Healing Together: Family Therapy For Trauma Recovery

Trauma can impact a family’s well-being

Online therapy can help

Understanding trauma

While trauma can manifest in different ways depending on many factors, it is commonly understood as a distressing experience involving intense fear, confusion, helplessness, and other negative and disruptive feelings. Such feelings are often severe enough to have a lasting impact on a person’s functioning and mental state. In some cases, trauma may challenge an individual’s sense of reality. 

There are many potential causes of trauma, including those caused by human behavior, such as abuse, rape, neglect, combat situations, and other types of violence. Natural disasters, such as earthquakes and tornadoes, can also be significant sources of trauma, as can severe losses, such as the death of a loved one. 

Types of trauma

Research continually reveals new insights into the experience and origins of trauma, who it affects, and how it manifests. These findings can inform how we recognize and categorize different types of trauma. Examples include the following:

• Acute trauma: This generally occurs in response to an isolated event that you witness or personally experience. Examples include natural disasters, accidents, or witnessing an act of violence.
• Chronic trauma: This typically involves prolonged exposure to traumatic events. Examples include ongoing abuse, neglect, and violence.
• Complex trauma: Complex trauma can occur when an individual is exposed to many traumatic events, typically in a relational context. Examples of complex trauma include domestic violence, childhood abuse, and war-related trauma.
• Intergenerational trauma: This generally refers to the passing of trauma across generations within families or communities, sometimes manifesting in specific patterns of behavior, beliefs, and coping mechanisms.
• Developmental trauma: This is usually trauma that occurs during critical developmental periods in a person’s childhood or adolescence. This type of trauma can impact an individual’s overall development, emotional regulation, and attachment style. 
• Secondary (or vicarious) trauma: Secondary trauma may occur when an individual is exposed to the traumatic experiences of another. It sometimes occurs in first responders, healthcare professionals, and therapists. 
• Medical trauma: This typically refers to traumatic stress caused by physical and psychological responses to injury, serious illness, traumatic treatment experiences, and medical procedures. 
• Race-based trauma (racial trauma): This type of traumatic stress normally involves experiences of racial and ethnic discrimination, typically through racism and/or hate crimes. It can come from another person or occur within a more extensive system. 

Trauma symptoms

While trauma tends to be complex and multifaceted in how it manifests, persists, and impacts different people, studies reveal patterns in how the experience of trauma influences thoughts and behaviors. Below are some examples of symptoms associated with trauma:

• Hyperarousal 
• Sleep disruptions, including nightmares
• Impaired memory of traumatic events and circumstances
• Flashbacks
• Irritability and/or aggression
• Emotional dysregulation
• Emotional numbness
• Trouble concentrating
• Social isolation and withdrawal
• Anxiety and persistent fear
• Depression
• Substance misuse (formerly referred to as substance abuse)
• Intrusive, distressing thoughts and images
• Low self-esteem
• A sense of hopelessness and/or helplessness
• Dissociation and avoidance as coping mechanisms
• Acute or chronic physical symptoms, like headaches, shortness of breath, racing heartbeat, dizziness, extreme fatigue, body aches, and gastrointestinal distress

Trauma symptoms often co-occur. When they’re left unaddressed, they can lead to other severe types of physical and mental illness beyond post-traumatic stress disorder (PTSD) and other trauma-related conditions.

Understanding trauma in families 

The reactions to trauma within families can be as diverse as the families they impact. For some, trauma brings them closer together and strengthens their bonds. For others, the challenges it brings may be too much for the family to process, threatening to separate them emotionally. In worst-case scenarios, trauma can even break up families or lead to animosity between members. 

While there is no “cookie-cutter” way in which trauma affects families, research suggests there are some typical patterns.

Fearfulness 

Fear can present in different ways in families as a trauma response:

• Parents or caregivers may fear for the family’s safety or worry that another distressing event will happen. This may prompt them to become more controlling and less flexible around rules and boundaries in the household.
• If one person in the family was exposed to trauma, they may be afraid to talk about it with the rest of the family. Likewise, the rest of the family might be afraid to approach the subject with the individual. 
• Studies on intergenerational trauma indicate that “trauma experienced in utero can impact a child’s ability to modulate fear responses in the presence of a safety signal, independent of the children’s own trauma exposure.”

Anger

Like fear, anger can be a typical emotional response to trauma that may emerge in families for complex reasons. 

