What to Expect From Trauma Therapy

Dr Tammy Oluyori

November 8, 2026

Light filtering through green leaves inside a peaceful room

A gentle guide to how we work together towards safety, understanding and change.

“What can I expect from trauma therapy?” It is one of the questions I am asked most often. What will we cover? Will I have homework? How do you work?

The honest answer, after many years as a trauma therapist, is that the direction is different for everyone. Each person brings a unique history, their own circumstances past and present, and their own needs and preferences. This guide explains the shape our work often takes, so that you know what to expect, while recognising that your therapy will be shaped around you.

How I work

I am trained in several therapeutic approaches and integrate them. This means I use the techniques that fit you, rather than trying to fit you to a technique. There are more than 500 types of therapy, and you do not need to be familiar with any of them. My job is to help find what works for you.

I am not trained in every approach, so I will always be honest if I think someone else would be better placed to help you. I equally welcome you telling me if you sense it first. We cannot always get along with everyone, and that is a normal part of human relationships, not a failure.

What does “feeling better” mean?

Most people come to trauma therapy wanting to feel better, and “better” means different things to different people. For many, it includes:

Feeling safer in their body, their relationships and their everyday life. Safety is at the heart of everything we do.
Changing patterns that keep them stuck, hurt them or no longer serve them.
Developing new ways of coping that are kinder and more effective than the ones they had to rely on before.
Understanding themselves and making sense of experiences they have never been able to put into words.
Carrying less shame and guilt about who they are and how they have survived.

We do work towards your goals, but we do not usually start by setting them. Goals often become clearer once we understand what is really going on.

The shape our work often takes

Understanding: Making sense of what is happening and why.
Safety and stabilisation: Building capacity to feel and cope.
Processing: Helping the past feel like the past.
Integration and endings: Keeping the gains and moving forward.

This follows a widely recognised phased approach to trauma recovery: building safety first, then working with traumatic memories, then reconnecting with life. The phases often overlap, and we may move back and forth between them. (Herman, 1992)

Phase 1: Building an understanding

Our first aim is to understand the problem together. This does not always mean going into your trauma history straight away, because that can be very difficult. Instead, we often begin with:

What feels difficult right now
The factors that make it difficult
The patterns that keep it going

When it feels safe enough, we can begin to explore what has contributed to your current difficulties, and how past experiences may be shaping the present.

Mind maps

In many cases, I share material that helps you understand how the mind and body work. I call these mind maps. Depending on your needs, I may draw on:

The three systems model from compassion-focused therapy, which explains how we regulate our emotions.
The window of tolerance, which describes our capacity to cope with stress and emotion.
The nervous system, and how it responds to threat and safety.
The neuroscience of anxiety and depression, and why our bodies and minds react as they do.

These mind maps help us understand what is happening in the brain, and how our environments and the ways we have learned to cope contribute to the symptoms we have come to hate, or that get in the way of our lives.

The three systems of emotion

Adapted from Gilbert (2010), this mind map describes three emotion systems:

Threat and self-protection: Detects danger and keeps us safe. Associated experiences include anxiety, anger, fear, shame and disgust.
Drive and achievement: Motivates us to pursue goals and resources, including excitement, wanting, striving and achieving.
Soothing and connection: Helps us rest, feel safe and connect with others, bringing calm, contentment, safeness and warmth.

Ideally these systems work in balance. After trauma, the threat system often becomes dominant, and the soothing system may have had little chance to develop. Many people learn to use the drive system, by achieving, working or pleasing, to manage feelings of threat. Understanding this can be a powerful first step towards change.

The window of tolerance

Adapted from Siegel (1999), the window of tolerance helps describe our capacity to cope with emotion and stress.

Hyperarousal: Too much activation, which may feel anxious, panicky, angry, overwhelmed or restless, with racing thoughts and difficulty settling.
Within the window of tolerance: We can think, feel, connect and respond, even when things are hard.
Hypoarousal: Too little activation, which may feel numb, shut down, foggy, disconnected, exhausted or empty.

Trauma can narrow this window, so we are more easily pushed into feeling overwhelmed and panicky, or numb and shut down. Part of therapy is gently widening your window.

How early experiences shape us

Imagine growing up without a single adult who protected you. Without someone you trusted to go to when you were hurt, or who could comfort you. A child in that situation would naturally grow up with deep fears about who they are, about other people and about the world around them.

About myself: “I am defective.” “I am unlovable.” “I am not worthy.”
About other people: “People are not reliable.” “People cannot be trusted.” “Others are powerful; I am not.”
About the world: “The world is unpredictable.” “Something bad will happen.” “I am never truly safe.”

To survive, that child would also develop ways of coping. These are often primitive, not because they chose them, but because that is what humans do, especially little humans. Shutting down, staying alert, pleasing others, avoiding closeness, or becoming fiercely independent may once have been the safest options available.

Understanding this can lessen the shame and guilt we carry. It can also help us begin to put words to our experiences, especially the parts we have struggled with for so long. Many people tell me that after these sessions they feel able to set goals for their therapy for the first time.

For some people, this kind of exploration is not the right starting point, and that is okay. We work with what you need in the moment.

Looking at the systems around us

None of us develops in isolation. Our experiences are shaped by our families, communities, culture, faith, race, class, migration and the wider society we live in. Trauma can also be passed down through generations, carried in family patterns, unspoken rules and the experiences of those who came before us.

