Therapy for chronic trauma when survival has become a way of life
Chronic trauma is what happens when harm, threat or strain continues over months or years. Therapy for chronic trauma helps your system come out of long-term survival mode, slowly and on your terms.
Living through prolonged stress, whether a controlling relationship, ongoing discrimination, years of medical procedures, caregiving under pressure or repeated violence in your community, asks the body and mind to stay on guard for far too long. Many people cope remarkably well on the outside while feeling depleted inside. I offer trauma-informed care in New York that combines therapy, somatic practice, parts work and medication support where relevant.
“You became extraordinarily good at getting through. Healing asks a different question: what would it feel like to stop bracing?”
We approach that question carefully, because a system that has been on alert for years needs time to trust that it can rest.
What makes trauma chronic?
Chronic trauma is defined less by what happened once and more by duration and repetition: exposure to threat, harm or powerlessness that kept going.
Chronic trauma can occur at any age. It may stem from childhood, but it also arises in adulthood through an abusive or coercive partnership, a hostile workplace, long periods of housing or financial insecurity, repeated medical interventions, life in a conflict zone, or caring for someone through a long and frightening illness. It also includes systemic trauma: the cumulative weight of racism, homophobia, transphobia, misogyny and other forms of marginalisation that arrive not as one event but as a constant pressure.
When threat is ongoing, the nervous system adapts by staying ready. That might look like vigilance, irritability and insomnia, or like flatness, fatigue and disconnection. Over time these states can become the baseline, so that calm feels unfamiliar or even unsafe. Many people with chronic trauma are highly capable, responsible and admired by others, while privately running on empty.
Because the stress was long-lasting, the effects are often felt across many areas of life at once: physical health, concentration, relationships, sense of identity and hope for the future. Therapy for chronic trauma recognises this breadth. Rather than targeting one memory, it helps restore capacity across the whole system, step by step.
High-functioning survival
Some of the people I see for chronic trauma have built impressive careers, families and communities. Their coping is real and has served them. Yet underneath there may be chronic tension, digestive or pain problems, a sense of never being able to switch off, or an emptiness that achievement does not touch. Therapy can honour those strengths while making room for the parts of you that are exhausted.
Systemic and identity-based trauma
Ongoing discrimination is not simply a series of upsetting incidents. It shapes how safe you feel in public, at work, in healthcare and sometimes at home. I bring a feminist, LGBTQIA+ affirming and culturally curious perspective to this work, so you do not have to justify or explain why these experiences matter. Your context is part of the picture, not a side issue.
Medical and caregiving trauma
Years of hospital visits, invasive procedures, uncertain diagnoses or caring for a loved one through serious illness can leave the body braced and the mind on constant watch. These experiences are frequently overlooked as trauma. In therapy we give them the attention they deserve and help your system find moments of genuine rest.
When your body has been on guard too long
The effects of chronic trauma tend to build quietly. They may feel like personality traits or simply how life is. If several of these experiences sound familiar, therapy for chronic trauma may help you understand them as responses to prolonged stress, and begin to ease them.
- Feeling permanently tired yet wired
- Trouble relaxing even on holiday
- Emotional numbness or flatness
- Unexplained aches, tension or gut issues
- Difficulty concentrating or remembering
- Irritability that surprises you
- Withdrawal from people you care about
- A foreshortened sense of the future
- Feeling unsafe in ordinary settings
Restoring capacity, one layer at a time
Chronic trauma treatment is about widening what your system can hold. I combine approaches thoughtfully and keep checking in, so the work never becomes another thing to endure.
Collaboration and consent
You are a full partner in deciding what we focus on and how. I explain my reasoning, invite your feedback and adjust when something is not working. After years of having little control, experiencing real choice in therapy can be quietly powerful.
Window of tolerance
We map the range in which you can think and feel without becoming overwhelmed or shutting down. Somatic practices help you notice when you are leaving that range and return to it, gradually widening it over time.
Parts work
Chronic trauma often creates strong protective parts: the one who keeps working, the one who stays numb, the one who expects the worst. We get to know these parts respectfully, so they can relax their grip without you losing the strengths they provide.
Body and lifestyle care
Long-term stress affects sleep, digestion, energy and immunity. A comprehensive lifestyle evaluation helps us identify gentle changes, and we can discuss supplements that may support your system, reviewed for safety and interactions alongside any medication.
