Talking or Doing: Which One is Most Important in Trauma Recovery?

Some somatically trained practitioners express that talk therapy gets the ‘cart before the horse’, asking clients to relive past traumas in order to heal. Many classically trained professionals are ignorant of the many body-based modalities that have been developed to help survivors.

With respect, I very much disagree with the rather black/white view presented by individuals who are trained one way or the other.

I too, am a survivor previously diagnosed with depression, anxiety, PTSD and other trauma-related disorders. I have moved beyond (I don’t often use the term “cured”) the effects of depression, anxiety, Complex PTSD and other trauma-based conditions. I am now a coach and counselor (after 20 years of licensure as a clinical social worker) who specializes in treating all kinds of trauma, including those who have left cultic groups.. I have used somatic work in my own healing process as well as art and talk work.

I found the work with Trauma Release Exercises®, bioienergetics, breathwork and other modalities more than helpful and at times, profound. However, I take issue with the view that talk therapy is “the cart before the horse” because I know that there is absolutely no way I would ever have participated (or—I would have participated and been re-traumatized) in a somatically based therapy before establishing rapport and trust with a trained practitioner. Don’t get me wrong. I spent years and many insurance benefits, getting a lot of ‘vent’ therapy. It didn’t do much to help me process through the trauma, but it probably helped me stay alive at times.

I trained, for the MSW, with Colin Ross at his inpatient trauma treatment unit in Dallas, TX, over 15 years ago. I was fortunate to be there at a time when the director of the program, and certain other interns were there who actually, in a very intuitive way, used somatic work in addition to talk therapy, anger expression, psychodrama and other modalities. My own professional work has naturally included what I now call Somatic Awareness Exercises™. These are simple breathing and mindfulness exercises that I use to help clients begin to develop awareness of their body’s responses as they talk about their experiences, current and past. I have never felt that re-living the story over and over was useful, in fact, in my training I learned that this was not the ideal approach.

During my internship I observed and led groups of up to 20 trauma survivors diagnosed with PTSD, Dissociative disorders, (so-called) Borderline Personality disorder and others. One guideline of the daily groups was that participants were not to talk about the details of their abuse/trauma—this was for individual work. I saw miracles of recovery work happen in those groups.

Before engaging in my training in Dallas I had read several of Dr. Ross’ books. In his treatment text on Dissociative Identity Disorder (and later, in The Trauma Model) he teaches about what he calls “Locus of Control Shift” (I call it “Internalized Blame of Self”). This is essentially, an explanation for the self-blame, not good enough belief and self-sabotage that survivors are stuck in, as adult survivors of childhood trauma. It’s a defense that worked well to help the child survive overwhelmingly traumatic events and circumstances but it causes problems for adults. Self-blame for coping can prevent survivors from fully participating in somatic work. In fact, in those who have used dissociation for defense, they can become re-traumatized if somatic work is introduced prematurely.

When I came to this understanding—that I actually had learned, as a child, to blame myself, take responsibility for the actions of adult caretakers—my life changed and my recovery progressed rapidly. I got out of a religious cult, finished two college degrees (from 40-48 years old), began practicing as a therapist and moved beyond many aspects of the PTSD and especially, the “Complex” nature of the Complex PTSD. I know I could never have engaged in anything like TRE® without this understanding first.

Without this understanding, this “talk therapy” if you will, I would never, never have been able to give up the dissociative defenses I’d developed. These defenses kept me separated so that if anyone would have asked me, “what is the purpose of the body?” I would have said, “to carry my head.”

For some people, somatically based approaches such as EMDR and TRE are helpful, first thing, without much re-telling. But, in a workshop I attended, David Bercelli (the creator of Trauma Release Exercises), said, “if your trauma is extensive and you need to tell your story, you need to do some talk therapy, first”.

I believe, due to the “trauma-informed” movement that many practitioners are evolving a mind/body, talk/somatic practice. I certainly employ many modalities in work with trauma clients. These include psychodynamic, somatic, didactic, art, music, creative writing, role-play, and many other tools. Much of my job, at first, by the way, is to convince people that what they’ve experienced IS “trauma”—it’s a defense of survival that causes humans to deny their experience even as they are describing the serious after-effects of those experiences.

We live in a world, currently, that includes many, many caring and innovative practitioners and healers. To say that “talk therapy” is the “cart before the horse” and that one particular modality is ‘the correct way’ to treat trauma is, in my view and experience, short-sighted and narrow-minded.


I have created a list of “Trauma-Informed Ethics”. One of these states: “I will strive to keep up to date with developments in the trauma-informed field, but refrain from holding up any one method or modality as the only or right way.” I believe this is an ethical issue because we practitioners do have a lot of power in the therapeutic setting, like it or not. We influence people based on our authority as educated, licensed, trained, certificated, life-experienced individuals and often, by the sheer force of our personalities. If we hold out a particular “evidence-based” treatment as the only right tool, then we are going to reinforce (especially to the Complex PTSD clients and patients) that they are not good enough to heal.

We need to consider these thoughts before we hold out a particular modality as better than another. Psychological research and practice is done by and on humans, thus it cannot ever be that certain ways of being are right, successful or “curing” for all people, all the time.

It’s time all who identify as helpers and healers evolve our view of what works and use an individualized approach.