By Annie Wright · Licensed Marriage & Family Therapist (#95719)Clinically reviewed July 2026What Therapy for Trauma Actually Looks Like (A Realistic Guide for Driven Women)
LAST UPDATED: JULY 2026
Marina had been thinking about therapy for six years. She’d known she needed it the way you know you need to see a dentist about the tooth you’re avoiding chewing on. This guide explains what trauma-informed therapy actually involves: what the first sessions look like, which evidence-based approaches have real research support, and why progress in trauma work rarely moves in a straight line. It’s educational, not a substitute for an individualized treatment plan from a licensed clinician.
- The Therapy Marina Kept Avoiding
- What Isn’t Trauma Therapy?
- Which Evidence-Based Approaches Actually Work for Trauma?
- Ready to Understand the Patterns Beneath Your Patterns?
- What Do the First Sessions Actually Look Like?
- When Therapy Feels Like a Performance, Not a Process
- The Systemic Lens: Why Do Driven Women Resist Therapy?
- What Should You Expect in the Early Sessions?
- Both/And: Capable and in Need of Support
- How Do You Find the Right Therapist?
- What Does Progress Actually Look Like?
- Frequently Asked Questions
Trauma therapy is a structured clinical process that works with the nervous system, attachment patterns, and implicit memory, not just the story you can tell about what happened. Evidence-based approaches like EMDR, Somatic Experiencing, AEDP, and IFS work at the body and relational level, not only the narrative level. Progress isn’t linear. Sessions can feel activating before they feel relieving. In my work with driven women, the hardest part usually isn’t the therapy itself. It’s tolerating a healing arc that doesn’t move on the same schedule as a project deadline.
In short: Trauma therapy works at the nervous system and attachment level through evidence-based approaches like EMDR and somatic methods, and progress is nonlinear, which is why it can feel so different from the problem-solving mode driven women are used to relying on everywhere else in their lives.
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I’ve guided clients through trauma therapy across more than 15,000 clinical hours, and the mismatch between what people expect (linear progress) and what actually happens (a spiral, with setbacks built in) is usually the first thing I need to name out loud. Bessel van der Kolk, MD, psychiatrist and trauma researcher, documented that effective trauma treatment has to engage subcortical brain regions that top-down verbal processing simply can’t reach on its own, which is part of why body-based and relational modalities produce outcomes that talk therapy alone often can’t. This guide is educational. It’s meant to help you understand what trauma therapy generally involves, not to replace an individualized assessment from a licensed clinician who knows your specific history.
The Therapy Marina Kept Avoiding
Marina had been thinking about therapy for six years. She knew she needed it the way you know you need to see a dentist about the tooth you’ve been avoiding chewing on. Every few months, she’d open her laptop, type “trauma therapist near me,” scroll through a dozen profile photos, and close the tab. Her Notes app had a section titled “therapy???” with four names in it, none of them called.
She had her reasons lined up like a legal brief: too busy running a product team of thirty-one people, too expensive with uncertain insurance coverage, no clear way to tell a good therapist from a mediocre one. And some quieter part of her wasn’t sure it would actually help; if it hadn’t worked for the two friends who’d tried it, why would it work for her.
But the real reason, the one she didn’t say out loud to anyone, not even to her husband on the nights she almost brought it up: she was afraid of what she’d find if she finally sat down and looked.
Note: Marina is a composite character drawn from many driven women I’ve worked with over my 15,000+ clinical hours. Her story illustrates common patterns. It doesn’t expose any individual’s private history.
The fear Marina carried is extraordinarily common in driven women, and it isn’t irrational. Good trauma therapy asks you to slow down, to look inward, to feel things you’ve been successfully not feeling for years, sometimes decades. For a woman whose entire identity has been built around competence, productivity, and forward motion, that prospect can feel genuinely threatening. It’s not weakness that makes people avoid therapy. It’s a rational risk calculation made by a nervous system that has kept itself safe, so far, by staying busy.
My goal in this guide is to demystify what actually happens in trauma-informed therapy. Not to make it sound easier than it is, because it isn’t always easy. But to make it feel more understandable and less frightening, so that the decision to go, or not to go, is an informed one rather than a fear-driven one.
