Reforming Therapy Into Trauma Medicine

By separating psychotherapy from evidence-based trauma treatment, we could finally bring mental health care under the same ethical, diagnostic, and procedural rigor as physical medicine. Psychotherapy could remain a philosophical or reflective practice — much like yoga or meditation — while trauma therapy becomes a legitimate branch of medicine focused on measurable outcomes, standardized diagnostics, and patient rights.

Medicine as a Framework

In medicine, every patient interaction follows a standardized ethical and diagnostic process: (1) evaluation and history-taking, (2) diagnosis disclosure, (3) treatment options, and (4) informed consent. Physicians cannot withhold a diagnosis simply because they fear a patient might be ‘destabilized.’ They are obligated to tell the truth, explain risks, and allow the patient to decide.

For example, an oncologist cannot withhold a cancer diagnosis under the rationale that it might upset the patient — nor can they manipulate the patient toward one treatment path over another. The ethical foundation rests on autonomy and informed consent.

Applying This to Therapy

If we treat trauma as a medical condition — a neurobiological injury resulting from prolonged stress or abuse — then therapy must meet the same standards. This means therapists should be trained to perform structured evaluations, disclose working diagnoses like complex PTSD, and outline evidence-based treatment plans. The patient should always know what the therapist believes is happening and why specific interventions are being used.

Currently, therapy operates more like a black box. A client presents symptoms; the therapist makes internal judgments but often withholds the diagnosis or theory of change. This lack of transparency would be unacceptable in any other field of medicine. Imagine being treated for diabetes for years without being told that’s what you have.

Splitting the Field

The solution is to split the discipline. Psychotherapy can remain an open-ended, introspective practice without medical authority. Meanwhile, trauma therapy should join the broader medical system, with ethical oversight, board certification, and integration into hospitals. This allows clients to receive real medical treatment for trauma — while those seeking self-exploration can still pursue psychotherapy as an elective service.

This division would also resolve many insurance inefficiencies. Insurance could cover trauma medicine, which has measurable outcomes and diagnostic justification, while psychotherapy would be self-funded. The result would be clearer ethics, less manipulation, and better patient safety.

In short, therapy should be as accountable and evidence-based as medicine — and until that happens, it should stop pretending it already is.