As mental health practitioners, we are particularly on the front line of human suffering and resilience. We know now that trauma is not an exception but a universal aspect of human life, one that can have both subtle and dramatic effects on our biology, psychology, and social interaction.
In order to deliver the most effective and ethical care, we need to stop symptom-treating only, but rather develop a model that acknowledges trauma in our society.
It’s a reframing that marks a radical change of mindset, replacing the question: ‘what’s wrong with you?’ to ‘what happened to you?’. The shift occurs because it recognizes that a full account of people’s past and present lives is needed in order to respond effectively with healing-based service provision.
This article will outline the core principles of Trauma-Informed Care (TIC) that every mental health professional should be mindful of and incorporate into their practice.
What is Trauma-Informed Care?
TIC is not a therapeutic ‘model’, but rather an organizing paradigm that pervades every dimension of service delivery, from reception to lunch breaks to therapy room. The National University calls TIC a ‘transformative force’ that ‘centers on the deep awareness and response to the profound effects trauma inflicts on individuals and communities.’ It is an ‘everything’ initiative that requires clinical and organizational embrace to be supported.
It reflects four fundamental beliefs, commonly referred to as the 4 R’s:
- Realize the prevalence of trauma and possible routes to healing.
- Recognize symptoms of trauma in clients, families, and staff within the system.
- Respond with integrating what we already know about trauma in policies, procedures, and practices.
- Resist re-traumatization by being pro-active in avoiding practices and interactions that might serve as triggers or reflections of a past traumatic experience for the person.
By infusing these ‘4 R’s’ into our work, we begin to build environments where healing is not only possible but purposely fostered.
The 6 Core Principles of Trauma-Informed Care
Guided by the CDC and Substance Abuse and Mental Health Services Administration (SAMHSA) work in this area, there are six fundamental principles that underlie a trauma informed system. The principles should lead the way for our conversations, our policies, and the climate of care.
Safety
Safety is the bottom line that we cannot negotiate with in TIC. It’s safety for clients and the staff, both physical and mental. In clinical context, this refers to a predictable and calming setting, and privacy in a respectful and non-threatening manner. To a trauma victim, the experience of the therapy office needs to be safe, inviolate, and free from threat.
Trustworthiness & Transparency
Trauma is frequently a deep, lasting betrayal of trust. To prevent this, the organizations need to operate and make decisions in a transparent manner so they can win and hold on to their clients’ trust. This involves clear, transparent and honest communication, consistent messaging, and a description of the ‘why’ in our decisions or policies.
According to National University, this helps relieve anxiety and gain trust. When clients know what they’re getting and believe their therapist is being straightforward with them, a real therapeutic relationship can start to develop.
Peer Support
Peer support is vitally important to any trauma-informed system. It’s about including the perspective of individuals that have ‘been there’ as a constant part of the organization, so they can bring support, hope, and confirmation.
Having a mutual understanding and shared experience can reduce isolation, bring comfort, and be a source of practical advice and support. Clients say that it can be profoundly inspiring and de-stigmatizing to see recovery is possible from someone who has traveled the same path.
Collaboration & Mutuality
A trauma-informed approach is in the process of redressing power imbalances between practitioners and clients, and within teams. The ideal is to encourage teamwork and decision making together. This philosophy is based on the understanding that you are the expert of your own life.
We move away from the hierarchical model in which the professional decides what’s best for you and promote a collaborative attitude with the client’s voice at the center of care.
Empowerment, Voice & Choice
Trauma experiences are inherently about disempowerment. Indeed, a central goal of TIC should be to use strengths-based principles in empowering individuals by uncovering, developing, and affirming their strengths.
In practice, this would involve providing clients with options regarding their treatment, showing respect for the choice made and assisting them to reclaim a sense of control over their lives. All choices, however small, contribute to the rebuilding of self-efficacy.
Cultural, Historical & Gender Humility and Responsiveness
On this principle, we can only turn away from a one-size-fits-all model to see that every human being lives in a particular cultural, historical, and social world. It means actively identifying and confronting our own biases and stereotypes around race, ethnicity, sexual orientation, gender identity, age, and ability.
It also means recognizing what historical and intergenerational trauma is, and the effect it has had on whole communities. In practicing cultural humility, we are committed to learning from our clients how to provide care in a way that is sensitive, respectful, and meaningful.
The Benefits of a Trauma-Informed Approach
Embracing these principles leads to extraordinary benefits for all, including opportunities for patients to actively engage in their own healthcare, develop a trusting relationship with their therapist, and improve their long-term health and wellbeing.
The rewards are no less great for practitioners and companies. A trauma-informed approach addresses and mitigates against burnout and secondary traumatic stress, both of which are common dangers.
A Commitment to Healing
Being trauma-informed is not a list of things to do; rather, it’s an organizational culture and operational philosophy that is infused into all aspects of an organization’s operation. There’s no one-size-fits-all answer, but it leads us to reflect on our own behaviors and into the systems in which we are working to create more safety, and build more trust, resilience, and empowerment.
As we’re getting better educated about trauma, it’s not just a professional responsibility to incorporate these concepts; it’s a moral imperative. To further develop your understanding and become a trauma-informed practitioner, check out our many courses on trauma, ethics, and practice at Zur Institute.
