TRAUMA

THERAPIST TOOLKIT

© 2022 Esther Goldstein

www.integrativepsych.co

All rights reserved.

No part of this publication may be reproduced for public use without the prior written

permission of the owner. For permission requests, email [email protected]

The content and activity provided is for informational purposes only. If you are experiencing

concerns with your mental health, please seek professional counsel. Additionally, please ask for

assistance from a health care professional when interpreting any of these materials and

applying them to your individual circumstances. Use of this activity does not constitute health

or medical intervention. It is merely one of many tools that can aid in tracking and

maintaining health. It is advisable to seek medical or therapeutic advice from a professional if

you have concerns or a complex mental health history.

Please subscribe to our email list to receive more free content like this over time.
Sign up now at www.integrativepsych.co .
Welcome !
I am so glad you're here! The world is in need of more good trauma
therapists, and I am honored to join you on your journey to becoming just
that.

In this download, I have provided with some helpful information and

tools so that you can get a taste of what it means to deepen your work as a
trauma therapist. If you are looking for more advanced training, sign up
here for our upcoming Trauma Therapist Training. The training is
designed to help you become a more skilled clinician, while giving you
practical tools to be more attuned to your client's needs, and improve
your clinical outcomes.

Esther Goldstein
Founder of Integrative Psychotherapy
Trauma Specialist
[email protected]
 TABLE OF CONTENTS

TRAUMA INFORMED CARE BASIC PINCIPALS, RESOURCES & TOOLS.

(HELPFUL SNIPPETS FROM OUR ADVANCED TRAUMA COURSE.)

Basic Principals of Trauma Informed Care 1

Contemporary Trauma Healing: A Paradigm Shift 5
Teaching Clients to Self-Pace 9

Recognizing Trauma and its impact on the 12

Mind, Body & Soul
 TRAUMA
M A K I N G O F A

T H E R A P I S T

“Your beliefs become your thoughts,

Your thoughts become your words,
Your words become your actions,
Your actions become your habits,
Your habits become your values,
Your values become your destiny.”

- Mahatma Gandhi
 TRAUMA
M A K I N G O F A

T H E R A P I S T

Basic Principals
of Trauma
Informed Care
AWARENESS
You understand the high prevalence of trauma in
society, learn to notice triggers, and common
responses to triggers. You will use that knowledge
to identify potential roots of your client’s adaptive
and maladaptive coping skills to help design a
framework for the building of emotional assets.

BUILDING A RAPPORT (SAFETY & TRUST)

Clients who have experienced any sort of trauma
might have challenges trusting people and might be
apprehensive when it comes to safety; physical,
emotional, spiritual or cultural. You will spend time
establishing a trusting and safe relationship before
embarking on any practical work.

p1
 STABILIZATION & ATTENTION TO
BASIC NEEDS
You will make sure your client has the basic
necessities of a healthy lifestyle; Self care, food,
sleep, exercise, a good support system and
good boundaries. You will help your client
develop the capacity to; regulate emotions,
self-soothe, re-identify and recreate. A big part
of this is psychoeducation, connection to
resources and giving them more knowledge
about the treatment process.

VALUES, SKILLS & STRENGTHS

You will help clients pinpoint their core values,
methods for self-advocacy, setting and
maintenance of boundaries as well as coping
strategies that can help to promote resiliency,
empowerment and support overall health and
wellbeing.

CHOICE COLLABORATION & CONNECTION

You will work to create opportunities for choice
and connection within the therapeutic setting.
This might include client involvement in the
research, collaboration on rules for the
therapeutic relationship and encouraging
clients to brainstorm ways to implement new
strategies. You will set up ways in which a
client can let you know that they are
uncomfortable with something you said or did
in a way that they will not feel judged or
shamed.

p2
 RECONNECTION & INTEGRATION
Self-exploration can be daunting and emotionally exhausting. In order to
avoid symptoms of retraumatization, it is important to encourage
reconnection to self, others, and the world before the close of each session.

EMBODIED RESILIENCE & RESOLUTION OF SHAME

You will support your client in the acceptance of their newfound reality built
on empowerment and resilience. It will be important to collaboratively
identify and establish ways that this empowerment can translate and
contribute to his or her day-to-day life. Your client will be challenged to notice
ways in which they are able to enjoy elements of their life that they were
previously unable to enjoy while reducing the impact of shame based
triggers.

SELF CARE FOR THE THERAPIST OR CAREGIVER

In order to preempt potential vicarious trauma, therapists must be on top of
their self-care game and continuously be re-evaluating the methods they use
to make sure they are still working. It is recommended that anyone in this
sort of role have their own therapist who can support the proactivity of their
self-care efforts and hold them accountable when countertransference
becomes a problem. Engaging in ongoing supervision and consult groups will
also be critical. Trauma Therapists should never practice without ongoing
professional support and guidance.

p3
“In my early professional years I
was asking the question:
How can I treat, or cure, or
change this person? Now I would
phrase the question in this way:
How can I provide a relationship
which this person may use for his
own personal growth?”

