Trauma-informed Practice

Why trauma-informed care matters

When I first started my healing journey from childhood abuse, I had no idea what recovery looked like and what I would need to recover from it. Throughout my healing journey and later in my professional training, I learned about the vast variety of therapy forms, what is useful for recovery from trauma, and what was not.

 

What is not useful for recovery from trauma?

When I first started my healing journey, I did not know anything about trauma-informed practice. The first therapist I worked with was shaped by the medical model. How did this play out in our client-therapist relationship? At the core of our relationship, she looked at me with the perspective of “What is wrong with you?” Needless to say that I often left the sessions feeling more stigmatized and burdened.

The therapist did not mention some of the essential elements of trauma-informed practices: Emotional and psychological safety, boundaries, education about symptoms of trauma, and adaptive coping mechanisms due to what happened to me. The counsellor did also not take care to navigate the power differential in our client-therapist relationship mindfully. Overall, her approach wasn’t helpful for my recovery. It left me doubting that healing was possible.

 

What is the medical model?

In the mid-’50s, the perspective on trauma was shaped by the medical model. It is based on diagnosis and treatment and looks at human beings and their problems through an illness or pathological symptom-based lens. The guiding question of the medical model is “What’s wrong with you?” This question in itself is stigmatizing and blames the survivor of trauma for what has happened to them. Based on the medical model, clients are often labeled as “difficult,” “resistant,” and “avoidant” when they don’t perform as socially expected. The complex interdependencies of trauma on the human psyche are largely ignored. The approach often shames clients. Furthermore, it overlooks clients’ resilience and strengths which were developed despite the trauma.

The medical model is not appropriate for mental health issues

Overall, the medical model may be helpful for physical health such as broken bones and other physical health issues where diagnosing is clear and medication is available. The medical model isn’t appropriate to explain the complex dynamics of the human psyche and support people to recover from trauma. It also further stigmatizes people and burdens them. Unfortunately, there is no pill available to heal from trauma as for many physical health issues. While healing is possible, it is an inner process that requires time and effort.

The approach to treating trauma is constantly evolving. One approach used to be that a person who had experienced trauma retold the story again and again, another one was to not talk about trauma or to use the “get over it” mentality. These approaches have in common that they are not effective.

Trauma-informed practice to create supportive environments

After the experience with my first therapist, I was lucky enough to find trauma-informed mental health professionals, whether they were counsellors or coaches. These experiences allowed me to integrate my past and recover from what has happened to me. These therapists focused on creating safety in our sessions and taught me skills to navigate emotions. They also acknowledged the inner resources and resilience I had developed despite the trauma. We also explored my boundaries and needs. Furthermore, the therapists actively navigated the power dynamics in the therapeutic relationship. In our collaboration, I finally found the supportive environment that allowed me to thrive.

A trauma-informed approach focuses on the question “What has happened to you?”

In its essence, trauma, childhood abuse, and/or systemic violence are a violation of trust, safety, control, and power. From a trauma-informed perspective, the main question is “What has happened to you?” The focus is not only on the client’s behaviour but the causes for their behaviour as well as the relief it might provide them. Dependent on what happened to us, we have developed different adaptive coping mechanisms that helped us to protect ourselves from feeling coerced or hurt. While these adaptive coping mechanisms were useful at some point, they may become harmful in our current circumstances. A trauma-informed therapist understands these complex interdependences and has a non-shaming, supportive approach to the client’s issues. Trauma-informed practice supports accountability and personal responsibility combined with empathy and compassion.

Six Key Principles of Trauma-informed Practice

As described by the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-informed practice is based on the following six key principles:

  • Safety
  • Trustworthiness and Transparency
  • Peer Support
  • Collaboration and Mutuality
  • Empowerment and Choice
  • Cultural, Historical, and Gender issues

Trauma-informed practice is not about trauma therapy and is a systemic approach. Organizations can use a trauma-informed approach and it can be applied in many fields such as dentistry, the medical field, education, and social work. Please be aware that not every mental health professional applies trauma-informed practice, although I hope that we move towards applying trauma-informed practices in all areas.

“No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest.”

Judith Herman, Author of Trauma and Recovery

Implementation of Trauma-informed Practice

While these principles are the guiding foundation, trauma-informed practice needs to be implemented in the processes of an organization. In my role as a therapist, I implement these principles into my work, independent if the client identifies with having experienced trauma or not.

Examples of applied Trauma-Informed Practice

Here are some examples of how I integrate these principles into my work as a counsellor:

  • I talk to my clients about safety – whether it is physical safety, emotional safety, or creating a safe(r) environment where healing can occur. I also support clients to build inner resources for emotional regulation and navigating trauma responses.
  • Since we live in a society that is shaped by systemic oppression and racism, I also acknowledge that safety depends on privilege. Social dynamics influence the client-therapist relationship. For example, if I work with a Black person or an Indigenous person, I have white privilege towards them. I proactively navigate my privilege in the therapeutic relationship to provide a safer space for BIPOC individuals.
  • Boundaries and the exploration of boundaries are a regular part of the collaboration.
  • I educate my clients about the symptoms of trauma to increase understanding and awareness.
  • I actively navigate the power differential in the client-therapist relationship.
  • I collaborate with my clients in setting the goals for their process as well as in creating a treatment plan.
  • I intend to give clients different choices and options when it comes to what happens in our sessions.
  • I intend to find ways that clients can reclaim their power and connect them with their resilience, their inner resources, and their inner wisdom.
  • I also acknowledge that there is an interconnectedness between myself and the client. This means I create awareness of how my words and behaviours may affect my clients.
  • I acknowledge systemic influences on my client’s life whether they are cultural or historic dynamics. Examples are the influences of colonization, oppression, and/or systemic racism.

Please note that these are some examples of how I implemented trauma-informed practice. Other counsellors may apply them differently. If you are interested in working with a different counsellor, it may useful to ask them how they apply it.

Trauma-informed practice for anxiety, depression, and loss

Many of my clients live with anxiety and/or depression or have experienced loss. While they don’t consider their experiences as traumatic, they still benefit from trauma-informed practice since the principles are universally applicable. Furthermore, clients may not be aware that they had traumatic experiences in the past that may contribute to their depression or anxiety. Trauma-informed practice offers clients the opportunity to explore connections to past experiences and how they affected them.

Take Away

Trauma-informed practice matters because it fosters resilience and healing. A trauma-informed therapist proactively manages safety and power dynamics in the relationship. Trauma-informed practice uses a non-judgemental, stigma-free approach that acknowledges adaptive coping skills and empowers clients to reclaim their lives. Overall, it creates healing and growth-centered relationships that are an essential part of thriving.

“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”

Kahlil Gibran

Resources

SAMHSA’s Trauma and Justice Strategic Initiative (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach.

Crisis & Trauma Resource Institute (2019). Trauma-Informed Care: Building a Culture of Strength. Training Manual

Greenwald, R. (2012). EMDR within a phase model of trauma-informed treatment. Routledge

Photo by Omar Lopez on Unsplash

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