Trauma-informed care is an approach to therapy that asks “What happened to you?” rather than “What is wrong with you?” This shifts the tone from victim-blaming to recognizing the person as a survivor. Trauma-informed care is not a specific or technique-heavy modality, rather it is a set of guiding principles that recognizes that trauma has significant effects on people and is often under-recognized and under-reported.
A trauma-informed therapist will assume that you have had experiences that may have deeply affected you, and they recognize and respond to you in a way that emphasizes safety, collaboration, and empowerment.
Understanding Trauma
Trauma is a strong, negative, emotional response to a terrible event. Commonly, people think of events like a sexual assault, serious injury or disease, violence, or abuse. However, many other experiences cause trauma as well and can result in symptoms. Trauma itself is very common, with studies in the US that show trauma rates at 50-60% in the general population.1
Trauma has been linked with increased risk of mental and physical health problems and substance abuse.2 Not everyone who experiences trauma will develop post-traumatic stress disorder (PTSD), but it is estimated that 7.8% of Americans will have PTSD at some point in their lifetime.3 Often, care is not available or people wait a very long time to get professional help. If you have experienced a traumatic event, it is very important not to wait to get help. There are many evidence-based therapies available to help you recover.
What Is Trauma Informed Therapy?
Trauma-informed therapists assume that, more likely than not, their client has experienced trauma that should be addressed safely and compassionately. Additionally, trauma-informed care providers recognize the impact of cultural, historical, and gender issues and how they may affect a person.
Trauma-informed therapists work first to establish a sense of safety and trust before trying to dive deep into your trauma history. They start by developing a strong collaborative and supportive relationship. Trauma-informed clinicians will work to empower their clients by honoring their voice and their choice on what they want and need from their therapy. Compassion and respect are the foundation of trauma-informed care.
Who Is Trauma Informed Therapy For?
Trauma-informed care is for everyone regardless of personal history, and oftentimes, you may not realize that your life experiences were indeed traumatic. Often, the therapy will move slower in the beginning, taking time to establish trust before bombarding you with questions about all the details of your life. Trauma-informed therapists use many different styles and techniques and they generally tend to see clients weekly for approximately 50-minute sessions depending on the needs and preferences of the client.
Why Finding Trauma-Informed Care Is Important for Trauma Survivors
Traumatic experiences often happen in the context of relationships. When a trusted person hurts us, the damage to our sense of ourselves and of the world often changes in some very negative ways. Betrayal from someone we trusted can destroy our sense of trust in others. Trauma-informed therapists recognize and understand this and work hard to make sure that their clients are not retraumatized by providing a safe place for you to express those feelings without worrying about judgment or repulsion.
Healing is more likely to happen when a person is allowed to experience safety and care in the hands of an expert that understands how to listen and validate their feelings. Although all therapists have these basic skills, a trauma-informed therapist is typically going to have advanced training in treating trauma and they will have more experience helping someone who has experienced trauma.
Just like surgeons usually specialize in certain areas of the body, finding a therapist that specializes in trauma means you should be getting more skill and expertise and improved outcomes. Trauma-informed therapists will focus on making a strong working relationship grounded in safety and connection and use evidence-based treatments to help you recover.
Key Concepts of Trauma Informed Practices
Although there is no standard definition of trauma-informed therapy and no national standards or directories, there are some basic practices that trauma-informed therapists will all follow. Generally, a therapist or healthcare professional will be familiar with the impact and consequences of trauma as well as its prevalences. They will identify appropriate trauma-related screenings and assessments and learn when and how to use and interpret them.
Key principles of trauma-informed care include:4
1. Safety
Safety begins at the front door, where privacy is respected and the area is welcoming to all people. There is a focus on the physical and emotional sense of safety of every client, ensuring that they have an understanding of what will happen next.
2. Choice
Choice refers to the client having clear control of what happens during their care, and consent is obtained by making sure the client fully understands their rights and can provide continuous consent.
