Caitlyn had been to several mental health professionals for ongoing depression, but hadn’t gotten better. She felt that none of the therapists understood her. In addition to her mood symptoms, Caitlyn experienced periods of time where she felt very out of control, sometimes cutting her arms with a razor blade. She did not want to die, but some of her past therapists had hospitalized her every time she talked about her cutting.
Caitlyn was about ready to give up all hope of counseling helping her when she had a different experience with a new therapist. Caitlyn hesitated in mentioning her “self-mutilation,” as her other therapists called it, but when she finally did, this therapist responded differently than the others. The previous therapists had asked questions suggesting there was something wrong with her, but this one gently said, “I wonder if something traumatic has happened to you. Would you like to talk about it?”
In that transformative moment, Caitlyn felt safe enough to begin discussing her traumatic childhood experiences. Through her tone and her words, the therapist communicated that there was nothing wrong with her, and that her cutting behavior was a way she had learned to cope with a horrific experience.
What made the difference? Her therapist had been trained in trauma-informed care (TIC).
The recognition of trauma as an important factor in psychological and physical symptoms is not new. During the American Civil War, combatants were described as suffering from “soldier’s heart” or “nostalgia.” The use of heavy artillery in World War I led to the idea of “shell shock.” More recently, the diagnosis of Post-Traumatic Stress Disorder has entered our lexicon, and specific treatment approaches have been developed.
Now, we recognize that anyone can experience psychological and physical reactions to trauma. Victims of childhood abuse, crime, and other traumatic events may display a myriad of reactions. In fact, a longitudinal research study, The Adverse Childhood Experiences (ACES) Study, found long-term physical and mental health consequences resulting from traumatic experiences during childhood and adolescence.
Trauma-informed care is not about specific therapeutic techniques—it is an overall approach, a philosophy of providing care. Let’s look at some of the key principles of TIC and how they applied to Caitlyn:
- A safe therapeutic environment is essential to aid in recovery. Caitlyn had not felt safe with past therapists. She felt that she was considered a “problem client” who sometimes needed more than the therapist was willing and/or able to give. Therapists guided her away from certain topics because they feared “opening up” her pain. On the other hand, her new therapist recognized that learning to cope with her pain was an essential part of her recovery.
- Trauma-related symptoms and behaviors originate from adapting to traumatic experiences. Caitlyn sometimes withdrew and “shut down” when she felt overwhelming pain. The therapist accepted that this was a coping skill. Also, the therapist recognized that cutting served to soothe Caitlyn’s emotions. While these behaviors were not ideal coping strategies, they did serve a purpose. Trauma-informed care gives individuals an opportunity to see how resourceful they were in managing a very difficult experience.
- Recovery from trauma is identified as a goal in treatment. Recall that Caitlyn initially came to therapy because of depression. She hadn’t connected the dots between her past trauma history and her current difficulties. The therapist expresses hope that Caitlyn can recover, and that dealing with past trauma is part of the recovery process.
- Resiliency and trauma-resistant skills training are part of treatment. There are many alternative coping strategies that can be learned to cope with past trauma. The therapist works with Caitlyn to develop a repertoire of such skills.
- Trauma-informed care includes a focus on strengths rather than pathology. Caitlyn’s therapist noted that she had survived the trauma and asked questions such as: “What would you say are your strengths? What characteristics have helped you manage your experiences? How have you coped with your feelings? What are some of your accomplishments that make you feel proud?” With a therapist using such positive language, Caitlyn was able to recognize that she had coped quite well with very difficult experiences.
- Trauma recovery is a collaborative effort. The therapist asked Caitlyn about her personal goals for treatment, about what recovery would look like for her.
All of these factors enabled Caitlyn to see herself as a person deserving of respect, as a strong individual capable of recovery.
There are many other components of trauma-informed care. One of the most important concepts is that TIC is not just about how a therapist interacts with a specific client. It is also about how entire organizations become better prepared to serve all their clients.
Look for future articles that cover other aspects of TIC.