What Is Trauma-Informed Therapy?

Trauma-informed therapy considers a client's past trauma and its effects on their behavior, mental health, and engagement in treatment. Therapists assume that a client might have experienced trauma and take care to avoid triggering or re-traumatizing them during therapy.

What Is Trauma?

Trauma can come in many forms, and people respond differently to it. Not everyone who experiences a traumatic event will develop trauma. The DSM-5 defines trauma as exposure to actual or threatened events involving death, serious injury, or sexual violation. This can happen through:

• Directly experiencing the events.
• Witnessing the events as they happen to others.
• Learning about the events happening to a close family member or friend.
• Being repeatedly exposed to distressing details of the events.

The CDC and Kaiser Permanente study ongoing stressors in children, known as Adverse Childhood Experiences (ACEs). ACEs can lead to behavioral issues in children and adolescents and have lifelong effects. Adults with high ACE scores are more likely to face physical health issues, mental illness, and early death.

There are ten identified ACEs:

1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Physical neglect
5. Emotional neglect
6. Family member or caretaker mental illness
7. Family member or caretaker substance abuse
8. Witnessing violence against the mother
9. Having a relative sent to jail or prison
10. Losing a parent due to separation, divorce, or death

Recent research also suggests that racial trauma should be considered an ACE for Black children.

More than 46% of children have at least one ACE, highlighting the need for trauma-informed care. Trauma-informed therapists understand trauma's potential impact and focus on asking, "What happened to you?" instead of "What's wrong with you?"

Types of Trauma Therapy

Several types of therapy can help treat trauma. Workman highlights a few options that mental health practitioners may use to address trauma-related issues and PTSD:

• Prolonged Exposure (PE): This therapy involves gradually exposing you to the source of your fear until it no longer scares you.
• Cognitive Processing Therapy (CPT): This approach helps you challenge and reframe your thoughts and beliefs about the traumatic event. It can be done individually or in groups.
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): Designed for children and adolescents, this therapy addresses inaccurate beliefs and unhealthy behavior patterns.
• Eye Movement Desensitization and Reprocessing (EMDR): This treatment uses bilateral stimulation (like eye movements) to help process and release emotions blocked by trauma.

PE and CPT are particularly effective, with solid research backing their use. These therapies can be completed in about three to four months, which is relatively short considering the long-term suffering that trauma can cause. They can be conducted both in-person and online.

CPT is also flexible, as it can be done without discussing the actual trauma, which is helpful if you don't remember the trauma or prefer not to talk about it. TF-CBT and EMDR are also effective in reducing PTSD symptoms, improving overall functioning, and enhancing quality of life.

Techniques of Trauma-Informed Therapy

Trauma-informed therapy isn't about a specific technique; it's about adapting interventions to fit each person's trauma history, triggers, and unique needs. Therapists view clients through a trauma-informed lens, considering the impact of trauma on emotions, self-regulation, and behaviour, as well as the effects of intergenerational trauma.

Critical aspects of trauma-informed therapy include:

1. Physical and Emotional Safety: Ensuring that clients feel safe during sessions.
2. Collaboration: Empowering clients by informing them of their options and involving them in their care.
3. Transparency: Being open and honest with clients.
4. Competency: Staying educated on research and best practices for working with trauma and being aware of each client's cultural background and experiences.

What Trauma-Informed Therapy Can Help With?

Trauma-informed therapy is helpful for anyone who has experienced trauma, whether in childhood or as an adult. Even if you're not seeking treatment specifically for trauma, this approach can help ensure your emotional safety during sessions.

Not everyone has experienced trauma, but using a trauma-informed approach won't harm those who don't need it. That's why many therapists use this approach in all sessions, not just when the main concern is related to a specific trauma.

The Effectiveness of Trauma-Informed Therapy

Trauma-informed therapy doesn't involve a specific set of techniques, but this approach is practical for both youth and adults who have experienced trauma. It can also help address feelings of guilt and shame that trauma survivors often experience.

Things to Consider When Starting Trauma Therapy

If you believe trauma-informed care suits your needs, it's essential to find a therapist with the proper training. Here are some things to consider before starting trauma therapy.

Not All Therapists Are Trauma-Informed

While many therapists are trained in trauma work, not all specialize in trauma-informed care. Finding a therapist with the proper training and approach for your needs is important. When looking for a therapist, consider asking the following questions:

• What training have you done in trauma-informed care?
• Do you consider yourself trauma-informed? What does that mean to you?
• What is your approach to therapy with clients who have a trauma history?
• What kinds of clients and types of trauma do you work with?
• Are there any types of trauma you don't feel comfortable or qualified to work with?
• At what pace do you go when treating trauma?

It's okay to ask these questions to ensure you find a therapist you're comfortable with. Just because a therapist lists trauma as a specialty doesn't mean they have the same level of training or experience in trauma-informed care.

You May Be Asked About Your Trauma History During the First Session

During the first session, the intake appointment, therapists typically gather detailed information about your history to tailor the therapy to your needs. This may include questions about your trauma history. Letting your therapist know if you're uncomfortable sharing specific details is okay. A trauma-informed therapist will respect your boundaries and adjust their approach to make you feel safe.

Some therapists might not delve into the details of your trauma right away. They may want to ensure you have the skills to cope with any strong emotions that arise before exploring the trauma itself. A trauma-informed therapist will explain their approach and guide the session accordingly. If your therapist redirects the conversation, it's not because you've done something wrong; they may have good reasons and should explain them.

Therapy Can Be Exhausting Work

Therapy often involves exploring emotions and memories you may not usually confront. Think of your trauma as a wound that needs care. Just like a physical wound, it must be cleaned for proper healing, even if it is uncomfortable. Be gentle and patient with yourself as you navigate this healing journey. Remember, feeling drained after sessions is normal, but this is part of healing and growth.

How to Get Started?

If you've experienced trauma and want treatment, look for a therapist, psychologist, or psychiatrist who specializes in trauma therapy.

If you're already seeing a mental healthcare provider for your symptoms, they can refer you to a specialist. Veterans can find support through local and national organizations that offer therapy and resources for trauma and PTSD.

For BIPOC and LGBTQ+ individuals, it's essential to work with a therapist knowledgeable about discrimination, oppression, and inequality. They should be competent in discussing issues like racism, racial trauma, cultural concerns, and historical and intergenerational trauma.

The Most Inclusive Online Therapy Platforms of 2024 offer options for finding a trauma specialist. When you contact a practitioner, they may ask about your medications, medical history, and insurance plan. They will also assess whether trauma therapy is right for you and recommend the best treatment.

You and your mental healthcare provider can work together to set therapy goals and create a treatment plan that suits your needs. If you're experiencing the effects of trauma, it's okay to seek help. A trauma-informed therapist will support you, validate your feelings, and help you develop healthy coping strategies to process your trauma safely.