Counselling for Depression: How It Helps and What to Expect
How counselling and talking therapies help with depression, what NICE recommends, NHS and private routes in the UK, and when to get urgent help.
Therapy After Trauma: Your Options
Therapy options after trauma in the UK: trauma-focused CBT, EMDR and other approaches, what NICE recommends for PTSD and complex PTSD, and how to find support.
Key takeaways
- Distress after trauma is common and often eases in the first weeks; ongoing symptoms deserve support.
- NICE recommends trauma-focused CBT and, for some people, EMDR as the main psychological treatments for PTSD.
- A good trauma therapist goes at your pace and helps you feel safe before working on memories.
On this page
After a frightening or distressing event, it’s normal to feel shaken, on edge or unable to stop thinking about it. For many people these reactions ease over the following weeks. When they don’t, or when past experiences keep affecting your life, therapy can help. In the UK, the main recommended treatments for post-traumatic stress disorder (PTSD) are trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing (EMDR), and you can access them through the NHS or privately.
Common reactions after trauma
Trauma can follow a single event, such as an accident, assault or sudden loss, or repeated experiences, such as abuse, domestic violence or war. Reactions include:
- Reliving: flashbacks, nightmares or intrusive memories
- Avoidance: staying away from reminders, or trying not to think or talk about it
- Feeling on guard: jumpiness, irritability, trouble sleeping or concentrating
- Changes in mood and beliefs: guilt, shame, numbness or feeling the world is unsafe
PTSD is diagnosed when symptoms like these last for more than about a month and cause real difficulty. Complex PTSD, recognised in the World Health Organization’s ICD-11 classification, can follow prolonged or repeated trauma and adds long-lasting difficulties with emotions, self-worth and relationships.
The first weeks
In the first month after a traumatic event, NICE suggests active monitoring for people with milder symptoms: checking in and reviewing how things are going, rather than rushing into treatment. It advises against single-session psychological “debriefing” for everyone straight after a trauma. If symptoms are severe, treatment can start sooner.
In these early weeks, it can help to keep routines, stay close to people you trust, avoid using alcohol to cope, and give yourself time.
The main therapy options
| Therapy | What it involves | NICE position (adults) |
|---|---|---|
| Trauma-focused CBT | Making sense of the trauma, changing unhelpful beliefs and gradually facing memories and reminders. Types include cognitive processing therapy, cognitive therapy for PTSD, prolonged exposure and narrative exposure therapy | Recommended for PTSD, usually 8 to 12 sessions, more if needed |
| EMDR | Recalling parts of the memory while following side-to-side eye movements, taps or tones | Recommended for PTSD after non-combat trauma, in line with the guideline |
| Supported self-help | Structured, trauma-focused materials with practitioner support | Can be considered for some people with less severe symptoms |
| Other talking therapies | Counselling, psychodynamic or person-centred work | Can help with wider effects of trauma, but aren’t the first-line treatments for PTSD |
| Medication | Antidepressants such as sertraline or venlafaxine | Considered if a person prefers it, or alongside therapy |
Our guide to EMDR therapy explains that approach step by step.
What to expect from trauma therapy
Good trauma therapy is collaborative and paced. You won’t be pushed to describe everything at once.
- Assessment: what happened, how it affects you now and what you want to change.
- Safety and stabilisation: learning ways to manage distress, sleep and flashbacks. This phase may be longer for complex trauma.
- Processing: working with memories in a structured way so they lose their power.
- Moving forward: rebuilding confidence, relationships and plans.
It’s normal to feel worse briefly before feeling better. Tell your therapist if things feel too much; they can slow down.
Getting help in the UK
| Route | Notes |
|---|---|
| Your GP | Can assess you and refer you to local services |
| NHS Talking Therapies (England) | Self-referral; offers trauma-focused CBT and EMDR in many areas |
| Specialist trauma services | For complex or severe PTSD, usually by referral |
| Op COURAGE (England) | The NHS mental health service for veterans and service leavers |
| Charities | For example Rape Crisis, Victim Support and Mind offer information and support |
| Private therapy | Choose someone trained in a recommended trauma therapy and registered with a recognised body |
Our guides to finding a counsellor in the UK and what happens in a first session can help you take the next step, and talking to your GP about mental health explains how to start that conversation.
Choosing a trauma therapist
Ask:
- What trauma-focused training do you have (for example in trauma-focused CBT or EMDR)?
- Are you registered with a professional body such as BACP, UKCP, the HCPC or the EMDR Association UK?
- How do you help people feel safe before working on memories?
- What happens if I feel overwhelmed between sessions?
It’s fine to meet more than one therapist before deciding. Feeling safe with the person matters; see how to tell if a counsellor is right for you.
Looking after yourself
- Keep to routines for sleep, meals and activity.
- Use grounding skills during flashbacks: notice your feet on the floor, name what you can see and remind yourself where you are now.
- Limit alcohol and drugs, which can worsen symptoms.
- Let trusted people know what helps and what doesn’t.
If you need help now
If you feel unable to keep yourself safe, call 999 or go to A&E. You can call Samaritans free on 116 123, any time, or text SHOUT to 85258. In England, call NHS 111 and choose the mental health option.
Frequently asked questions
Do I need a PTSD diagnosis to get trauma therapy?
Not necessarily. Many services and private therapists help with the effects of trauma whether or not you meet the criteria for PTSD.
Will I have to talk about every detail of what happened?
No. Therapists go at your pace, and some approaches need less detailed talking than others. You stay in control of what you share.
Can therapy help with trauma from a long time ago?
Yes. Trauma-focused therapies can help even many years after the events.
Sources
Every article is edited by a human and checked against our editorial policy. Spotted a mistake? Tell us.
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