What is Trauma-Informed Therapy and How Is it Unique?
In general, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) 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.”
Examples of traumatic events include:
- Physical, sexual, emotional, mental abuse.
- Not getting childhood emotional needs met.
- Car accident.
- Witnessing someone else get injured, abused or neglected.
- Child of divorce.
- Child taking on parental role.
- Being the child of an emotionally or physically sick parent.
- Parent incarcerated.
- Death of loved one.
- Being denied your reality (i.e. “stop crying”, “get over it”, “that didn’t happen”).
When trauma occurs, it not only impacts an individual’s brain, but it also impacts their body. Organs, tissue, skin, muscles, and endocrine glands can all store trauma. Stored trauma makes individuals more likely to suffer from both physical and physiological conditions, from depression, cancer, obesity, anxiety, and stroke (ACE Questionnaire, 2017). Furthermore, people with unresolved stored trauma get sicker and die younger.
How does trauma affect me?
The ways in which trauma impacts the body are complex and cause unnecessary stress on the body (Mate, 2013). When an individual is stressed, the focus goes from maintaining homeostasis to protecting itself. This is unlike normative stress (i.e. a break up, marriage, death of loved one).
Normative stress allows an adaptive response to occur – coping strategies, self-soothing, and/or seeking resources to help return an individual back to their baseline (known as allostasis). This process allows us to develop resilience (Mate, 2013). Normative stress helps to grow and adapt, whereas chronic stress wears down and impacts every system in the body.
Stored trauma is activated when our protective parts subconsciously force our past onto our present. During this time, our protective parts attempt to come to our aid to defend us. The perceived danger, whether real or not, causes the amygdala (fear center) to light up.
Once activated, the amygdala sends defense signals to other areas of the body, causing systems in the body to respond and mobilize the necessary defensive responses (Mate, 2013). We may experience this as a rush of feelings, emotions, sensations and thoughts. This then results in self-protective patterns and a dysregulated nervous system (Baldwin, 2019).
What is trauma-informed therapy?
Trauma-informed therapy involves accounting for clients’ trauma and the impact that it has on their behavior, mental health, and ability to engage in treatment. Trauma-informed therapy is not about a specific intervention. Rather, it tailors 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 behavior. Although trauma-informed therapy does not refer to a specific set of interventions, this approach has shown effectiveness in decreasing symptoms of trauma in youth and adults.
Additionally, trauma-informed therapy can also address feelings of shame and guilt that trauma survivors often experience. The trauma-informed therapist will also consider the effects of intergenerational trauma on clients.
Trauma-informed therapists emphasize 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.
Why is trauma-informed therapy unique?
Trauma-informed therapists assume that the client could have a trauma history and take steps to avoid inadvertently triggering or re-traumatizing the client in treatment. What this means, is that that trauma informed therapist is knowledgeable about trauma and the potential impacts that trauma has on each of their clients.
The trauma informed therapist emphasizes not asking, “What is wrong with you?” Rather, “What happened to you?” The trauma therapist will then work with the client to become aware of their bodies and what is going on inside of them. Especially at times that the client feels triggered.
Trauma-informed therapy is beneficial in working with any individual who has experienced trauma, either during 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.
Is trauma-informed therapy right for me?
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?
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.
Some therapists might ask clients not to dig into the details of their trauma in a first session. This is because they want to ensure that the client has the skills to cope with whatever feelings come up before exploring the trauma itself. A trauma-informed therapist will communicate their approach to you and guide the session to fit with this approach.
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. Choosing a trauma-informed therapist can be challenging. If you feel that you are in need of a trauma-informed therapist or have questions about trauma-informed therapy. Please reach out to me today.
- ACEs Questionnaire. (2017). ACEs Questionnaire. Found online at https://link.springer.com/chapter/10.1007/978-3-319-31815-8_2
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Baldwin, S. (2019). How to Gain Control Over How You Feel: A Polyvagal Approach to Gaining Nervous System Regulation [ebook].
- Mate, G. (2003). When The Body Says No: The Cost of Hidden Stress. Knopf Canada.
“Ashamed”, Courtesy of J Taubitz, Unsplash.com, CC0 License; “Sitting in the Parking Lot”, Courtesy of Brock Wegner, Unsplash.com, Unsplash+ License; “Reflection”, Courtesy of Tiago Bandeira, Unsplash.com, CC0 License; “Sitting on the Dock”, Courtesy of S Migaj, Pexels.com, CC0 License