Trauma-informed is a phrase that somehow gets used a lot and not often enough at the same time! Many therapists, healthcare professionals, massage practitioners, and others who provide healing or caring services may describe themselves as trauma-informed. Anyone can describe themselves as trauma-informed, similar to how anyone might say that they are trans-affirming or LGBTQ-competent. However, that does not mean that everyone has the same set of knowledge and skills, nor does it mean that they will provide care in a way that works for you. In this post, we will take a look at what trauma-informed means to us and offer a few ways to assess if a certain person’s approach to trauma-informed care will work for you.
A widely used definition is that being trauma-informed means that a practice or person has a working knowledge of trauma and the impacts of trauma, that they have structured their work in such a way that they are prepared to work with people who have experienced trauma, and that they strive to avoid re-traumatizing people.
In prior blog posts (Intro to trauma, impacts of trauma on our brains and bodies, impacts of trauma on relationships) we explored some of the basics of trauma – what it is, what impacts it can have on our lives and relationships. A common phrase used to describe trauma-informed services is shifting from “what is wrong with you” to “what happened to you.”
Unfortunately, if taken very literally, this framework can lead to people asking, “what happened to you?” in a judgmental tone. At its worst, it can lead to people seeing survivors only through the lens of the worst things that have happened to them. This framework can be helpful, though, if it is used more as a shift in our thinking, rather than as an exact phrase to say to people.
For example, if a provider is working with a person who does not trust anyone – in this framework, rather than assuming that person is rude or a jerk, the provider would approach the situation with compassion and curiosity, knowing that being distrustful may have helped protect that person at some point in time. A mental health professional might shift from jumping into diagnostic criteria to taking time to explore with the person what is going on with them. The provider would likely take extra steps to demonstrate that they are trustworthy and offer the person the time and space to decide if they wanted to trust them or not.
Elements of Trauma-Informed Care
A key component of being trauma-informed is about being prepared to work with people who have experienced trauma. Being prepared can heavily involve how services are set up. Working with people who have trauma responses means that people may be more likely to feel high amounts of anxiety, have fast changes in mood, and/or feel on guard a lot of the time. People may be hesitant to trust and build connections; they may struggle with memory and keeping track of things. Knowing these basics, a provider can plan ahead.
Let’s look at an example. Instead of thinking that people feeling guarded are going to be the exception – what would change in how a provider plans for services if they consider that being guarded will be the norm with people they work with? They might build in time in their practice to introduce themselves more thoroughly. They might check in throughout a meeting to see if the person has any questions. They might share information about what to expect ahead of time and be clear about when things might be different than what was planned. And what’s really important is that they would do this all the time. Rather than waiting to find out or try to guess or assess who has trauma – they would act as though everyone could have traumatic experiences.
Trauma Reminders
Another issue to prepare for is trauma reminders. Everyone has different trauma reminders, so it can be difficult to know what may or may not re-traumatize them. But we can take active steps to avoiding re-traumatizing people: For some people a smell, a sound, an outfit may bring back traumatic memories or flashbacks. For others it may be more situational – a tone of voice, closed doors, silence.
Realistically, it is impossible to assume that people who are survivors will never be reminded of our trauma or feel activated. For service providers, it may be impossible to never work with someone who is triggered. Knowing that, trauma-informed services still aim to both minimize the likelihood that the service will be triggering and, in some situations, to help build skills for responding when a trauma reminder does happen.
Service providers may think through some of the most common trauma reminders– loud noises, closing doors without asking, touching without asking, involving/interacting with the police. Many providers make sure to avoid these in their practices. For example, someone who meets people in an office setting might ask before closing the door or in a group setting, a provider may alert people before there’s a loud noise. In medical settings, practitioners would practice asking before touching someone. A nurse may explain the steps of a procedure before doing it – “First I will wrap this band around your arm. Then it will tighten a lot, before slowly loosening. Is that okay with you?”
Ideally, events and organizations would happen in places that did not have high police presence and had non-invasive security practices. Metal detectors, body scans, and armed security are all things that can be upsetting for trauma survivors and cause special hardships for trans people who are more likely to have their bodies surveilled and judged. Providers may instead focus on training their staff in de-escalation tactics, ensuring sufficient staff are available in any waiting areas to notice security risks, or utilize other less intrusive techniques for safety.
Since we cannot always avoid triggers, providers would know at least basic tools to help people get re-grounded. Providers would also have some skills to recognize what was happening and avoid punishing or shaming a person for their trauma responses. A mental health professional or an anti-violence advocate may also be working to share coping and grounding strategies throughout the work that they do with you. This might look like sharing breathing techniques or helping you to develop ways to recognize flashbacks and come back to the present.
