Is Talk Therapy Enough? Exploring the Limits of Talk Therapy

In the mental health world, talk therapy has long been championed as a go-to in the treatment of various psychological conditions, including those psychological conditions brought on by traumatic experiences. The idea of sitting down with a trained professional and discussing one’s experiences, feelings, and thoughts is rarely questioned as the indicated course of treatment when we consider psychological healing. However, as our understanding of exactly how trauma impacts the body grows, so does our awareness of the limitations of talk therapy in addressing the complex needs of trauma survivors.

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I believe that talk therapy can indeed provide a safe space for individuals to explore their trauma. However, it is essential to acknowledge that talk therapy is not, and can never be, the one-size-fits-all solution that it has been hailed to be. Did you know that for some clients talk therapy may even make their symptoms worse? And even hinder their healing process? It is a hard pill to swallow, but it is true. Talk therapy is limited in its ability to adequately support certain types of clients. As a trauma informed mental health counselor in private practice, I have come face to face with the limits of talk therapy in the clinical setting.

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How Can This Be?

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One of the key challenges of using talk therapy alone in the treatment of trauma symptoms lies in the fact that trauma can profoundly affect the nervous system.

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When someone has experienced a traumatic event, their body’s stress response system can become dysregulated because of that experience. This person’s nervous system may become more sensitive to perceived threat, and begin to signal that a threat is present when actually there is none. This happens because the nervous system attempts to use the memory of that previous traumatic experience to keep you safe in any new possibly threatening experiences. Here, the nervous system responds in a dysregulated manner.

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A Dysregulated Manner?

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This means that experiences that appear non-threatening to others, can feel overwhelmingly threatening – or triggering – to the trauma survivor. A trigger is an environmental stimulus of any kind – a sound, a smell, another person, and can be an actual threat to the person or a perceived threat. When a person is triggered by something in the present moment, that person experiences a sense of heightened arousal and hypervigilance that is biologically intended to keep them alive.

In other words, when we are reacting to a trigger, we are unconsciously operating in service of the preservation of ourselves. This is important intelligence that I think everyone should know. Since we all will get triggered at one time or another, I believe that knowing this can lead you to be kinder and more compassionate to yourself when you get triggered.

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What’s This Gotta Do with Talk Therapy?

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Because most talk therapists rely on their client to talk about what is happening with them, talk therapy can (inadvertently) lead to repeated experiences of being triggered while in the therapy room. In the worst case, talk therapy alone can trigger intense emotional and physiological responses that may overwhelm the individual and create cycles of acting and reacting that impede progress.

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Let me provide an example:

A 34-year-old mother of 2 comes to therapy to for support. She describes feeling like her heart is racing nearly all the time. She says that she follows some mental health influencers on TikTok who have talked about the impact of trauma, and she is starting therapy to finally deal with her trauma history. She says that she has a sense that her trauma makes her feel the way that she does.

In session, as she talks about her upbringing, she becomes inconsolable. She experiences many shifts in emotions – sadness, then anger, tearfulness, then, a little triumph? Then despondence. She has been talking nonstop for 20 minutes and she shows no signs of stopping. It is as if she’s left the room…

For the next few sessions, she presents in this way: sharing her narrative bluntly, with eyes staring through the wall, oscillating between outbursts of tears and rage.

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Here, I would argue that talk therapy alone is not?sufficient to help this client.

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Because the client has described experiencing a feeling of her heart racing nearly all the time, I can tell that she is starting therapy from a place of nervous system dysregulation. I believe that this client can be better supported by offering her invitations to pause. Because a traumatic event is anything that happened too fast, too soon, too much, or too long for us to respond, trauma healing is often about supporting clients as they understand the value of pausing, checking in, and noticing what is happening in their “right now” experience of themselves and their environment.

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Additionally, I believe that this client could benefit from guidance towards a more embodied sharing of her story, that makes room for her to experience herself as she shares. The fact that she launched into sharing without check in with herself along they way might also indicate that while she is sharing, her telling and retelling is more likely trauma dumping than it is trauma healing.

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Toward the end of this example, we get the sense that the client has traveled into her story and has even “left the room”. This experience – called dissociation – is where a person experiences a loss of connection between their thoughts, feelings and present experience. While the client is still able to share her experiences in therapy, she does so with little or no conscious embodiment. As a result, she is disconnected from her bodily experience while she shares. However, with each recounting of the details of her trauma experience(s), her heart rate increases, and she feels as though she is reliving the trauma all over again. This cycle of retraumatization reinforces the individual’s sense of helplessness and vulnerability.

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So, Is Talk Therapy Bad Then?

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It's crucial to acknowledge that talk therapy is not inherently harmful. In fact, for many individuals, it can be a valuable tool in their journey towards healing. If the therapy goal is trauma healing, the key lies in understanding when and how to incorporate talk therapy into a comprehensive treatment plan that addresses the unique needs of the trauma survivor.

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For some trauma survivors, especially those with complex or severe trauma histories, embodiment practices and somatic experiencing may be more beneficial because they focus on addressing the physiological and emotional aspects of trauma in addition to cognitive processing, therefore offering a more holistic approach to healing.

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In my therapy practice, I utilize a blend of somatic experiencing and embodiment practices intended to support trauma survivors through encountering trauma stories without retraumatization.

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My intention is not to discredit talk therapy by zeroing in on its limitations but instead to emphasize the importance of a nuanced and individualized approach to trauma care. By recognizing that talk therapy may not always be the most effective or appropriate intervention, we can better support survivors in their journey towards wellness.