What to look for in a trauma therapist

Deborah C. Escalante

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.

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Part 2: How to Find a Real Trauma Therapist and What You Should Look For

This post is part two of a three-part post that covers why it is important to work with a real trauma therapist, what a real trauma therapist is, what you should look for when finding a therapist, and what you can expect when in treatment with a real trauma therapist.

“Real” Trauma Therapists

This subheading may sound somewhat confusing, as to some patients, and perhaps therapists, a “real” trauma therapist is “anyone who works with trauma.” Well, that is … extremely inaccurate. I cannot put it any other way other than that this notion is entirely false. Unfortunately, there are many, many therapists who advertise that they work with trauma. Many times this comes from an interest in trauma or perhaps the thought “I wouldn’t mind working with trauma, plus this opens up my clientele, so let’s see what happens.” Unfortunately, that is not what it takes to actually effectively help someone who has experienced trauma.

Working with trauma is a highly specialized area of psychological practice, which is why it is important you seek treatment from a trained and experienced trauma psychologist or therapist.

Yes, it is simple for a therapist to state they work with trauma if they have even once sat with a patient and listened while the patient shared a traumatic experience. But, that is not trauma treatment. Listening to a patient share a life experience does not even cross the threshold of what is involved in understanding trauma, knowing how it impacts the individual, knowing how to effectively treat trauma, and how to problem-solve nuanced aspects of the treatment process.

Take this brief metaphorical example that may help to make more sense of this: If a patient goes to their general practitioner (GP) and has a conversation with the GP about complications from recent heart surgery, does that now make the GP a cardiologist? Absolutely not. In fact, in such cases, the ethical and competent GP would refer the patient back to the specialist (the cardiologist); in the case of psychology and trauma, it is important you see a trauma specialist in order to obtain treatment with a knowledgeable and skilled therapist that can actually help you.

So What is a Real Trauma Therapist?

Put simply, a real trauma therapist is a licensed mental health professional who has had explicit training, supervision, and clinical experience working directly, and perhaps almost exclusively, with trauma. The therapist is likely to be a psychologist, licensed mental health counselor, or sometimes a social worker. A real trauma therapist is not someone who has had passive experience working with trauma; this means that working with one or two patients, even if the primary focus was trauma, does not qualify someone as a trauma therapist. More specifically, the next section outlines what to look for when searching for a trauma therapist.

Qualities of a Real Trauma Therapist

1. The therapist has trained in a dedicated trauma setting. This typically means the therapist has completed an extended-length practicum, internship, or residency in a trauma facility or center, with a focus on trauma psychology. To confirm this, read the therapist’s bio or “about” page. It should mention receiving training and supervised clinical experience in a DoD (Department of Defense), VA (Veteran’s Administration), hospital, or community trauma center. If still unsure, look up the facilities where the therapist has gained experience and see whether they exclusively work with trauma. Also, ask the therapist about their experience with treating trauma.

2. The therapist has treated multiple trauma cases. Again, working with a few trauma cases does not make a therapist a trauma clinician. Going back to the cardiologist example, does a resident doctor who examines a few cardiology patients instantly become a cardiologist? No. Trauma psychology is a very specialized area of psychological practice, which requires that the therapist has significant experience working with a variety of trauma cases from start to finish in order to be considered competent and proficient in providing trauma treatment.

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3. The therapist must possess sound and applied knowledge of the development of acute stress and post-traumatic stress. Knowing how post-trauma responses form and develop over time is an incredibly important aspect of knowing how to treat trauma. A therapist must know what to look for and how to best treat the symptoms you are experiencing (and even the ones you are unable to report because they happen so automatically that you don’t realize they are happening). A real trauma therapist will be very knowledgeable about these aspects of diagnosis and treatment.

4. The therapist must possess a thorough understanding of the impact of trauma on one’s life. This is only gained by being extremely familiar with trauma and trauma treatment, which is a function of significant training and experience with trauma. The reality is that if you work with a pseudo-trauma therapist, they just won’t know what trauma responses actually “look like.” This means they won’t pick up on the struggles you are experiencing, won’t know the right questions to ask, and the subtle behaviors and statements to pick up on. Only genuine trauma therapists have the breadth and depth of training to be able to thoroughly and accurately provide treatment.

5. The therapist should be trained in at least one, but hopefully more evidence-based trauma treatments (EBTs). EBTs are therapies that have empirical evidence supporting their effectiveness. Fortunately, trauma treatment includes three EBTs that are highly effective in reducing trauma symptoms and helping the individual to regain their quality of life: these are CPT (Cognitive Processing Therapy), PE (Prolonged Exposure), and EMDR (Eye Movement Desensitization and Reprocessing). A real trauma therapist should be trained in at least one of the three, but ideally is trained in all three since they are not exactly interchangeable.

6. The therapist should be certified in trauma treatments. The definition of training can be vague. Some clinicians will unethically state they are trained in a particular treatment based on having minimal exposure to the therapy. For example, perhaps the treatment was discussed during one lecture in a graduate course, or they observed a supervisor administer the treatment a few times. This does not equate to being trained. “Trained,” in the most ethical use of the term, means that the clinician has been taught, practiced, refined, tested, and frequently uses the treatment. For this reason, it is better to work with a therapist who is certified in one or more of the aforementioned treatments (CPT, PE, and EMDR). This is the only sure way of knowing that the therapist truly knows what they are doing and can provide the treatment according to protocol, which means it is more likely to be effective for you.

7. The therapist focuses their clinical practice on trauma. This means that they identify themselves as a trauma clinician and markets their practice specifically as providing trauma treatment. If the therapist advertises themselves as primarily treating another problem area (for example, as an ADHD therapist), and then lists multiple other clinical problem areas “on the side” that includes trauma, trauma is not their focus. Likewise, if their primary area of practice is on children and they are offering treatment for combat veterans who have PTSD, then trauma and adults (i.e., combat veterans) are not their focus. If trauma is not their focus, it often means they are not as experienced in treating trauma (which may be why it is not their area of focus), they are not as passionate about treating trauma, or they acknowledge their proficiency in treating trauma is reduced as most of their training and clinical work has likely been in the area which they primarily market themself and their practice (e.g., ADHD, autism, couples, eating disorders).

8. The therapist does not generally apply CBT (cognitive behavioral therapy). Yes, CBT forms the basis of some of the trauma treatments (e.g., CPT), but a therapist who is generally teaching patients CBT skills for the treatment of trauma is not a trauma therapist; that is a therapist who is reaching for methods to help you, but is not actually trained in the treatments that are specific to healing from trauma.

While generally speaking it is important to find a specialist for most mental health problem areas, this is especially true with trauma due to its highly nuanced and specialized nature. Again, the biggest concern on the patient’s part is usually results. You are far more likely to obtain positive results if you are working with a therapist who knows what they are doing and how to help you. Part 3 will review what you can expect when in treatment with a real trauma therapist.

To find a therapist, please visit the Psychology Today Therapy Directory.

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