I pay close attention to these systems. Experiences such as racism, discrimination, poverty, displacement and intergenerational trauma are real and important, and they are welcome in our work.

Phase 2: Safety and stabilisation

A large part of trauma therapy is helping you establish a sense of safety, both in your body and in your life. Before we work directly with painful memories, we build the skills and capacity to cope with strong feelings.

We develop and practise these skills together, especially around emotional regulation and co-regulation: learning to settle with the support of another person before learning to do it on your own. This might include grounding, breathing, noticing what is happening in your body, and finding ways to soothe yourself when you feel overwhelmed.

Phase 3: Processing trauma memories

Another important part of trauma therapy is identifying how past traumas are keeping you stuck, and often working directly with traumatic memories. This is sometimes called processing.

What does processing mean?

When something traumatic happens, the brain sometimes cannot file the memory away properly. It stays “live”, so a smell, a tone of voice or a situation can make your body react as if the danger is happening now.

Processing helps the brain finish filing the memory, so that it becomes something you remember rather than something you relive. The memory does not disappear, but it loses much of its power over your present.

Approaches I may draw on include:

EMDR (Eye Movement Desensitisation and Reprocessing): A structured therapy recommended by NICE for post-traumatic stress. My separate guide, Understanding EMDR Therapy, explains it in more detail.
Compassion-focused therapy (CFT): Including chair work, which helps us work with shame, self-criticism and different parts of ourselves.
Somatic and body-based approaches: Recognising that trauma is held in the body as well as the mind.

At your pace

We only work with traumatic memories when you feel ready and when there is enough stability in your life to do so safely. If you are still in an unsafe situation, our focus will be on safety first. You can always slow down, pause or change direction.

The therapy relationship

My work is relational. The relationship we build matters a great deal in trauma recovery. Many traumatic injuries are interpersonal injuries: they happen in relationships, often with the very people who should have kept us safe. So it makes sense that healing often happens in relationship too.

My hope is that our relationship can offer safety and trust. It can also become a place to learn and practise new ways of relating.

Noticing patterns as they happen

Sometimes I will gently name patterns as they show up between us. For example, many people apologise for crying in therapy. I might ask, “Where did you learn that expressing your emotions is an inconvenience?” Because it is not an inconvenience to me. Your emotions are part of why you are here, and I want to be here for you and for them.

Your emotions are not an inconvenience. They are part of why you are here, and they are welcome.

Rupture and repair

In any real relationship, there will be moments when things go wrong. I might misunderstand you, get something wrong, or say something that does not land well. When that happens, I apologise. People sometimes tell me I do not need to, but I do, because accountability matters. You have every right to expect it, and to decide whether you accept my apology or whether we need to work through it more.

For many people who have experienced trauma, relationships have not allowed for this. Disagreement may have felt dangerous, and hurt may never have been acknowledged or repaired. Experiencing rupture and repair in therapy can be deeply healing. We can then explore how similar patterns show up in your relationships outside therapy, and practise new ways of navigating them.

Between sessions

Will there be homework? Often, yes, though I think of it more as reflection than homework. I may suggest reflective tasks, such as noticing a pattern, trying a regulation skill, or writing about something that came up. These help bring what we explore in sessions into your everyday life. They are always discussed and agreed together, and there is no such thing as getting them wrong.

How long does trauma therapy take?

It varies. A single, recent traumatic event may need less time than experiences that were repeated, longstanding or that began in childhood. Most of the people I work with see me for a minimum of a year, depending on their needs. This includes a carefully planned ending, so that the progress you make lasts.

Sessions are usually weekly. They can be single (50 minutes) or double (100 minutes), depending on your capacity, needs and preferences.

Intensive sessions

Where appropriate, I also offer more intensive work. This usually involves double sessions of 100 minutes, sometimes twice a week. Intensives can suit people who want to work more deeply over a shorter period, or for whom weekly sessions are not practical. We would discuss together whether this approach is right for you.

Reviewing our work

We review your progress regularly together. We look at your goals, what is changing, and what is not going so well. I prefer to do this through open conversation rather than relying only on questionnaires, because what matters most is how you are experiencing your life and our work.

Progress is rarely a straight line. There may be weeks when things feel harder, especially when we are working with difficult material. This is not a sign that therapy is failing, and we will always talk about it together.

Endings and keeping the gains

I place great value on making sure that the progress you make in therapy is maintained. For this reason, endings are planned carefully and structured, rather than happening suddenly.

As you start to feel better, we gradually reduce how often we meet: for example, from weekly to fortnightly. We then usually move to monthly review sessions for between three and six months. This gives you the chance to practise your skills in everyday life, with support still in place, and to build confidence that the changes will last.

Getting started

We usually begin with a free telephone consultation, where we can talk about what you are looking for and whether working together feels right. For those funding their own therapy, the Comprehensive Insight Assessment can also be a helpful starting point, offering an in-depth understanding of your difficulties before therapy begins.

My separate guide, What to Expect From Your First Session, explains what happens when we first meet.

Support between sessions

I am not able to offer a crisis service. If you need urgent support between sessions, please contact your GP, or call NHS 111 and choose the mental health option. You can call Samaritans on 116 123 at any time.

If you or someone else is in immediate danger, call 999 or go to A&E.

A note from me

Whatever you have lived through, and however you have survived it, you deserve to be met with safety, respect and care. Trauma therapy is not about changing who you are. It is about helping you feel safe enough to become more fully yourself.