A New Model for Treating Trauma |
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Severe, lifelong trauma can sometimes heal rapidly when therapy focuses on the present moment.
Healing doesn’t always require reliving past trauma.
In the first part of this series, I presented research suggesting, perhaps for the first time, that therapy focused on changing how people feel in the here-and-now can be incredibly helpful even without extensive explorations of the past. But how do you heal past wounds in real time by focusing on the present? I’d like to share a case of a woman I treated who was suffering from severe, lifelong traumas to bring some of the newer techniques to life, as well as some exciting new research.
A few years ago, I decided to teach a weekly TEAM CBT class for Stanford psychiatric residents, featuring live therapy with trauma patients. The idea behind TEAM is radical but simple; in many cases, an entire course of therapy can be completed in a single session.
I invited faculty to refer patients who had suffered severe trauma and had been difficult to help. Each week, I treated one patient while the residents observed, followed by a discussion. This was novel, since most of their teaching emphasized that severe depression takes months—or years—to resolve.
One woman, let’s call her Maggie, had come to Stanford after her private psychiatrist of 20 years died. She said this was a devastating loss, since he had become her only real friend in the world. When therapy becomes a long-term paid friendship, it raises a red flag in my mind. Does therapy involve meeting our patients' needs for intimacy, or giving them the skills they need to develop greater intimacy?
Maggie was in her late 60s and had lived through what clinicians call "complex trauma"—not one catastrophe but many, stretched across a lifetime. One sibling suffered from a severe developmental disorder. As a teenager, Maggie experienced assault by a neighborhood gang. Later, the only man who ever told her he loved her ran away with another woman and vanished with her life savings.
Yet despite all this, Maggie had built an extraordinary life. She had a wildly successful career designing popular electronic devices, one of which many of you may be holding in your hand right now. She was also a gifted painter, well-known in her hometown. After retiring, she looked forward to devoting herself fully to her art.
Then came the final blow: She was diagnosed with a fatal neurological disorder. One of the first symptoms was a severe, uncontrollable tremor, so disabling that she could no longer paint.
At the start of our session, she told me she was planning to sell her home and move to Oregon. She spoke carefully and indirectly, but her meaning was clear. Assisted suicide was legal there, and she didn’t want anyone to know. "People would judge me," she said. I made the mistake of trying to reassure her that I wasn’t judging her and told her that I accepted her 100 percent. She got angry and insisted that I wasn’t being genuine.
I told her that her criticism stung, and shared the story of my cat, Popcorn, who had also needed an assisted suicide. At the time, he was my favorite pet and closest companion—but I knew that one of us would die first, and if it had to be him, I would do whatever I could to help him make the journey peacefully. I told Maggie, "I would never let my cat suffer, because I loved him so much. So why would I want you to suffer? If you move to Oregon, I absolutely give you my complete support." The room went silent, and she began to cry.
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We used TEAM CBT to identify and challenge, one by one, the distorted thoughts that had been triggering her feelings of depression and inadequacy. As part of the process, she asked the psychiatric residents whether they were judging her. They weren’t. It was quite the opposite. By the end of the session, Maggie reported that her intense feelings of depression, anxiety, inadequacy, loneliness, hopelessness, and anger had vanished.
Since she’d been hiding out from her friends as well, her homework was to tell them about her plans to move to Oregon. She was terrified of being judged, but bravely agreed. The following week, she reported that her friends had responded with extraordinary warmth and love. For the first time in her life, she felt deeply connected, and her lifelong loneliness was gone.
We hadn’t worked through the many horrible traumas that she had endured during her life. We never explored Maggie’s childhood. We never revisited the assault, the betrayals, or the decades of loss.
What we did seem to change, however, was her belief that she was defective, alone, and unlovable. And we gave her the tools to develop the intimacy that had eluded her.
Had we revisited her past traumas, we might have gained some insights, but I'm not convinced we would have made a dent in her crushing feelings of depression and worthlessness. In fact, dwelling on the past could easily have intensified her negative feelings.
Maggie’s healing emerged entirely in the here-and-now. When she tested her fears of judgment, she received the compassion she never expected. She discovered that courage, honesty, and vulnerability created connection rather than rejection. And as the data in my previous article suggested, the past had no power once the present changed. That’s because the past is totally embedded in any current moment when you’re suffering. So, when you change this moment, you’re healing your past simultaneously.
A week later, Maggie told me something I’ve never forgotten. At the end of her life—after losing everything—she felt vastly happier and more connected than she ever had before. She said she had finally found joy, love, and self-esteem.
Insight looks backward, but healing lives in the present!
Was the story of Maggie unusual? In fact, her rapid recovery was comparable to my experiences with trauma patients throughout my career. In my recent book, Feeling Great,1 you can find a summary of my work with 40 consecutive severe trauma patients I treated in a single, two-hour session. In Figures 1 and 2, below, you can find the data on changes in feelings of depression, anxiety, anger, and happiness at the beginning and end of each session.
Keep in mind that while these results are extremely encouraging, this was a naturalistic study and not a controlled outcome study. However, we also have a fresh analysis of the data reported in Part 1 of 290 beta testers of our digital app. You may recall that these individuals experienced profound changes in negative feelings in just 3 days. How did the trauma patients do?
At the initial evaluation, we asked each individual if they’d ever had PTSD (65 beta testers) or if their doctor had ever told them they had PTSD (24 beta testers). Then we asked: Did individuals with a history of PTSD improve more slowly than the other individuals in the database?
The answer was a surprising no. As you can see in the simplified structural equation model in Figure 3 (below), the PTSD individuals recovered at the same rapid rate, and to the same extent, as the patients without this diagnosis.
While these results are incredibly encouraging, further research will be needed to confirm these findings. But the work we've done so far—and the time I spent with Maggie—tells me that healing from trauma doesn't necessarily require revisiting it, as long as we're given the right tools in the here and now.
1. Burns, D. D. (2024). Feeling Great: The Revolutionary New Treatment for Depression and Anxiety (Chap. 6, “High-Speed Treatment—Is It Possible? Desirable? Or Just Fool's Gold?”). Bridge City Books.