According to the Center for Integrated Health Solutions: "In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 percent of clients in public behavioral healthcare settings have experienced trauma." Over half the nation deals with trauma at some point—too frequently as children. Trauma can manifest in the following symptoms:
Anger can become chronic, damaging relationships and taking a toll on mental and physical health over time.
Anxiety can manifest for years after trauma, causing people to experience flashbacks, nightmares, and poor concentration, regardless of whether or not they sustained a physical injury.
Fear can be long lasting, causing people to avoid situations or people they associate with the traumatic event and creating life-changing behaviors.
Guilt resulting from trauma can be very serious, and is associated with negative feelings of shame, depression, low self-esteem and thoughts of suicide.
Sleeplessness is a common symptom of trauma as the hyperarousal caused by the stress response can contribute to insomnia- trouble falling asleep and staying asleep.
Substance abuse is often used as a way to self-medicate in response to fear and anxiety after a traumatic event, and can complicate recovery.
You do not necessarily need a post-traumatic stress disorder (PTSD) diagnosis to require trauma therapy.
Given the severity of trauma, you might expect that trauma therapists follow a well-established educational and career path and apply a fixed set of demonstrably effective methods in treating their patients. Unfortunately, that's not the case. Trauma therapy lacks standards and regulation, and trauma therapists often need to develop expertise on their own.
If you're interested in learning how to become a trauma therapist, read on. This article covers several related questions, including:
Therapist is a broad term. A broad variety of mental health professionals qualify as licensed therapists. Additionally, some states allow life coaches, hypnotists, and others to call themselves therapists, even when they aren't licensed.
Similarly, any therapist can technically refer to themselves as a trauma therapist. According to a post on the Northwestern University child trauma therapy website, "Currently there are no state or national regulations defining 'trauma-informed provider' or 'trauma-informed therapist.'" That said, a few states "are working toward 'credentialing' or ensuring that clinicians have minimum education and training around trauma-informed practice."
Although the definition of the field is somewhat loose, some professionals are more suited to the role than others. According to an article in Psychology Today, the most common types of trauma therapists are:
Psychologists research and study emotional and behavioral patterns through observation and interviews in order to diagnose disorders.
Licensed mental health counselors work with individuals and groups and examine issues of aging, stress, anger, relationships and self-image through discussion, referring clients to other services, if needed.
Social workers work with individuals and groups to assess the needs of clients in challenging situations like illness, abuse, mental health emergencies, or the complications of unemployment, and refer clients to available resources to aid in improving well-being.
The best of these have undergone some specialized training in trauma therapy.
Psychiatrists and marriage and family therapists can also treat trauma, but don't do it as often. If you plan to treat trauma, it is recommended that you earn the proper certifications—no matter which of these vocations you pursue.
Trauma therapists work with people of all ages and backgrounds who are dealing with their trauma, which often manifests in the form of post-traumatic stress, substance abuse, and other forms of mental illness. Patients can include:
Accident victims can sometimes get trapped in a repetitive loop playing the event over and over, causing strong feelings that interfere with everyday life.
Children need a particular kind of care after traumatic events, and therapists can help by determining a child's symptoms and adapting treatment to their particular behaviors and expressions.
Intimate partner violence includes not only therapy to heal, but plans for immediate safety of clients who may suffer continued abuse.
Treatment of sexual assault survivors can cross all age and gender lines, and can help victims deal with feeling fear, shame, as well as anxiety and depression.
Care for veterans can take place in the immediate aftermath of trauma, or in the years following when symptoms are identified by individuals and their families.
The goal of all trauma mental health professionals is to help survivors develop proper coping mechanisms. Trauma treatment may help patients manage flashbacks or trauma-related nightmares. It can take years to unpack fully and process these feelings, which is why professionals should have specialized knowledge of trauma-informed care. Trauma therapists frequently specialize in a specific group of patients. This makes sense, as trauma therapy for children differs considerably from trauma therapy for a war veteran.
Be prepared to earn a graduate degree to become a trauma therapist. It can take as much as a decade of education before you are allowed to start practicing.
You need not major in psychology as an undergraduate to pursue a career as a trauma therapist. Most graduate schools focus more on one’s GPA, GRE scores, and an applicant's stated reasons for applying than to the applicant's specific major.
That said, if you want to become a psychologist, a bachelor's degree in psychology is a good way to start your journey. For social workers, a Bachelor of Social Work (BSW) is preferred (although not required). Counselors often earn one of these degrees as well—frequently a bachelor's in psychology.
Here is a brief rundown of the graduate education needed to become a trauma therapist in the three most popular career choices.
Most psychologists earn either a PhD or the more clinically focused (and less time-consuming) PsyD. Psychologists can occasionally practice with just a master's degree, but it's not very common.
