The Long-Term Effects of Trauma

Aiesha Lee, PhD, NCC, LPC, began her career at a community counseling clinic where she worked with clients who have experienced a significant amount of systemic and generational trauma. “Systemic trauma refers to the psychological impact caused by social systems that perpetuate inequality, discrimination, and violence, often affecting marginalized communities,” Dr. Lee says. “These experiences of trauma are not isolated incidents but are ingrained in the larger social and political context, contributing to a collective sense of fear, mistrust, and grief. Generational trauma, similarly, involves the transmission of traumatic experiences and their effects across generations within a family or community. This can manifest as patterns of behavior, emotional responses, and relational dynamics that are passed down, often unconsciously, from parents to children.”

Dr. Lee later transitioned into her private practice, where she primarily serves Black women who have experienced generational trauma and are actively deconstructing and reconstructing their narratives. Dr. Lee recently shared her thoughts with us about the importance of trauma-informed care. 

What are the long-term effects of trauma on a person’s mental health?

Trauma can significantly alter how an individual engages with the world around them for the foreseeable future. I often use the analogy of a child’s experience with a hot stove when discussing the impact of trauma: Generally, when a child gets burned by a hot stove, their relationship with that stove is altered. Where they may have been curious previously, they are now cautious and maybe even avoidant. If anyone gets near the stove, the child makes sure to warn them “Hot! Be careful!” The same protective mechanisms are at play when a person experiences trauma and the long-term mental health effects often encompass the general internal message of “Hot! Be careful!” 

The experience of trauma is much more complex than a child being burned by a hot stove; however. The long-term effects on a person’s mental health can be viewed as the brain and body’s long-term protective mechanism to remind them of the danger they once experienced. Our brains’ and bodies’ reminders of this danger can manifest as symptoms of post-traumatic stress disorder (PTSD), like flashbacks, anxiety, and emotional dysregulation. 

A great deal of this fear and anxiety shows up in interpersonal relationships, significantly impacting one's ability to trust, connect, and feel secure with others. Individuals who have experienced trauma might find themselves struggling with forming and maintaining close relationships, often due to an inherent sense of caution or a need to protect themselves and often colored by a deep-seated fear of discrimination or retraumatization. 

How does this inform your work? How do you approach building trust with a new client who has experienced trauma and create a safe space that fosters trust and respect?

First, I’m very slow to pathologize clients and instead view their symptoms and current circumstances through a trauma lens. Meaning, instead of wondering what is “wrong” with clients, I ask myself, and them, what has happened in their lives so far that has brought them to their present circumstances. And I’m very open about my focus on my clients’ stories and really emphasize my genuine interest in them and their story. I find that this type of openness, particularly letting my clients know that I am not here to diagnose/label them or tell them there’s anything wrong with them, begins to bring down some defenses.

I also do a lot of validating early in the therapeutic relationship. After a client has told me their story and shared their current symptoms, I’ll share with them how much sense it makes to me that they are experiencing their current symptoms because of the experiences they’ve had. I oftentimes use psychoeducation in these moments to inform clients about how protective our minds and bodies are of us and how their mind and body is working very effectively to keep them out of danger. Even before getting into clients’ stories, I do my best to lay a foundation of mutual understanding, meaning I’m very clear about my role, their role, and the function of the therapeutic process.

What approaches/therapeutic modalities do you find most effective in trauma-informed care? What strategies do you use to help these clients develop healthy coping mechanisms?

I primarily utilize narrative therapy to effectively engage in trauma-informed care due to its cultural responsiveness and nonpathologizing concepts. I find that narrative therapy is particularly beneficial in trauma work, as it gives clients space to just tell their story and it emphasizes deconstructing and reauthoring the personal narratives impacted by traumatic experiences that clients bring into therapy. This approach respects their stories, values their cultural contexts, and avoids pathologizing their experiences. 

By helping clients to externalize their problems and view them as separate from their identity, narrative therapy allows them to gain a new perspective on their trauma experience and reclaim their personal power. This is particularly important for folks who’ve experienced cultural trauma (i.e., traumatic experiences that deeply affect the collective identity and values of a cultural group), which can feel like an attack on one’s sense of self. To complement narrative therapy, I also incorporate cognitive behavioral therapy (CBT), which has shown to be effective in addressing trauma symptoms. CBT provides a structured approach to understand and change the thought patterns that contribute to clients’ trauma responses. It's particularly effective in helping clients develop a more realistic and compassionate understanding of their experiences, which can reduce symptoms of PTSD and other trauma-related disorders. Lastly, I also find cognitive processing therapy (CPT) to be effective, as it combines narrative and cognitive components to reframe and reevaluate traumatic memories. 