What Isn’t Trauma Therapy?
Let’s clear away some of the myths first, because they’re real barriers to entry for a lot of the women I work with.
Trauma therapy isn’t lying on a couch talking about your childhood for years while a silent therapist takes notes. That old Freudian caricature has almost nothing to do with contemporary trauma-informed care. Modern trauma therapy is active, collaborative, and focused, helping the nervous system heal in the present rather than excavating the past for its own sake.
Trauma therapy also isn’t about re-living your trauma in exhaustive, blow-by-blow detail. A common fear I hear from women considering trauma therapy is that they’ll be asked to relive their worst experiences in a way that overwhelms them all over again. That’s not how good trauma therapy works. The goal isn’t to re-traumatize you. It’s to help you process unprocessed material at a pace your nervous system can actually tolerate, and a skilled therapist won’t push you faster than your system can go.
And trauma therapy isn’t a sign of weakness. The internalized message for a lot of driven women is that needing help means you’ve failed at self-sufficiency. It doesn’t. Seeking therapy is one of the more intelligent, courageous moves a person can make, a recognition that the nervous system, like any complex system under sustained load, sometimes needs skilled outside support to recalibrate.
A therapeutic approach that recognizes the widespread impact of trauma, integrates that understanding into every aspect of treatment, and works to avoid re-traumatization while building safety, trust, and a sense of agency for the client.
In plain terms: It’s a way of doing therapy that starts from the premise that a lot of what looks like a personality trait or a character flaw is actually a trauma response, and that healing requires building safety before anything else. It’s the opposite of pushing through.
Which brings up a question I hear constantly from women like Marina: if trauma therapy isn’t what pop culture suggests, what does the research actually say works?
Which Evidence-Based Approaches Actually Work for Trauma?
There are several evidence-based approaches to trauma therapy with real research support behind them. Understanding what they are, and what they actually involve, can help you make an informed choice about what might fit you.
A psychotherapy approach developed by Francine Shapiro, PhD, psychologist and originator of EMDR, that uses bilateral stimulation, typically eye movements, though sometimes taps or tones, to help the brain process traumatic memories that have become “stuck” in the nervous system (PMID: 11748594).
In plain terms: It’s a therapy that uses a specific protocol to help your brain process traumatic memories that got stored in a fragmented, dysregulated way. It isn’t hypnosis, and it doesn’t require you to narrate your trauma in exhaustive detail. A lot of my clients find it surprisingly efficient. Not painless, but efficient.
I read Dr. Shapiro’s original research years into my own clinical training, and what stayed with me wasn’t the mechanism itself, it was how consistently it worked for clients who’d spent years in talk therapy without much movement. EMDR is one of the most well-researched trauma treatments available, with strong evidence for treating PTSD and complex trauma. It works by activating the brain’s natural information-processing system, the same one that processes experience during REM sleep, allowing traumatic memories to be integrated rather than left frozen in the nervous system.
A body-oriented approach to trauma therapy developed by Peter Levine, PhD, that focuses on the physiological dimensions of trauma, working with the body’s sensations and impulses to complete defensive responses that were interrupted during the original traumatic experience (PMID: 25699005).
In plain terms: It’s a therapy that works with the body, not only the mind. Instead of focusing mainly on the narrative of what happened, somatic work engages the physical sensations, impulses, and responses trauma left behind in the body. It’s particularly effective for trauma that shows up as chronic tension, hypervigilance, or shutdown, the kind that talking about doesn’t seem to touch.
What Dr. Levine’s work documents is exactly the pattern I see in driven clinical populations: women who can narrate their history fluently and still startle at a raised voice or freeze at an unexpected email from their boss. Their thinking mind understands. Their body hasn’t gotten the memo yet.
An attachment-based, emotion-focused model developed by Diana Fosha, PhD, psychologist and founder of the AEDP Institute, that helps clients access and process core emotion in the felt safety of the therapeutic relationship, rather than only discussing it intellectually.
