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These days, mental health organizations and individual practitioners are quick to throw around the term “trauma informed care” when touting the paradigms they use to treat victimized clients. But I’m not sure that all providers and agencies really understand what “trauma informed care” means. Certainly, many of them recognize the need to incorporate questions about the possibility of a prior history of trauma, abuse, or neglect during the initial phase of assessment. It’s common practice for intake workers to ask about childhood sexual and physical abuse. Not everyone thinks to ask about growing up with domestic violence, neglect, a depressed, highly anxious or substance abusing parent. And even fewer clinicians include questions that assess for the witnessing of trauma- something that can be as impactful as experiencing it firsthand. In fact, oftentimes witnessing violence or abuse is even more psychologically complicated because it evokes survivor guilt and the misguided belief that somehow the person who witnessed trauma had the power to stop it or prevent it.
But even when these important questions do get asked, it’s typically before any real therapeutic relationship or trust has been established. Additionally, clinicians don’t always take into consideration the triggering effect that this kind of personal probing can have on clients. Once it has been established that some form of trauma was experienced, “trauma informed care” mandates that every effort is made to keep clients emotionally, psychologically, and physically safe throughout the treatment process. In addition, practitioners who operate from this paradigm understand the importance of continually "connecting the dots" for trauma survivors. They help them understand the long-term emotional, physical, behavioral, and psychological impact of trauma, and the ways in which traumatic experiences are processed and stored in the brain. They also focus on the inevitable coping strategies that emerge for survival and are able to de-pathologize those “symptoms.”
...expressive, right-brain based modalities must be incorporated into the work for true healing to occur.
For me, there are two additional hallmark clinical features of genuine “trauma informed care.” First, there is the realization that expressive, right-brain based modalities must be incorporated into the work for true healing to occur. This means moving beyond 50 minutes of “talk therapy” with clients frozen on the sofa. Instead, clients are encouraged to have a greater awareness of body sensations, and are supported in incorporating movement as trauma narratives are disclosed. It also means weaving art-therapy based techniques into the work including: drawing; collaging, and sand tray narratives so clients can access memories that are stored visually.
The second critical feature of trauma informed care relates to the clinician’s ability to help pace the work so clients never become emotionally flooded or overwhelmed. It means incorporating good boundaries and making sure that the material that surfaces in session is sufficiently contained so clients can leave the office and function well in the outside world. For survivors who are seeking therapy that is truly “trauma informed,” I want to encourage and empower you to take the time to interview prospective clinicians. Ask about their treatment paradigms and listen for strategies that are expressive and creative, not just cognitive. Ask them about the techniques they use to enhance a sense of safety throughout the therapy process. And listen to your own good instincts about whether or not there is the potential for a therapeutic relationship that will feel genuinely compassionate, non-judgmental, and healing for you.
