When it comes to trauma recovery, the name of the game is finding much needed relief and deep healing from things nobody should have to endure. Often, the first thing that well-meaning people suggest is that the trauma survivor ought to go to therapy in order to get this needed help.

In a perfect world, one where all therapists are trauma-sensitive, going to therapy might be fabulous advice, and most survivors would probably feel gradually increasing relief with regular therapy sessions. However, it can be exceedingly difficult to find therapists who are qualified to truly help people process trauma in healthy ways.

When a therapist is not trauma-sensitive, it is common for people to experience an increase in trauma response symptoms following sessions, rather than a decrease. Insomnia might intensify. Panic attacks, flashbacks, dissociation and other symptoms might also increase. People can remain in this incredibly triggered place for hours, days, weeks, months or even years after working with one or more professionals who are not proficient in helping with trauma processing. Many survivors go from one therapist to another for years on end, in hopes of finding relief, but instead consistently find themselves worse off than they were prior.

In short, the survivor is experiencing a dramatic uptick in fight, flight, freeze and/or fawn responses that developed as a way to help them survive their traumas. Instead of finding relief, their brains believe they are in danger, still in their root traumatic experiences. They become retraumatized and then find themselves with additional trauma from how these inappropriately trained mental health professionals respond to their struggles.

Many survivors suffer alone with these symptoms, believing that there is no other way. The toll on themselves and their families is devastating. When they do bring up concerns with a therapist who is not trauma-sensitive, they might be told that they have to be patient and suffer through these symptoms before they can make progress. Or, the therapist insists on speaking in person when that feels unsafe or undesirable to the survivor.

I’m going to let you in on a little secret: Trauma processing through therapy does not have to be terribly intense in order to be effective.

In no other medical setting would we be okay with an approach to care that says that harm is okay. Can you imagine going to the doctor for a broken arm and having them break it further and send you on your way, instead of putting it in a cast? What if the doctor determined that you have strep throat, but instead of offering needed medicine, tells you to suffer through it because it will get better on its own? Or, how about having an appendix that needs to come out, but the doctor refuses to perform the needed surgery?

For sure, there are instances of fatphobia, racism and other forms of discrimination where people receive improper care at the doctor, but in general we know it is not supposed to be that way. We label it as malpractice and do not think of it as a good thing. Yet, somehow when it comes to mental health care for trauma survivors, this is often not the case, and that is horribly tragic.

Science has shown us that the pain receptors for physical and emotional pain are essentially the same. The brain does not really distinguish between the two. When we recognize this truth, it becomes crystal clear just how inhumane it can be to be for mental health providers to expect trauma survivors to live in excruciating pain instead of trusting their pain reporting and offering appropriate pain relief.

This is why it does not always make sense for every survivor to go to therapy. It can be challenging to find appropriately trained therapists who understand the delicacy and tenderness needed in working with trauma survivors. When a survivor does find an appropriately trained therapist, their services can be cost prohibitive, keeping help out of reach. Many survivors also lack resources, transportation, child care and other necessities, which makes therapy with an appropriately trained trauma therapist nearly impossible to obtain.

That being said, trauma-informed therapy is sometimes possible. In addition to interviewing a therapist about their background in trauma training, you might look for the following signs of a good therapist:

• Therapy feels gentle, without repeated emotional triggers or long recovery periods.
• The therapist avoids encouraging narrative work and revisiting, which can be retraumatizing.
• Short-term need for some enjoyable rest following sessions is to be expected, but long-term exhaustion is not.
• The therapist is skilled in pacing therapeutic work so that it feels safe and is not activating.
• The therapist does not force particular modalities like EMDR or Somatic Experiencing if it is not right fit or the right timing for the client.
• The therapist does not rush progress, but is able to affirm progress as it unfolds naturally.
• The therapist is open to feedback and adjusts their approach to meet client needs.
• The therapist focuses on grounding at the end of sessions and aims for a feeling of relief after each session, rather than an intensification of symptoms.
• The therapist focuses on the client’s goals and where they want relief first.
• The therapist encourages the client to seek out other appropriate modalities like neurofeedback, HRV biofeedback, Alpha-Stim interventions and more.
• The therapist encourages boundary setting on the part of the client.
• The therapist encourages the client to trust themselves and the signals their mind and body send about what is working or not working in therapy.
• The therapist is knowledgeable and has appropriate training on things like CPTSD, DID and more.