In plain terms: It’s a therapy that leans heavily on the relationship with the therapist itself as part of the healing mechanism, not just the backdrop for it. The idea is that certain wounds were formed in relationship and need to be metabolized in relationship, with a therapist who is actively, visibly attuned to you in the room.
A model of psychotherapy developed by Richard Schwartz, PhD, that conceptualizes the mind as containing multiple “parts,” sub-personalities carrying different roles, beliefs, and burdens, and works to build a relationship between those parts and the core “Self” (PMID: 37924221). You can read more in my piece on IFS and the protector parts that show up for driven women specifically.
In plain terms: It’s a therapy that works with the different parts of you: the part that drives, the part that shuts down, the part that’s still a frightened kid, the part that’s the harsh inner critic, and helps them work together instead of against each other. It’s especially well-suited to the fragmented self-experience that complex trauma tends to produce.
These approaches aren’t mutually exclusive. Many skilled trauma therapists integrate elements of several, tailored to the individual client’s nervous system and history. The most important factor isn’t the specific modality on the label. It’s the quality of the therapeutic relationship carrying it. Bruce Wampold, PhD, psychologist and one of the field’s most rigorous meta-researchers on psychotherapy outcomes, has spent decades documenting this exact finding: the therapeutic alliance accounts for more variance in outcomes than any single technique.
RESEARCH EVIDENCE
Peer-reviewed findings that inform this clinical framework:
- 52% of female academic physicians reported burnout, compared with 24% of male peers (PMID: 33105003), a disparity that tracks closely with the caseload of driven women who arrive in trauma therapy already depleted.
What Do the First Sessions Actually Look Like?
For a lot of driven women, the anticipation of therapy is worse than the reality. Here’s what the first sessions of trauma therapy typically look like, so you can walk in knowing roughly what to expect.
The first session is almost always an assessment. Your therapist will ask what brought you in, what you’re hoping to work on, and some background on your history. It isn’t an interrogation, and it’s the start of a collaborative relationship. You don’t need to arrive with your history organized or your language polished. You can say “I don’t know where to start,” and that’s a completely valid opening line.
The next several sessions typically focus on building safety and the therapeutic relationship itself, including your current coping strategies and support system. That’s not a judgment. It’s an assessment of what resources you already have before approaching harder material. This phase can feel frustratingly slow to driven women who want to get straight to the work, but it is the work. What you won’t be asked to do in the first session is relive your trauma in granular detail. If a therapist pushes you to do that in session one, that’s a red flag worth taking seriously.
Marina’s first session, when she finally booked it, looked almost nothing like what she’d braced for. She showed up fifteen minutes early to a rainy Tuesday appointment, laptop bag still slung over one shoulder from a board meeting, and spent the first ten minutes apologizing for not having “a clear goal” for therapy. Her therapist asked what she’d noticed in her body on the drive over. Marina blinked. Nobody had asked her that before. “Tight,” she finally said, touching her sternum. “Like I’m bracing.” That was the whole first session: naming what tight felt like, and why bracing had once made complete sense.
When Therapy Feels Like a Performance, Not a Process
Marlene had been in therapy twice before she came to see me. Both times, she’d left after a few months feeling vaguely worse than when she’d started, despite having been, by her own account, an excellent client both times.
Note: Marlene is a composite character drawn from many driven women I’ve worked with. Her story illustrates common patterns. It doesn’t expose any individual’s private history.
When I asked what those two experiences had been like, she described something I hear constantly from driven women: talk therapy that stayed almost entirely at the cognitive level, paired with a therapeutic relationship that felt more like a performance review than a genuine encounter.
“I’d go in and talk about my week,” she told me, turning her wedding ring around her finger the way she did whenever a session touched something real. “My therapist would reflect things back, ask good questions, and I’d leave feeling like I’d had a great conversation. But nothing was actually changing. I kept waiting to feel different and I never did.”
What Marlene was describing is common: therapy that’s helpful but not transformative, because it isn’t working at the level where the trauma actually lives. The trauma wasn’t in her thoughts about her childhood. It was in her nervous system, in automatic patterns running her life below the threshold of her extremely capable conscious mind. Talk therapy alone couldn’t reach it.