-Carl R. Rogers
 TRAUMA
CONTEMPORARY

H E A L I N G
P A R A D I G M S H I F T

A Humility Infusion
We are all fellow humans with similar body systems.
Those of us who have done "the work" can understand the
strength and resolve required to truly make the shifts
toward whole body health.

Focusing on self development and doing our own "work"

allows us to access our deeper wisdom and internal
resources. Investing in our own growth, allows us the gift
of healing and the ability to become more efficient in
supporting our clients in their healing work as well.

Being in the "helper role" absolutely does not mean that

the helper is superior to the receiver. We are all humans.
Humility is just as important as being clear about the
boundaries of the role you're in.

Gone are the days when the therapist sat in a big

dominating chair across a cold desk or next to their client
lying vulnerably on a cold couch. There is a power
differential in being the "helper" and it's important to be
mindful of to ensure a healthy, reparative experience.

We're all doing the best we can with the tools we've got.
Some of us have more access to resources than others.
Acknowledging these components are important to be
cognizant of as we support our clients on their journeys.

Many of the shifts in trauma treatment are huge, and

some are more nuanced.

p5
 The Art of
Nuance
TALK UNDER, NOT OVER
Lowering our voice can help clients regulate
themselves. Old-school doctors and psychologists
would talk louder, stronger and more firmly when a
client got defensive, dissociative, disagreed with
them or scared "for no reason". We now understand
how damaging that approach was. Today we lower
our voice and we slow down our pace because we
want to be sure our clients will tune in to the
conversation. We aren't in the business of fighting
against their worry and concern. Slowing our pace
and lowering our voice will help the client stay
engaged and connected.

EYE LEVEL SUPPORTS SAFETY LEVEL

If you are a tall therapist or tend to have an
overpowering presence, it's important to be humble
enough to lower yourself to be at the eye level of
your client (or lower). If you are standing, then try to
bend if you are taller and when sitting, lower your
seat if possible. This helps to energetically meet your
client where they are at. They might already sense a
power differential, so it's important that we not
magnify that. This is a big part of rebuilding safety
in the therapeutic dynamic (especially important
when a client had a challenging power dynamic with
a past therapist.) It likely won't be a nuance that they
can point it out, but it's this sort of tangible, yet
covert, energy that conveys “you're in the driver's
seat and I'm collaborating with you.. I'm following
your lead." This subtle autonomy will be a big part of
their healing process.

p6
 “Psychological capacities and beliefs
are inextricably linked with the
structure and movement of the body.”

- Dr. Pat Ogden

NON VERBAL COMMUNICATION

We want to become highly attuned to our client's body language, and learn to sense what our client's
subconscious is saying to us, even before they can identify it for themselves. Eventually they will learn to
be more mindful of the messages they are giving off and become more attuned to the body language of
others. As a therapist, we also need to be aware of our own body language too.

When a client walks into the room, you can use their unintentional or intentional body language as a
clue into where they are at. We have some fantastic body based assessments and interventions coming
up in later modules. For now, try to just observe and even make notes about their posture, the ways they
move their body, and their range of motion capabilities. You will be fascinated to learn how much these
observations can support the therapeutic process.

Pat Ogden, PhD says that when a client can develop a strong “movement vocabulary” it will also increase
their resilience.

p7 © 2021 Esther Goldstein | www.integrativepsych.co | Do not duplicate without express permission

 TRANSPARENCY
We need to set up our therapist-client relationship
for success right from the start - from the very first
appointment.

Start off (after your warm welcome) by saying

something like "I don't know you well right now, but
I am committed to getting to know you at a pace
that feels right to you and organic for both of us.
Although I am a skilled therapist, I'm a newbie in
your life and I look forward to getting to know you,
Together, in this room, we will create a space for you
to feel, to hurt, to cry, to mourn and also to let go of
the pain you are holding alone. Our relationship is a
blank canvas on which we will create a masterpiece
together as you blossom and evolve into the person
you never thought was possible. And I'll be here to
hold all of the heaviness for you."

These types of sentences will help your client on

their journey toward an earned secure attachment.

Good therapy is less about framing and laying out

your narrow action plans than it is about being
incredibly nuanced and mindful about your body
language, empowering, guiding, being open... while
also being healthily guarded (we don't want to
present any confusing energetic messages.)

p8
The pacin
g of sessio
is one of t ns

he most

importan
t skills
needed w
hen

providing
trauma

therapy

-Esther G
oldstein, LC
SW

p9
 TEACH YOUR CLIENT HOW TO "DRIVE" THE SESSIONS
Part of creating a healthy nuanced atmosphere is empowering your client with tools

to drive the conversation at their own pace.

