Hello, fellow clinicians supporting individuals through trauma.
Let’s talk about something important: what happens between therapy sessions? Especially when flashbacks, nightmares, or emotional flooding show up. If you’re working with trauma survivors, you know the journey isn’t always smooth. The deeper clients go in their healing, the more intense their symptoms can become.
This is why it’s essential to set expectations early. Whether it’s during the intake, assessment, or first few sessions, be honest with your clients about the reality of trauma work: the closer we get to the pain, the more likely it is to stir up old wounds.
That doesn’t mean therapy is making them worse. It means they’re finally accessing the things they’ve worked so hard to bury.
Your job is to prepare them for that.
Educating Clients on What to Expect
As clinicians, we sometimes assume clients know what therapy involves. But they didn’t go to school for this, we did. For many clients, you are their first experience with mental health care. So you have to walk them through it.
Think about how frustrating it is when your own doctor doesn’t warn you about medication side effects or what recovery will feel like after a procedure. You leave confused, scared, and unsure if what you’re experiencing is normal. The same applies to therapy, especially trauma therapy.
Let your clients know:
- Flashbacks, nightmares, and heightened startle responses may increase temporarily
- They may become more emotionally sensitive or hyper-aware of their surroundings
- Old memories or physical sensations might resurface
But don’t just list symptoms, explain what those things mean, why they happen, and how to handle them.
Saying “you may experience sensory triggers” isn’t enough. Say:
“You may notice loud noises that feel more intense or that certain smells remind you of past experiences. If that happens, here are a few ways to ground yourself…”
Grounding Clients in Reality, Between Sessions
Flashbacks often don’t happen neatly during sessions. They come up between sessions, when the client is alone, overwhelmed, and unsure how to cope. That’s why equipping your client with tools early is essential.
Some effective between-session techniques include:
- Grounding exercises (5-4-3-2-1, holding an ice cube, describing surroundings aloud)
- Self-soothing strategies (comfort objects, calming music, movement)
- Mindfulness tools (breathing techniques, guided meditations, sensory regulation)
These aren’t one-size-fits-all. Not every client will respond the same way to trauma or to the tools you provide. Some clients with PTSD may have vivid flashbacks, while others may dissociate or feel numb. Tailor your support to their responses, and always keep space open for adjustments.
It’s also okay to say:
“You may not feel this way, but some clients do. Just in case, here are a few ways to handle it. And if anything comes up, we’ll talk about it next session.”
This kind of warm, proactive preparation builds trust. It helps your client feel less afraid of what might come up and more confident in your support.
Build Safety from the Start
Therapy is sacred work. For trauma survivors, safety and trust don’t come easy. Their survival instincts have taught them not to trust, so just being in the room with you is a leap of courage.
That’s why we have to build safety into the therapeutic process early on:
- Discuss what to expect emotionally
- Explain that symptoms may get worse before they get better
- Schedule follow-ups or check-ins consistently to create a sense of continuity
- Remind them that therapy is a process, and that you’re walking with them
Every time a client returns, they’re choosing to trust you again. Let’s honor that by giving them the tools to handle the in-between.
Because therapy isn’t just about what happens in the room, it’s about how we help clients carry what they’ve learned when we’re not with them.
