What Is Trauma-Informed Therapy?
Trauma-informed therapy involves accounting for clients’ trauma and its impact on their behaviour, mental health, and ability to engage in treatment. Trauma-informed therapists assume that a client could have a trauma history and will take steps to avoid inadvertently triggering or re-traumatising the client in treatment.
What Is Trauma?
“Trauma” can mean many different things, and there is no one set type of trauma or one way that people will respond to a traumatic event. The same event will have different impacts on different people, and not everyone who experiences a traumatic event will have trauma afterward.
In general, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)1 defines trauma as: “Exposure to actual or threatened events involving death, serious injury, or sexual violation in one (or more) of the following ways:
- Directly experiencing the events.
- Witnessing the events in person as they occur to others.
- Learning that the events occurred to a close family member or friend.
- Experiencing repeated or extreme exposure to adverse details of the events.”
The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Insurance continue to study the impact of ongoing stressors on children, known as Adverse Childhood Experiences or ACEs.
According to this research, Adverse Childhood Experiences can lead to conduct issues in children and adolescents and can have lifelong consequences. Adults with high ACE scores are at greater risk than those with lower scores for physical health issues, mental illness, and early death.
The researchers identified 10 Adverse Childhood Experiences:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Family member or caretaker mental illness
- Family member or caretaker substance abuse
- Witnessing violence against the mother
- Having a relative sent to jail or prison
- Losing a parent due to separation, divorce, or death
Additional research suggests that racial trauma should also be considered an Adverse Childhood Experience for Black children.
When a therapist is trauma-informed, they are knowledgeable about trauma and understand the potential impact of trauma on each of their clients. Trauma-informed therapy emphasises not asking, “What is wrong with you?” but instead asking, “What happened to you?”
Techniques of Trauma-Informed Therapy
Trauma-informed therapy is not about a specific intervention but rather tailoring interventions in the context of the individual’s trauma history, triggers, and specific needs. It is a lens through which the therapist views their clients, taking into account the impact of trauma on emotions, regulation, and behaviour. They will also consider the effects of intergenerational trauma on clients.
Trauma-informed therapists emphasise the following areas in their practice:
- Physical and emotional safety. A trauma-informed therapist will take steps to ensure that clients feel both physically and emotionally safe in their sessions.
- Collaboration. Trauma-informed therapists aim to empower clients by educating them about their options and giving them an active role in their care.
- Transparency. Trauma-informed therapists are open and honest with clients.
- Competency. Trauma-informed therapists make sure that they are educated and up-to-date in research and best practices for working with clients who have experienced trauma. They are also aware of the unique cultural considerations that each client experiences.
What Trauma-Informed Therapy Can Help With
As the name suggests, trauma-informed therapy is beneficial in working with any individual who has experienced trauma, either in childhood or as an adult. Even if you are not in treatment specifically for your trauma, this approach can ensure your emotional safety in your sessions.
Although not everyone has experienced trauma, a trauma-informed approach will not harm someone who does not need trauma-informed care. This is why many providers take a trauma-informed approach in all sessions and not just when the presenting concern is related to a specific trauma.
The Effectiveness of Trauma-Informed Therapy
Although trauma-informed therapy does not refer to a specific set of interventions, this approach to care has been shown to increase the effectiveness in youth and adults who have experienced trauma.
Trauma-informed therapy can also address issues of guilt and shame that trauma survivors often carry.
Things to Consider When Starting Trauma Therapy
If you think that trauma-informed care is a good fit for your needs, you want to seek therapy from someone with the appropriate training. Here are some things to consider before you begin trauma therapy.
Not All Therapists Are Trauma-Informed
Most therapists are exposed to trauma work in their training, but not all therapists are trauma-informed.
When finding a therapist and determining if their trauma training is a fit to your unique needs, you might ask the following questions:
- What training have you done in trauma-informed care?
- Do you consider yourself trauma-informed, and what does this mean to you?
- What is your approach to therapy with clients with trauma history?
- What kinds of clients do you work with, or what kinds of trauma do you work with?
- Are there any types of trauma that you do not feel comfortable or competent to work with?
- At what pace do you go when treating trauma?
Many therapists will list several specialties in directories or biographies, and not everyone who selects “trauma” as an area of expertise has the same level of training or comfort in trauma-informed care. It is OK to ask questions and find a therapist with whom you feel comfortable and safe.
You May Be Asked About Your Trauma History During the First Session
In an intake appointment, therapists typically need to gather extensive information about your history in order to make appropriate recommendations for your care. This may include questions about your trauma history. If you feel uncomfortable sharing certain details, it is OK to tell the therapist. A trauma-informed therapist will address your concerns and make adjustments based on your needs.
If you begin sharing these details and your therapist decides to redirect the session, this does not mean that you have done something wrong. Your therapist might have sound reasons that they should explain to you if this comes up.
Therapy can be exhausting work because it involves exploring emotions and memories that you are not used to thinking about. Imagine that your trauma is a physical wound that you have been ignoring—you need to clean the wound so that it can heal properly, even though you know cleaning it is going to be painful. Be gentle and patient with yourself as you go on this healing journey.