• Individuals may unwittingly displace their anger toward the cause of the trauma on others in the family.
• Often, trauma survivors experience anger as a physiological “fight-or-flight” response to a threat, even if there is no direct threat present. They might project these feelings of anger onto other members of the family.
• Anger may be a response to helplessness in the wake of trauma for survivors and family members. 
• Some individuals, particularly those who survived childhood trauma, may use aggression to push others away and protect themselves against emotional pain.   

Compromised ability to communicate

Fear, anger, uncertainty, insecurity, helplessness, shame, and guilt are just a few of the typical emotions associated with trauma that can accumulate and create breakdowns in communication within families. Other factors might include the following:

• Sometimes, family members may not be confident speaking to each other or simply don’t know how to approach the topic the “right” way. 
• It can be triggering for individuals to discuss the fear and anxiety they may experience when exposed to stimuli related to the trauma.
• When family members are struggling to come to terms with the trauma and how it impacted their loved one, they may avoid speaking about it. 
• In some cases, trauma can create severe fatigue that makes it challenging to communicate.

Dysfunctional attachment styles

Although this isn’t always the case, exposure to early trauma can significantly impact an individual’s attachment style later in life, potentially causing problems within family relationships. For example:

• Adults who experienced neglect or were exposed to addiction or violence in the household as children might develop an anxious attachment style. People with anxious attachment often experience a fear of abandonment that may lead them to act in a “clingy” or insecure manner. They may also experience a sense of mistrust in relationships. 
• People who experience neglect and inconsistent care as children may develop an avoidant attachment style in which they are prone to disconnection and withdrawal from others. 
• Individuals who experienced a combination of abuse, neglect, exposure to violence, and/or inconsistent care as children may form a combination of anxious and avoidant attachment styles later in life.

The importance of trauma-informed care in family therapy

Trauma-informed care in family therapy can be critical for providing effective, compassionate support to families who have experienced trauma. Here are a few ways this specialized form of treatment supports the entire family system.

It can help families understand the impacts of trauma

Learning about trauma tends to be an integral part of therapy for families. Education about trauma can provide a comprehensive picture of its causes and symptoms, as well as how trauma symptoms can emerge and how they may impact trauma survivors in the long term. Psychoeducation may teach families how trauma can affect the body and neurological function, and it can identify any misconceptions the family may have about trauma. 

Psychoeducation can also be helpful for cultivating greater compassion and empathy for trauma survivors, dispelling myths, discouraging stigma, and strengthening the family’s resolve to work together toward healing. In some cases, psychoeducation also involves teaching family members specific skills to aid in emergency situations or triggering experiences. 

It can create a safe and supportive environment for all family members

Part of the purpose of trauma-informed care is generally to acknowledge and validate the significant impact that trauma can have on individuals and families. It can provide trauma survivors and their families with a safe and secure environment for them to express their emotions freely.

Family trauma therapy can build trust and communication skills

Trust tends to be essential in any relationship between counselor and patient, but this can be especially true in working with families who have been exposed to trauma. The therapeutic process is often collaborative, requiring input from all parties. Family therapy for trauma frequently focuses on cultivating trust and rapport so all parties are comfortable participating.

It can empower families to take an active role in the healing process

By providing education, resources, and a safe, supportive environment to communicate, trauma-informed family therapists can help families better develop the skills and resilience needed to navigate and take control of their own recovery. 

It can address unhealthy family dynamics

Trauma typically impacts communication, relationships, and family dynamics in complex ways. Trauma-informed family therapists are usually trained to understand these dynamics and complexities within the family, as well as to develop an effective intervention plan tailored to the family’s needs. 

It can teach families tools for coping with trauma to avoid re-traumatization

Re-traumatization can be common in many cases, so trauma-informed care often prioritizes the avoidance of re-traumatization. Trauma therapists are normally trained to recognize and respond to trauma triggers, facilitate the therapeutic process in a sensitive, respectful way, and create a safe space for families to process their trauma.  

Seeking support

To find the right family trauma therapist for you, it usually helps to know where to look, which questions to ask, and how to identify a licensed professional experienced in working with trauma patients.

When searching for a therapist, interview them about their training and experience in treating trauma in families. You might also ask them directly how they would structure a treatment plan for a situation like the one your family is facing.  

The following resources all have pages to help individuals find trauma-informed therapists by location:

• The US Department of Veteran’s Affairs National Center for PTSD
• The National Institute of Mental Health
• Mental Health America

Several online therapy platforms also offer virtual options for individual and couples therapy. Although it may not be appropriate in all cases, some choose this type of therapy as an alternative to traditional, in-office treatment for its flexibility, convenience, and affordability.

According to a large body of research, online therapy typically produces the same client outcomes as in-person therapy and can effectively treat a wide variety of mental health challenges.