Trauma Informed Care is a very important practice in many different fields, including physical health practices, schools, and therapy, especially since trauma effects so many people. Research tells us that an estimated 70% of adults in the United States have experienced at least one traumatic event in their lives.
However, in order to understand what trauma-informed care is, we first must look at what trauma is. Trauma is defined differently to different people and can change across different platforms. Trauma is a very fluid concept and depends on each individual person.
One source defines trauma as a combination of a horrible experience or a string of experiences that involve real or perceived threats of serious injury or death, or threat to the physical person or others, and from which that person feels overwhelming fear, hopelessness, helplessness or terror.
This overwhelming stress can create long-term impacts, including changes in the physiology of the brain, especially in those of developing children and adolescents. Trauma can physically change the way your brain functions.
This definition feels very overwhelming and wordy when you first read it. In more simple terms, trauma is an event or multiple events that cause great fear, helplessness or hopelessness that creates overwhelming stress that impacts people long-term. Trauma can physically change the makeup of the brain especially in those that are still developing.
However, one of the most important things to consider is that trauma is defined by the person experiencing it. For example, to some being yelled at by someone may not be traumatic, but to someone else, it might be. It depends on the person and how they perceive the threat at the time.
Trauma is unique to each individual. What may be no big deal to you – may be traumatic to another. It is important to approach trauma work knowing that the person experiencing it is who decides if it is traumatic or not.
This is why trauma-informed care is so important. We must be willing to take a step back and be informed by the person who has experienced the trauma rather than go in as an expert. The client is the expert when it comes to trauma.
What is Trauma Informed Care?
Trauma Informed Care is an evidence-based therapeutic framework of treatment that involves understanding, recognizing, and responding appropriately to the effects of all types of trauma. It is important to utilize Trauma Informed Care to lessen the chances of retraumatizing clients.
Being informed on a wide spectrum of trauma and how to approach those healing from trauma allows for understand and compassion rather than potentially causing more harm or causing someone to relive their traumatic experiences.
The Five Principles of Trauma Informed Care
Trauma Informed Care consists of five principles: safety, trustworthiness and transparency, choice and voice, collaboration and mutual partnership, and empowerment. These principles are used to provide the best therapy for each client. It takes therapy from being a standard way of practice to being an individualized practice for each client.
The first principle to ensure a counselor is using trauma-informed care approach is safety. This includes making sure all feel welcomed into the common counseling spaces, that their privacy is respected and that they feel physically and emotionally safe.
To make sure all spaces are safe, counselors must make sure people feel safe culturally, emotionally, and psychically, as well as having awareness of when people are uncomfortable.
This takes work and effort. Counselors must ensure they build a strong rapport with clients, so they know they are accepted and protected in the counseling process. Clients that have experiences trauma function out of a heightened sense of stress and are constantly in fight or flight mode which means they need a place they feel safe in, in order to work through their trauma and to experience the benefits of counseling.
Trustworthiness and Transparency
As mentioned above, those who have experienced trauma are constantly under stress and functioning out of their fight or flight mode. Therefore, when counselors are working out of a trauma-informed care framework they must provide full and accurate information about what they are doing and what is coming next. Thus, the client will be able to have a sense of control in their counseling.
Trauma typically involves a lack of control for people which then creates their need to control things. When practicing from a trauma-informed framework you want to create a sense of control for your client by being transparent and clear, as well as consistent and able to be relied on.
Another aspect of being trustworthy is to provide clear boundaries with a client. Make sure your client knows what the boundaries of your practice are upfront and stick to these. It is also helpful to encourage clients to set up their own boundaries with others to ensure their wellbeing.
Choice and Voice
Trauma informed care includes honoring the individual’s dignity. This allows them to have their own choices heard and their voice listened to. This gives the individual control in their own therapy. It was mentioned earlier that when someone experiences trauma they feel like they have lost control, allowing them a space where they have control gives them power back.
This includes allowing the individual to clearly know that their rights and responsibilities are in therapy and letting them know they can choose if they want to move forward, pause or take a step back whenever they are in the middle of their therapy. As a therapist, our role is to let the individual know we hear them by using skills such as active listening, so clients feel heard and their voices feel valued in the conversation.
Collaborations and Mutual Partnership
It is important when working with a client who has a past history of trauma, to partner with them on their therapy journey. This means sharing the power with them when it comes to planning and evaluating serves. There is a natural power differential when someone comes in for therapy.
Since the therapist is the one naturally with the power they must make an intentional effort to make decisions with the individual. Frequent check-ins with the client about whether they like the direction therapy is going in allows them to be a partner in their therapy rather than a recipient only.
