Trauma and PTSD Treatment

Signs that may point to unresolved traumatic aftereffects

The diagnosis is made by a professional after a clinical assessment. But these are the most frequent manifestations of unprocessed psychological trauma:

• Re-experiencing: recurrent nightmares about the event, flashbacks (reliving the scene with sensory intensity), intrusive thoughts that show up uninvited.
• Avoidance: needing not to talk about the event, not to visit related places, not to see images that bring back what happened: avoidance that becomes chronic instead of easing with time.
• Hypervigilance: being permanently "on alert", an exaggerated startle response to noises or movements, difficulty trusting people or environments.
• Dissociation: a sense of unreality, of "being outside your body", blank moments when you do not remember what you did, depersonalization ("my body doesn't feel like mine").
• Lasting changes in how you see yourself, others and the world: "I'm bad", "the world is dangerous", "you can't trust anyone", "everything is going to go wrong".
• Somatic symptoms with no medical cause: chronic pain, constant muscle tension, digestive problems, overwhelming fatigue. The body carries what the mind has not yet been able to process.
• Problems with emotional regulation: outbursts of anger, uncontrollable crying over small triggers, emotional "emptiness", difficulty feeling joy or connection.
• In complex trauma (CPTSD), also: chronic difficulty trusting relationships, a persistent sense of "being fundamentally different or broken", repeated patterns of harmful relationships without understanding how they form.

How we work with trauma in therapy

The approaches with the best empirical support for PTSD are: trauma-focused CBT (TF-CBT), prolonged exposure therapy (Foa), cognitive processing therapy (CPT) and EMDR (Eye Movement Desensitization and Reprocessing). In our practice we use TF-CBT and CPT as the main pillars, integrating elements of prolonged exposure when appropriate. If someone specifically needs EMDR (which requires a specific certification that not all of us psychologists have), we refer them to an accredited professional in Santa Cruz.

Trauma treatment follows a clear clinical sequence and does NOT skip stages. First, stabilization: reducing risk behaviors, building a therapeutic alliance and developing emotional regulation tools so the person can tolerate the later work without becoming overwhelmed. This phase can take weeks or months depending on the severity of the condition and the support network available. Second, processing: a gradual and controlled approach to the traumatic material so that the nervous system can reprocess it in a safe context. This does NOT mean "reliving the trauma": it means allowing the memory to stop being frozen in its original form and to become integrated as part of your personal history without continuing to trigger symptoms. Third, reconstruction: integrating what has been processed into a coherent narrative, restoring functioning, and rebuilding relationships and life plans.

It is slow work, especially with complex trauma: 1 to 2 years of weekly sessions is typical. The initial stabilization is NOT shortened. Jumping to processing without prior stabilization can make symptoms worse. When appropriate, we work in coordination with psychiatry (complementary medication reduces hyperarousal and improves sleep in many cases).

When to seek help?

If you went through a recent traumatic event and the symptoms (nightmares, flashbacks, hypervigilance, avoidance) have lasted more than 4-6 weeks without easing, that is a good time to seek help: early treatment reduces the likelihood of it becoming chronic. If you carry the aftereffects of past trauma (childhood abuse, previous violence, an accident or a traumatic loss years ago) and recognize several of the signs in the list above, it is also time, no matter how long ago it was.

If there is active suicidal ideation, recurrent self-harm, problematic substance use "so as not to feel", or severe dissociation that interferes with caring for children or with work: the first appointment can be within the same week. If there is imminent risk, call 168 (Santa Cruz medical emergencies) or go to the emergency department of the nearest hospital, where they must see you without an appointment in an emergency. If you are currently in a situation of violence (within the family, from a partner, at work), the first clinical step is safety: you can call the FELCV (the Bolivian police's Special Force Against Violence) at 800 14 0348, available 24 hours a day, and we coordinate with legal and protection support networks before starting processing work, because processing without safety can be iatrogenic.

An important note on scope: we work with single-incident trauma and complex trauma of mild to moderate severity using TF-CBT and CPT. Severe dissociative conditions (Dissociative Identity Disorder, severe chronic depersonalization) and complex trauma associated with torture or prolonged kidnapping may require referral to a team specialized in dissociation. We always assess this explicitly in the first appointment and give clear referrals when referral is the best option for you.