3. Collaboration
Collaboration happens when the therapist, rather than acting as the expert to the “sick” person, asks the client to share power and make decisions on what treatment goals they would like to work on. They have a significant role as the expert in their care.
4. Trustworthiness
Trustworthiness means always being honest, clear, and consistent, especially with maintaining boundaries and never violating the client’s trust.
5. Empowerment
Finally, empowerment means that you should always feel heard, cared for, and validated by all staff as they focus on helping you build more coping skills and learn to regulate your emotions.
These basic principles were developed to promote healing and work to reduce retraumatization. These principles ensure that all people feel safe, listened to, and are given a voice.
Additionally, trauma-informed principles must also be rooted in an understanding of the cultural, historical, and gender issues that the client brings to treatment.4 Many clients are not only having difficulty because of their trauma history, but because they may be marginalized or wounded by society in the form of racism, bias, and lack of access to affordable, quality care in their community.
How Do I Know if a Therapist Is Trauma Informed?
Trauma-informed therapists are those who have understanding and education around the implications of trauma and the impact trauma has on someone’s therapy journey. Trauma-informed therapists will understand that your experiences shape you and that trauma is part of that experience. They will ask with compassion and curiosity about your trauma to learn more about you, as opposed to looking at that trauma as solely a source of pathology.
If you’re unsure, ask your potential therapist the following questions to determine if they have a trauma-informed approach to therapy:
- How do you make sure clients feel safe?
- What is your training on trauma?
- What does trauma-informed mean to you?
- How do you treat trauma in sessions?
- What trauma-related scenarios have you treated?
What to Know When Starting Therapy for Trauma or PTSD
It can take time to understand how therapy can be helpful as recounting the trauma can be difficult. It’s important to know that you can speak up if something feels too overwhelming for you. If you are not sure if you are getting much out of therapy or you don’t feel completely safe with your therapist, getting another opinion can be helpful.
Not All Therapists Are Trauma-Informed
Some therapists may state they have trauma training, however that can vary drastically as it is a very subjective statement. Trauma-informed therapists have specialized training in working with trauma. They view trauma from a unique lens and bring a sense of safety to sessions. If you are not sure if your therapist has that training or is trauma-informed, asking more about this is encouraged.
You May Be Asked About Your Trauma History During the First Session
Your first session can be overwhelming. The therapist may request an extensive history, but it is important to speak up about how you are feeling recounting the trauma and stating what your boundaries may be at this time. Even though therapy is designed to be a safe space, it can still take time to get comfortable talking about your history. The first session involves a lot of data-gathering, so understand that the direction of your session is not a reflection of you, but rather is part of the clinical process of crafting a treatment plan. It’s important to go in with an open mind and also understand that it can take a toll emotionally working through all of your difficult emotions and memories.
Where to Access Trauma-Informed Care
First, call your insurance company if applicable. They will assist you in finding someone qualified within your network and they will explain what your mental health benefits are and how to use them. You should ask about possible referrals, copays, coinsurances, and deductibles. Although your therapist may be able to bill your insurance, it is your responsibility to verify your coverage as many plans are different, even within the same insurance company. Knowing your costs beforehand can save you frustration down the road.
Alternatively, you may want to start with your primary care physician. If your insurance requires a referral, this is a necessary step. Additionally, they may know of someone qualified and specialized in the area you need. Your primary care physician will do an evaluation of any physical symptoms, and can be a great first step in getting the right care.
Once you know your benefits and how to use them, you might try using an online therapist directory in which you can search for a licensed mental health provider that specializes in trauma.
Many behavioral health providers offer free phone or video consultations where you can ask questions like:
- “Have you worked with trauma survivors before?”
- “What does trauma-informed counseling mean to you?”
- “How do you help survivors of trauma recover?”
If you can, try to do a phone interview with 2-3 therapists and determine which one you feel the most natural level of comfort with and whom you could see yourself trusting to help you on this journey. It is crucial to your recovery that you feel comfortable and trust the person you chose to help you. The consultation is a chance for you both to determine if they are a good fit for your needs.
