Nicole Szesny-Mahlau

The system of trauma care in Germany fails to support the traumatized children as well as the psychotherapists. Nicole is reimagining trauma care as a more coherent, inclusive, supportive, and effective system for all. By creating a peer network of psychotherapists and sensitizing other actors in the care ecosystem, Nicole aims to improve trauma care for children and adolescents, thus creating a long-term societal improvement in mental health cases.

Nicole’s vision is to reshape how Germany addresses childhood trauma — moving from isolated, siloed care to a connected, multi-professional system rooted in everyday practice. Through trauma.help, she has created the country’s first nationwide practice-oriented peer support network for therapists working with traumatized children and adolescents, offering knowledge, practical tools, and crucially, a protected space for peer support and emotional safeguarding.

Addressing trauma in childhood is crucial to reducing the long-term negative effects of post-traumatic stress and enabling healthy development. In Germany, tens of thousands of children are officially identified each year as experiencing severe violence or neglect, while research indicates that many more are exposed to traumatic adversity such as abuse, violence, or significant loss during childhood. Yet most of them go without timely and appropriate support, as the existing care system is overstretched, fragmented, and lacks accessible resources. Psychotherapists also struggle due to a lack of training and incentives to provide quality trauma care to children.

Believing that no child should be left without care, Nicole builds a community of psychotherapists supported by a digital platform to enable peer-to-peer support as well as organized help to enable them to take on more cases and deliver quality trauma care. As a psychotherapist herself, Nicole experienced first-hand the isolation felt by a professional working alone on trauma cases thus lacking the collegial support they might need in the process. trauma.help offers trainings and expert sessions for capacity building, fireside chats for peer-to-peer support, and coaching / supervising systems for individualized support in specific cases. In doing so, Nicole aims not only to enhance therapists’ self-efficacy, effectiveness, and professional confidence but also to improve systemic incentives, creating an environment where more therapists feel encouraged to take on the emotionally demanding trauma cases.

Having reached a critical community of psychotherapists in the last 5 years, Nicole is now aiming to influence professionals in related fields to encourage trauma-sensitive practices in hospitals, youth welfare system, police centres, schools, and so on. She also would like to influence the education of therapists from an early point on, thus partnering with training institutions to reach the newcomers of the system. By strengthening the role of therapists, fostering multi-professional trauma teams, and setting new standards in practice, trauma.help aims to transform institutional approaches and create a new, trauma-informed culture of care across Germany.

In Germany, a substantial number of children and adolescents are exposed to violence, abuse, severe loss, or other potentially traumatic experiences, yet only a small fraction receive timely, evidence-based trauma-focused treatment. Although not every child exposed to trauma develops a trauma-related disorder, a considerable proportion does — especially in cases of repeated, interpersonal, or early-life trauma. PTSD is the most visible diagnosis in the healthcare system, but many affected children show complex trauma-related symptoms that remain underdiagnosed and inadequately treated. This gap reflects a multi-layered systemic problem: children and adolescents with trauma often do not receive help early enough, while psychotherapists lack sufficient incentives, training, and community support to take on and sustain trauma-focused work.Based on data, expert consensus and field experience, current capacity for specialized trauma-focused treatment for children and adolescents is estimated to be limited to the low thousands of cases per year — far below what would be needed to meet actual demand.

Once a traumatized child enters the healthcare system, access to treatment depends largely on whether an individual therapist is willing and able to take on the case. For young patients, treatment often requires extensive coordination with families, schools, youth welfare services, or law enforcement. However, this additional coordination time is not reimbursed. Beyond these operational barriers, trauma cases are emotionally demanding and carry an increased risk of secondary traumatic stress or burnout for therapists, particularly in the absence of regular supervision and collegial exchange. As a result, many treatments are postponed for months, interrupted, or not initiated at all. Based on field experience and internal analyses, the trauma.help team estimates that only a minority of children and adolescents with PTSD currently receive adequate trauma-focused treatment.

Immediate help is crucial in childhood trauma, as untreated trauma significantly increases the risk of subsequent mental health problems, chronic physical illness, and addiction. A strong body of research shows that trauma-focused therapies — such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and EMDR — significantly reduce PTSD symptoms and improve overall mental health in children and adolescents. Nevertheless, access to such treatments remain limited. Even when children do receive outpatient care, public health insurance typically covers only a restricted number of therapy sessions, which may be insufficient for complex trauma presentations.

