What is Trauma-Informed Care?

I went on a mission trip a long time ago, and when I came back I found myself in a conversation with someone who had obviously read something about the place I had just been.

She told me all about what it was like there.

And she was wrong about most of it.

I have also had the experience where “Friend A” told “Friend B” what a difficult time I was having with a recent situation.

It was something I wasn’t actually having a difficult time with.

Friend A was thinking about how she would have felt in that situation, assuming I felt the same way and telling the story accordingly.

These kinds of interactions are the reasons we have trauma-informed care.

Truthfully, all counselors are trained to avoid these types of pitfalls, but when a counselor gets extra training in trauma, the commitment to avoiding them seems to increase.

We see how critically important it is to consider someone’s trauma and be curious about someone’s needs if we are going to be effective in a therapeutic relationship with them.

 “Trauma-informed” is more of an idea than it is a counseling theory. It’s a way of being with someone. 

And not just someone who has endured the kind of trauma that everyone would agree is traumatic.

I have come to assume that everyone carries some trauma, and interacting with people in a trauma-informed way is beneficial outside of the counseling room as well as during sessions.

My training as a counselor drilled in the fact that counselors need to show accurate empathy, have unconditional positive regard for clients, and be genuine. The therapeutic relationship between client and counselor is one of the most important factors to a successful therapy experience.

A client needs to feel safe in therapy, and when someone has experienced trauma, that feeling of safety can be elusive. It might be a foreign feeling to you; you can’t even remember a time when you truly felt safe in someone else’s presence.

Being trauma-informed goes the extra mile to provide that safety. 

What does trauma-informed care look like?  

Accurate empathy

To show accurate empathy means I really tune into what life is like for you, and actually feel some of what you are feeling. 

This is important, because too often, people will hear what someone else is going through and immediately think of how they would feel in that situation (remember Friend A?).

That’s a good start, but a trauma-informed clinician also has to keep their thoughts in check so that they don’t assume someone felt a certain way.

There have been times when I am sitting with someone in the therapy room, imagining what would be hardest for me in their situation, and when I ask them, “What was the hardest part of that?” it surprises me.

Trauma brings so many individual nuances and residual impacts, which are shaped by our unique life experiences and personal beliefs and triggers.

Nobody can assume, with 100% accuracy, how someone else is feeling.

Trauma-informed care can make those kinds of guesses, and say things like, “I imagine maybe you felt….” but there is always a question in that guess, leaving room for you to really explain or correct.

Trauma informed care does not assume or jump to conclusions.

Unconditional positive regard

Unconditional positive regard means that I value you just because you exist as a human.

To go the trauma-informed extra mile means that I am not looking at “what is wrong with you.” I am trying to understand what happened to you.

I am going to recognize that you were doing the best you knew to do at the time.

I am not going to think less of you because you couldn’t access a different way to cope.

When we experience symptoms that lead us to start therapy, we are quick to feel shame about our symptoms, how they developed, or how we have reacted to it.  

Often we develop our symptoms  through the way we tried to cope with something that felt too overwhelming for us to handle when it happened. 

Trauma-informed unconditional positive regard also means that no success is too small to celebrate. You will have many little wins on your way to mental health, and each one of them is important. Others in your life (and even you) might minimize their significance. 

I am here with the cheerleading pom poms, ready to call out your strengths!

Genuineness

Genuineness is the practice of being authentically yourself.

Counselors should not pretend to be someone they are not.  A task of therapy is usually to help someone become more of themself.

How can someone who doesn’t live that way herself help you reach that goal of being authentically yourself?

This doesn’t mean I share all kinds of personal stuff about my life in your therapy sessions. I might share a little bit, if I think it would help you. 

The extra mile of trauma-informed genuineness recognizes that someone who has been through trauma has probably lost her trust in someone and considers it that much more important to be able to trust her therapist. In order to be a trustworthy therapist, I have to be genuine.

Trust

This goes along with genuineness and unconditional positive regard.

Trust is huge for trauma survivors.

I hold this sacred and invite clients to watch and see if they think I am trustworthy.

I am never going to try and force it.

In my initial phone call to you, I tell you that the intake form that will come in the initial paperwork packet is something we can talk through instead of filling it out online. It can feel scary or overwhelming to complete that form and send it to someone you’ve never met. 

I also make sure you know that you don’t have to answer any questions that you don’t feel ready to answer.

You control what you tell me and when you feel ready to tell me.

Even once you have decided to work on a certain topic, I tune into how you are doing as you are talking about it, looking for signs that some part of you might not feel ready to go there.

We do not proceed without your permission.

The trauma-informed extra mile considers how hard it might be for you to feel vulnerable enough to share your feelings with me and puts you in control of that.

Control and Choice

Control goes with trust, but choices are part of control.

Someone who has experienced trauma may have had choices taken away from them.

They may have been existing in a situation that made them feel trapped.

They may have given up on trying to even have choices or an opinion, because it hurts more to express a desire or a need and have it shot down than it does to pretend you didn’t have a need in the first place.

I think of the practical things, like setting up my office so that I do not sit between you and the door. 

I let you know you can keep your eyes open during any kind of relaxation or breathing exercise.

If an intervention aimed at visualizing a “safe” place doesn’t resonate with you, we find a “neutral” place.

I check in with you to give you options on how we use our time together.

I honor and respect your choices.  

A trauma-informed approach understands that trauma is not always obvious.

Sometimes we can even hide it from ourselves.

We rationalize, “It’s not that bad, I just need to buck up.” It can feel easier to cope with when we do this.

I wrote about the ways trauma can show up in subtle ways. A trauma-informed clinician can tune into the ways you have been coping with trauma and see that you have been doing your best to protect yourself. Your brain has been trained to be on alert and to react in certain ways because of your past experiences.

When trauma is part of our story, it can permeate the way we think, feel and act.

Similarly, a trauma-informed way of being infuses the way I work with clients with empathy, positive regard, genuineness, strengths, and choice. 

Someone recently asked me how I can sit and hear stories of trauma all day.

Yes, it’s hard.  I grieve with my clients, and I feel a lot of other emotions with them as well. 

But I have the benefit of being able to hold onto the hope that you can move through these feelings. Processing trauma allows those memories to get stored away in a place in the brain where they no longer activate all of those emotions.

Those memories do not define you.

I am here to help you, in a trauma-informed way, to find freedom from your past, and peace for your present and future. Please reach out when you are ready to get started.

Jennie Sheffe is a National Certified Counselor ™ who helps women find freedom from anxiety and peace in their chaos. She sees clients virtually in the state of Pennsylvania, or in her Carlisle, PA office. She offers Christian counseling and EMDR Therapy.