Untreated trauma can pose significant dangers to an individual’s health. Mental health clinicians need to understand this and work to integrate therapy techniques for trauma, as well as incorporate trauma-informed approaches into their programs from the moment the client makes the first phone call. Addressing these needs sooner rather than later will lead to better long-term outcomes.
To create this guide to trauma-informed therapy best practices, we consulted with the following experts from the National Council for Mental Well-Being:
- Karen Johnson, MSW, LCSW
- Cheryl Sharp, MSW
- Linda Henderson-Smith, PhD, LPC
Using screening and assessments as therapy techniques for trauma
Before trauma-informed therapy can begin, the practitioner conducting the therapy needs to understand the client’s history with trauma.
During the screening and assessment process, the most important factor to consider is establishing safety and trust. The practitioner is far more important than the tool used in creating a safe space for disclosing a history of trauma.
When first meeting a client, begin with a trauma screening. The goal is to identify if difficult events have happened in a person’s life that might be impacting their current challenges. As such, screening for trauma tends to be much shorter than conducting an assessment.
In assessments, we still do not go into “the who, when, and how” questions, but we do explore the “what.” Assessments help us identify the triggering event(s) and the client to understand that we are asking these questions to ensure we guide them appropriately through therapy and other treatment techniques.
Staff needs to understand that a person might not feel safe enough to tell us too much. To start building trust, give the client the option of not answering questions. Proper therapy techniques for trauma are only effective when clients feel comfortable. You can also administer these screenings and assessments digitally, so the individual can complete them without face-to-face interaction.
For many clients, this might be the first time that they have been asked the question and will feel relieved that someone is finally getting to the heart of the matter. Simple responses when someone does disclose might be, “I am very sorry this happened to you,” or “This should never happen to a child.” This can go a long way to calming the triggers that might arise.
Please remember, trauma survivors are not fragile. They have been living and surviving for years with the events that have occurred in their lives.
Recalling a traumatic event
How service providers work with clients to recall traumatic events has undergone a paradigm shift in recent years. Previously, many providers would view the maladaptive behaviors that often accompany a history of trauma and think, “What’s wrong with you?” Now, providers approach this process with the following question in mind: “What happened to you?”
In this way, the field has moved from the disease model to a strengths-based model. The actual question (“What happened to you?”) is not always asked, and when it is, it needs to be asked in a sensitive, safe way by a trained clinician employing validated tools.
The purpose behind asking the question is not to have the client recall all details of the event but to help them connect the dots between their life events and how they are currently functioning. This reframe can open a whole new world for service providers and the people they serve and help them to change internal messages around their perceived weaknesses and deficits.
The message “I am broken and weak” can become “I am a survivor. I am strong.”
To train your staff to use this approach, try involving the voice of people with lived experience in training through videos and/or consumers sharing their story. This can help people to see the need for this paradigm change.
A trauma survivor sharing how the interactions outside of the therapy room were stigmatizing and disrespectful, or trauma-informed, can be very powerful for staff.
Remembrance vs. recall in trauma-informed care
In any good model of trauma treatment, the first goal should be to do no harm. The telling of events is something that a person needs to be ready to remember. In a trauma-informed environment, this requires that the person feels safety, security, and trust. It is also important that the person can remain grounded and/or learn to ground themselves.
In a trauma-informed organization, staff members look at the full experience of the client and work to create an environment that helps to provide the corrective experience that the person so desperately needs. The retelling of the story, not just recalling factual events as in a clinical assessment, can have a healing effect. When recalling the facts, many people are able to separate themselves from those facts without much dysregulation.
Still, in the retelling and assessment phases, we can establish the early stages of safety and trust using solid clinical skills that convey that we are here to listen, not judge, and allow the person to let the retelling unfold.
In remembrance, we support the person’s story and allow this to be a gentle process and are mindful of the power of our presence as a witness to a person’s deepest pain. We do not push or prod, we invite the unfolding. This can take time, but the process has proven powerful.
Finally, good therapy techniques for trauma allow for mourning. Remember that a person has a right to express their anger or grief and that this is healthy.
Trauma-informed peer support
Peers are frequently integrated into trauma-informed care work. Peers provide a unique opportunity to offer essential feedback from the perspective of lived experience. This includes having utilized the services offered as well as having recovered from trauma of their own.
Since peers have lived through many of the same experiences as their clients, trauma-informed peer support can help clients combat many of the feelings that arise from trauma. These include:
- Loneliness
- Hopelessness
- Vulnerability
- Unsafety
By working with a peer, trauma survivors can see that there is hope and begin to work toward concrete goals.
When performing trauma-informed peer support, SAMHSA recommends that organizations take the following steps:
- Work with clients to understand how they are coping and surviving.
- Create a safe space for clients to learn new coping strategies.
- Work with clients to find coping strategies or mechanisms, rather than identifying symptoms.
Like adult peer specialists, those working with adolescents help clients develop healthy coping mechanisms based on their own goals. Through these interactions, adolescents learn to elevate their own voices, allowing them to feel heard and appreciated.
You can train your peers on taking trauma-informed approach and applying therapy techniques for trauma in the same way you would train your clinical staff:
- Training on trauma-informed best practices
- Offering technical assistance through the learning process
- On-going coaching and supervision to help answer questions after they start work as a peer
Creating a Trauma-Informed System of Care: Addressing Individuals, Professionals, and Organizations
Trauma-informed care (TIC) is an organizational framework that involves recognizing, understanding, and responding to the effects of trauma. TIC is different from other models of care because it can be used in any type of service setting or organization. See how Relias can help you understand and implement TIC at your organization.
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