Childhood trauma is far more widespread than official statistics suggest. Epidemiological studies indicate that between 30% and 60% of children experience at least one potentially traumatic event before the age of 18. Of these, an estimated 4–16% develop PTSD or related trauma-related disorders. At the same time, officially documented diagnoses in children remain very low, indicating substantial underrecognition. In the German healthcare system, psychotherapy capacity is not planned based on specific diagnoses or epidemiological need, but according to general population-based allocation formulas. As a result, highly prevalent and complex conditions such as childhood trauma remain structurally underrepresented in care planning. There are no designated trauma treatment slots and no trauma-specific capacity planning, leading to long waiting times and fragmented care pathways despite clear evidence for the effectiveness of early intervention.

Delayed or insufficient treatment not only worsens individual outcomes but also affects family dynamics and parenting, increasing the risk of re-traumatization and the intergenerational transmission of trauma. Beyond individual suffering, the lack of timely and effective trauma care results in substantial societal costs. A trauma cost study conducted by the University of Ulm estimates that untreated trauma leads to annual costs in the billions of euros in Germany due to healthcare expenditure, lost productivity, and social services. Comparable international studies suggest that trauma-related costs account for approximately 3–5% of GDP in high-income countries, contributing to early retirement, disability, and long-term reliance on social welfare systems.

On the professional side, psychotherapists struggle to meet clinical demands while protecting their own well-being. Trauma-focused work is more complex, emotionally taxing, and legally sensitive than many other forms of psychotherapy, yet the additional effort required is neither adequately compensated nor systematically supported. This discourages many therapists from accepting trauma cases or leads to premature termination of treatment. In addition, a persistent pessimistic narrative around childhood trauma within parts of the professional discourse further reduces willingness to engage with these cases.

Even when therapists take personal initiative, they often lack sufficient training or supervision. In Germany, only a small proportion of standard psychotherapy training is dedicated to trauma-related topics, leaving many clinicians insufficiently prepared. Further specialization frequently requires self-funded training and supervision, while therapists in rural areas often lack access to peer networks. Surveys report high levels of emotional exhaustion and secondary traumatic stress among trauma therapists, exacerbating existing shortages of qualified specialists.
Although psychotherapists are the primary target group of trauma.help, many other professionals involved in the care of traumatized children — including educators, social workers, and healthcare staff — also lack access to practical tools and supportive professional networks. Nicole addresses this multi-layered problem through a holistic, system-oriented approach that uses digital platforms to strengthen professional capacity and collaboration at scale.

Trauma.help’s strategy is designed to strengthen the care landscape for therapists working with traumatized children and adolescents by addressing key challenges on three interconnected levels: strengthening the individual therapist, fostering peer and professional networking among therapists, and enhancing collaboration with the broader care system. In doing so, Nicole aims to equip and connect therapists to not only take on more cases, but also handle the cases at hand with utmost professionality.

On the first level, trauma.help strengthens therapists in their roles through peer support, emotional safeguarding, and professional development. A big part of this work is done via their digital platform, which is designed by therapists, for therapists. Their offers on the digital program include: (1) “Fireside Chats”: Informal conversations with experienced trauma practitioners sharing real-world insights and best practices. (2) “Case Conferences”: Confidential, peer-supported discussions where therapists collaboratively explore complex cases, reflect deeply on clinical decisions, and receive both expert and peer advice. (3) Networking Opportunities: Facilitated connections within the trauma care community to build professional relationships and collaborative support networks. (4) Continuing Education Resources: Access to training materials, workshops, and up-to-date educational offers to support ongoing professional development. These formats serve a dual purpose: reducing professional isolation and increasing clinical confidence. One good example is their video supervision offer—enabling therapists to receive remote feedback—as well as resources for self-care and shared mindfulness practices, emphasizing emotional safeguarding alongside professional development.

For the trauma.help team, bringing therapists together -be it online or in-person- is only the first step of change. The key to long-term success is creating a community of practice where each member acts as a change agent within the wider care system—sharing their newly gained confidence in trauma care with colleagues and within their organizations to improve the broader support network. At this stage, engaging influential names of the sector as well as academics is crucial in multiplying the ripple effect. As leaders of the field, supervisors, mentors, and academicians take part in trauma.help activities, they spread the word about these offerings in their networks.

Therapy space can be disconnected as different schools of thought are adopted by specific institutions/therapists. To ensure a variety of effective methods are available to their community, trauma.help is explicitly interdisciplinary and inclusive, welcoming therapists from all evidence-based therapy schools (e.g., cognitive-behavioral, depth psychology), as well as medical professionals such as psychiatrists and psychosomatic specialists who are crucial for accurate diagnosis and collaboration.

Nicole’s final strategic pillar focuses on fostering more integrated and coordinated care pathways. This approach aims to tackle common challenges like delayed diagnosis, misdiagnosis, and poor communication between sectors. To achieve this, trauma.help is gradually expanding beyond therapists to include other childcare professionals. The platform facilitates cross-professional networking and interdisciplinary case discussions, showing how collaboration improves outcomes. While doctors and therapists are active users, the next step is to engage nurses, educators, social workers, and youth care professionals to broaden the integrated care network.

