Who this approach usually helps
- PTSD, nightmares and intrusive memories
- Trauma after sexual assault or domestic violence
- Detention, imprisonment and interrogation
- War-related and dangerous-migration trauma
- Complex trauma and childhood abuse
- Accidents and sudden loss
What is trauma-focused therapy?
Trauma means an experience in which our life, body or safety, or that of people we love, was seriously threatened: an accident, sexual assault, domestic violence, detention and interrogation, war, sudden loss or a dangerous migration journey. Not everyone develops post-traumatic stress disorder (PTSD), but for some the mind cannot file the event as "over", and the memory keeps returning as if it were happening now.
Trauma-focused therapy is the name for several structured methods that work directly with these memories and their effects. The main ones are trauma-focused cognitive behavioural therapy (TF-CBT), prolonged exposure (PE), cognitive processing therapy (CPT) and EMDR. What they share is that, with the therapist's help and at a bearable pace, the memory is processed rather than avoided.
How these methods work
Treatment usually starts with stabilisation. Before approaching the memory we make sure present life is as safe as possible and practise skills such as slow breathing, grounding and handling intense emotion. For some people, especially those with repeated trauma, this phase is a substantial part of therapy in itself.
In prolonged exposure, the person recounts the memory in detail with the therapist's guidance and gradually approaches safe situations they have been avoiding, so the brain learns the danger is over. CPT focuses on beliefs formed after the trauma, such as "it was my fault" or "nowhere is safe", and examines them carefully.
EMDR (Eye Movement Desensitisation and Reprocessing) was introduced by Francine Shapiro. The person holds part of the memory in mind while attending to bilateral stimulation: following the therapist's moving finger with the eyes, tones alternating between the ears, or gentle alternating taps. EMDR follows a defined eight-phase protocol and should only be done by a formally trained clinician.
What a session looks like
Take a man in his thirties who was detained years ago. He now lives somewhere safe, but a knock at the door sets his heart racing and he has nightmares. In the first sessions the therapist listens without pressure, measures symptoms with a short questionnaire and explains why his body is still on alert. Together they build an imagined "safe place" and a few calming skills.
When he is ready, if EMDR has been chosen, the therapist asks him to identify an image from that day, the negative belief attached to it ("I am helpless") and where he feels it in his body. Short sets of bilateral stimulation follow, and between sets the therapist asks what came up. Time is always left at the end to settle, so he leaves in a steady state.
Who it helps and what the evidence says
These treatments are used for PTSD, for trauma after violence, sexual assault, accidents or war, and for complex trauma (C-PTSD) arising from prolonged, repeated harm such as childhood abuse or imprisonment. In complex trauma there are also difficulties with emotion regulation, deep shame and trusting others, and stabilisation usually takes longer.
Major international guidelines, including those of the World Health Organization and the American Psychological Association, recommend trauma-focused treatments such as TF-CBT, PE and CPT for PTSD, and EMDR is recommended in several guidelines too. Many people experience a meaningful reduction in symptoms, but not everyone benefits equally, and sometimes the method needs to change.
How long does it take?
For PTSD after a single event, protocols such as PE and CPT are typically designed for about 8 to 16 sessions, and EMDR often runs a similar course. Complex trauma usually takes longer, sometimes many months, because building safety and trust takes time itself. Early in processing people can feel somewhat worse for a while; talk about this with your therapist in advance so you have a plan.
Online and in Farsi
Research shows trauma-focused therapies can also work well by video. In online EMDR the bilateral stimulation is adapted: following a moving dot on screen, alternating tones through headphones, or the "butterfly hug", where you cross your arms and tap your own shoulders in turn. This needs a trained clinician who is familiar with online delivery. Before starting, you agree a plan for a dropped connection or for feeling overwhelmed mid-session.
For many Iranians trauma is tied to war, repression, imprisonment, the execution of loved ones, earthquakes or a dangerous migration route, and telling it in a language other than Farsi, or to someone who does not know the context, can feel impossible. A Farsi-speaking therapist familiar with these experiences does not need everything explained from scratch. If you are in Iran, connect from a safe, private place.
Limits, safety and alternatives
If you are still in danger, for example in a violent relationship, safety comes before processing memories. Serious suicidal thoughts, heavy alcohol or drug use, or severe dissociation usually need to be managed first, with treatment moving more carefully and slowly. Sometimes combining therapy with medication under a psychiatrist helps.
If memory-processing methods do not suit you, other approaches such as general CBT, ISTDP or compassion-focused work can help. Please remember that online sessions are not an emergency service. If you are in immediate danger or might harm yourself, call your local emergency number or go to the nearest emergency department.
