Trauma-Informed Therapy: How It Works & Why It’s Important

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 negative symptoms. Some people experience chronic trauma as a result of repeated exposure to traumatic events. Trauma itself is very common, with studies in the U.S. showing trauma rates at 50-60% in the general population.¹

Trauma & PTSD

Trauma has been linked with increased risk of mental and physical health problems.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 Does Trauma Informed Mean?

Trauma-informed refers to a concept based on the assumption that trauma can often be present in someone’s life and that this should be considered in the way they are served. This translates into a protocol that acknowledges the devastating effect trauma can have on a person’s physical, emotional, and mental well-being. Trauma-informed practices can typically be found in different sectors such as healthcare facilities, mental health clinics, schools, and social service agencies to ensure that trauma survivors have a safe and validating environment supporting their unique challenges and needs.²

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 someone’s 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.

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, our sense of ourselves and of the world often changes in some very negative ways. 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 them 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 who 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.

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.

How Does Trauma Informed Therapy Work?

Trauma-informed care is for everyone regardless of personal history, and oftentimes, you may not realize that your life experiences were indeed traumatic. Often, therapy for healing trauma 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.

Techniques of Trauma Informed Therapy

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 prevalence. 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 & Transparency

Trustworthiness means always being honest, clear, and consistent, especially with maintaining boundaries and never violating the client’s trust.

5. Peer Support

This key principle in trauma-informed care values peer support and connection, which can be of great importance, particularly for those who have experienced trauma. Peer support respects the survivor’s wellbeing and seeks to prevent the re-traumatization cycle, permitting them to have a chance to start the recovery process and choose the treatment or support that enhances it. The peer role is deep-rooted in the mindset of not trying to “fix” people, but instead empower them to become the person they envision themselves to be.

6. Cultural, Historical, & Gender Awareness

This integral pillar in Trauma-informed care involves appreciating and acknowledging someone’s cultural background, experiences, and identities as important components to effective trauma-informed services. This entails looking past cultural stereotypes/biases based on race, ethnicity, sexual orientation, etc., providing access to gender-affirming care, appreciating the healing value of traditional cultural bonds, and integrating guidelines that are sensitive to the racial, ethnic, and cultural necessities of the people being helped, as well as identifying and addressing historical and intergenerational trauma.

7. 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.

The Benefits of Trauma Informed Therapy

Trauma-informed therapies treat people within the context of their trauma in a safe environment that’s conducive to their healing and recovery process.

Here are some of the key benefits of trauma-informed therapy:²

• Helps the client learn about trauma: Trauma-informed therapies educate clients about their trauma, symptoms, triggers, etc. and how therapy can help.
• Re-establishes safety: Any type of trauma-informed intervention attempts to bring a sense of physical, mental, and emotional safety by creating a space where the person feels protected and not at risk of becoming retraumatized.
• Identifies triggers to help someone cope & heal: During visits, the therapist has the proper understanding and sensitivity to know how and when to help the person identify triggers and ways to effectively deal with their trauma.
• Decrease in trauma stress symptoms: As clients better understand their trauma, its effects, and different strategies to cope, their trauma-related symptoms and unhealthy responses decrease.

How Do I Know if a Therapist Is Trauma Informed?

Trauma-informed therapists have an 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 Trauma Therapy

It can take time to understand how therapy can be helpful, as recounting your 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 therapy 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 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.

How to Find a Trauma Informed Therapist

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?”

It’s a Good Idea to Talk to More Than One Potential Therapist

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.

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.