On 24/08/2025

Psychotherapy or Traumatherapy? What is the difference?

Anastasia Nikolitsa © Sofo Soma

September 2025

Today, there is an increasingly urgent need to clarify what Traumatherapy is and how it differs from Psychotherapy. Due to the rapid discoveries and developments in Neurobiology and the technology with which the human brain is now studied, we are witnessing a shift in the scientific paradigm in many areas. As it tends to happen during transitional phases, there is unfamiliarity and confusion even amongst mental health professionals. This is the case now, especially in Greece. On the one hand, Psychotherapy is now known even to older generations and is much more accepted as a solution for those suffering with psychological/mental issues, compared to previous decades. Most Psychiatrists recommend Psychotherapy sessions as a supplement to medication, which was not the case in the past. On the other hand, there is a generalized grey area that seems to encompass everything that might look like Traumatherapy yet too often it is not. Clearly, there are now trauma-informed Psychotherapeutic approaches that are more aware of trauma’s manifestation in the therapeutic context but with a different goal and scientific tools and certainly different results from Traumatherapy. But, let’s take it from the beginning:

The differences between Psychotherapy and Traumatherapy are very specific and important and have to do with the focus and goals, the assumptions made around the person-in-therapy, the techniques and methods, the role of the therapist and the therapeutic relationship and the understanding of symptoms. Also, the study of Traumatherapy requires both the completion of studies and years of practice in Psychotherapy but not the other way around. In other words, there is an affinity between the two as the latter is the evolution of the former and, so far, it is considered as a necessary basis. This may change in the near future as the science of Neurobiology is rapidly advancing in its discoveries about the psychobiological functions of the brain and this will lead to a concept of therapy that is almost entirely neurobiological and almost not psychological at all. Perhaps Schools will be created to re-train mental health professionals on body-oriented Traumatherapy, where “bottom-up” treatment is practiced, without the need for years of study on outdated psychological theories I have listed the differences between Psychotherapy and Traumatherapy in a table to facilitate reading as well as comparison between them.

Psychotherapy

(Psychodynamic/Person-centred/Body-oriented, etc.)

Traumatherapy

1. Focus and objectives

1. Focus and objectives

º It addresses broader mental health issues such as anxiety, depression, relationship problems or personal development.

º Its goals include improving coping skills, enhancing self-awareness and resolving emotional or behavioral patterns, on a cognitive and emotional level.

º It assumes that the therapist’s distress may stem from a variety of sources (e.g. cognitive distortions, interpersonal conflicts, or stressors).

º It may explore explicit past experiences/memories, but often focuses on current functioning or future-oriented solutions (depending on theoretical approach).

º The Traumatherapist sees the clinical picture of the person-in-therapy in the present day as a result of early psychological trauma (attachment trauma, abuse, neglect, etc.). That is, he/she takes for granted that there is trauma underneath the manifested symptom, illness or disorder. He/she recognizes the effects of trauma on the nervous system, memory, mood, and sense of self and can discern when the person being treated is in dissociation, hyper-vigilance, or in a flight-fight-freeze response.

º The Traumatherapist can distinguish the differences between PTSD, Personality Disorder or Dissociative Disorder.

º Priority goals are safety, stabilization, processing of explicit and implicit traumatic memories and their integration into the autobiographical memory. This gradually brings about a change in what the person presents as a problem or difficulty from the beginning, without further analysis, as the integration of the traumatic fragments of memory allows the realizations that the person needs to occur and the redefinition of his/her needs and choices.

2. Assumptions about the person-in-therapy

2. Assumptions about the person-in-therapy

º It is taken for granted that the person-in-therapy is capable of participating in focused perceptual or cognitive processing and mentally oriented work, with a relatively stable basis of emotional regulation.

º It is assumed that the person-in-therapy can access and discuss thoughts and feelings with some degree of clarity. There is no focus on dissociative phenomena during the session or the skills to manage such phenomena.

º The underlying trauma may not be taken into account, unless explicitly mentioned by the person-in-therapy. There is a fear of how we talk to the therapist about it and whether we are allowed to touch it on our own initiative.

º It is taken for granted that the person-in-therapy may have difficulty regulating his/her Nervous System on his/her own. It is also taken for granted that within the session there might take place dissociative phenomena, emotional overflow or neurochemical responses of freeze, avoidance, fight, avoidance, submission or collapse as a reaction to what is emerging in the individual’s consciousness on a physical, emotional and/or mental level.

º The Traumatherapist recognizes that trauma may limit the person’s ability to express their experiences with clarity, coherence and emotional resilience.

º Priority is given to psychoeducation as well as the development of presence in the body, because it is considered that due to trauma the connection to one’s own body and the sense of physical security are disturbed. This gradually provides the lived experience of safety to the person-in-therapy and enhances his/her capacity for self-regulation as well as taking responsibility for the healing process.