I do this by teaching about the "brakes and the gas pedal."

With your guidance, your client will learn to sense when the conversation is too much

for them or if they are capable of going full speed ahead.

As a therapist, you will want to identify the moments when you need to use your own

brakes and pedals. For example, something you learn in this course might be

triggering for you. If something isn't sitting right, make sure to ask yourself ;

Do you need to mute, or pause the video?

Do you need to do a grounding exercise?
Do you need to remind yourself that you can compartmentalize?

In the same way that when we drive a car we must have working brakes and a gas

pedals (and know when to use each one), as a therapist we also need to make sure our

breaks and pedals are up to code and we are alert about when to step on each one.

We will learn a lot more about this in the modules dealing with assessments and

interventions, but I wanted us to start thinking about it now, in the same

conversation as all the other important nuances we will want to fine tune.

p 10
 BRAKES AND GAS PEDAL
SELF-AWARENESS EXERCISE
SUPER-HYPERAROUSAL (REALLY HIGH LEVELS OF AROUSAL)
Sympathetic Nervous System Over-Activation

Overwhelmed (deer in headlights) Cold sweat

Hyperventilating Indigestion
Hearts beating super fast or insanely slow Lose control of bladder or bowels
Significantly high blood pressure Terrified
Numbness
Pupils dilated or tiny
Not aware of surroundings
SLAM ON THE BRAKES Eyes really dry
Can't think straight
if you checked any of these boxes Droopy eyes or super open (not blinking) Totally scattered
(the goal is to not let it get this far) Looking really pale or flushed Vomiting
Sweating like crazy Memory loss

HYPERAROUSAL (HIGH LEVELS OF AROUSAL)

Sympathetic Nervous System Activation

Tense
Dysregulated
Fast breathing Not able to focus
Labored breathing A bit scattered
Heart rate rising Stomach tightening
Pupils dilated Lump in throat
Headache
Dry eyes
Dizzy
START THE BRAKES Slightly pale Tingling
if you checked any of these boxes Starting to sweat Numbness
Dry skin Nauseous
Cold Restless
Rage Muscle aches
Slight memory issues
Scared
Not be able to integrate
Limited ability to connect

VENTRAL VAGUS ACTIVATION (HEALTHY LEVELS OF AROUSAL)

Integrated Sympathetic & Parasympathetic Nervous System

Feeling of Safety Calm & Alert

Clarity Disgust
Relaxed Healthy Anxiety
Easy to breathe Excited
Calm
Resting heart rate
Pleased
Normal blood pressure Full access to executive functions
KEEP DRIVING Heart rate slightly elevated if excited Sense of humor
if you checked any of these boxes
Normal skin complexion Access to creativity
(This is the healthiest place to be)
Muscles relaxed or toned Can concentrate
Can focus on the conversation
Comfortable body temperature
Can feel heavy emotions without
Healthy Anger Getting hyper-aroused
Healthy Shame Can integrate therapeutic gains

LETHARGIC (LOW LEVELS OF AROUSAL)

Parasympathetic Nervous System Activation

Apathy Depression
Low mood Heavy sadness
Muscles slack Unhealthy shame
Shallow breathing Disgusted
Withdrawn
Slow heart rate
Feeling of emptiness
Low blood pressure
Isolated
GENTLY EXCELERATE Eye lids heavy Limited access to executive functions
if you checked any of these boxes
Debilitating Grief (over a few months) Will likely not be able to integrate

p 11 © 2021 Esther Goldstein | www.integrativepsych.co | Do not duplicate without express permission

 “After trauma, the
world is experienced
with a different nervous
system that has an
altered perception
of risk and safety.”
- Bessel Van Der Kolk

RECOGNIZING

TRAUMA
IN THE MIND
BODY & SOUL

p 12


IMPACT NEUROTRANSMISSION
OF Dopamine transmitters and receptors become
underdeveloped or damaged creating a

TRAUMA predisposition for addiction. Messages are not

powered by the right hormone releases which
makes the body work more inefficiently, causing

ON THE BODY heightened fatigue and reduced focus. Low

serotonin causes depression.

NEURAL PATHWAYS
Unhelpful thought patterns and
behaviors continuously reinforced and
strengthened.
BRAIN
ARCHITECTURE
HORMONES Shrinkage in prefrontal cortex,
Continuous release of corpus callosum and
norepinephrine and cortisol hippocampus. Enlarged and
creates heightened reactivity to more reactive amygdala.
stress, and damage to many other
parts of the body (shutting down
less essential body functions.) BRAIN WAVES
Redirection of
brainwaves to foreign
NERVOUS SYSTEM areas of the brain forces
the brain to compensate
Highly active sympathetic
in different ways;
nervous system. Lagging
causing dysregulation,
parasympathetic nervous
anxiety, inability to
system causes challenges to
concentrate etc.
homeostasis and balance.

