Trauma-Informed Therapy Explained: Techniques and Benefits
Trauma is a deeply personal and often complex experience that can profoundly affect an individual's mental, emotional, and physical well-being. Trauma-informed therapy is an approach that recognizes the widespread impact of trauma and seeks to create a safe and supportive environment for healing and recovery. This post aims to provide an overview of trauma-informed and trauma-focused therapy, including the key components, common approaches, and importance in promoting healing and resilience.
Introduction to Therapy and Trauma
Therapy offers a confidential and supportive environment for individuals to communicate with a mental health professional about personal experiences, thoughts, feelings, or challenges they may be facing. Those seeking therapy might have encountered situations that disrupt or affect their cognition, emotions, relationships, or overall well-being. Additionally, individuals may choose therapy as a neutral and supportive space to discuss general life experiences. Therapy is sought out by various demographics, including children, adolescents, adults, couples, and families.
Trauma can be broadly defined as any event or series of events that overwhelms an individual's ability to cope, leaving them feeling helpless, vulnerable, and emotionally distressed. Trauma can result from various experiences, including but not limited to:
Physical, emotional, or sexual abuse
Neglect
Natural disasters
Accidents
Witnessing violence
Military combat
Loss of a loved one
Chronic illness
Near death experiences
Oppression and discrimination, including systemic discrimination
Racism
Generational trauma, such as slavery & colonization
Homelessness
Poverty
Incarceration
Trauma alters the way an individual regulates their thoughts and emotions, as well as their capacity for emotional and psychological self-care. It can impact every facet of a person's life and disrupt their sense of security. Trauma can reshape the brain and nervous system, leading to dysregulation and symptoms like depression and anxiety. The impact of trauma can also influence mood, relationships, and self-perception. Substance abuse, mental health issues, and other risky behaviors have been correlated with traumatic experiences.
While some individuals may move forward without enduring negative consequences following a traumatic event, others may struggle and experience traumatic stress reactions. How an individual responds to trauma is a deeply personal experience. Given that these behavioral health challenges can pose obstacles in relationships, careers, and other areas of life, it is crucial to have a therapist who is sensitive and knowledgeable about trauma-informed care.
Trauma-Informed Therapy
Trauma-informed therapy refers to the approach taken by mental healthcare providers when engaging with clients, aiming to implement an effective treatment process while avoiding retraumatization. It involves recognizing that past trauma can have lasting effects on individuals' current lives and acknowledging that those with trauma may have different needs. This approach entails adhering to principles that prioritize understanding and sensitivity to trauma-related issues. Trauma-informed therapists should be able to exhibit understanding how generational, community, and childhood trauma affects development. This can be both a macro and micro perspective. Care that is trauma-informed recognizes the impact of experiences that threaten a person’s sense of safety and wellbeing.
Trauma-informed therapy isn't a distinct modality but rather a collection of guiding principles acknowledging the profound impact of trauma on individuals, often overlooked and underreported.
Principles of the Trauma-Informed care - as outlined by Substance Abuse and Mental Health Services Administration (SAMHSA)
Safety: The therapeutic space should offer a safe and nurturing atmosphere where the client feels at ease to openly share their experiences to emphasize physical and emotional safety of a client. This could entail setting forth explicit boundaries and parameters for the therapeutic alliance while offering continuous support and reassurance as necessary.
Trustworthiness and Transparency: The therapist strives to foster trust with the client through displaying empathy, compassion, and a non-judgmental demeanor. This approach aids in cultivating a feeling of safety and assurance, encouraging the client to feel increasingly at ease in sharing their experiences openly. This often means that the therapist takes into account the client’s comfort with safety planning and the client’s experience with systemic systems of power, such as police involvement. Trustworthiness means always being honest, clear, and consistent.
Peer Support: This fundamental principle of trauma-informed care underscores the significance of connection, especially for individuals who have undergone trauma. Peer support prioritizes the client's well-being and aims to break the cycle of re-traumatization, allowing the individual in therapy the opportunity to initiate the recovery journey and select the treatment or support that best supports it. The peer role is founded on the belief of not attempting to "fix" individuals, but rather empowering them to evolve into the person they aspire to be.