The second issue, the performance, is equally common. Driven women are extraordinarily skilled at being good clients: doing the homework, articulating the insights, showing up cooperative and engaged, sometimes for years, without ever being genuinely vulnerable. A relationship that feels like a performance is usually one where the therapist hasn’t yet built enough safety for the client to be actually present, rather than skillfully performing presence.
When Marlene and I began working together, I made a deliberate choice to bring the body into the room: to slow down, to notice what was happening in her nervous system moment to moment, to build the conditions for a genuine encounter instead of a skillful one. It was uncomfortable for her at first. She’d spent forty-seven years more at home in her head than in her body, and I could see her want to narrate her way past the discomfort the way she narrated everything else. But something began to shift over time. Not in her thoughts about her history. In her actual felt experience of herself, sitting in a chair, in real time.
“Chronically traumatized people are continually hypervigilant, anxious, and agitated… The women remained vigilant, unable to relax or to sleep.”
Judith Herman, MD, psychiatrist and author of Trauma and Recovery
I’ve come to think of what Marlene was doing as the good-client trap: the pattern where a woman’s competence at therapy itself becomes the thing standing between her and the therapy working. It shows up almost weekly in my caseload of driven, articulate women, and it’s not a character flaw. It’s the same over-functioning that made her a partner-track attorney by forty, applied to the one room where over-functioning quietly gets in the way.
The Systemic Lens: Why Do Driven Women Resist Therapy?
The resistance driven women feel toward therapy isn’t only personal; it’s cultural and systemic, and treating it as purely an individual failing misses half the picture.
We live in a culture that pathologizes needing help and valorizes self-sufficiency. The message to driven women has long been: you’re capable, you’re strong, you can handle this yourself. Needing therapy becomes, inside that framework, evidence that you’re not as capable as you appear. That message lands in a Tuesday-afternoon way: it’s the reason a woman like Marina will spend forty minutes finding a therapist’s website, then close the tab because she has a 2pm she can’t reschedule.
This message lands with particular force for women of color, who’ve often been told, explicitly or implicitly, that the luxury of mental health support isn’t available to them, that they need to stay strong for their families and communities. Cultural archetypes like the “strong Black woman” or the “model minority” function as a kind of cultural gaslighting: they deny the reality of emotional need and turn asking for help into something that feels like betraying an identity you worked hard to build.
There’s an economic dimension too. Quality trauma therapy is expensive, and insurance often doesn’t cover it, or covers it inadequately. That’s a genuine barrier worth naming as a systemic failure rather than a personal one. The inaccessibility of mental health care is a public health crisis with a price tag attached, not a personal budgeting problem.
And there’s the time dimension. Driven women are busy managing careers, families, and communities, and finding an hour for weekly therapy can feel like an actual impossibility, not a scheduling inconvenience. But the time you spend in therapy isn’t time subtracted from your life. It’s time invested in your capacity to run the rest of your calendar without your body paying the interest on it.
Marlene once told me she’d calculated, almost as a joke, how many billable hours a year of weekly therapy “cost” her. I asked her to calculate something else: how many hours she’d spent managing dysregulation she hadn’t yet addressed, the sleepless nights before depositions, the spirals after an email from her mother. She didn’t finish the math out loud. She didn’t need to.
What Should You Expect in the Early Sessions?
One of the most common sources of anxiety about starting trauma therapy is not knowing what to expect. The unknown is uncomfortable for anyone, and particularly for driven women accustomed to walking into rooms prepared.
The first several sessions are primarily about assessment and relationship-building. A good trauma therapist will want to understand your history, symptoms, goals, and experience of any previous therapy. They’ll be listening not just to what you say, but how you say it: what you emphasize, minimize, or route around without noticing. You won’t be asked to dive into your trauma right away. Rushing into trauma content before the relationship is solid isn’t good practice; it can be retraumatizing.
You may feel, in the early sessions, like nothing is happening. That feeling is common and not accurate. Being genuinely listened to and taken seriously isn’t preliminary to the work. It is the work, quietly, before it has a name. You may also, at some point, feel worse before you feel better, which is often a sign the work is landing rather than a sign it’s failing. The timeline varies depending on the nature of the trauma and the modality in play. Some people experience meaningful shifts in months; others work in therapy for years. What matters is that you’re moving, however slowly, toward more freedom rather than less.
