A woman once came to therapy because she was feeling distressed about her current situation. She was trying to stop using illegal substances. She wanted to get back on track with her life. She had no job and no independence as she relied on a man who was not even nice to her. She had lost everything.As I got to know her, it was clear that she was nervous all the time about not having the ability to make changes in her life. She admitted to hating herself, not even believing that she could be sober or get a job or go back to school. She was depressed because she did not believe she could do any of it. She wanted so badly to give up.
Her story broke me. Something in me wondered if there was more to her story. I wondered if she had experienced some traumatic situations in her life. All the symptoms were there. So, I asked her to share her story with me. I assured her she could share only what she was comfortable sharing.
And I was right. When I gave her the ACEs questionnaire, she scored really high. And that means that her trauma history was extensive, to say the least. She had gone through sexual abuse, physical abuse, emotional, and verbal abuse. She had had close family members who abused substances.
She witnessed and had been the victim of severe domestic violence. She had experienced community violence through her connection with drug dealers. She had lived a thousand lifetimes in only about 35 years.
And she was frustrated with herself for not being able to handle her current stressors.
The eager counselor in me wanted to dive deeper into her trauma story to begin recovery, or even begin EMDR with her. But it did not take long to bring me back to reality. She was not even stable yet. How could I imagine that she would be ready to move through the dark places of her story? She could barely get through each day.
This is one of many examples one could give of why Trauma Informed Care is crucial to having a non-harmful therapy experience. If I had not thought to consider more about her history, I could have gotten frustrated as I asked her every week if she had filled out any job applications.I could have been bothered by the relapses or the lack of initiative. But her trauma had shaped her life. Her personality. Her emotional intelligence. The very structure of her brain. It was crucial for me to understand this.
When trauma is present in one’s life, there are inevitable effects. When someone has a high ACEs (Adverse Childhood Experiences) score, those effects exponentially increase. This was so important for me to understand about her. Knowing this, it made sense that she struggled with a substance use disorder.
She could barely sleep at night from her nightmares. It also made sense that she could hardly keep a job – despite her drug use history, she never even felt safe enough around others to be around them for long periods of time. She always felt threatened, so she got in arguments often with others.
I could not expect her to be at a high-functioning level – her PTSD was too severe for that kind of functioning – and until she could find some stability in her life, she was not able to heal from any of her trauma. We had to start from square one, create a safe environment, and build basic coping skills because that is what she needed to be able to thrive.
This is one example of a Trauma Informed approach to therapy. It is vital to understand the prevalence of traumatic experiences and their potential effects on one’s life. Let’s talk a bit more about Trauma Informed Care and why it is important.
What is Trauma Informed Care?
The University Center for Social Research defines this in a few different ways. Most simply stated, “Trauma Informed Care understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize”.
One does not have to be an expert in trauma or the various effective treatments to be able to provide Trauma Informed Care. Though that is very helpful, it also helps to just be knowledgeable about traumatic experiences, their prevalence, and their effects. This will guide the therapeutic practice so that people seeking help will feelhelped. It will also guide the referral process if that is necessary.
The goal of this type of care is to avoid re-traumatization as much as possible; to be careful to first do no harm. As counselors, social workers, or others in various fields of health, this must be a top priority. Below, there is a list of some ways to practically incorporate Trauma Informed Care into one’s therapy practice or other settings.
If a person is considering therapy or if he or she is already in therapy (a client), it is vital that one finds a therapist that is knowledgeable about traumatic experiences and that is careful to provide an environment and counseling relationship that:
1. Ensures one’s physical and emotional safety
2. Provides someone with choice and some control over the process
3. Makes decisions with the client (not for the client) and shares power
4. Clearly defines tasks and boundaries and is consistent to follow through
5. Prioritizes empowerment and skill-building
Why is Trauma Informed Care Important?
The definition above uses the word “re-traumatize.” What does it mean to “re-traumatize?” Is this even avoidable? How can that be possible when the nuances and details of someone’s trauma are often unknown?
“Re-traumatization is any situation or environment that resembles an individual’s trauma literally or symbolically, which then triggers difficult feelings and reactions associated with the original trauma”.
To re-traumatize is to put someone through a new or similar traumatic experience (knowingly or unknowingly). This can greatly hinder the therapeutic process, and it can harm the relationship between a counselor and the therapist.
It is not completely avoidable because often there are unknown pieces of the story, but there are specific practices that can be helpful. The Five Principles of Trauma Informed Care are shown below.
First, here is an example. Once a client shared with me that she was strongly considering suicide, but when I shared that she needed to go to the hospital, she had a panic attack.
After she was able to calm down through the use of relaxation skills, she shared that her last hospitalization was extremely traumatic for her, even leading to symptoms of PTSD. I had unintentionally re-traumatized her just by bringing up the word hospital
Saying this to her was best practice as a counselor due to the crisis of the situation, but it was also very helpful for me to understand why she felt so afraid. I was then able to talk with her and allow her to be a part of the decision-making process to choose the next right step for her, the step that made her feel the safest and most understood.
Because I was willing to show empathy and give her back some of the power, she then began trusting me and continued to thrive in therapy from that point.
Five Guiding Principles
The University Center for Social Research at the University of Buffalo has provided a very helpful description of these principles. This chart is a summary of these principles: safety, choice, collaboration, trustworthiness, and empowerment.
Chart by the Institute on Trauma and Trauma Informed Care (2015)
The key in seeking trauma treatment (and other kinds of treatment as well) is to find a place that incorporates these five principles into practice so that one feels safe, empowered, understood, and respected.
If these are not present, then it is good to give oneself permission to seek out alternative care. When Trauma Informed Care is present at all levels, people can make more progress and often find healing after a traumatic experience.
What is Trauma Informed Care? The University Center for Social Research in the School of Social Work at the University of Buffalo. Retrieved August 13, 2019, http://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-Trauma Informed-care/what-is-Trauma Informed-care.html
“Hands to Hold”, Courtesy of Matheus Ferrero, Unsplash.com, CC0 License; “Tough Times”, Courtesy of Ben White, Unsplash.com, CC0 License; “A Shoulder to Lean On”, Courtesy of Toimetaja Tolkeburoo, Unsplash.com, CC0 License; “Comfort”, Courtesy of Alisa Anton, Unsplash.com, CC0 License
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