Collaboration and Mutuality: Trauma-informed therapy involves a collaborative approach, where therapists and clients collaborate as equal partners in the healing journey. Therapists empower clients by acknowledging their strengths, validating their experiences, and respecting their autonomy in decision-making. Therapists are meant to be supportive partners rather than authoritative figures, guiding rather than dictating clients through their path to healing.
Empowerment, Voice, and Choice: Empowerment entails ensuring that you consistently feel listened to, supported, and affirmed by a therapist as they prioritize supporting you in developing additional coping skills and mastering your preferred therapeutic treatment goals. In aiding clients with their recovery journey, therapists must acknowledge and promote clients' voices, choices, and strengths. Counselors should operate from the belief that clients possess resilience and have the capability to take control of their healing journey.
Cultural, Historical, and Gender Issues: Recognizing the diverse backgrounds and experiences of clients is vital in trauma-informed therapy. Therapists exhibit cultural humility by recognizing their own biases and actively striving to understand and respect the cultural, ethnic, and societal context of their clients. Therapists should avoid responding to clients based on assumptions about their cultural experiences, instead responding based on the unique cultural narrative provided by the clients. This foundational aspect of trauma-informed care involves valuing and acknowledging a person's cultural background, experiences, and identities as significant elements in effective trauma-informed services. This includes moving beyond cultural stereotypes or biases related to race, ethnicity, sexual orientation, etc., providing access to gender-affirming care, recognizing the healing significance of traditional cultural ties, and incorporating guidelines that are sensitive to the racial, ethnic, and cultural needs of those seeking assistance, while also identifying and addressing historical and intergenerational trauma. In this, you as a client should feel safe voicing how your culture or background affects how you perceive trauma, safety, and privacy.
Trauma-informed vs. Trauma-focused
You might be familiar with the terms "trauma-focused" and "trauma-informed" care, which, despite their similarities, represent distinct approaches to mental health treatment and therapy.
Trauma-focused care delves into comprehending the effects of particular traumas on an individual's life. It aids in processing these traumas and identifying the coping mechanisms developed as a result. As the name implies, it concentrates on the traumas themselves.
On the other hand, trauma-informed care transcends any singular trauma; it's more of an overarching approach than a specific therapy, acknowledging the pervasive impact of trauma on an individual. This approach can be applied in various settings, even when the individual isn't directly addressing their trauma. A primary objective is to prevent retraumatization.
Both types of care require a thorough grasp of trauma. However, while trauma-focused care is centered on addressing specific traumas, trauma-informed care entails an understanding of how trauma affects all aspects of life.
Types of Trauma-Informed Treatment & Techniques
Today, various types of trauma-focused and trauma-informed treatments are available, often referred to as trauma interventions. It's important to note that no single intervention type is inherently "better" than another. There are various trauma-focused and trauma-informed treatments to address the diverse needs of individuals that can vary significantly depending on factors such as age, type of trauma experienced, setting, culture, or geographical location.
Therapy Modalities Commonly used in Trauma-Informed Care:
➜Eye Movement Desensitization and Reprocessing: Eye Movement Desensitization and Reprocessing (EMDR) therapy is a form of psychotherapy that utilizes rhythmic left-right (bilateral) stimulation.This, combined with focusing on the traumatic memory, is believed to diminish the emotional intensity of the memory. Consequently, individuals can start to heal from the fear and distress associated with their traumatic memories. With time, exposure to these memories decreases the negative reactions to them.
➜Narrative Exposure Therapy: Narrative Exposure Therapy (NET) is a therapeutic approach aimed at treating trauma-related disorders. NET seeks to contextualize the various elements associated with the fear network - including sensory, emotional, and cognitive memories of trauma - within the specific life context of the client. This process aims to understand and effectively process traumatic memories chronologically with a unique focus on recognizing and creating an account of what happened in a client’s life in a way that serves to emphasize client’s self-worth and resilience.
➜Dialectical Behavior Therapy: Dialectical Behavior Therapy (DBT) is designed to equip individuals with skills for managing emotions, enhancing interpersonal relationship skills, tolerating distress, and practicing mindfulness, which can be particularly beneficial for individuals with a history of trauma. DBT can help individuals develop coping strategies, increase emotional resilience, and create more adaptive responses to triggers.
