After a frightening or overwhelming experience, it's normal for the mind to keep returning to it for a while. For most people, that settles over the following weeks. For some, it doesn't. The memory stays raw, life starts organising itself around avoiding reminders, and the body stays on alert long after the danger has passed.
I offer two of the most effective treatments for trauma and PTSD: trauma-focused CBT and EMDR. I am a BABCP-accredited CBT therapist and an EMDR Europe accredited practitioner, and I work with adults online across the UK and in person in Queen's Park, North West London.
Signs that trauma is still affecting you
PTSD has a recognisable pattern. You don't need all of these for therapy to be useful, but they are the core features:
- Re-experiencing - intrusive memories, flashbacks, nightmares, or sudden waves of fear or distress when something reminds you of what happened
- Avoidance - steering clear of places, people, conversations or thoughts connected to the event, or keeping busy so there's no room for it
- A persistent sense of threat - being on edge, easily startled, scanning for danger, struggling to sleep or concentrate
- Changes in how you see yourself and the world - guilt, shame, feeling damaged or permanently changed, or finding it hard to feel close to people
Some people also notice that trauma shows up indirectly: as irritability, working constantly, or a numbness that's hard to explain. It's common to have managed for years before recognising the connection. If you want to understand why trauma memories behave the way they do, I explain it in Why traumatic memories feel like they're happening now.
Single-incident and complex trauma
Trauma that follows a single event, such as an assault, an accident, a medical emergency or witnessing something terrible, often responds well to a focused course of treatment.
Where trauma was repeated or prolonged, or where several difficult experiences build on one another, the effects tend to be broader. They often show up less as flashbacks and more in how people see themselves: a persistent sense of shame or of not being good enough, and constant alertness to criticism or disapproval. Treatment uses the same core approaches, but typically involves more groundwork and more time. I write about this in more detail in Complex trauma: when it wasn't one event.
Treatment options
Trauma-focused CBT
Trauma-focused CBT helps you process the memory and change the meanings attached to it: that you're still in danger, that it was your fault, that you should have done something differently. It usually involves going through the memory in detail in a structured way, updating it with what you know now, and gradually reclaiming situations you've been avoiding.
EMDR
EMDR helps the brain reprocess traumatic memories using bilateral stimulation, usually eye movements, while you briefly hold the memory in mind. It involves less detailed retelling and less homework than trauma-focused CBT. You can read more on the EMDR therapy page.
Both are recommended in the NICE guidelines for adults with PTSD, and both have strong evidence. Which one we use depends on your history, on what is likely to suit you, and on your own preference. Sometimes elements of both are useful. I'll explain my reasoning after the assessment so the choice is an informed one.
You don't need to tell me everything in the first session. Assessment is about understanding the shape of what's happening now, and you stay in control of how much you say and when.
What to expect
Treatment starts with a 50-minute assessment, where we look at what you're struggling with, what has happened, and what you'd like to be different. From there, we agree a plan. Sessions are 50 minutes, usually weekly. Early sessions focus on preparation: making sure you understand what's happening in your mind and body, and that you have ways of managing distress. Then we move on to the memories themselves, and finally to rebuilding the parts of life that trauma has narrowed.
A common worry is that therapy will make things worse before they get better. Going near the memory can be uncomfortable, and I won't pretend otherwise. But the process is paced and planned together, and many people find that facing the memory in a contained way is far less overwhelming than continuing to keep it at bay.
Is this the right service for you?
I work with adults (18 and over) on a private, self-pay basis, online and in person in Queen's Park on Thursdays. My practice is suited to adults who are managing their day-to-day lives, even if that takes considerable effort, and who are not currently at risk. If, at assessment, I think a different service would suit you better, I'll say so and help you think about where to turn.