Supporting People After Trauma
Trauma-informed care is also rooted in ideas about how to support people who have experienced trauma and how to avoid causing trauma. The most common of these are: safety, transparency, trust, collaboration, agency, and culture. These terms come from SAMHSA. Learn more here. Each of these ideas should be used to inform all of the work that person or organization does as well as be tailored to the individual. That can feel complicated, because different people have unique needs and perceptions.
Let’s look at safety for example: Some people feel safe in groups and some people feel safe alone. How can we design a waiting room that lets people have privacy and space, but also lets people see what is happening around them? There’s no one setup that will work for every single person. But we can offer choice. Maybe it’s arranging some seating in clusters and some more spaced apart. Maybe it’s seating facing different directions. Maybe it’s having a clear path to the exit and sightlines to the front desk and the doors. In an ideal world, people would also be able to indicate that they would prefer to wait somewhere more private.
Other issues around safety are more “controversial.” Many people recognize that healing from trauma is harder while the harm is still happening. People may say things like, “You can’t heal from violence that is ongoing.” or “For healing to happen, you have to be in a safe place.” Or even, “You can’t love others unless you can love yourself.”
However, there’s a lot of nuance to this. Do we recognize the systemic and cultural violence that is targeting trans/nonbinary people, people of color, disabled people all of the time? Do we support the individual’s agency and ability to decide for themselves what they need and when they need it? Are we doing anything to help make the world safer for the person? Are we blaming them (intentionally or unintentionally) for the violence they experience – for example, by refusing someone’s access to domestic violence services until they have ended the relationship?
Let’s look at agency and collaboration as examples too. Though different, these ideas can often be related. Agency is an individual’s right and power to make decisions for themselves. Collaboration is for the “patient” and “provider” to work together to find solutions. (Patient and provider are in quotes, because each place uses different words: client, patient, survivor, etc).
Domestic violence agencies often help people with safety planning. Agency means that the survivor decides what will and will not work for them in a safety plan and what they need to plan for. Collaboration means that the survivor can do that with the support and resources that a domestic violence advocate has. The advocate may share ideas, help think through advantages and disadvantages, discuss risks, or find concrete resources.
Each person may need or want different levels of support. For one survivor, collaboration may look like the advocate giving them a list of referrals, because they want to call in their own time. Another survivor might prefer the advocate calls, because the survivor is afraid of being judged for the sound of their voice. An advocate may recognize that trauma is impacting a survivor’s ability to keep information organized. That advocate might offer to help write down task lists or body double with the survivor while they make phone calls.
As someone who is seeking support, how do we know if those who say they are trauma-informed actually are, and if what they provide is right for us?
First, those are two different considerations – someone may be brilliantly trauma-informed, and still a bad fit for us. Someone may be the best person for us to work with and have little to no practical knowledge of trauma. Either is okay. You get to choose. Check out this link for more on therapy: https://forge-forward.org/resource/lets-talk-about-it-a-transgender-survivors-guide-to-accessing-therapy/
Here are some things that you might do when meeting with a new provider.
You have the right to ask questions before getting any sort of service or support. Some of these questions may be helpful to you.
- What does trauma-informed mean to you?
- What are some of the ways that being trauma-informed has changed how you do what you do?
- What are your practices around consent?
- How do you work with someone who has trauma and is still experiencing harm?
Think about what you want and need:
Take some time with yourself or with another person/people and think about some of the values behind trauma-informed services that were listed above. What do these mean for you, especially when seeking services?
- When, if ever, do you feel safe? What helps you feel safer?
- If you can, think specifically about the type of provider you are going to. What would help you feel safe at a medical doctor or with a sexual assault advocate?
- What does someone do or say that helps you consider them trustworthy?
- What is important for you to be able to have a choice about?
- What do you need to know ahead of time? (for example, before getting an exam do you need to know all of the steps? Do you prefer not to hear the details? Do you want to just learn one step at a time by being told the next step only?)
- Are there trauma reminders that you have that you want people you are working with to know about? What would help you to share those?
We don’t always have many choices about who we see for different services. Whether there’s only one yoga class or one healthcare provider in town, or only one dentist who takes your insurance that can see you in the next year. Still, you have the right to ask for what you need.
A provider may be a good fit for you but not use the language of being “trauma-informed”. Perhaps the provider is trauma-informed, as described above, but just doesn’t use that vocabulary. Perhaps they do not know much about trauma, but still practice consent and collaboration or they communicate effectively.
One person shared with FORGE, “I’ve found that a lot of “trauma-informed” providers are quiet and feel gentle in a way that I don’t like. I start thinking they are treating me as delicate, which I don’t like. I prefer louder, laughing providers, who seem comfortable around me. This helps me feel like they trust me more. I do often notice that the people I feel most comfortable with are not the people that others I know would like, so it’s easy to see how much our personal preference also matters!”
As this person shared, we are all different. We need a wide variety of services and ways those services are offered. Trauma-informed approaches to care should not be “one size fits all.” They should be tailored to the individual while holding a broad understanding of trauma.