➜Brainspotting: Brainspotting is a form of therapy that targets trauma, distressing mental health struggles, and lingering emotional stress by pinpointing, processing, and releasing them. It operates on the principle that one's visual focus influences their emotional state, identifying eye positions that correspond to unconscious emotional experiences. By concentrating on specific eye positions linked to distressing issues, individuals can alleviate emotional and physical tension related to those issues. This therapy aids in reprocessing negative experiences and reshaping emotional responses.
➜Prolonged Exposure: Prolonged Exposure (PE) is a form of therapy that involves assisting individuals in gradually facing and addressing trauma-related memories, emotions, and situations they've been avoiding. PE helps people decrease distress related to trauma by slowly helping them confront their trauma memories in a safe and therapeutic environment.
➜Trauma-Informed Expressive Arts Therapy: Trauma-Informed Expressive Arts Therapy incorporates psychological arts-based interventions and embodied awareness concepts to facilitate trauma recovery and healing. The core psychotherapeutic strategy involves utilizing expressive arts therapy, which encompasses a combination of art, music/sound, dance/movement, enactment/improvisation, storytelling/narrative, play, and imagination.
➜Somatic Experiencing: Somatic Experiencing (SE) is an approach to treating trauma that centers on the body. Grounded in the notion that traumatic experiences can manifest as physical symptoms and unlike traditional approaches that emphasize one’s thoughts, SE directs individuals to attend to physical sensations like bodily tension, heartbeat, and breathing. By doing so, it facilitates the observation and management of the physiological manifestations of trauma, promoting a sense of control.
Benefits of Trauma-Informed Therapy
Trauma-informed therapy emphasizes understanding, compassion, and empowerment in the therapeutic process. It recognizes that trauma affects individuals differently and that healing is a unique and deeply personal journey for each person. The focus is on fostering resilience, safety in the therapeutic relationship, and promoting recovery.
The following are examples of the ways in which a trauma-informed approach can benefit a client who has experienced trauma:
Learn about trauma and its impact
Trauma-informed therapy offers a supportive environment to understand typical reactions to trauma, particularly how a traumatic event has affected someone. This process of exploration and education assists one in comprehending the reasons behind certain thoughts, emotions, and behaviors, providing clarity and validation to their experiences, and reinforcing the understanding that they are not alone in their experience. Through psychoeducation, therapists provide clients with information about trauma, its impact on the brain and body, common symptoms, and available treatment options.
Re-establish safety
Trauma can disrupt one’s sense of safety, encompassing violations of physical, emotional, psychological, and relational safety. An advantage of trauma-focused therapy is its role in helping one rebuild a sense of internal (emotional, psychological, relational) and external (physical environment, sensations) safety through targeted activities and discussions addressing these areas. People who have experienced trauma and have repeatedly been told that their experiences, characteristics, or emotional reactions are unreasonable and unacceptable may suffer further and develop chronic difficulties. Therapy can help validate one’s experiences and offer the understanding and acceptance one needs to start healing.
Identify triggers
Engaging in trauma-informed therapy can help an individual with recognizing, comprehending, exploring, and articulating memories and emotions linked to the trauma they experienced. An advantage of treatment is that it helps individuals identify which experiences or emotions might be triggered by reminders of the trauma (commonly known as triggers) and gradually learn to respond to them more effectively over time.
Develop helpful coping skills
Acquiring skills and enhancing coping strategies to effectively manage reminders and emotions related to the traumatic event. techniques to regulate emotions, manage stress, and improve interpersonal relationships. Coping skills aim to empower individuals to navigate future challenges more effectively.
Trauma processing or integration
This includes the careful processing of traumatic memories and experiences in a secure and controlled environment. Therapists employ a range of techniques like cognitive restructuring, exposure therapy, and narrative processing to aid clients in integrating their trauma.