I focus on helping clients develop healthy coping mechanisms through mindfulness, emotional regulation strategies, and resilience-building. Mindfulness practices are highly effective in helping clients become more aware of the present moment, reducing the intensity of flashbacks and intrusive thoughts. Emotional regulation strategies, such as identifying and naming emotions, understanding triggers, and learning to respond rather than react are crucial in managing the symptoms of trauma. Building resilience empowers clients to recover from difficult experiences and fosters a sense of mastery and self-efficacy. 

Often a client may initially seek counseling for anxiety or depression, not realizing that it is the result of trauma until it is discovered in session later. How do you walk a client through what could be considered “surprise” trauma that they weren’t aware of without making them feel defensive?

First, I choose my words very wisely. For many, especially those from marginalized communities, what the profession considers trauma, they may consider a normal part of their experience. This is often because they’ve seen friends, family, and others in the community having the same or similar experiences, so they can often minimize their own experience. For this reason, I don’t always use the word “trauma.” For example, during the intake process, when asking about trauma I’ll use phrases like “extremely distressing or stressful event” or “an event that has had a major impact on your life.”

Once trauma has been uncovered, I’m still slow to use the “t-word.” I provide space for the client to just unpack that they’ve had an experience that has significantly impacted them, because many clients haven’t even had time to fully process this truth. After this space has been provided, I’ll typically validate clients’ experience by indicating that what they’ve experienced can be viewed as traumatic. I think it’s important that I don’t tell clients that their experience is traumatic because it’s their personal experience, and I don’t believe I get to judge or put labels on that. Instead, I give my perspective, as a mental health professional, and give clients the space to choose what wording they want to use. I think it’s important to note that semantics isn’t a big deal to me. As a narrative practitioner, I’m much more focused on how clients tell and interpret their own stories rather than how I understand them.

What are some key factors that contribute to a successful outcome in trauma therapy?

Of course, the first and most important and foundational factor is the therapeutic relationship. Trust and safety are key in the trauma-informed counseling process and can only be fostered through a therapeutic relationship. To foster trust and safety, it is necessary for clinicians to provide/express empathy and mutual respective and collaborative opportunities. In this, being transparent and open about the therapeutic process, including the counselor’s roles and expectations of the client, is vital. I find it extremely helpful to have an open discussion about what counseling entails, what my role as a counselor is, and how I engage in the therapeutic process, and I expect and invite the client to engage in the therapeutic process. The more information we can provide about what the client can expect, the more safety and trust we build. With this, though, we have to do our best to uphold our word. If we say that the treatment planning process is collaborative, we must actually collaborate with clients as we develop the treatment plan. 

This speaks to another key factor, the client’s active engagement. As counselors, we can do all the “right” things, but if our clients aren’t willing or able to actively engage in the therapeutic process, nothing we do will be beneficial. This is especially crucial to consider when directly addressing and working with trauma. Most likely our clients are coming to us with established protective mechanisms that keep them from fully engaging in the therapeutic process. As trauma-informed counselors, we must be slow to view this as resistance and instead recognize clients’ apprehension to engage in the process as a protective function and symptom of trauma. With this, it’s important to work at a pace that is comfortable for the client so we don’t overwhelm them as we ask them to engage in a really difficult experience.

Are there any specific cultural considerations you take into account when working with clients from diverse backgrounds who have experienced trauma?

I refer back to the importance of the therapeutic relationship when considering specific cultural considerations. Being culturally humble means being open to learning from clients about their cultural backgrounds rather than imposing preconceived notions or stereotypes. It requires a willingness to acknowledge and address power imbalances in the therapeutic relationship and to continually educate oneself about different cultures and their impact on mental health. Engaging in a culturally humble practice not only enhances the therapeutic alliance but also promotes a more inclusive and effective therapy environment. 

Lastly, ongoing self-reflection and education as a counselor is crucial. This involves continually exposing oneself to different cultures and being aware of one’s own biases and assumptions. In this, we enhance our ability to be culturally humble, as continued exposure to various cultures and critique of our biases increases our ability to remove our egos from the therapeutic process. This provides space for more empathetic and effective support to clients from diverse cultural backgrounds, ensuring that the therapeutic space is a safe, respectful, and healing environment.

Aiesha Lee, PhD, NCC, LPC, is an Assistant Professor of Counselor Education in the Department of Educational Psychology, Counseling, and Special Education at Penn State University and the owner of Rooted Healing Counseling. She received a master’s in marriage and family therapy/counseling from The College of New Jersey and a doctorate in counselor education and supervision from William & Mary.