Big T vs Small T Trauma Therapy Options

What you need to know instead

I recently saw some social media posts on the “big T/ small t trauma” framework. While this framework has some merit, relying on it to find Big T vs small t trauma therapy options falls short of what’s needed to identify appropriate trauma counselling.

I recognize that the framework is still widely used since the counselling field does not have a unified perspective on trauma. You’ll see it in articles, hear it from counsellors, and find it in treatment centers. However, our knowledge about trauma is constantly evolving. We used to believe that we could only cope with trauma, but neuroscience and research on new trauma-focused approaches show that we can heal from it. In all my specialized trauma training, I’ve never encountered the big T/ small t trauma framework.

In this article, I want to explain why I consider the Big T/small t trauma framework problematic and why it’s not part of my practice. I’ll describe what I use instead and introduce trauma recovery options that go beyond this model’s limitations, providing a foundation for deeper healing.  

What is big T/ small t trauma?

Big T trauma is usually described as a major, life-threatening event like war, sexual assault, severe physical abuse, or natural disasters. Small t trauma is framed as “less severe” experiences and includes emotional neglect, chronic invalidation, bullying, relational instability, and systemic oppression.

On the surface, this distinction can sound reasonable. But in practice, it creates a hierarchy of suffering—and that hierarchy often leaves survivors of small t trauma questioning whether their pain is “enough” to matter. Therefore, there is a risk that the big T/ small t trauma framework invalidates their experience of trauma. In my practice, I believe that any experience of trauma is valid, independent of its label. What matters is your experience.

For many people, this framework doesn’t bring clarity—it brings doubt. Since I work with many people who have experienced chronic childhood neglect, emotional invalidation was generally part of their experience. The big T/ small t trauma framework risks feeding into this wound.

Trauma is not defined by the event

Trauma is not defined by what happened. Trauma is defined by how the nervous system experienced what happened, and whether there was enough support, safety, and regulation at the time.

Two people can go through the same event and have very different outcomes. One may integrate the experience with support. Another may develop long-lasting trauma responses.This is not a personal failure. It reflects how the human nervous system works.

When we focus too heavily on the event itself, we miss what actually matters: impact, meaning, your capacity to integrate at the moment, inner and outer resources.

That doesn’t make either response more or less valid, nor does it make one person weaker than the other. Whether an event or an experience becomes traumatic depends on a complex combination of inner and outer factors that are, to a large degree, beyond your control.

Big T/ small t model creates a hierarchy

The problem with the big T/ small t trauma framework isn’t that it tries to name different kinds of events that could potentially be traumatic. The problem is how it implicitly ranks them.

When we label some experiences as “small,” we unintentionally communicate that:

• They should be easier to get over.
• They shouldn’t cause significant symptoms.
• If they do, something must be wrong with the person.

Many survivors already carry deep shame. This framework often reinforces it.

Clients regularly say things like:

• “Nothing that bad happened to me.”
• “Other people had it worse.”
• “I shouldn’t still be struggling.”

These thoughts don’t come from nowhere. They are often reinforced—subtly or overtly—by how trauma is discussed.

Complex trauma is not “small”

Emotional neglect, chronic misattunement, psychological abuse, and relational instability are not minor stressors. When they happen repeatedly—especially in childhood—they shape the nervous system, sense of self, and capacity for safety. Research confirms that emotional abuse is just as damaging as sexual or physical abuse. These research results are not reflected in the big T/ small t framework.

There is no neutral nervous system exposure to chronic harm.

For a child, a caregiver’s emotional absence can be just as threatening as physical danger—because survival depends on connection.

Calling these experiences “small” minimizes their impact, even when the consequences are severe. The impact of emotional abuse and neglect can be as harmful as the impact of sexual and physical violence.

The big T small t framework often minimizes and invalidates the experiences of adults with childhood trauma orcomplex trauma. The traumatic impact did not come due to one event with a clear beginning and end, but an ongoing, continuous threat of emotional violence.

To learn more, check out my blog post “What’s the difference between trauma and complex trauma.”

The nervous system does not rank trauma

The nervous system doesn’t categorize experiences as Big T or small t. It asks one question:

“Am I safe?” “Or do I see a risk of danger or life-threat?”

If the answer is consistently “I am not safe,” the body adapts.