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Both/And: Capable and in Need of Support
Here’s the Both/And at the center of this guide: you are both extraordinarily capable and in need of support. Both are true at once, and they aren’t contradictions, even though they can feel like ones.
The capacity that’s gotten you this far, the resilience, the drive, the ability to manage complexity and keep moving when other people would have stopped, is real, and it’s yours. Nobody is asking you to hand it over or dismantle it. It’s also true that this capacity was often built, in part, on a foundation of unprocessed pain, and that foundation is allowed to need attention now. Not because you’re broken. Because you’re human.
Asking for help isn’t a failure of capability. It’s an expression of it. It takes real courage to walk into a room and say: I need support. I don’t have this fully handled. That courage isn’t weakness dressed up as an admission. It’s one of the more honest things a person can do, especially one whose whole professional identity runs on looking unshakeable.
It’s also possible to be skeptical about therapy and try it anyway. You don’t need to believe it’ll work before you walk in. You only need to be willing to show up and see what happens. Of course it feels risky to hand a stranger the parts of yourself you’ve spent years managing alone. You’re not being dramatic. You’re responding sanely to something that genuinely asks a lot of you.
Marina told me, months into our work, that the hardest part hadn’t been any single session. It had been the six years of deciding, over and over, not to go. “I thought I was protecting myself,” she said. “I was mostly just delaying the thing I actually needed.”
How Do You Find the Right Therapist?
Finding the right therapist is one of the more consequential decisions you can make for your healing, and it deserves real attention rather than a five-minute directory search.
Look for a therapist specifically trained in trauma work, not just a general therapist who “does some trauma work” on the side. Ask directly about their training in EMDR, Somatic Experiencing, AEDP, or IFS, and don’t be shy about wanting a real answer.
Look for a therapist who works at the pace of your nervous system rather than the pace of a treatment plan template. A good trauma therapist won’t push you faster than you can go. They’ll stay attuned to your level of activation and adjust the work accordingly. If a therapist pushes you deeper before you feel safe, that’s a sign the fit may not be right, not a sign you should try harder.
Look for a therapist with whom you feel genuinely seen, not merely skillfully reflected. The most important question isn’t “does this therapist use the right techniques on paper?” It’s “do I actually feel safe in this specific person’s presence?” Marlene told me she’d known within ten minutes of our first session something was different: she’d stopped performing sooner than she expected to.
It’s also worth knowing that it’s completely acceptable to try more than one therapist before finding the right fit. The first therapist you see doesn’t have to be the right one. Finding the right therapeutic relationship can take some searching, and that searching is worth doing rather than settling.
What Does Progress Actually Look Like?
Progress in trauma therapy doesn’t look like a steady upward line. It looks more like a spiral. You revisit the same material at different depths, and each time, you have more capacity to hold it than you did before.
Progress looks like noticing the pattern before you’re fully inside it. Like having a reaction and being able to say: I know what this is. I know where it comes from. Like the gap between trigger and response widening, just slightly, so there’s a moment of choice where before there was only reflex.
Progress looks like the body beginning to feel safer: chronic tension in your shoulders starting to ease, sleeping better, being able to sit still without the anxiety that used to make stillness feel impossible. It looks like relationships beginning to shift, asking for what you need without the terror that asking will cost you the relationship, tolerating conflict without shutting down or exploding.
And it looks like moments of genuine aliveness starting to appear, when you’re fully present and not performing or managing or running. Those moments are the goal, and they’re possible, not as a permanent state (healing isn’t a finish line) but as an increasingly familiar visitor.
Progress also looks like your relationship with yourself changing. The inner critic that’s been running at full volume starts, slowly, to quiet down, not because you silenced it through willpower, but because you’ve begun to understand where it came from. The self-compassion that felt impossible at the start of therapy begins to feel, gradually, more like your actual voice and less like a performance of self-care.
