Angela shared how her background is in Trauma, surrounding Bereavement, Refugees and Sexual Abuse.

Initially discussed how the DSM does not cover everybody with PTS, resulting in some people getting missed and not being treated for Trauma.

Angela went on to share with us the DSM definitions which were written in 1980 and most recently reviewed in 2013.

Explored PTS triggers such as “being a witness to a traumatic event” and how this did not used to be recognised and how trauma was only previously recognised as “exposure to actual or threatened death, serious injury or sexual violation” until 1987.

Looked at how not everybody goes on to experience PTS from one single traumatic event, it can sometimes be a long term event or a single event followed by another small trigger.
Explored the symptoms of trauma, how PTS impacts people differently, how it changes the view of yourself, others and the world. Went onto talk about how the emotional impact of trauma can create a loss of faith, that there isn’t any safety in the world, and leaves people constructing their own reality about the world.

Angela showed us a diagram of the brain, showing areas which are affected when experiencing trauma, such as the amygdala. The amygdala’s job is to send out an automatic threat alert, also known as the fight or flight response. It is the survival part of the brain which was more necessary back in the primitive stages of life. The hippocampus known for processing and separating the past from the present and the pre frontal cortex is known for the thinking brain. When someone experiences trauma, there is a breakdown between the three areas which prevents the hippocampus from processing the experience. Angela shares that if we can allow the hippocampus to process the memory it does not then impact the functioning.

Angela talks us through some scenarios on hidden traumas such as domestic violence, prejudice, and loss, and how they can be hidden through normalising a long term event, social anxiety and grief etc.

Angela highlighted how a client’s thoughts on the experience can be helpful, such as thoughts around avoidance, rather than seeing them as being dysfunctional thoughts.

Looked at how they are protecting and logical given the situation. Helping a client move forward can be done by reflecting back how resilient they can be, as opposed to “this will not happen again”.

Discussed the expectations and the trauma of being a witness to a traumatic event and how people can feel pressurised to be a witness, and how being a witness can mean you have to hold onto the information/images for the support of your community.

Angela shares that to work with trauma, you have to listen, try not to make assumptions and find ways of resource building. If a client does not want to talk about it, go with that. If they do want to talk, be open to work with it.


Have you any advice for people in private practice?

  • Encourage client to inform GP and request for trauma related treatment such as EMDR
  • Consider using impact of event scales (IES) to illicit more information around clients presenting issue.
  • Recommended reading: Babette Rothschild – Working with Flashbacks


Jennifer Pennington