The Hidden Layers: A Therapist's Guide to Understanding Trauma

"Trauma creates change you don’t choose. Healing is about creating change you do choose."

— Michelle Rosenthal

There is a common metaphor used to describe a complex situation, the onion metaphor. Just like an onion has many layers, many of which cannot be seen until you peel back the layer above, so too there are situations when you can only understand their true complexity once you start peeling back the more outer, or obvious layers.

In short, sometimes what you see is merely the surface, and there is a lot more going on underneath.

When it comes to trauma, the onion metaphor is very apt. Often to the untrained eye, the “WHAT” part of the trauma is the only thing that is important.

What? - hit by a car

What? - bitten by an animal

What? - mugged at gunpoint

However, we fail to realize that in all of the above cases, there may still be more underneath the surface.

I learned this first hand from a doctor after a personal injury that was due to my own personal incompetence.

I cut my finger badly when I was preparing soup. I rushed to the hospital to get it stitched up.

Ten days later, when I needed to see the doctor about the injury, he asked me how it happened.

“I cut myself” and “I was being careless” were insufficient answers for him.

Growing agitated by his need for me to rehash the exact nature of my injury, I finally said all, including the fact that the injury occured when I was cutting a sweet potato.

This satisfied the doctor, who then shared that it is always important to get all the information. Had the injury occured whilst cutting raw meat or fish, then bacteria would be a concern.

So the “WHEN” i.e. the cutting of the potato, was very important to the story of the cut finger.

As a trauma therapist, it is my job to slowly and methodically guide the client through all the different layers of their traumas.

Whether the trauma is physical, emotional or sexual, the “HOW”, the “WHO”, the “WHERE”, the “WHEN” and the “WHY” can be important contributors to the “WHAT”.

Let me use a sexual assault as an example.

To the untrained eye, they might only see the “WHAT”, which is obviously the sexual assault.

But the others might also play key roles in understanding the trauma that this person is suffering.

“HOW”: Were they manipulated? Were they drugged? Was there a weapon used to threaten?

“WHO”: Was it a stranger? Relative? A respected individual who abused their position of trust?

“WHERE”: Was it in public? In their school? In their own home?

“WHEN”: Was it on a special day? E.g. if this occurred on their birthday, they might view their birthday very differently from now on.

“WHY”: Was it known that the perpetrator had a history of abuse but it was hidden by the community? Were there obvious signs of grooming that went ignored by parents and trusted adults?

Ultimately, the onion metaphor is a symbol of how cases of trauma are always more than meets the eye. What appears on the surface, the "what," is often just one piece of a much larger puzzle. By exploring the other layers, the "how," "who," "where," "when," and "why," clinicians can guide the clients to understand the true depths of both the client’s experience and struggle.

Peeling back these layers of trauma might be excruciating for some, but it’s also where the transformation happens. Each layer we uncover is a step toward reclaiming power, meaning, and connection. Healing doesn’t come from rushing past the pain, it comes from understanding it, one layer at a time.