PTSD

It can arrive when nothing is happening. You are in the kitchen, on a train, halfway through an ordinary message, and your body is suddenly back there. The room you are in becomes less convincing than the place you survived. Your heart races. Your stomach drops. You may see it, hear it, or catch a smell that belongs to a moment that is supposed to be over.

Post-traumatic stress disorder can develop after an event, or a series of events, that were threatening or horrifying. What keeps it going is not the event itself but the way the memory has been stored. It sits in the mind unprocessed and poorly linked to time and place, so that fragments of it are triggered by ordinary cues and felt as a threat happening now rather than a thing that has already happened. Alongside this sit strong beliefs formed in the aftermath, about danger, about yourself, about whether the world can be trusted again.

When life has narrowed around what happened

Most people arrive having built a life around not being taken back there. You may avoid particular streets, certain conversations, or sleep itself, because the quiet is when it returns. The effort of staying away from the memory is part of what keeps it powerful, because the mind never gets the chance to file it as past.

There may be flashbacks, nightmares, a body that will not stand down, sudden anger, or a numbness that puts a pane of glass between you and everyone you love. Some people function well at work and come apart the moment the front door closes. Some do not call any of this trauma, because they have spent years telling themselves that other people had it worse.

A single event can do this. So can years of it: threat, coercion, violence, neglect, or a childhood home where you never knew, from one hour to the next, what was coming. When the harm was repeated and began early, the effects can reach into how you regulate emotion and how safe you feel with other people. This is sometimes described as complex PTSD. The treatment still begins in the same place.

How I work with trauma

My first trauma training came in NHS Child and Adolescent Psychiatry in Scotland, at the start of my career and before my work as a Consultant Cognitive Behavioural Psychotherapist, where the youngest patients taught me that the memory rarely arrives as a tidy story. Fifteen years of private practice have followed. So I will not rush you towards words you do not have yet.

NICE, which sets treatment standards for the NHS, recommends that adults with PTSD are offered individual trauma-focused CBT as a first-line treatment, as set out in the NICE guideline on post-traumatic stress disorder. The word to hold onto there is focused. Trauma-focused work does not mean being made to narrate the worst of it on day one. It means the therapy is organised around the memory and how it is held, rather than around it forever.

The early work is about the present: what pulls the trauma close, what your body has learned to brace against, and what you have quietly stopped doing to keep it at bay. We build enough steadiness that the memory can be approached rather than survived. When we do turn to it, the aim is to work through it with a clear reason for being there, so that it can settle into the past where it belongs, and so that the cues in your daily life stop reading as present danger. If you have opened and closed this page more than once because reading it tightens something in your chest, that is the memory doing exactly what it does, and it does not mean you are not ready.

Shame is often part of this. It may be about what happened, or about what you did or could not do in the moment, or about something you have never said aloud to anyone. That is ordinary territory in trauma work, not a thing to be tidied up before you bring it. You do not have to make it acceptable first.

Starting from where you are tonight

Therapy is not a substitute for medical assessment or treatment. I do not diagnose and do not prescribe. Sessions are fifty minutes, online, and usually weekly to begin with.

You do not need a polished account of what happened in order to make contact.