How to be a trauma informed therapist

Deborah C. Escalante

What Is Trauma-Informed Therapy?

Trauma-informed therapy involves accounting for clients’ trauma and its impact on their behavior, 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-traumatizing 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) defines trauma as: “Exposure to actual or threatened events involving death, serious injury, or sexual violation in one (or more) of the following ways:

  1. Directly experiencing the events.
  2. Witnessing the events in person as they occur to others.
  3. Learning that the events occurred to a close family member or friend.
  4. 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:

  1. Physical abuse
  2. Sexual abuse
  3. Emotional abuse
  4. Physical neglect
  5. Emotional neglect
  6. Family member or caretaker mental illness
  7. Family member or caretaker substance abuse
  8. Witnessing violence against the mother
  9. Having a relative sent to jail or prison
  10. 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.

The initial study indicates that more than 46% of children have at least one Adverse Childhood Experience, highlighting the need for trauma-informed care.

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 emphasizes 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 behavior. They will also consider the effects of intergenerational trauma on clients.

Trauma-informed therapists emphasize the following areas in their practice:

  1. Physical and emotional safety. A trauma-informed therapist will take steps to ensure that clients feel both physically and emotionally safe in their sessions.
  2. Collaboration. Trauma-informed therapists aim to empower clients by educating them about their options and giving them an active role in their care.
  3. Transparency. Trauma-informed therapists are open and honest with clients.
  4. 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.
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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:

  1. What training have you done in trauma-informed care?
  2. Do you consider yourself trauma-informed, and what does this mean to you?
  3. What is your approach to therapy with clients with trauma history?
  4. What kinds of clients do you work with, or what kinds of trauma do you work with?
  5. Are there any types of trauma that you do not feel comfortable or competent to work with?
  6. 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.

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.

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.

A Word From Verywell

If you’re dealing with the effects of trauma, there is no shame in reaching out for help. A trauma-informed therapist will validate your emotions and equip you with the healthy coping mechanisms that are necessary to safely process your trauma.

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The term trauma-informed care is a very important concept. A trauma-informed therapist is aware of the complex impact of trauma (any perceived trauma) on a person’s suffering and how it shapes a person’s efforts to cope. A trauma-informed approach integrates a thorough knowledge of this impact into every aspect of treatment. It also means that any person or organization that claims to be trauma-informed makes emotional and psychological safety a priority for the people they serve.

Unfortunately, trauma-informed care — or TIC — is also becoming a buzzword. More people are using it casually with too little regard for what it means.

If you hear someone describe himself or herself or their organization as trauma-informed, I want you to have a good idea what that means so you can look for signs that the quality of care holds true to that claim. I want to give you some tips for finding a truly trauma-informed therapist in a landscape where it has become a buzzword.

Your Safety Takes Top Priority in Trauma-Informed Care

Trauma-informed care recognizes the impact of experiences that threaten a person’s sense of safety and wellbeing.

Trauma changes how a person regulates their thoughts and feelings, and their ability to care for themselves emotionally and psychologically. TIC also recognizes that a person with a history of trauma may not think of himself or herself as a trauma survivor, and may not even be fully aware of what it means to live with the consequences of what they experienced.

A therapist who is trauma-informed knows that the mind and body of a person with unhealed trauma is functioning in an altered way. That person may be easily triggered to feel too much emotional intensity (hyperarousal), or shut down and unable to feel much at all (hypoarousal).

Someone offering trauma-informed care uses all the tools and treatments they can to promote healing, while preventing further harm from hyper- or hypoarousal. An organization or person offering trauma-informed care prioritizes six key principles says SAMHSA (the Substance Abuse and Mental Health Services Administration):

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, Historical, and Gender Issues

What Is Trauma-Informed Therapy?

A trauma-informed approach seeks an awareness of the widespread impact of trauma on life experience and relationships. It recognizes trauma’s role in the outlook, emotions and behavior of a person with a trauma history. A trauma-informed approach also accepts that trauma’s impact is far more prevalent than most people realize.

As trauma-informed therapists, we choose to focus not only on the behavior someone is trying to change —but also on the underlying reasons for the behavior and the relief it provides currently.

We focus on behavior, beliefs and desired relief so we can do repair work at the deepest level to make the change long lasting. A trauma-informed approach attends to the underlying trauma from any cause.

Trauma-informed care can apply to anyone. It’s not just for people with obvious sources of trauma like physical or sexual abuse. Trauma-informed care applies as well to people with a history of depression or anxiety that has wreaked havoc on life, people with emotional abuse or attachment wounds, or any kind of trauma.