This list is only a small snapshot of what it can feel like to work with a therapist who is trauma-sensitive and it is not all inclusive, by any means. The general guideline is that a therapist ought to encourage overall relief and reevaluate or refer out when this is not possible.

When it is not possible to find a good trauma-sensitive therapist, this does not mean that healing is not possible. Trauma survivors can take great hope in the reality that healing occurs in a wide variety of ways for people, depending on their unique stories and needs. From neurofeedback and biofeedback, to modalities like Qigong, artistic endeavors, or therapeutic theatre projects, the options are many.

If you have a friend or family member who is a trauma survivor and is struggling, especially over long periods of time and despite repeatedly seeking help from mental health practitioners, please understand that it is most likely not their fault. So many therapists and other mental health practitioners simply do not understand how to help people without retraumatizing them.

If you are a survivor who has gone on this rollercoaster yourself, please also know that you are not at fault and you are not alone. You are worthy of compassionate, trauma-sensitive care that leaves you feeling relief at the end of sessions. You have already suffered enough in living through your trauma(s), and your professional care should relieve that suffering instead of contributing to it. It is okay to say no to a therapist, to try different therapists, and even to walk away and try something else altogether if things are not working for you.

If you are in a larger body, chances are good that going to the doctor hasn’t always been an enjoyable experience for you. Go in for a sore throat? They prescribe weight loss. Sprained wrist? Lose some weight, of course. Diabetes diagnoses? Weight loss is the first line of treatment. Practitioners often do not know, let alone communicate, that weight is not a good indicator of health or that losing weight is the greatest predictor of future weight gain.

Unfortunately, this fat shaming and discrimination can be traumatic. It often feels more humane to stay home and ignore health needs than to face dehumanization and triggers in a physician’s office.

Dear fat friends, we are worthy of loving, caring, inclusive medical care! Our physicians work for us, not the other way around. We do not have to accept discrimination and trauma triggers as a given when it comes to our medical care.

The Association for Size Diversity and Health (ASDAH) maintains a directory of physicians and other professionals who practice from a Health at Every Size (HAES) perspective. Lindo Bacon maintains a wealth of resources and information for you and for your providers. Mosaic Comprehensive Care has drafted a practitioner letter to help you advocate for the care you want and need. Consider using these resources, not only as a reminder of what is true when it comes to weight, but also as a way to advocate for yourself in medical settings.

When searching for compassionate and inclusive medical care, remember that you can interview physicians before you agree to an exam. Look for the following things in a size-inclusive provider:

• They do not believe that you can judge health based on weight.
• They do not believe that you can judge nutrition based on weight.
• They do not believe that you can judge activity level based on weight.
• They do not advertise weight-loss services.
• Chairs are size inclusive, with armless options available.
• Appropriately sized blood pressure cuffs are available.
• Stepping on the scale is not pressured or required during appointments.
• They believe in enjoyable movement, not exercising to change your body.
• They believe in eating for well-being, not to change your body.
• They are respectful of your boundaries and treat you with kindness.
• Consent is valued as integral to quality medical care.
• They understand trauma and how to provide trauma-sensitive care.
• They understand the harm caused by diet culture.
• They understand eating disorder recovery and are sensitive to the needs of people in recovery.
• They value mental health as integral to overall health.

Consider having a few pocketed responses for troubles you might encounter in a non-HAES medical environment. For instance, you might say, “I don’t do that,” when asked to step on the scale. Or, if your provider is suggesting weight-loss as a treatment, you might ask them what treatments they would prescribe to a thin person with the same diagnosis. You are also free to get dressed and leave a medical appointment at any time.

You might also consider your self-care strategies in advance. Perhaps you can schedule an appointment with a therapist or coach for immediately following your appointment. Maybe you can bring an HRV biofeedback device with you, to help ease stress and increase your ability to advocate for yourself. If you have a service animal, maybe ask for some deep pressure therapy or focus on doing tasks with them while you wait for the doctor and after you leave. Consider bringing a HAES-friendly loved one or friend as added support and as an additional person who might advocate on your behalf.

Also, if now is not the time for you to make that next medical appointment because of how past trauma is impacting you, know that you are not alone. Medical trauma is epidemic for those of us in fat bodies and it can take time to process your experiences with doctors and hospitals. Trauma-sensitive coaching with a HAES practitioner can help you navigate what you have experienced. So can modalities like HRV biofeedback, where you learn to transform stress into resiliency, or neurofeedback, where your brain processes trauma without revisiting or retraumatization. Healing is possible for you, and you are worthy of a community of people who will support you on that journey.