Those adaptations—hypervigilance, dissociation, collapse, people-pleasing, emotional numbing—are not signs of weakness. They are intelligent survival responses.

The duration that your nervous system is exposed to the threat matters. For single-incident trauma, there is a clear ending which can help with healing. For enduring conditions like abusive relationships or oppression, the continuous nature of the threat may keep the nervous system stuck long after the real threat is over (in context of oppression, this is more complex). Furthermore, the dynamics are more likely to be reactivated if you meet another person with abusive behaviours. Therefore, your recovery needs are likely to look different depending on what has happened to you which goes beyond traditional big T vs small t trauma therapy options.

How this framework affects survivors in trauma counselling

When therapists rely too heavily on the Big T / small t distinction to define trauma therapy options, several things can happen:

• Survivors minimize their own experiences
• Mental health professionals underestimate the depth of impact 
• Mental health professional may invalidate your experience of trauma or victim-blame you
• Their approach to healing focuses on insight rather than reconnecting with your body and your inner world
• Clients feel unseen, misunderstood, or “too much”

This is especially harmful for people with developmental, relational, or complex trauma, whose wounds often don’t come from one identifiable event. Most clients I work with experience symptoms of trauma, but can’t identify events (a magical survival decision of your brain to help you survive). In my own recovery, it took me years to identify that my childhood was shaped by complex trauma. Mainly because the mental health professional never helped me to identify what had happened to me and treated me through a pathological lens. Any form of healthy trauma counselling is non-pathologizing.

Many people with developmental, relational or complex trauma have learned to function at a high level while carrying significant internal distress. Their trauma is often overlooked precisely because it doesn’t fit a dramatic narrative.

Why talk therapy and CBT alone is often not enough for trauma recovery

Traditional talk therapies as big T vs small t trauma therapy options can be helpful for many things like processing emotions, meaning making or insight. However, for trauma—especially complex or developmental trauma—it is often insufficient on its own.

This isn’t because clients aren’t trying hard enough. It’s because trauma lives in the body and the nervous system, not just in thoughts or memories. Furthermore, trauma can lead to inner fragmentation, aka structural dissociations and a split into rational, survival-focused parts and emotional parts. Traditional talk therapy only works with the rational parts but doesn’t address the emotional parts, which are often hidden behind a wall.

Without addressing physiological regulation, traditional therapy can unintentionally:

• Ignore the body, where trauma is stored
• Reinforce self-blame (“I understand it, so why can’t I change it?”)
• Miss dissociation or shutdown
• Doesn’t go deep enough to heal how trauma affects body, mind, and emotions
• Usually overlooks nervous system dysregulation, failing to validate trauma
• Can inadvertently reinforce the rational parts’ control over the wounded parts
• Focuses on symptom management rather than trauma resolution
• Leave clients feeling as if they are forever broken

This doesn’t mean talk therapy or CBT can’t help to some degree. It means it works best when integrated with body-based and nervous-system-informed approaches. Therefore, trauma counselling is a specialized approach to heal trauma.

A different framework beyond big T vs small t trauma therapy options

If the big T/ small t trauma framework doesn’t adequately explain trauma or approaches to trauma recovery, the next question is an important one: what does?

A more useful lens looks at trauma through the nervous system, attachment, and meaning-making, and at the symptoms you are experiencing right now and how they affect your life — rather than through the perceived severity of an event. This shifts the focus from what was the event to what changed inside the person as a result.

From this perspective, trauma-focused work is less about categorizing events and more about understanding patterns. It may explore questions like:

• Did you have trauma due to one or a few events or enduring conditions, i.e. abusive environments?
• How did your nervous system adapt in order to survive? What symptoms of dysregulation do you notice in your daily life?
• What patterns of inner fragmentation do you notice (e.g. self-hatred, suicidal parts, parts that use substances, shut down, overwhelming emotions)? To learn more, listen to the episode Parts work therapy to heal trauma.
• How were safety and connection in relationships disrupted? How often are you in safety and connection today? (To explore more, tune into the episode Polyvagal theory for trauma. )
• How was your relationship with your caregivers in your childhood? Were they able to teach you co-regulation, or were they either frightened or frightening? What attachment style did you develop as a result?

This approach doesn’t require proving that something was “bad enough.” It starts from the assumption that if you notice unhelpful patterns, these experiences deserve care and curiosity.

