Deciding to get help for trauma is usually the hard part. Working out who to approach comes second, and it matters more here than for most difficulties — because trauma work done badly, or too fast, can leave someone feeling worse than before they started.
This guide explains who does what, what trauma-informed actually means in practice, and what to ask before you begin. It applies whoever you choose to see.
First — is this urgent?
If you are in immediate danger, or the trauma is ongoing — you are still in the situation, still being harmed — then safety comes before therapy. Therapy cannot process something that has not stopped happening.
The short answer
- Ongoing distress, flashbacks, avoidance, feeling permanently on edge → a psychologist doing trauma-focused therapy
- Sleep and symptoms severe enough to need medication considered → psychiatrist, usually alongside therapy
- Symptoms after one identifiable event → trauma-focused therapy, often shorter work
- Difficulties going back years, tangled with relationships and self-worth → complex trauma work, which is slower and paced differently
What a psychologist does with trauma
Trauma therapy is not simply retelling what happened. Done properly it has stages, and the first is not processing at all — it is stability: sleep, managing overwhelm, and having enough capacity to approach difficult material without being flooded by it.
Only then does processing follow, using approaches such as trauma-focused CBT, EMDR, or parts work, chosen for the person rather than applied uniformly. A psychologist does not prescribe, and refers where medication may help.
When a psychiatrist should be involved
Medication does not treat trauma itself, but it can make the surrounding symptoms manageable enough that therapy becomes possible — severe insomnia, panic that will not settle, or depression heavy enough that nothing else can begin.
Many people do trauma work with a psychologist while a psychiatrist manages medication. That combination is common and sensible.
Also read: Psychiatrist vs psychologist in Nepal — who should you see? →
What trauma-informed actually means
The phrase appears on a great many websites, so it is worth knowing what it should mean in the room:
- You are never pushed to describe more than you are ready to describe
- Stability and coping come before processing, not after
- You can stop or slow down at any point, and saying so is welcomed
- The clinician watches for overwhelm and adjusts rather than continuing
- You are not required to relive the event in detail for the work to help
If a first session pushes you to recount everything immediately and you leave feeling worse, that is worth naming — with that clinician, or by finding a different one.
A note on EMDR
EMDR is a well-evidenced trauma therapy and is available in Nepal, though the number of fully trained practitioners is small. Full EMDR training is a formal, multi-level qualification, and there is a real difference between a clinician trained in it and one who is EMDR-informed.
It is entirely reasonable to ask which applies. It is also worth knowing that EMDR is one effective option among several — trauma-focused CBT and other approaches have good evidence too, and the right one depends on you.
Also read: EMDR vs talk therapy for trauma in Kathmandu →
Single-event trauma and complex trauma differ
Trauma from one identifiable event — an accident, an assault, a disaster — often responds to relatively focused work.
Trauma that ran for years, particularly in childhood or within a relationship you could not leave, tends to affect identity, trust, and how safe other people feel. That work is slower and needs a longer stabilisation stage. Being told this at the outset is a good sign, not a discouraging one.
Also read: Complex PTSD vs PTSD — the differences and treatment →
In the Nepali context
Some of what people carry here is collective rather than personal — the earthquake, the conflict years, migration and long separation. It is also common for trauma to present physically first: headaches, gastric trouble, sleep that will not come, so people spend months in medical investigation before anyone asks what happened to them.
A normal medical report does not mean the problem is imaginary. Keep any medical review going, and consider psychological support alongside it.
Questions worth asking whoever you book
- What is your training in trauma specifically?
- How do you decide when someone is ready to start processing?
- What happens in a session if I become overwhelmed?
- Do you work with complex or childhood trauma as well as single events?
- Can I slow down or stop, and how would that be handled?
- Would you refer me for medication if that seemed useful?
Where we fit
Bhatta Psychotherapy is one of the practices in Kathmandu doing trauma and complex-trauma work. We are psychologists: paced, safety-first trauma-focused therapy, DBT-informed skills before processing, and parts work where that fits. We do not prescribe, and refer to a psychiatrist where medication may help. English, Nepali, or Hindi; in person or by secure video.
We are one option among others, and if something else suits you better we will say so. If this sounds like the kind of care you are looking for, a short clarity call is a low-pressure way to find out whether we are a match.
Also read: Trauma and PTSD therapy in Kathmandu →