The Challenge: Help Trauma Survivors Heal When They Don’t Recognize Their Own Trauma

Trauma-informed care is intended to meet the challenge of helping someone safely recognize their trauma history even when they don’t believe their experience includes trauma.

You may not consider your life experience to include trauma.

Yet the way you have learned to cope in life may reflect the impact of trauma even if you don’t recognize it in yourself. That is why the most effective treatment is from an approach that is trauma-informed.

The reality is, a wide range of adverse events can cause trauma. Some are easier to recognize than others. A trauma-informed therapist’s job is to help someone heal from adverse experiences, even when that person does not identify as a trauma survivor.

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Why is a Trauma-Informed Approach Necessary?

Recognizing trauma’s role in a person’s experience is essential to treating and healing the toxic stress of trauma on one’s life. Untreated, this stress can result in so many negative health outcomes. In her TED Talk, Nadine Burke Harris discusses how childhood trauma affects health across an entire lifetime.

Recognizing the nature of trauma and understanding its impact is where the hope lies—it’s where recovery begins! Trauma-informed care is built on a holistic view that offers safety and compassion. It inspires hope, strength, relief, and enables people to make long-lasting change.

What Happens if You Don’t Have a (Truly) Trauma-Informed Therapist?

Unfortunately, some clients find me after working with someone who claimed to be trauma-informed but whose approach left clients feeling more distressed and unsafe.

When I hear a client tell me their last therapist wanted to know all the details of their trauma on the first appointment I think, “Whoa! If your ‘trauma-informed therapist’ ever asked you to do this—this approach was not trauma-informed!” Talking about the details of the trauma — without building resources to regulate your emotions first — activates the same neural pathways again. This rightly leaves a person with trauma feeling unsafe in that moment, too!

I certainly don’t want the trauma to be re-enacted during a first meeting. The process needs to be gradual, and it must start with safety, stabilization and trust.

Have you Been Turned Off by Past Therapy Because it Felt too Overwhelming?

When therapists move too fast, it can do damage to the healing process and the client. Until both the therapist and client understand the underlying issues and build resources and safety, talking about what happened can lead clients further down a path to harmful behavior, depression, anxiety or even shame.

A safe, compassionate environment is the hallmark of trauma-informed therapy. It offers a way to make your experience understandable and manageable so there is hope, healing and long-lasting change. This is why I’m shouting from the rooftops about the benefits of trauma-informed care! If you have had a negative therapeutic experience in the past, I encourage you to try again with a trauma-informed therapist who has the knowledge and training to explain what it means clearly to you.

Seeking a Trauma-Informed Therapist? Here’s What to Look For

Unfortunately, there’s no official database of “trauma-informed therapists.” But I’d like to share some tips—what to look for—when you’re seeking a trauma informed therapist. Pay attention to a how a therapist describes themselves on their website; listen to how they talk to you on the phone.

When a therapist has an authentically trauma-informed approach:

  • They will talk about safety from the beginning: physical safety, emotional safety, and creating a safe environment where healing can occur.
  • They will talk about self-care, boundaries, grounding and resourcing.
  • Their approach recognizes that your behavior isn’t who you are—rather that it makes sense based on your history. It is what happened to you, not who you are!
  • They work to understand your coping skills, how you survived your experiences, and help you build new healthy coping skills.
  • They move at a pace you’re comfortable with, collaborating with you along the way, and work to keep you within your window of tolerance of emotions.

Don’t be afraid to request more information like: Tell me what a trauma-informed approach means to you.

In addition, pay attention to how you feel in the initial meetings with a new therapist. You should feel respected and comfortable. You should feel that you are being allowed to slowly build a relationship and a sense of safety in the therapy room before ever sharing deeper information about your trauma history. My hope for you is that you will also feel compassion, warmth and kindness.

Most importantly, if any therapist asks you for the nitty-gritty details of your trauma the first day you meet them, RUN in the other direction!

Here’s more on finding a good therapist.

You Deserve the Best Care!

If you’re on a therapeutic journey or thinking about it for yourself or a loved one, I can’t stress enough the importance of having a trauma-informed therapist.

I know it may be hard to think that you deserve the best, but if you can take only one thing from this article, it’s that you DESERVE a therapist who can help you heal by respecting you and working together with you, compassionately, to help you heal and move forward.

More Resources

Trauma & Relationships

Trauma & Addiction

Trauma & Compassion

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