How long will I be in therapy if I have severe childhood trauma?




I'm Sarah Lee, a UKCP registered psychotherapist. I work in Manchester City Centre helping people suffering from depression, anxiety and low self esteem. I have a special interest in working with clients with depression and survivors of long term abuse. If you're further afield you can work with me online. If you have any questions, you can call me on 0161 694 7259 or send me a message.

When I trained and we used to ask my trainer these kind of questions he used to smile and say ‘how long is a piece of string?’ (I know, we used to find it annoying too.)

The problem with childhood trauma is that it can contaminate everything without you knowing. It’s like being slowly poisoned by carbon monoxide - you can’t smell it, you can’t taste it and all of a sudden you’re really sick (or worse) but you don’t know why and it’s an emergency. Worse still other people might thing you’re exaggerating or making things up or tell you ‘you look fine’. Not every traumatised person is unable to work or go out; most of my clients have jobs and friends many have partners. Childhood trauma is insidious and it can affect everything on a day to day basis. Often people wonder what’s wrong with them and how everyone else manages fine when it feels like they are struggling for air.

Do therapists get frustrated with clients that take 'too long'

I’ve had clients in therapy with me for years. The clients I struggled with were the ones who didn’t come or who came too sporadically for me to be of any use to them or those who were very closed off to the idea of change. Ideally a client needs to be ready for change for therapy to be the most effective. This is the crux of the matter I think; how much work are they really prepared to do?

I’m not frustrated by clients who are in therapy long term as long as we are getting somewhere. If the client is feeling supported (and for clients with childhood trauma I might be the only person that supports them or that they are risking trusting) and we are working on their issues, they can afford to pay me and they see benefit in the treatment then I am happy.

Does everyone need longterm therapy?

Some people do not want or need long term therapy, but for some people, there are so many little things for them to sort through (such as cumulative trauma or C-PTSD/CPTSD or complex traumatic stress disorder), so many triggers that they need to reprocess on a weekly basis (or sometimes more.) I think of this as emotional dialysis.

In an ideal world, clients learn to recognise, process and tolerate emotions at a young age. When there are attachment issues (as is often the case with childhood trauma) people don’t learn these skills. Their emotions (if they haven’t shut themselves off from them) are overwhelming and scream at them for hours or sometimes days or weeks often over little things. They cannot turn them down because they don’t know how. If they are not coming weekly, how do they deal with these emotions? They might self harm, eat too much or too little, take drugs - anything to try and numb out or escape the things that follow them around.

When they come on a long term basis, we can not only process the day to day issues, but as they learn to trust me we can process the underlying hurts. It can take years for people who have been very badly traumatised to trust a therapist. It is also surprising what can come up that clients were not aware of or did not consider to be problematic. In a short term therapy there is simply no time for this ‘idling’ and waiting for something to happen.

It can be disheartening for clients to learn that therapy may not be a quick fix solution. They may feel shame either from themselves or others that they are not fixed after such a long time. Ideally the client learns to internalise the therapist as an attachment figure (this means that they hear or visualise the therapist when they are in need of comfort or guidance) or finds other reliable attachment figures (such as friends or a partner or maybe their church or community). If this happens then the need for the therapist may diminish.

Sadly, I don’t think childhood trauma ever really goes away completely. But it can be quietened, it can be forgotten to provide some reprieve. It can be rewritten with happier memories and it can be dulled by the realisation that the client is not bad and not faulty. There will still be bad days and bad triggers but with work and time they become less frequent, less catastrophic and they fade sooner.

It is possible to learn to trust, to learn how to communicate and have healthy relationships, to recognise, express and tolerate emotions, to activate your parasympathetic nervous system (which enables you to calm down) and to improve how you view yourself. 



Sarah Lee