How to Talk to Clients About Trauma | Dr. Kate Truitt

Read Time: 8 minutes

There is a moment in the room that most trauma clinicians know well. Your client is halfway through describing something painful, and their voice starts to change. It gets tighter. Their eyes drop. They look up at you with a kind of pleading exhaustion and say some version of the same sentence I have heard several thousand times.

"I don't know what is wrong with me."

For a long time in my career, I answered that question in the ways I had been trained to answer it. I offered reassurance. I gave psychoeducation about the nervous system. I named what I was seeing in warm, professional language. None of it was wrong, exactly. But none of it was landing in the place the question came from, either. My client would leave the session still holding the same shame, still framing herself as broken, still waiting for me to confirm or deny it.

Somewhere in the second decade of this work, I started doing something different. Not because I read it in a book. Because I finally noticed that the shape of the question was doing more damage than any answer I could give to it.

What I want to share in this piece is a small shift in language that has changed more of my sessions than any other single move I make. It is not a technique. It is not a protocol. It is a different question, offered in the moment the old one arrives, and it opens a door that reassurance cannot.

Why "What Is Wrong With Me" Cannot Be Answered Without Doing Damage

The problem with the question is that its frame is already the wound. When a client asks what is wrong with them, they are not really asking. They are locating themselves inside a story where something has to be wrong, where the wrongness has to be found and named, and where the finding will produce either confirmation or dismissal. Both feel like harm.

If I answer the question directly and say "nothing is wrong with you," the client hears it as reassurance from someone who is either being kind or who has not really understood how bad it is. If I answer with psychoeducation about the nervous system, the client often hears an intellectual explanation that does not reach the felt sense of being fundamentally broken. And if I stay silent, or reflect the question back, the client often reads that as evidence that even I cannot quite name what is wrong.

The frame is the problem. And the frame runs deeper than the client's language. When someone asks "what is wrong with me," their amygdala is already firing around the possibility of being unworthy, unloveable, or fundamentally defective. Their body is preparing for the answer to confirm the worst. Fotopoulou and colleagues (2022) have mapped how threat prediction and affective state interact at the somatic level. What happens in the body while a client is bracing for that answer is not neutral. It is a small cycle of activation and shame, and it repeats every time the question comes up.

Answering the question in kind reinforces the shame. Not answering it feels dismissive. There is a third option, and it starts with asking a different question altogether.

Three Phrases I Use, and What They Do

Three specific phrases have earned their place in my session vocabulary. Not because they are clever, but because I have watched them do something in the room that other language does not. I offer them here with the understanding that language is idiosyncratic and clinicians should adapt what fits their voice.

"What is your brain trying to protect right now?"

This is the phrase I reach for most often when a client is in the middle of asking what is wrong with them. It does something specific. It moves the client out of the shame-organized question and into a curiosity-organized one, without dismissing the pain that produced the original question.

Neurobiologically, this matters. The shame-organized question activates limbic circuitry associated with threat and self-referential negative processing. The curiosity-organized question invites some engagement of the prefrontal cortex, particularly regions involved in observation and metacognition. Kredlow and colleagues (2022) mapped the prefrontal-amygdala circuits involved in this kind of top-down modulation. When we help a client shift from being inside the shame to noticing the shame, we are helping their brain access the neural equipment that can actually work with it.

The other thing this phrase does is offer the client a new identity in the conversation. Instead of being the broken one, they get to be the observer of their own brain. That shift, held over months, changes something about how they carry themselves in and out of session.

"Your nervous system is doing exactly what it was built to do."

This one is a corrective offering. I use it when a client is judging their own reaction to something, when they are angry with themselves for panicking, for shutting down, for crying at what feels like the wrong thing.

The phrase does two things at once. It decouples the client's identity from the response, which lowers the shame charge. And it points the client toward a specific reframe that has research support. The trauma-shaped brain is not malfunctioning, it is adapting. Leone and colleagues (2022) demonstrated that trauma-related predictive patterns are structurally protective, even when they are no longer useful. The system holds onto them because the cost of being wrong about safety is much higher than the cost of being wrong about threat.

When I offer this phrase to a client, I am not asking them to feel better about their response. I am giving them a different lens through which to see the response. The feeling can stay hard. The story about the feeling gets to change.

"Let's find out what your body is telling us."

The third phrase is the interoceptive invitation. It is the one I use when a client is stuck in their head, when the story is being told from a distance, when the words are coming out but the body has left the room.

This invitation is a delicate one, because interoception is not always available. Candia-Rivera and colleagues (2024) have shown that interoception, network physiology, and self-awareness are deeply interconnected foundations for a coherent bodily self. For clients whose interoceptive access has been shut down by chronic threat, "what is happening in your body right now" can feel like an interrogation. The word "us" matters. It positions the therapist as a companion in the discovery, not a demand for answers the client cannot yet give.

When this phrase lands, it opens the somatic channel. The client checks in. They report something. Maybe they cannot name it precisely, but they notice they are noticing, and that noticing is a data point their brain can use.

What to Do When the Reframe Does Not Land

I want to be honest about something. None of this language works with every client every time. There are seasons in a client's work when the pathology frame is the frame they need, and my job is to sit with them there until something else becomes possible.

I have watched the Brain Partnership reframe land beautifully with a client one week and get rejected the next. I have had clients tell me, gently, that "your nervous system is doing exactly what it was built to do" sounded to them like I was letting the world off the hook for what it had done to them. Both responses are legitimate. Neither is a failure of the reframe.

The clinical judgment is about timing. Language like this tends to land well when there is enough relational safety in place, when the client has some interoceptive access to draw on, and when the shame is not so acute that any reframe feels like invalidation. When those conditions are not yet present, the work is to build them, gently, over time. The language will still be waiting when the client is ready for it.

There is also a version of this that comes from the therapist's side. If I am tired, if my own nervous system is running hot, if I am reaching for the reframe because I cannot bear to sit with the client's shame for another minute, the reframe often does not land. Clients feel the difference between language offered from settled ground and language offered from the therapist's own overwhelm. When I notice I am reaching, I usually slow down before I speak.

A Note for the Clinician

The same three questions apply to us. When we catch ourselves at the end of a hard week asking some version of what is wrong with me for feeling this way, we can offer ourselves the same question we offer our clients. What is my brain trying to protect right now? What is my nervous system doing that it was built to do? What is my body telling me?

This work asks a great deal. It asks us to metabolize other people's overwhelm on our own physiology, hour after hour, and to do it while carrying the same news, the same prices, the same uncertain era our clients are living through. The reframe we offer clients is not something we deserve less than they do.

You are allowed to hold yourself in the same frame you hold them.

You belong here.

Dr. Kate Truitt, PhD, MA, MBA