Trauma is one of the primary reasons people seek out a therapist, but not all trauma is created equal and some it – particularly the persistent and intense versions – require a more considered approach in providing care within a mental health setting. People have varying levels of capacity to deal with trauma. And sometimes, even with the best of intentions and training, it can be challenging to provide the correct support to an individual as for example, victims of sexual abuse will require quite a different approach to those that have experienced human trafficking. Both are undeniably traumatic experiences, but also two very different expressions of trauma. And that’s where integrating the tools and framework of a trauma-informed approach in therapeutic setting can have a significant impact on the person receiving support. And in some instances and can be the difference between sticking with therapy and not feeling seen, felt or heard
What Exactly is a Trauma-Informed Approach?
A trauma-informed approach shifts the focus from ‘what’s wrong with you?’ To ‘what happened to you?’ It’s a very subtle shift in tone, but it’s one that changes the nature of the question entirely. Instead of asking someone what’s wrong with them and why they’re in a less than the ideal expression of themselves – which although it can be asked in a compassionate tone, still has an underpinning of shame attached – the emphasis is on asking the person to share and to open up and about what’s happened to them. This is a much more open-ended question, which allows the individual more freedom in how they answer, as it doesn’t direct them straight to the heart of their trauma. It instead invites them to open up and choose whichever starting point they feel is appropriate.
A trauma-informed approach to care acknowledges that both health care organisations, teams and therapists need to have a complete picture of a patient’s life – both past and present. This context is vital in understanding how to provide not just a standardised version of support, but correct support. One that can be considered as an authentic person-centred approach. By adopting trauma-informed practices the intention is to improve engagement with therapy by creating a safe container in which the way into talking about the more difficult and denser aspects of trauma is carried out in a way that respects where the individual has come from. It seeks to guide people without pushing them to open up about what’s happened instead of what’s wrong, which can create a feeling of damagedness and a feeling of being ‘abnormal.’
A proper trauma-informed approach seeks to:
- Understand the complete impact of trauma to create a clear path to recovery
- Become aware and understand the signs and symptoms of trauma in patients and family etc.
- Integrate knowledge about trauma into policies, procedures and practices.
- Endeavouring to avoid Re-traumatisation at all times.
6 Guiding Principles of a Trauma-Informed Approach
There’s generally considered to be six guiding principles that comprise a trauma-informed approach. Many of these are broad concepts, making it difficult to expand on them entirely here. And so, they’re very much open to the interpretation of the organisation or the practitioner in question.
Safety is one of those broader concepts to take into account when trying to create a trauma-informed container. And the variable of safety can come into play as soon as you enter the building you’re heading to for therapy. Even some as trivial as meeting the receptionist can have a massive impact, as they’re the first point of contact. The waiting room experience can also have a big impact in setting the scene, as well the interpersonal dynamic with the therapist and the how they choose to end a session. Patients need to feel physically, mentally and emotionally safe all throughout the therapeutic experience. What it all comes down to though it creating a safe environment.
- Trustworthiness and Transparency
When people are coming to therapy in an extremely traumatised state, especially when the nature of the abuse involves close family members or friends, that person’s level of trust is almost non-existent. And so, a large part of the recovery process is rebuilding that trust. However, unfortunately, and perhaps ironically, the person seeking help from a therapist will likely not have a great deal of trust in them, initially. The reason being that, ‘if my family could do the things they did to me, then it’s absolutely possible this stranger might hurt me, as well.’ So, it’s the role of therapist to gain and maintain that trust with how they show up consistently.
- Peer Support
As we pointed out at the beginning, not all trauma is created equal, meaning each person is going to require a specialised and person-centred approach relating to them and their needs. What that means in practical terms is many people may be hesitant about opening up to mental healthcare professionals because they feel they could never understand what they’ve been through. That’s why it can help to seek out someone who specialises in the type of trauma you’re experiencing. As often times – but not always – therapists with specific specialisations often have similar pasts relating to that trauma. And when this is the case, it allows them to provide more meaningful compassion through peer support.
- Collaboration and Mutuality
As much as therapists can study and complete various qualifications needed to become a fully qualified therapist, there’s still no substitute for actively engaging with patients. You can have the greatest theories for how to support a patient on paper, but very quickly when you enter the field, you often find a lot of that planning – while very useful and necessary – might not align with your patient’s needs. And all therapy – not just trauma-informed – is very much a needs first-based dynamic which should be heavily weighted to what the client needs at the moment. So, it’s vitally important that they be listened to and acknowledged as what they share in their sessions might just benefit their recovery, but potentially the recovery of 100s or 1000s of people if a breakthrough is made that goes mainstream and integrated with the lexicon of trauma-informed psychology.
- Empowerment, Voice and Choice
Given that psychotherapy is primarily a talked-based approach to healing and recovery, there needs to be a heavy emphasis placed on the voice of the individual. Their trauma is their story and a big part of recovery is having the courage to speak up and own that story and to no longer be rule by it. But more so than that, empowerment, voice and choice are also an extension of the collaboration piece above. And within this, it’s important for therapists to understand there’s often a perceived power differential in themselves and the client. And so, it’s vital that focus is on the client’s story and what’s happened to them and how they open up.
- Cultural Issues
To properly understand an individual’s needs, an effective trauma-informed practitioner needs to be fully aware of their cultural background. This enables them to act without coming from a place of cultural, racial or gender bias. How this might play out for example is if say a female has experienced significant sexual trauma, they might only have the capacity to talk about those experiences with another female. Even if she hasn’t shared the same experience, there can still be an element of peer support through the commonality of shared gender. This might also be the same for someone who’s dealt with racism or people with the LGBT community who might find it more support to speak with someone who innately understands their issue first hand.