Not only is this beneficial during the therapeutic work, but long after. It teaches the client to be their own therapist moving forward. Therefore, when they are faced with a difficult situation they are able to use their skills. The therapeutic relationship must recognize there is a shared partnership in decision-making.
The last component of trauma-informed care is empowerment. Empowerment is helping them access their confidence in themselves. This is done by creating an environment where skill building can be taught and practiced while also affirming and validating the client. This is done at each and every step.
It involved identifying and recognizing the client’s unique strengths than building on their strengths while encouraging growth where needed. Small and big wins are celebrated along the way, continually building on the client’s self-worth.
When the clients feel empowered they feel validated in who they are, and it makes changing and growing more sustainable. The goal is to shift from empowering the client to the client being able to empower themselves.
Adverse Childhood Experiences
After diving into what Trauma Informed Care is, it should be noted that trauma is frequently experienced in childhood. A commonly used way of identifying specific forms of childhood trauma is Adverse Childhood Experiences (ACEs). ACEs is used to describe all types of trauma from abuse to accidents or family violence for anyone under the age of 18 years old.
An ACE score is determined from the 10 most common childhood traumas and a score is received based on how many a person has experienced. ACEs have been connected to chronic health issues, behavioral issues, mental health concerns, low life-potential, and even early death. As a person’s ACE score increases so does their risk for these potentials outcomes.
However, the presence of ACEs does not guarantee a child or person will have poor outcomes. Providing children or adults who have experiences trauma with a trauma-informed environment or trauma-informed counseling can strengthen their positive experiences and healing.
The most important part to remember with ACEs scores is that they are a guideline. They do not determine a person’s future nor are they the only types of toxic stress a child can experience that causes trauma. However, knowing a commonly used measurement for childhood trauma can be helpful in identifying your own past trauma.
Trauma Informed Environment
One thing to consider is how to make your environment more trauma informed. This is something you can do without having to come in for therapy. This space could include your home, your office or your counseling practice. Using the five principles, think through what you can do to change your space to make your space more trauma informed and comfortable of all people.
First, look at your physical space. Is your space a safe and inviting place for others? We want to make our spaces a place where a connection can happen. Is your home or office feel stale, closed off and a place you do not want to be? Then it most likely isn’t a place other people want to connect in.
Changing the layout of furniture can make it more inviting for people to connect and open up. It also fills the need to feel safe. This includes making your space open and organized. If someone is experiencing trauma and they come into your home and there is stuff everywhere it could increase their anxiety rather than invite them to share.
If you have children, and you want their space to feel safe allow them into the conversation. This gives them a bit of control in their own world. Allow them to pick their wall colors, their comforter and where their clothes go in their drawers and closet.
If you want your counseling office to feel safe and open, make sure to keep it organized. The colors should be calming and there should be no barriers such as large tables or screens to distract from the environment.
Secondly, consider noises in your space. Outside and unexpected noises can be very startling. Consider using a sound machine with white noise in bedrooms or to make sure there are not any overwhelming sounds.
Lastly, look for ways to be collaborative. If your space is very separated look for ways to redesign the space for there to be open collaboration. This allows for people to feel secure and a part of the discussions going on around them when we meet together. These are just a few ways to make your environment more trauma informed around you.
Benefits of Trauma Informed Care
After looking at what is trauma, defining the principles of trauma-informed care, looking into one common type of childhood trauma, and seeing how to make your spaces more trauma informed I think it is important to look at why this all matters. What is the benefit of being trauma informed?
The beauty of it all is that the principles are the benefits. Providing a safe place for people allows them to heal while empowering them them to see their own strength. Trusthworthiness, choice, and collaboration allow the client to have control over their healing. These are what make trauma-informed care so successful. The benefit is that clients feel safe, heard, encourage, and strengthened so that they can begin to heal.
Each person lives everyday through so many different experiences. Their story is their own, your story is your own. However, if you have experience trauma in anyway and are feeling stuck there are people who want to hear your story, that want to empower you, and walk with you as your process, heal and change. If you think you might benefit from trauma-informed care reach out for counseling. I would love to be a safe, trustworthy, collaborative place for you to be heard and empower in your journey of healing.
“Man in the Mirror”, Courtesy of Marcus P., Unsplash.com, CC0 License; “Waterfall”, Courtesy of Thomas DeGrange, Pexels.com, CC0 License; “Packed and Ready”, Courtesy of Andrew Neel, Pexels.com, CC0 License; “Mountain View”, Courtesy of theverticalstory, Unsplash.com, CC0 License