My approach to counselling and psychotherapy is person-centred and humanistic, because both approaches look at the whole person and their uniqueness. For me the optimal way to work with people is in an integrative way. It is important to focus on symptoms as clues but not to become mired in diagnosing or treating someone based on their symptoms alone. Many supposedly different conditions or groups of symptoms have the same root cause. Therefore it is much simpler and faster to treat the root cause, or causes.
In my experience the root cause is nearly always uresolved trauma (another root cause can be poor gut health), whether it manifests in physical or mental disease as per the famous ACE study* that has demonstrated how adverse childhood experiences (ACES) increase the rates of alcoholism, drug abuse, depression, suicide attempts, heart disease, cancer and many more besides.
My focus is on how people experience events rather than looking mainly, or only, at the events themselves. Nijenhuis and van der Hart (2011)** define trauma as a wound, in their words: “We do not understand 'trauma' as an event but as a psychobiological 'wound' evolved in relation to a variety of coupled psychological, biological, social, and other environmental factors".
In a recent course that I completed with psychologist Robert Rhoton, he used an excellent analogy. If you experience an event that complies with criterion A1, you might react by producing a cup of cortisol in your system, but someone else might have 20 teaspoons of cortisol a day with 'smaller' incidents, but they add up to a cup in just one day, if not more, and they are cumulative. They are day after day after day. This chronic repetitive trauma has ravaging effects that usually starts in childhood, but not always. However, the young developing brain is particularly vulnerable to the effects of traumatic stress.
The problem with emphasising events, as many psychometric tests do (particularly for trauma), is that it often results in the minimisation or the maximisation of someone's experience. The terms small t and big T trauma illustrate this perfectly. Trauma can be acute or chronic, but what really matters at the end of the day is whether you are traumatised or not, not what traumatised you.
It is my firm belief that everyone's experience should be taken seriously and respected. That way they get the help that they need. Everyone is different and therefore experiences the world differently. There really is no one size fits all approach, customisation is crucially important when it comes to any form of therapy. I don't think that trauma can be defined objectively, it can only be experienced subjectively.
* Felitti & Anda et al. (1998), Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, American Journal of Preventive Medicine, 14(4), 245-258. More research can be found here.
** Nijenhuis, E. R. S. and van der Hart, O. (2011). Dissociation in trauma: A