A degree like the Master of Science in Applied Psychology is a prerequisite for PhD admissions.
Psychologists generally have the opportunity to work in trauma during their clinical hours or post-doctoral studies. Some schools offer PhD or PsyD programs with a focus on trauma psychology. They include:
"Patients need a fully trauma-informed support team across every healthcare specialty, and the demand for compassionate experts in treating trauma-related psychological issues has always been high. When you choose an emphasis in Trauma at Palo Alto University, you’ll work alongside researchers, teachers, policy makers, and clinicians to treat patients in crisis and address the growing public health needs."
"Upon completion of the program, students will be prepared to work in a range of settings, including mental health clinics and clinical practices, hospitals, VA's, colleges and universities, state offices, research institutes, and as consultants to a wide variety of other professional and community providers of services to adults who are trauma survivors."
According to the US News and World Reports, the top doctoral programs in psychology include:
"PhD training is intended to produce high levels of expertise in developing and conducting research, analyzing and interpreting data, and interpreting existing theory and research in psychology (i.e., scholarship)."
"Our graduate program is mentor-based. Students train under the direct guidance of one or more specific faculty members whose scholarly interests parallel their own."
"The Department of Psychology has fostered excellence in research and scholarship for over 100 years. The department provides graduate students with the best available training to prepare them for a variety of professional careers in academic, clinical, research, and other settings."
After completing their education, psychologists must earn a state license. Each state imposes different requirements, but the American Psychological Association (APA), which is the closest thing to a unified governing body of psychology, provides a list of universal ones. It states that psychologists must:
Jurisdictions vary on how many practice hours are required, but an average of about 2,000 during internship and another 2,000 hours postdoctoral should meet most state requirements.
Applicants tend to do better taking their exam soon after completing their degree than those who wait. Most states require at least a 500 on a computer-based exam (or a score of 70 percent) and some will require an oral exam in addition.
Some states will only require you to take a jurisprudence exam. You'll need to follow state regulations as they will vary depending on where you practice.
State's licensing boards monitor this work and determine the validity of your license.
Clinical social work therapists must hold a Master of Social Work (MSW) in order to practice. Relatively few hold a doctoral degree.
The two levels of clinical licensure that a social worker can have are:
This is level one of social work, and is earned with an MSW from a Council on Social Work Education (CSWE) accredited program. Depending on your state, you may also need to take a licensure exam to work in case management.
This second level of practice indicates a higher level of expertise and years of direct clinical experience. This may mean up to two or three years of full-time clinical work with supervision in the years following completion of an MSW.
Each state sets its own social work licensure requirements. Generally, they include having an MSW and completing a requisite number of fieldwork hours.
Becoming an LMSW is the first level of clinical licensure. Master social workers can only practice under the supervision of licensed clinical social workers. If you want to open a private therapy practice, you will need to earn an LCSW certification, which requires more supervised fieldwork.
US News & World Report’s top-ranked MSW programs include:
"The Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University is ranked one of the country’s top 10 schools of social work—and #1 in Ohio—by U.S. News & World Report. Our on-campus master’s in social work program combines research, theory and hands-on practice to help you tackle today’s complex social challenges and emerge as a leader in the field."
"Since 1950, The University of Texas at Austin—the flagship institution of The University of Texas System—has been producing outstanding professional social workers to serve Texas and the nation."
"The Crown Family School master's program has been continuously accredited by the Council on Social Work Education and its predecessor organizations since 1919. The rigor and quality of a Crown Family School education have earned us a spot among the top graduate schools of social work in the world."
Becoming a mental health counselor is a bit like becoming a social worker; it requires a master's degree (in counseling, not social work) and state-mandated fieldwork hours. Additionally, you should attend a program that is accredited by The Council for Accreditation of Counseling & Related Educational Programs.
Accredited programs can be found at:
"(T)he certificate will prepare graduates for the following: (a) to work with a variety of populations in the community as a licensed mental health professional, (b) eligibility for state licensure, and (c) national certification as a counselor. Students can gain additional expertise in working with children through the Play Therapy certificate program."
"(T)he programs focus on the development of competencies to address biopsychosocial and environmental barriers to educational achievement and development. Students also engage in challenging educational experiences focused on enhancing their skills and knowledge with an emphasis on culturally-informed and holistic practice."
"Graduates from our programs are qualified to practice in a variety of educational and behavioral health settings. We strive for an inclusive learning community encouraging professional growth through a balance of challenge and support."