Decrease traumatic distress symptoms
Therapy with a trauma-informed therapist can help a person learn to better regulate their emotions and reactions, as well as how to better manage and express their feelings. While it is never a goal of trauma therapy to downplay a traumatic event, while in therapy to address trauma, a therapeutic goal is often to decrease emotions of fear & distress around emotional triggers that stem from trauma. The therapist also works with the client to build coping skills to work through difficult feelings, sensations, and emotional reactions when they do arise.
How Do I Know if a Therapist is Trauma-Informed?
Currently, there are no state or national regulations that provide specific definitions for "trauma-informed provider" or "trauma-informed therapist." However, several states are progressing towards implementing credentialing processes to ensure clinicians possess adequate education and training in trauma-informed practices. In addition, therapists can possess training or certification in various trauma-informed practices. Some of these include: Certified Clinical Trauma Professional (CCTP), Trauma-Informed Yoga Certification, Mindfulness-Based Stress Reduction (MBSR) Certification, The Safe and Sound Protocol (SSP) Certification, Eye Movement Desensitization and Reprocessing (EMDR) Certification, and Somatic Experiencing (SE) Certification.
Regardless of location or professional background, there are certain questions you can ask a therapist to gain insight into their training and experience working with clients who have been exposed to trauma.
Consider asking:
What is your educational background, including your degree and professional title?
What are your areas of specialization?
How long have you been practicing therapy?
What experience do you have in working with clients who have experienced trauma?
What approach do you take when working with clients who have experienced trauma?
Have you undergone any specialized training related to the treatment of trauma?
How do you ensure that clients feel safe in sessions?
How do you incorporate trauma-informed principles into your practice?
The Substance Abuse and Mental Health Services Administration (SAMHSA) outline necessary skills for trauma-informed mental health providers, known as the “Four R’s”:
Realization about trauma and how it can affect people and groups
Recognition of the signs of trauma
Response and having a system of skills that can respond to trauma
Retraumatization and the importance of sensitivity & knowing prevention strategies to avoid retraumatization triggers for clients in treatment
Healing is most probable when individuals are provided with safety and nurturing by an expert who comprehends the importance of listening and validating their emotions. While all therapists possess these fundamental skills, a trauma-informed therapist generally has specialized training in trauma treatment or extensive experience assisting individuals who have undergone trauma. With compassion and curiosity, they will inquire about your trauma to gain a deeper understanding of you, rather than viewing that trauma solely as a source of pathology. A trauma-informed therapist will consider the client’s needs and preferences to collaborate on treatment goals in therapy.
This approach integrates a comprehensive understanding of trauma's impact into all aspects of treatment, emphasizing emotional and psychological safety for those receiving care. Individuals may experience heightened emotional intensity (hyperarousal) or emotional shutdown (hypoarousal) when triggered. In providing trauma-informed care, therapists employ various tools and treatments to facilitate healing while safeguarding against further harm from hyperarousal or hypoarousal states.
A trauma-informed therapist values your narrative and offers compassionate support as you share your experiences, focusing on regulating the nervous system. They understand the importance of pacing in trauma therapy to help clients manage emotions without becoming overwhelmed. Most importantly, they respect your autonomy in disclosing trauma and never pressure you to reveal details unwillingly. A trauma-informed therapist should prioritize checking-in on a client’s comfort level, self-care, boundaries, grounding techniques, and resources.
When evaluating a therapist's approach, consider how you feel during initial meetings. You should feel respected and comfortable, with the opportunity to gradually establish a sense of safety in the therapy space before delving into deeper trauma-related discussions. It's essential to sense compassion, respect, warmth, and advocacy from your therapist.
Conclusion
In conclusion, trauma-informed therapy offers a compassionate and empowering approach to mental health treatment, recognizing the profound impact of trauma and prioritizing safety, trust, collaboration, and resilience in the healing process. Trauma-informed care aims to diminish re-traumatization and facilitate healing by implementing various strategies. These include fostering a physically and emotionally safe environment, establishing trust and delineating boundaries, encouraging autonomy and offering choices, fostering collaborative relationships and providing opportunities for participation, and adopting a perspective that emphasizes strengths and empowerment to bolster a client’s feeling of resilience. By incorporating trauma-informed principles and approaches into their work, therapists and professionals can create supportive environments that foster healing and growth for individuals and communities alike.