If you are aware that you have a history of traumatic experiences and are looking to connect with a caring and qualified mental health professional, there are a variety of ways that you can access treatment. The most important step is getting help. The majority of people experiencing a mental illness have not sought care for their illness and without help, trauma and its effects can worsen over time.5
Example of Non Trauma-Informed vs Trauma-Informed Care
So what does trauma-informed care look like in action? Here is a fictional client, Mary, and her two hypothetical experiences, the first with a healthcare provider that is not specifically trauma-informed and the second, with a trauma-informed therapist.
Example of Non-Trauma-Informed Care
Mary is a 40-year-old mother of three, who reaches out for help for her depression and marital stress. In the first meeting, she is asked to complete seven different forms without understanding their purpose. The questions seem very private and personal and she is worried about lying but also feels uncomfortable sharing details of her previous sexual and physical abuse she experienced as a child. She answers more questions when she meets the therapist, who is male, as he explains that he is there to complete her intake but will not be her actual therapist. He explains that it is a low-cost clinic, and as such, she may not choose her counselor.
Two weeks later, she meets with another new person and they ask her the same questions over again. At the end of the 2nd meeting, she is given a diagnosis and asked to sign a treatment plan that the counselor made based on her disorder and the goals they believe she needs to work on. She is told she needs to see a psychiatrist because she is too severely ill to be seen without also taking medications. She is told she must meet with the doctor and do what he tells her otherwise she could be discharged for non-compliance.
Mary leaves feeling bad about herself. The doctor again asks her in great detail about her trauma history and sends her home with two medications he thinks she needs. She goes home and never returns to the clinic.
Example of Trauma-Informed Care
Mary attends her first meeting with the therapist that first reviews her rights to privacy, confidentiality and safety. She is offered to sit wherever she feels comfortable and is asked by the therapist if she feels comfortable with the door closed to protect her privacy. She asks Mary if she would prefer to have a therapist of another gender or race, making sure that Mary is comfortable talking with her more before proceeding.
Mary is asked to tell the therapist about her experience of her problems and she is also asked about her previous experience with other therapists. She is not asked to fill out any assessments or detailed questions about her personal history. Mary tells her that her previous therapist asked a lot of questions and then told her she had PTSD, and they made her see a doctor who put her on meds that made her feel sick. This left her feeling more depressed and helpless, and unsure of what, if anything, would be done to help her.
The therapist listens warmly, showing compassion, and asks Mary if it would be ok to try something different—and Mary agrees. She offers Mary to meet weekly for the next month and together they would create a plan for Mary’s care based on what Mary needs and prefers as they develop trust and understanding.
During that first month, the therapist asks questions about Mary’s experiences and environment, making sure to clarify why she needs to know certain things and reminding Mary that she can always choose not to answer if she feels uncomfortable. She ends each session asking Mary for feedback on what is working and what is not and what can be done to continue to support her. Together they develop goals that Mary feels will most improve her relationships and her depression.
The latter example highlights the focus on safety, developing trust, and working collaboratively to help Mary understand how her life experiences have impacted her, maintaining focus on Mary’s needs and preferences at all times.
If you have ever had a bad experience with a therapist, you know the difference between the two almost intuitively. Good therapy feels safe, comfortable, and always under your control. These basic principles help to ensure that you are not retraumatized and that your unique needs can be met with compassion and respect for your autonomy and dignity.
Final Thoughts on Trauma-Informed Care
Treatment for trauma is measured in months, not weeks, so be prepared to commit to your process and expect therapy at times to be difficult. Although therapy is generally safe and promotes your wellbeing, there are always risks with treatment. Recalling and describing significantly disturbing events can sometimes affect your mood and mental health. However, with the help of a skilled professional therapist and with your feedback, you should be able to feel better quickly. Remember to be honest about your struggles and know that recovery from trauma is possible.
For Further Reading
Trauma-Informed Therapy Infographics
