these old patterns and find new ways of being.
(541) 735-9034 View (541) 735-9034
Photo of Milena Trifunovich, Licensed Professional Counselor in Oregon
Milena Trifunovich
Licensed Professional Counselor, MA, LMHC
Verified Verified
1 Endorsed
Portland, OR 97214  (Online Only)
I work with a wide range of client's wanting to focus on anxiety, ways of coping, depression, life and work stress, trauma, PTSD, self-exploration and growth, relationship challenges, women empowerment, LGBTQIA issues, body image concerns, and eating disorders/disordered eating. I work primarily from an emotion focused lens and provide EMDR. My goal is to provide trauma-informed, social justice-oriented and culturally aware therapy and a space where you can feel comfortable, safe, and heard. Please note that I have a virtual-only practice in the states of Oregon and Washington.
I work with a wide range of client's wanting to focus on anxiety, ways of coping, depression, life and work stress, trauma, PTSD, self-exploration and growth, relationship challenges, women empowerment, LGBTQIA issues, body image concerns, and eating disorders/disordered eating. I work primarily from an emotion focused lens and provide EMDR. My goal is to provide trauma-informed, social justice-oriented and culturally aware therapy and a space where you can feel comfortable, safe, and heard. Please note that I have a virtual-only practice in the states of Oregon and Washington.
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Photo of Dr. Jeffrey C Johnson, Licensed Professional Counselor in Oregon
Dr. Jeffrey C Johnson
Licensed Professional Counselor, PhD, LPC
Verified Verified
2 Endorsed
Albany, OR 97321
Have you been feeling overwhelmed or have you lost motivation? Have you been through trauma? Does ADHD or Autism impact your day to day function? You may have tried to find your own ways to cope and have just run out of ideas. Reaching out for counseling can be challenging, and I get that. Maybe you are skeptical that counseling is the right place for you. I believe that everyone is capable of changing their lives for the better.
Have you been feeling overwhelmed or have you lost motivation? Have you been through trauma? Does ADHD or Autism impact your day to day function? You may have tried to find your own ways to cope and have just run out of ideas. Reaching out for counseling can be challenging, and I get that. Maybe you are skeptical that counseling is the right place for you. I believe that everyone is capable of changing their lives for the better.
(458) 236-5519 View (458) 236-5519
Photo of Olivia Raccuglia, Licensed Professional Counselor in Oregon
Olivia Raccuglia
Licensed Professional Counselor, LPC, MA
Verified Verified
Portland, OR 97210
Hello and welcome! Sometimes life's challenges can leave us feeling overwhelmed and vulnerable. I offer a safe and supportive space for individuals seeking help with anxiety, depression, complex trauma, loss, relationship issues, and/or those looking to deepen their own self understanding. We'll delve into your unique experiences, emotions, and relationships, gaining insight into the root causes of your struggles, and the ways in which your past may be impacting the present. Together, we’ll find connections, build skills, and give you the support that you need to move you towards a more authentic and fulfilling life.
Hello and welcome! Sometimes life's challenges can leave us feeling overwhelmed and vulnerable. I offer a safe and supportive space for individuals seeking help with anxiety, depression, complex trauma, loss, relationship issues, and/or those looking to deepen their own self understanding. We'll delve into your unique experiences, emotions, and relationships, gaining insight into the root causes of your struggles, and the ways in which your past may be impacting the present. Together, we’ll find connections, build skills, and give you the support that you need to move you towards a more authentic and fulfilling life.
(503) 461-7204 View (503) 461-7204
Photo of Jeffrey Meuser, Licensed Professional Counselor in Oregon
Jeffrey Meuser
Licensed Professional Counselor, LPC, MA
Verified Verified
Tigard, OR 97223
I specialize in Trauma and Addiction by helping you understand your story and how our narrative is playing a role in life.
Sometimes we struggle to make sense of what is happening around us. Sometimes we need help to get through these hard times. In these tough times, we may battle depression, anxiety, connection with others, or addictions. My goal is to help you understand your story and help you make sense of what you have learned and become more insightful, confident, and successful in life, therefore making the change you would like to see in your life. I help people work through relationship issues, anxiety, depression, ADHD, and addictions which usually stem from events or traumas.
I specialize in Trauma and Addiction by helping you understand your story and how our narrative is playing a role in life.
Sometimes we struggle to make sense of what is happening around us. Sometimes we need help to get through these hard times. In these tough times, we may battle depression, anxiety, connection with others, or addictions. My goal is to help you understand your story and help you make sense of what you have learned and become more insightful, confident, and successful in life, therefore making the change you would like to see in your life. I help people work through relationship issues, anxiety, depression, ADHD, and addictions which usually stem from events or traumas.
(971) 407-1044 View (971) 407-1044
Trauma and PTSD Therapists

When should I seek treatment for trauma?

Not everyone who undergoes trauma needs therapy to heal, but many do. If, after experiencing a traumatic event, you find yourself struggling with symptoms such as nightmares, dissociation, irritability, or emotional numbness—especially if these symptoms last more than a month and are severe enough to interfere with your daily functioning—you may benefit from seeking out therapy with a trauma-informed provider.

How long does trauma therapy take?

Different types of therapy for trauma unfold on different timelines. Prolonged exposure therapy and cognitive processing therapy, for example, each take about three months, while trauma-informed CBT may last anywhere from 8 to 25 sessions. Other approaches, especially those that are less structured or that incorporate elements from multiple modalities, may be more open-ended, though many patients report feeling better within the first few months of treatment.

What happens if trauma is left untreated?

Unaddressed trauma can have serious—even devastating—effects on relationships, career, and day-to-day functioning. Post-Traumatic Stress Disorder (PTSD) can lead people to distrust or lash out at others, making it difficult to maintain intimate relationships; it can also trigger symptoms such as flashbacks or hyperreactivity that can interfere with a person’s ability to function effectively, personally and/or professionally. Some sufferers turn to drugs to find relief. Symptoms may lessen on their own with time, but there is no guarantee that PTSD will resolve on its own.

Can PTSD come back after treatment?

It is possible for PTSD symptoms to recur months or years after successful treatment. This is because, like most mental health disorders, it is not possible to “cure” PTSD, and stressful life events may cause symptoms to recur in even the most resilient individuals. There is no shame in re-experiencing PTSD symptoms nor in returning to therapy when such relapses occur; indeed, many forms of trauma therapy explicitly encourage periodic “maintenance sessions” to reinforce coping skills and ensure that symptoms stay manageable.