ave you ever heard about trauma-informed therapy and wondered what that looks like? How does being trauma-informed impact therapy? All therapists should understand trauma, so how important can it be to seek out trauma-informed therapy?
The answer is: really important. Believe it or not, all therapists are not trained in how to treat trauma. In fact, many therapists don’t even know how to recognize subtle signs of trauma. I believe it’s beginning to change now, but at the time I graduated from my graduate counseling program, trauma was not included as a formal part of training. It may have been included in some programs, but it was not standard in most. It’s hard to believe, isn’t it! And don’t let my gray hair fool you: I graduated from my training program in 2017, so I’m not talking about how therapists were trained 30 years ago. Here’s what I knew about dissociation: if a client is dissociating, hand them a cold canned drink to help them ground. And I only learned that because I overheard a classmate talking about it! So, in my case and probably in the case of a majority of trauma therapists, I had to seek out knowledge about trauma and how to treat it after I graduated.
Knowing this, then, I think it’s important the clients understand what trauma-informed therapy is and what the experience should be like. If you are currently being treated for trauma in a way that feels bad to you or that causes you to feel bad, you may not be receiving trauma-informed therapy.
Trauma-informed therapy is therapy which understands the ways trauma can affect people and takes this into account. For instance, when I was seeing trauma clients in person, I did not seat myself until they chose the seat that felt most comfortable to them. And when I did sit down, I tried to choose a seat that left them closer to the door than I was. I also showed the client how my door was locked from the outside, so no one could barge into the room, but that it was unlocked on the inside so they could leave any time they wanted to. For DID clients with a history of sexual abuse, one piece of trauma-informed therapy might be making sure that all parts know that the clothes stay on in the therapy room and no one is having sex in the therapy room. I found this provided significant relief to young parts who were just waiting for the bad things to happen.
SAMHSA (2020), laid out eight important principles of trauma-informed therapy:
1. Client safety. The emphasis is on creating an environment that is safe for clients both physically and emotionally. Maintaining client confidentiality is one aspect of this. Having very clear boundaries and expectations is also a part of this because it helps client know what to anticipate and provides them some sense of control. In my practice, one of the things I talk about with my clients during the first session is their right to say “no” if I make a suggestion or recommendation that doesn’t feel right to them. It’s really important that trauma clients in particular know they can disagree or say “no” without the therapist becoming angry, retaliating, or any other consequence; because they had no choice during their traumatic experiences, it is important that they have choices in therapy.
2. Trustworthiness and transparency. Trust and transparency should be a part of therapy in general, but these are particularly critical when it comes to clients who have a trauma history. Particularly for clients with DID and OSDD, people in these clients’ lives have not been trustworthy in many cases. Being very transparent as a therapist about what I’m doing or thinking or why I’m asking a question or suggesting a course of action is very important in allowing the client to slowly develop trust in me as a therapist. This also plays a clear role in the client being able to feel safe in the therapy room. As an example of this, if I want to challenge a client about something they’ve said, I warn them. I stop them and say. “I want to push back on something you just said, is that okay?” I started doing this when I realized how helpful it was to the client to have warning. It helps them to see that I’m not attacking them like they may have been in their past. And, to be clear, what I say after that is never confrontational. My intention is to get the client’s attention about a particular point. So after I have their permission, I might say something like, “A few minutes ago you told me you never do anything right, but just now you told me about your boss thanking you for your good work. I wonder if maybe you haven’t been giving yourself enough credit?”
3. Prioritizing client autonomy. Autonomy means the client gets to make choices for themselves. The therapist should not be making choices for them. With my clients, I tell them in the first session that they are in charge of their therapy in the sense that I will make recommendations and suggestions, but they can choose among them or say “no” to them. Particularly when it comes to DID and OSDD, clients rarely had choice and autonomy in their past. They were largely powerless. Part of this is also empowering clients by helping them to identify their strengths because awareness of strengths gives clients more choices as well. One way I prioritize client autonomy is telling them what I would like to do and asking if that sounds okay with them. For instance, I might say, “Would it be okay with you and everyone inside if I talk through you to ask some questions and you tell me what anyone inside says?” If it’s a new client, I might follow that up with a statement such as “I will not be asking questions about the trauma.” This goes back to the first two points of creating a space that is safe for the client and being transparent about what I am intending to do.
4. Cultural Sensitivity. Different cultures prioritize different values and traumas may be experienced differently as a result. And the result of trauma may look different in different cultures. If you are a client who has a different cultural background, you will want to take extra care to explore a potential therapist’s ability to address this. A different culture may be related to ethnicity, or it may be something like being raised in a deaf culture or coming from a family with unusually restrictive religious beliefs. For example, in some cultures, there is no such thing as DID, but there is a belief in possession which may show itself in the same ways as DID.
I would be very interested to hear in the comments examples of trauma-informed therapy you have experienced and why it was so helpful to you. By sharing, you can help others see what they should expect.