I am an early-career adult psychiatrist working across both the public and private sectors in Australia. In my private work, I provide trauma therapy, primarily within an EMDR framework, and draw flexibly on a range of psychological approaches as needed. I continue to learn, and have found that working pragmatically in this way suits my patients. In the public system, I have also tried to incorporate trauma-informed and trauma-focused work where possible. This has been difficult because of time, experience, and system constraints, but it has been a worthwhile attempt.

I began my psychiatric career with little exposure to psychotherapy, and an early experience that made me cautious about trauma therapy. Within my first few weeks as a PHO on an acute inpatient ward, I witnessed a previously well-functioning woman become acutely psychotic after beginning trauma exploration around her retirement. She required admission to HDU and multiple seclusions. At the time, my reaction was simple: trauma therapy felt dangerous, while medication felt safe and effective.

Soon after, I began to notice other limitations. One of my first confident prescriptions was an SSRI for a young person with social anxiety disorder. The patient disengaged after two sessions, and I never saw the outcome. I do not even know how long the medication was taken. Another patient, with a common diagnosis, told me she did not want to continue medication or see me, preferring instead to work with a psychologist. I remember feeling unsettled, wondering what a psychologist could offer that I, as a compassionate doctor, could not.

Over time, these experiences accumulated. I began to see the limits of a practice centred mainly on diagnosis and prescription, and the need to incorporate other approaches. 

During my consultation–liaison term, I met patients whose presentations did not fit neatly into diagnostic categories. I often struggled to know what, if anything, to prescribe. Yet many of these patients valued the meetings, and some showed symptom improvement or greater engagement with their home team after what was essentially “talking”. This drew me towards different therapy approaches and a curiosity about how they work.

It took me some time to understand what psychotherapy does, and how it works differently from medication. As I learned more, I realised I needed to combine therapy with my medical role. On a supervisor’s suggestion, I trained in trauma therapy, starting with EMDR, for which I remain grateful. Some of my early limited trials, even as a registrar in the public system, led to positive clinical outcomes. These experiences made me decide to stay in the public sector after my Fellowship. I wanted to continue developing my skills with a complex group of patients. Many carry significant trauma histories but have limited access to trauma-focused therapy.

I have only been able to do trauma therapy opportunistically and usually limited to brief interventions. Clinically, I have seen benefits across a range of presentations, often treatment-resistant with routine approaches. These include psychotic disorders with trauma backgrounds, PTSD and complex PTSD, OCD, body dysmorphic disorder, and depressive disorders. Not all improvements came from formal trauma processing. Some came from better engagement, a trauma-informed perspective, and careful validation of patients’ experiences.

From a personal development perspective, trauma therapy has shaped how I practise psychiatry. It has given me another way of seeing the patient behind the diagnosis, deeper, or at least different. It has helped me understand what “trauma-informed practice” means, even when I am not offering trauma therapy itself. It has also made me more humble and collaborative, particularly in my work with psychologists and other allied health professionals.

There are, however, real limitations. Trauma therapy can cause harm if done poorly or without adequate support. Time constraints in public psychiatry mean I can do far less than I would like. Collaboration can be difficult when few colleagues' practise trauma therapy, and continuity of care is fragile when patients move between services.

Despite this, I will continue to incorporate trauma-informed work where clinically appropriate. It helps me feel that I am making a meaningful difference. At the same time, working with the most complex patients provides an excellent opportunity for me to develop as a trauma-informed practitioner. 

Would I recommend trauma therapy training to other public psychiatrists? I would suggest considering it if your curiosity about psychiatry feels unsatisfied by routine practice. Trauma work is hard to sustain within the constraints of the public system. However, it offers a different lens through which to understand our patients, allows for deeper engagement, and often strengthens the therapeutic relationship. Even when it cannot be done fully or formally, this way of working can restore a sense of meaning and professional satisfaction in our everyday psychiatric practice.