IMMUNE SYSTEM TOXIN

Since the cortisol balance is out of ELIMINATION
whack, it causes dips and spikes in Since all the “less-
the hormones responsible for essential functions” are
inflammatory response and other shut down, the
parts of the immune system (sort intestines and kidneys
of like how the pancreas can’t are forced to work
regulate insulin properly for double time, putting
diabetics). This dysregulation is undue stress on the
responsible for all kinds of entire metabolic and
diseases. digestive systems.

EPIGENETIC CHANGES CELLULAR

Trauma and stress hormones change the CHANGES
way genes are expressed in the body and Shortened telomeres prematurely ages
this expression can last generations if left and causes reduced reproduction of
unsupported. cells, impacting health.

p 13 © 2021 Esther Goldstein | www.integrativepsych.co | Do not duplicate without express permission

 NEUROSCIENTIFIC

IMPACT SENSORIMOTOR CORTEX

OF
Over-activation of sensory and motor

TRAUMA functions
ANTERIOR
ON THE BRAIN CINGULATE
CORTEX
Reduced volume. Higher
resting metabolic activity,
decreased ability to
regulate autonomic
THALAMUS functions. Decreased
Decreased blood cognition.
flow to the part of
the brain
responsible for
relaying sensory
information

PREFRONTAL
CORTEX &
ORBITOFRONTAL
CEREBELLUM CORTEX
Plays a part in the Decreased gray and
dysregulation of the white matter density
arousal and reward and volume. Emotional
response system. Can dysregulation and
impact balance, decreased executive
coordination and posture. function. Decreased
responsiveness to trauma
AMYGDALA, and emotional stimuli.

HIPPOCAMPUS &
PARAHIPPOCAMPAL HYPOTHALUMUS
GYRUS Increased responsiveness to anything
Decreased memory encoding and
associated with traumatic event or
retrieval capabilities. Decreased
emotional trigger.
volume.
Secretion of hormones becomes
dysregulated as the gauge to monitor fight
or flight responses is "broken" (releasing
either too much or too little)

(Fear conditioning, synaptic plasticity and the amygdala: implications for posttraumatic stress disorder, Trends in Neurosciences, Amy L. Mahan, Kerry J. Ressler, July 27, 2011)

p 14 © 2021 Esther Goldstein | www.integrativepsych.co | Do not duplicate without express permission

 The nervous
system does not
know the
difference
between an
actual trauma
and a perceived
trauma.

We need to listen with our "sixth sense" in order to get to know what trauma
truly is, and how it tends to live in our minds, bodies and spirits.

Listen for words or sentences that your clients are saying so you can start to
hear the whispering themes of trauma “aloneness, fear, invisibility, rage...”

Past experiences will impact the way we perceive an event. The nervous system
does not know the difference between an actual trauma and a perceived trauma.

Any event can trigger emotional or physical reactions which can eventually
become a risk factor for a number of health conditions. Additionally,
experiencing trauma can lead to the diagnosis of mental health conditions such
as; depression, anxiety, PTSD, addictions, eating disorders, borderline
personality disorder and suicidal ideation.

Trauma informed therapy can provide long-term relief. Clients who get the
right care often experience less stress and an improved quality of life. By feeling
deeply understood, their nervous systems can settle. Through psychoeducation,
learning skills for coping, and receiving good clinical care, they can release the
burdens that weigh on their mind, body and spirit.

p 15
 “[Trauma is] A psychic wound that hardens you
psychologically and that then interferes with your
ability to grow and develop.

It pains you and now you’re acting out of pain.

It induces fear and now

you’re acting out of fear.

Trauma is not
what happens to you,
it’s what happens inside you
as a result of what
happened to you.

Trauma is that scarring

that makes you less flexible,
more rigid, less feeling
and more defended.”

- Dr. Gabor Mate

p 16


Dear Therapist,

Thank you for being the type of

professional who is passionate about
continuing to learn and evolve throughout
your career. Passionate and growth
oriented people like you have the ability to
change lives in incredible ways.

As a trauma therapist, you are the guide in

this life-changing work. You have the
ability to make a lasting impact on your
clients and the world around you.

Trauma Therapy is a pathway to

healing, change and transformation.

If you are looking for more than just an

introduction to trauma-informed care,
check out our online Trauma Therapist
Training Course.

Click here for more information.

I look forward to continuing to grow and

learn with you on this journey toward
evolving as fellow humans and as as
professionals. Join me in this course if
you are ready to help your clients

experience richer and deeper healing.

xo Esther
 Integrative Psychotherapy
91 Carman Ave
Cedarhurst, NY 11516, USA
United States
347-903-7835
[email protected]

Call or e-mail to book your next appointment.

Visit our website to sign up for emails to get notified about
more free downloads;

www.integrativepsych.co