Attending one of these programs generally makes it easier to become a Licensed Professional Counselor (LPC) because most states follow guidelines set by the National Board for Certified Counselors (NBCC), which is associated with the CACREP. Universal licensure requirements include fieldwork hours and passing one of the two NBCC exams—either the National Counselor Examination (NCE) or National Clinical Mental Health Counseling Examination (NCMHCE).
The letters that come after your name (LCSW, PhD, LPC) do not matter as much as the specialized training you receive. There is no single trauma therapy certification that mental health professionals can earn. Still, several evidence-based trauma treatment methods are considered the professional standard of trauma therapy. Fluency in one or more of these practices can be beneficial to both your career and patients.
The APA officially recommends the following treatments for those with PTSD:
Brief eclectic psychotherapy focuses on changing and managing painful thoughts and feelings that result from a traumatic event, targeting common emotions like shame and guilt.
Cognitive processing therapy uses psychoeducation to help patients become aware of difficult thoughts and feelings and the automatic thoughts that trigger PTSD symptoms.
Cognitive behavioral therapy targets thought distortions by teaching new information-processing skills and helpful coping mechanisms with an action-oriented approach.
Cognitive therapy focuses on present thoughts and behavior, rather than past memories, in order to use new thought to shape positive emotions.
Eye movement desensitization and reprocessing uses bilateral stimulation during recall of distressing or traumatic images in order to help fully process the memories.
Narrative exposure therapy uses the stories patients tell themselves about their lives to influence their current thoughts and behaviors and overall wellbeing.
Prolonged exposure therapy involves using both imaginal and in vivo exposures. The first is a retelling of the trauma memories and the second involves gradually confronting the specific places and situations that exist in the memories.
To become certified in one or more of these treatment methods, you will likely need to complete a training workshop and be a licensed mental health professional (in any discipline). For methods like EMDR and CBT, certification can happen through a specific professional organization. Alternatively, you might go through an educational institution. For example, the University of Pennsylvania offers a four-day PE training workshop and certification program.
This list might seem a bit sparse. It is. According to an article entitled "Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective", the lack of research opportunities makes identifying suitable trauma therapy methods challenging. Studies about complex PTSD (an advanced form that's usually developed in early childhood) treatments often go unfunded. That's one of the reasons there aren't more widely accepted evidence-based methods, even though some, like sensorimotor psychotherapy, have been championed by leaders in the field.
The bottom line is: trauma therapy is still developing as a field, and some very smart people disagree over its fundamentals. For instance, some experts say that cognitive behavioral therapy (CBT) is helpful when treating PTSD. Others say that it should be disregarded in favor of more specific trauma treatments. Complex trauma is, well, complex.
Trauma therapy isn't an officially recognized care specialty right now, even though organizations like the APA and National Association of Social Workers (NASW) have identified the need for such a designation. There is a movement within the APA that seeks to establish trauma therapy as a specialty, and a document from the NASW declares that "advanced practitioners know how to synthesize relevant theories of trauma and relate them to social work practice." However, there isn't a whole lot more guidance than that.
Marriage and family therapists have perhaps the most defined trauma education guidelines, even if they aren't the ones we first think of to treat the condition. The American Association for Marriage and Family Therapy (AAMFT) offers many continuing education courses in trauma.
If you're set on continuing your graduate-level education, look for a certificate program in trauma-informed therapy. For instance, Syracuse University offers a Certificate of Advanced Studies for Marriage and Family Therapists. The University at Buffalo School of Social Work has a "Trauma-Informed Care & Counseling" program, open to anyone with a master's degree in human services (that term encompasses psychology as well as social work).
The typical trauma therapist earns an average yearly salary of $76,704, according to Ziprecruiter. This is in line with what the US Bureau of Labor Statistics (BLS) projects as the median annual wage for clinical, counseling, and school psychologists ($76,990).
Of course, some therapists make less. Licensed professional counselors earn an average annual salary of $49,521, while social work therapists make $44,713, according to PayScale. On the upper end of the scale, the average psychiatrist makes $215,563. Keep in mind, psychiatrists must attend—and pay for—medical school.
These numbers are good baselines, but they don't tell the full story. For one, further specialization can correspond to increased earnings. Ziprecruiter says that PTSD therapists earn an average of $115,662 per year.
Additionally, opening a private practice (as all therapists with the proper licensure can) increases your earning potential. Therapists in private practice set their rates and see as many (or as few) clients as they want. If you work in a trauma center or hospital, these numbers are established for you. It might be difficult to get a private practice started, but the rewards can be great. Even counselors, who are almost universally underpaid, can earn six figures.
Just as there is no established salary for trauma therapists, there is no single way to become one. It takes a willingness to continue your education beyond the licensure requirements. Those who persist can help people to break the vicious cycle of their trauma and find a healthy way to cope with life.
(This article was updated on September 30, 2021.)
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