Key Takeaways:

1. Going to therapy might lead to you confronting aspects of your past that are challenging to think about, remember or articulate.
2. The therapeutic relationship between a client and a clinician can create a foundation that is safe and accessible for a client to process and work through past traumas. However, this takes time to form and will never be rushed by your therapist.
3. Trauma Informed Care offers a framework for therapy to take place in. It is a theory, but how it is used in practice does change depending on the therapeutic relationship. The main idea is that the therapist should be informed about how potential traumatic experience may influence a person’s functioning.

Have you ever been searching for a new therapist and seen the label “trauma-informed” listed under their specialties or modalities of practice? Have you ever wondered what that means? This blog post will explore the theoretical underpinnings of trauma informed care to give you a sense of what a clinician is referencing when they identify themselves as “trauma informed.”

The history of trauma informed care in the United States dates back to the mid 20th century. Following the world wars, it became apparent that the soldiers who had served in the military had come back as changed individuals. These changes ranged from difficulty sleeping to violent outbursts to dissociation to personality transformations. Through attempting to articulate these changes in meaningful ways, the diagnosis of Post-Traumatic Stress Disorder – formerly known as “shell-shock syndrome” after the explosive devices used in wartime – entered into the professional psychological landscape, and treatments began to be explored.

Through the post-war trauma-informed services movement, the idea of trauma has been expanded and applied to other groups of people besides soldiers: survivors of domestic violence, incarcerated individuals, refugees and immigrants, and more. The modern day approach to trauma-informed care centers around “the 4Rs”: Realize, Recognize, Refine, Regulate. Below are the 4Rs along with reflective questions for a patient to ask themselves about their experience of trauma-informed care.

Realize: Realizing that the impact of trauma is widespread, not just on an individual and interpersonal level, but throughout society.

Is therapy helping me to feel that trauma experiences are common? And that there is nothing inherently wrong with me nor am I to blame for the traumatic experience? 

Recognize: Recognizing the symptoms or signs of trauma happening. This requires training on behalf of the clinician to pay attention to the patient and know when and what questions to ask.

Can my therapist work with me to help me regulate my symptoms of trauma? Does my therapist know when it is challenging for me to share about my trauma? How do the two of us communicate about the traumatic experiences and how they have affected me?

Respond: Respond to admissions of trauma with dignity, not just interpersonally but through policies and procedures that impact the culture of how trauma is treated.

How does my therapist respond when I disclose trauma? Does their response make me feel safe and encouraged to share more in the future? Do I feel safe sharing my experiences, and if not, what is making it difficult for me? Can I talk through these difficulties with my therapist in a way that helps me feel safer sharing them?

Resist: Resist Re-traumatization. This is an active and intentional process of healing without deepening wounds.

What does my therapist do to resist re-traumatization? How do they encourage me to resist re-traumatization in my own life? Am I learning how to take care of myself and try to reduce the impact of trauma on my life?

In addition to the 4Rs, the Center for Disease Control has also outlined 6 Guiding Principles to trauma-informed care. As you pursue the list below, reflect on your own therapeutic experience/desires. How do these principles meet or challenge your idea of therapy? How might you want to experience these principles in your therapeutic relationship?

• Safety
• Trustworthiness & transparency
• Peer support
• Collaboration & mutuality
• Empowerment & choice
• Cultural, historical & gender issues

You might be thinking, shouldn’t all therapists be “trauma informed”? The answer, of course, is yes. While all therapists have come in contact with trauma-informed theory through their academic and professional training, not all therapists center this in their practice. Not all therapists work explicitly with individuals who have experienced and are seeking out therapy to process trauma. Knowing what kind of help you are looking for when you begin the therapist search empowers you to make connections that will meet your needs.

Many therapists who work with Start My Wellness have a strong interest in helping people that have experienced traumatic events and are looking for help in overcoming their difficulties.