Marina, a little over a year in, described it this way: “I still have the drive. I still like winning. But I don’t feel like I’m outrunning something anymore.” That’s not a universal outcome; it’s one composite picture of what sustained work can look like, not a promise. What I can say with more confidence is what the process itself is designed to do: help your nervous system tell the difference between the past and the present, so your reactions have a chance to match what’s actually happening now.
If you’re wondering whether therapy is worth starting, here’s what I can offer honestly, without promising an outcome I can’t guarantee for a specific person I haven’t met: trauma therapy is a well-researched, structured process that a great many driven women find genuinely worth the discomfort of beginning. Whether it’s worth it for you, specifically, is something only you and a licensed clinician who knows your history can assess together.
This article is educational and does not constitute individualized clinical advice or a treatment recommendation. If you are in crisis, contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
If what you’ve read here resonates, know that individual therapy and executive coaching are available for driven women ready to do this work. You can also explore self-paced recovery courses or schedule a complimentary consultation to find the right fit for you.
Warmly, Annie.
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Q: How do I know if I need trauma therapy specifically, or just regular therapy?
A: If you notice patterns that repeat, reactions that feel disproportionate, or a sense that your past is running your present, trauma-informed therapy is likely to be more effective than general talk therapy. The key is finding a therapist who works at the level of the nervous system, not just the narrative mind.
Q: How long does trauma therapy take?
A: This varies depending on the nature and extent of the trauma, the individual’s nervous system, and the modality used. Some people experience shifts in twelve to twenty sessions of EMDR. Others work in therapy for years on complex developmental trauma. Any therapist who gives you a definitive timeline in session one should be approached with caution.
Q: Will therapy make things worse before they get better?
A: Sometimes, temporarily. As you begin to process suppressed material, there can be a period of increased emotional activation. This is normal, and a skilled trauma therapist will help you manage it at a pace that’s challenging but not overwhelming.
Q: What if I can’t afford therapy?
A: This is a real barrier and deserves a real answer. Many therapists offer sliding scale fees, community mental health centers often provide lower-cost services, and some training clinics offer reduced-fee therapy with supervised trainees. It’s worth researching what’s available in your specific area.
Q: Can I do trauma healing work on my own?
A: Some self-directed practices, mindfulness, somatic awareness, journaling, can be genuinely supportive. But for complex or developmental trauma, the relational context matters: trauma formed in relationship tends to heal most effectively in relationship. Self-directed work complements therapy well. It isn’t usually a substitute for it.
Q: What’s the difference between EMDR and Somatic Experiencing?
A: EMDR uses a structured, phase-based protocol built around bilateral stimulation to reprocess a specific traumatic memory. Somatic Experiencing is less structured and works moment-to-moment with body sensation, without necessarily focusing on one memory at a time. Many trauma therapists integrate both.
Related Reading
1. Levine, Peter A. Waking the Tiger: Healing Trauma. North Atlantic Books, 1997.
2. Schwartz, Richard C. No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model. Sounds True, 2021.
3. van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014.
4. Shapiro, Francine. Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. 3rd ed. Guilford Press, 2018.
5. Rogers, Carl R. On Becoming a Person: A Therapist’s View of Psychotherapy. Houghton Mifflin, 1961.
6. Ogden, Pat, Kekuni Minton, and Clare Pain. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W. W. Norton & Company, 2006.
References
Peer-Reviewed Research (Vancouver)
- Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, et al. A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress. 2009;22(5):399-408. doi:10.1002/jts.20444. PMID: 19795402.
- Payne P, Levine PA, Crane-Godreau MA. Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Front Psychol. 2015;6:93. doi:10.3389/fpsyg.2015.00093. PMID: 25699005.
- Brenner EG, Schwartz RC, Becker C. Development of the internal family systems model: Honoring contributions from family systems therapies. Fam Process. 2023;62(4):1290-1306. doi:10.1111/famp.12943. PMID: 37924221.
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Helping driven women finally feel as good as their résumé looks.
As a licensed psychotherapist, trauma-informed executive coach, and relational trauma specialist with over 15,000 clinical hours, she guides driven women, including Silicon Valley leaders, physicians, and entrepreneurs, in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
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