Trauma responses are adaptations, not pathologies

Instead of viewing trauma responses as flaws and “what is wrong with you,” recognize them as adaptive strategies shaped by your circumstances. Shifting to curiosity is the first step toward real healing. Your experiences matter; healing is possible, and you deserve support that honours your unique journey.

A trauma-informed lens sees them differently. It moves to “what has happened to you?”

If I work with my clients, we usually find out that they developed for a reason. Substance use may have helped to regulate a dysregulated nervous system. A people-pleasing part may have helped to survive since it was impossible to escape the caregiver. Many stigmatized symptoms of trauma may not be helpful in the present, but they helped the individual survive extreme circumstances. They are evidence of survival, not dysfunction.

Healing, then, isn’t about forcing these responses to disappear. It’s about helping the individual safely reconnect with their inner experience and managing their responses so they feel empowered.

The actual types of trauma I use instead of big T, small t trauma

The actual types of trauma I work with are:

• Shock trauma – single incident overwhelming events
• Developmental trauma – trauma during critical developmental periods, aka Adverse Childhood Experiences (ACE’s)
• Complex trauma – repeated, chronic traumatic experiences
• Relational trauma – trauma within relationships
• Systemic trauma – trauma due to systemic violence and oppression
• Intergenerational/historic trauma – effects of a traumatic event (like abuse, war, genocide, or systemic oppression) experienced by one generation are passed down to their children and grandchildren, impacting their emotional, psychological, and even biological well-being.
• Vicarious trauma – trauma from witnessing or hearing about others’ experiences

Even with types of trauma, I acknowledge that some people experience a combination of different types of trauma. Furthermore, it takes time to really sort out what type of trauma has impacted you. For example, I have experienced complex trauma consisting of a combination of developmental, systemic and historic trauma. Your recovery journey may look different depending on what has happened to you.

The non-negotiable: Working with the autonomic nervous system

Here’s what all effective trauma approaches have in common: they must work with the autonomic nervous system.

Trauma is stored in the body and nervous system. Any therapy approach that ignores this fundamental truth will fall short. Whether you’re doing EMDR, IFS, somatic experiencing, or another modality, the work must include:

• Nervous system regulation
• Body awareness and somatic processing
• Working with the window of tolerance
• Integration of body, mind, and emotions.

Deep down, any form of trauma recovery requires working with body, mind and emotions. Trauma affects all these dimensions, and healing must address them all.

Beyond big T vs small T trauma therapy options: Trauma recovery that actually works

For your trauma recovery, the trauma counselling approach needs to respect your goals, what has happened to you and how it shows up in the present.

Matching trauma counselling to trauma complexity

For single-incident trauma (shock trauma):

EMDR or IFS can be effective as standalone approaches when someone has:

• Trauma due to a single or a few incidents
• Secure attachment or earned secure attachment
• Explicit memories of the event
• While some level of dysregulation is present, they have existing self-regulation skills.

If you’re wondering which approach is better for you, I’ve written a detailed comparison: IFS or EMDR: Which One is Better for Trauma Recovery? Both can work—it depends on what happened to you and your individual needs.

For complex and relational trauma:

The more complex your trauma, the more you’ll benefit from a multimodal approach that combines:

• Parts work therapy (like Internal Family Systems) to address fragmentation and inner conflicts
• Somatic approaches to work with the body’s stored trauma
• Attachment repair and relational healing
• EMDR for processing specific traumatic memories when your system is prepared enough
• Working with boundaries and learning to discern toxic from healthy relationship patterns

To explore more beyond big T vs small t trauma therapy options, check out my guide: EMDR or IFS for complex trauma: Why multimodal works best .

Big T vs small t trauma therapy options: Conclusion

Overall, the big T small t frameworks aren’t fully aligned with the evolving definition of trauma. Furthermore, it risks invalidating the experience of people with developmental, complex, systemic and historic trauma. Additionally, it is more useful to evaluate the effects of trauma on your life right now and find the appropriate approach for trauma recovery that suits your needs. The more complex your experience, the more likely you are to benefit from a multimodal approach that draws on modalities such as EMDR, parts work therapy, and somatic approaches.

If you’re exploring trauma recovery options and want help identifying which approach might serve you best, I offer a free consultation to discuss your unique situation. If this resonates, you can book one via my online booking system here.

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