3. Techniques and methods

o It works with the analytical capacities of the brain from top to bottom, i.e. the neocortical structures and the control that can occur because consciousness/awareness is developed through them. Even the most somatically oriented approaches (e.g., Dance Therapy or Somatic Psychotherapy) lead the individual to a “top-down” processing of explicit memory. Even if fragments of traumatic memories emerge in the one’s body, usually as sensations or emotions (affects), these may either not even be recognized as such or a “top-down” analysis of these may be promoted through the analytic mind.

o It uses a wide range of techniques depending on the approach, from cognitive processes to the use of arts, in order to connect body-mind.

o Sometimes structured interventions or exploratory methods may be used. There may be exploration first and analysis and then connection to the person-in-therapy here & now.

o It works with the deeper cortical structures of the brain (Midbrain and Brainstem) and is based on the embodied presence of the person-in-therapy, in the here and now, in order to achieve a “bottom-up” processing of the unresolved traumatic memory. In most Traumatherapy models the analytical mind is not even necessary, not even at the end of the session, as the brain’s inherent capacity for “bottom-up” processing involves “sorting out” all the fragments of sensation-affect-memory.

o It uses specialized methods to heal the “root of the trauma” after stabilization of the client has been ensured.

o It promotes body-based self-help strategies and self-observation to further empower the person-in-therapy in between sessions (e.g., grounding exercises, breathing or self-observation of bodily sensations).

o The therapist does not encourage or provoke stimulation of implicit or explicit memory without appropriate preparation of the therapist’s Nervous System or without psychoeducating the person-in-therapy first.

4. The role of the therapist and the therapeutic relationship

4. The role of the therapist and the

therapeutic relationship

º The Psychotherapist relies on his or her countertransference and the transference of the client to understand the unconscious dynamics projected upon him or her. He is trained in how to transform this information himself. He then helps the therapist to understand and manage them better/differently.

o The therapeutic alliance is very important. The therapist’s basic intention is that the therapeutic relationship is restorative for the person being treated.

º The Traumatherapist has no expectation that at some point the person being treated will trust him/her so that this will eventually allow for deeper disclosure and processing. He/she considers as a fact that due to trauma the person-in-therapy may have difficulty trusting others. Therefore, the therapist acknowledges this truth and offers another kind of alliance with the person-in-therapy where trust is not a prerequisite.

º The Traumatherapist attunes to the person being treated but does not experience his/her pain or affect during the processing of the trauma (since the therapist has healed his or her own trauma, it will not be triggered at the level of the Midbrain by what arises at the Midbrain level of the person-in-therapy).

º It acts as a co-regulator, remaining regulated and present in his/her body, helping the person-in-therapy to manage unbearable emotions without “escaping” with his/her own neurobiological responses (e.g. flight, avoidance, dissociation, etc.).

º The therapist avoids pushing the person-in-therapy too quickly, respecting the his/her window of tolerance (the range within which he/she can process emotions without becoming overwhelmed by them).

5. Understanding the symptoms

º Symptoms (e.g. anxiety, low mood) are often considered the main issue to be addressed, possibly stemming from maladaptive thoughts, behaviors or unresolved conflicts. The therapeutic work is mainly focused around these and the primary memories/perceptions/beliefs to which they are linked.

º May not explore whether symptoms are trauma-related unless the patient discloses an explicit traumatic history.

º It understands symptoms, addictions and obsessions as adaptive survival responses to trauma, e.g. hyper-vigilance as protection, distraction as a survival mechanism, etc.

º It addresses the “root of the trauma” (e.g. terror, grief/anxiety, anger or shame) as the healing of the root will eliminate the automatic responses to that root, i.e. the symptoms of freezing, avoidance, breaking, submission, flight, fight or collapse at all levels.

Common points:

– Both approaches value the therapeutic alliance and aim to improve the quality of life of the person being treated.

– Trauma-centered principles are increasingly being incorporated into general psychotherapy, blurring the dividing line in some contemporary practices.

Recognizing the differences between the two approaches will be of benefit to all involved, as those who practice Psychotherapy or choose it as a method of treatment for themselves will not have the distorted belief and high expectation that they will be able to heal the “root of trauma” (Nikolitsa, 2024, p. 29) and will be more aware of the risks of re-traumatization of the person being treated, even while history taking. Finally, those who practice Traumatherapy, or choose it as a method of treatment for themselves, will not fall into the familiar “trap” of over-analysis and intellectual understanding of what is being processed and will place more trust in the embodied presence and inherent processing mechanisms of the brain as the basis for deep work and change.

Bibliographical Reference:

Nikolitsa, A., 2024. The fractal of Being: body-mind-spirit in the healing of trauma. ISBN: 978-618-00-5487-3

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