Outside of trauma.help, Nicole collaborates closely with hospitals such as University Hospital Freiburg and Tagesklinik Passau to embed trauma-informed knowledge, strengthen interdisciplinary teamwork, and model holistic care through multi-year, multidisciplinary training programs. She guides these hospitals on a journey toward integrated trauma care—bringing together therapists, doctors, educators, parents, and others. In doing so, Nicole also aims to change narratives around trauma treatment by making sure the successful cases are shared among colleagues, resulting in an increased belief in the impact of timely and trauma-sensitive care.

Similar training is also offered beyond the medical system. For example, through cooperation with Caritas, trauma.help helped design plans for a new outpatient trauma and addiction center serving children and families. Trauma-sensitive training for teachers further extends trauma-informed care into everyday environments. trauma.help recognizes that trauma therapy operates within a complex web of social and legal challenges. To address this, the platform regularly hosts exchange formats with legal advisors and family engagement experts, equipping therapists to navigate these sensitive issues alongside clinical care.

To date, nearly 1,200 professionals working in trauma care for children and adolescents are registered on the digital platform, including outpatient child and adolescent psychotherapists, psychologists, physicians, and clinicians from hospital settings. In terms of outpatient care alone, this corresponds to roughly one quarter of all licensed child and adolescent psychotherapists in Germany, while the platform deliberately brings together professionals across sectors and disciplines.
According to a 2024 self-reported survey conducted on the platform, more than 80% of participating therapists report feeling more confident in their work with traumatized children after engaging with trauma.help. Ninety percent state that the support provided through the platform has contributed to improved therapy outcomes. In addition, 78% report a significant improvement in their trauma-specific clinical skills, and 72% indicate that they are now able to treat trauma cases more effectively and with greater efficiency. Alongside the growing number of members, survey responses also suggest an increased willingness among therapists to take on trauma-focused cases.

Rising demand from hospitals, youth services, and schools underscores trauma.help’s role as a practical resource for improving care coordination and quality. As professional journals such as Ärzteblatt draw attention to trauma.help’s work, this visibility supports a growing recognition of trauma-informed practice and helps shift professional culture in that direction.
Over the next five years, Nicole aims to scale the trauma.help platform to around 10,000 active users across the trauma care ecosystem, creating a shared infrastructure that strengthens knowledge, resilience, and collaboration. The platform combines on-demand access to trauma-informed content with supervision and consultation formats, self-care support, and a protected peer community—an integrated, complementary offering that does not replace formal training, but fills crucial gaps in everyday practice.
By extending these resources to the different professional groups and support figures surrounding a traumatized child—including parents and other close caregivers—trauma.help introduces a new, cross-sector approach that can generate system-wide impact: a consistent, trauma-sensitive response across all the adults who stand alongside the child.

From early on, Nicole became aware of how much harm can grow in silence. Growing up in rural Germany, she witnessed how the unresolved impacts of World War II still shaped families, and how experiences of violence and sexualized violence in her surroundings were often minimized or ignored. These patterns revealed to her not only the weight of what remains unspoken, but also the consequences when no one takes responsibility. Even as a student, she refused to accept this silence: she confronted misinformation, wrote about difficult issues in the school newspaper, and organized initiatives when she saw that others’ wellbeing depended on someone stepping forward.

As a teenager, Nicole faced a long period of serious illness and learned from within how easily people can fall through a system that is not designed for coordinated, timely care. This experience strengthened her conviction that support structures must be accessible, dependable, and capable of responding before harm compounds.

Committed to understanding these dynamics more deeply, Nicole studied psychology and completed her PhD at the Max Planck Institute, researching trauma and depression. In her clinical work with adults, she repeatedly encountered the long-term consequences of childhood adversity that had never been addressed — and the professionals who wanted to help but lacked the structures, tools, and emotional safeguarding necessary for sustained trauma care.

Rather than accepting these limitations as inevitable, Nicole chose to build what she believed the system should provide. She founded trauma.help to strengthen the adults who support traumatized children by integrating on-demand knowledge, supervision and consultation formats, self-care resources, and a protected peer community. Her aim is to ensure that all adults surrounding traumatized children — across sectors and settings — have the confidence, competence, and resilience to respond with clarity rather than fear.

Nicole leads with the conviction that systems change only when the people within them are empowered — and with a longstanding belief shaped in childhood and sharpened in practice: that meaningful change begins the moment someone refuses to look away and instead builds the structures that enable others to act.