Medication support if relevant
For persistent insomnia, depression, anxiety or hyperarousal, medication can sometimes reduce the load enough for therapy to take hold. I assess carefully, prescribe conservatively and make any adjustment gradually, with close monitoring and your full involvement.
Meaning and context
We look at the social, cultural and political forces that shaped your experience. Placing chronic trauma in its wider context can relieve self-blame and help you reconnect with values, communities and a sense of direction beyond survival.
Why chronic trauma needs a slower approach
A system that has been under strain for years benefits from steady, layered care rather than intense breakthroughs.
Rushed approaches
- Diving straight into the worst memories
- Expecting quick resolution
- Treating symptoms in isolation
- Ignoring social and systemic context
- Asking you to tough it out
Paced, whole-person care
- Building stability before processing
- Allowing change to unfold over time
- Attending to body, mind and relationships
- Naming the forces that shaped your experience
- Making rest part of the treatment
Beginning therapy for chronic trauma
Every stage is shaped together, with room to slow down whenever you need.
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1
Free consultation 15 minutes
A short, private conversation to hear what has brought you here and what you are hoping for. You can describe as little or as much as feels right. We will consider together whether my paced, integrative approach to chronic trauma feels like a good fit.
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2
Whole-person assessment
We take time to understand your history, current stressors, physical health, sleep, relationships and support. If psychiatric symptoms are present, I assess them thoroughly and talk through the full range of options, from therapy alone to therapy alongside medication or supplements.
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3
Stabilisation and resourcing
We focus first on reducing overwhelm: finding grounding tools that fit your life, improving rest, and identifying the people, places and practices that help you feel even slightly safer. This phase builds the capacity needed for deeper work.
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4
Integration over time
As your capacity grows, we gently work with the experiences and patterns that keep your system on alert. Progress is reviewed regularly, and the work evolves with you, so that healing fits into your life rather than taking it over.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Chronic Trauma FAQs
What is the difference between chronic trauma and complex trauma?
The terms are often used together. Chronic trauma emphasises duration: stress or harm that continued over a long period. Complex trauma usually describes repeated, interpersonal trauma, especially where escape was difficult, and its wide-ranging effects on identity and relationships. Many people with chronic trauma also experience complex trauma. In therapy we focus on your actual experience rather than which label fits best.
Can chronic trauma develop in adulthood?
Yes. While some chronic trauma begins in childhood, many people experience it as adults through abusive relationships, workplace harassment, ongoing discrimination, long illness, caregiving or living in unsafe circumstances. The nervous system responds to prolonged threat at any age, and therapy for chronic trauma is designed to address these adult experiences directly.
Why do I feel exhausted all the time?
Living under prolonged stress keeps the body's alarm system running, which uses enormous energy even when you are sitting still. Exhaustion, poor sleep and low motivation are common results. Part of our work is understanding this physiology, ruling out other contributors where appropriate, and helping your system find genuine rest rather than simply pushing through.
How long does therapy for chronic trauma take?
Because chronic trauma built up over time, recovery is also gradual. Some people notice early improvements in sleep or overwhelm within the first months, while deeper change in self-perception and relationships can take longer. I review progress with you regularly and adjust our focus, so you always have a clear sense of direction.
Do you work with trauma caused by discrimination or oppression?
Yes. Systemic trauma, including racism, homophobia, transphobia, misogyny and xenophobia, is real and cumulative. I bring a feminist, LGBTQIA+ affirming and culturally informed lens to therapy for chronic trauma, so your experiences are understood in context. You will not be asked to defend whether something was serious enough to count.
Is medication useful for chronic trauma?
Medication cannot undo prolonged stress, but it may ease symptoms such as insomnia, persistent anxiety, depression or hyperarousal enough for therapy to become more manageable. I assess whether it might help, discuss benefits and side effects openly, and make any change slowly and collaboratively, with careful monitoring throughout.
Can I start therapy for chronic trauma while the stress is still ongoing?
Yes, and many people do. When the difficulty is still present, such as a long illness, caregiving or discrimination you cannot simply leave, therapy focuses first on support, protection and capacity. We look at what you can influence, what resources are available, and how to care for your nervous system in the meantime.
Let your system begin to rest
A free 15-minute consultation is a low-pressure way to see whether we are a good fit. We can talk about what you are carrying and what support might look like.