Not all therapists choose to specialize in trauma. However, understanding trauma and how it impacts the body and mind can be essential in providing services to any client. Becoming trauma-informed may be less about choosing a specialty than knowing how to treat clients who have experienced traumatic events.
Trauma-informed care is not limited to those treating individuals with post-traumatic stress disorder (PTSD) or other trauma-caused conditions. People with trauma may live with various diagnoses and symptoms, and some may not fit the criteria for a diagnosis.
With trauma education more widely available in the 21st century, there are a few ways you can expand your knowledge of this subject in your practice and daily life to avoid the chances of accidental further harm to a client. Continue reading to learn more about how you might become a trauma-trained therapist and how doing so may improve your techniques and professional practice.
“Trauma” is often used to describe the state of having experienced one or more traumatic events. However, officially, the American Psychological Association (APA) defines trauma as “any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.”
What makes an event traumatic is often subjective, as what causes significant stress for one person may not be distressing for another. However, a few events that are commonly labeled as traumatic include the following:
- Abuse or neglect
- Sexual abuse or assault
- War violence
- Physical assault or violence
- Losing a loved one
- Natural disasters
- Not having a stable home
- Terminal or severe illness
- Hospitalization, surgery, and other medical procedures
- Extreme financial insecurity
- A lack of access to safe food, water, shelter, and relationships
- Near-death experiences
- Bullying or mass social ostracization
- A serious injury
- Witnessing the traumatic event of another person
- Seeing images, videos, or stories of trauma
If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text “START” to 88788. You can also use the online chat.
The Physical, Emotional, And Mental Impacts Of Trauma
Individuals can experience one or more traumatic events. Some people may experience multiple traumatic events throughout their lives, which causes repeated exposure to nervous system dysregulation and a frozen fight-flight-freeze response. Others may experience one trauma that causes severe loss of functioning, like in the case of PTSD.
When experiencing trauma, the body internalizes the experience. When the trauma is repeated over a long period, the protective mechanisms used to keep a person safe from severe stress don’t shut off. This can cause a continual influx of cortisol and adrenaline, even in situations that are safe. In the long term, this severe stress response can cause disease, inflammation, autoimmune conditions, and other negative outcomes. Physically, this process typically leaves trauma survivors with distressing symptoms that may worsen the cycle.
Emotionally, trauma can cause various reactions. The impacts may differ depending on whether the traumatic event was experienced in childhood, adolescence, or adulthood. For example, people who have experienced severe childhood trauma may be more likely to internalize messages they learned because of their experiences. In addition, severe dissociation can be more common in those with early developmental trauma. Dissociation can involve willingly or unwillingly detaching from one’s reality mentally and emotionally.
People often report remembering their traumatic events like pictures or films they watch from outside their bodies. When they talk about their traumatic event with a therapist, they may struggle to know what sensations are coming up in their body or what emotions they feel. They might talk about the event as if it is as “normal” as talking about the weather. Being able to discuss the details of trauma openly but struggling to truly be vulnerable and cope with the event can be expected in those with complex trauma. In these cases, a trauma-informed, patient, and empathetic therapist can make a significant difference.
What Does It Mean To Be Trauma-Informed?
Being trauma-informed may have unique meanings for different therapists. However, in general, it can mean the following:
- Not assuming whether someone has experienced a trauma or not
- Not judging what someone found traumatic
- Validating when someone has difficulty with daily functioning due to trauma
- Not pressuring, pushing, or rushing a client with their story
- Not pressuring a client to complete a task they struggle with due to trauma
- Understanding when exposure therapy might retraumatize a client
- Avoiding a client’s triggers unless given consent to discuss them in detail
- Noting when a client is dissociating to know when to dial back the conversation
- Learning how to help clients ground themselves in session
- Speaking in a gentle and safe tone of voice
- Understanding that a client may form an attachment to therapy
- Trying not to cancel on clients or leave them without communication during a difficult moment in their lives
- Understanding somatic healing techniques
Ways To Ensure A Trauma-Informed Practice
Trauma training can help therapists hold a more trauma-informed practice. However, you can also take a few steps to make your office a safe space, including the following.
- Remember The Physical Effects Of Trauma
Seeing trauma primarily as a behavioral and emotional issue can disregard the real physical symptoms, sensations, and challenges that may arise with trauma disorders and traumatic experiences. Since the nervous system is the primary system responding to trauma, prolonged dysregulation can cause various physical health effects.
Some people with trauma may experience chronic pain, frequent illness, headaches, chills, fevers, and other physical manifestations of their experiences. When they talk about their experience, they may develop these symptoms all over again. When stressed, their body may go straight to the fight-or-flight response instead of assessing the situation as dangerous or safe. For this reason, people with trauma often live with the unique mental health impacts of living with chronic illness or pain.
It can be important to be patient with your clients and remember that, although you are not a doctor and can’t treat physical symptoms, you can work with them in a somatic way to help them ground themselves, reduce their stress response, and potentially reduce their pain. Although exercise, healthy eating habits, adequate sleep, and a proper diet may help, these coping mechanisms cannot take away triggers or cause the stress response to weaken in someone who does not feel safe while doing them. Often, trauma work involves helping the client feel safe, validated, and regulated before moving on to behavioral approaches.
- Avoid A 100% Behavioral Approach
Using 100% behavioral techniques to help someone overcome trauma may seem beneficial. However, although some people might respond well to cognitive techniques or changing behaviors, trauma lives within the entire body and mind. Trauma is an unfair and unjust experience, causing individuals to believe that what they went through has fundamentally changed them in every possible way.
Suggesting that someone is experiencing pain because of their own thoughts or behaviors in the case of trauma, even if partially true, may cause them to believe they are being invalidated or blamed. It can also make clients believe their therapist doesn’t see how their trauma impacted them, which can cause them to perceive therapy as unsafe. When trauma occurs, the person is experiencing real pain in their nervous system because of the event. They are likely feeling complex emotions and attempting to understand or rationalize why these past events occurred, which can lead to low self-esteem and negative self-talk.
Instead of leading therapy with lifestyle changes like exercise, meditation, or journaling, leading with understanding, validation, and emotional support instead can be beneficial. A client may not be willing to practice a ten-minute meditation if you haven’t shown them why it matters in the scheme of their trauma. The trauma may be so all-encompassing to them that they do not believe or care that meditation has worked for others. However, when their therapist reminds them that this response is valid, that their emotions make sense, and that what occurred was unfair, it can help them emotionally connect with behavioral exercises.
When a client believes they are safe, behavioral techniques can then be implemented. However, some trauma therapists may choose to use techniques unique to trauma healing instead, such as grounding meditation, exploring core beliefs from childhood, or trauma-informed somatic healing. Studies back the efficacy of these techniques, showcasing that trauma-informed therapy modalities like EMDR trauma therapy are more effective than cognitive-behavioral techniques for PTSD in seven out of ten cases.
- Consider Those With Complex Trauma
When providing trauma-informed care, it can be crucial to consider those living with complex trauma. Although not a diagnosis in the DSM-5, complex PTSD (C-PTSD) is a label often used by therapists to describe those who have PTSD symptoms from multiple prolonged and repeated traumas, often throughout childhood. These individuals may be more likely to experience physical symptoms, dissociation, personality disorders, and prolonged patterns of behavioral challenges.
When trauma occurs in the most crucial developmental stages, it significantly alters the brain and one’s DNA. The lessons learned in childhood are crucial to how a person might act as an adult. For this reason, people with severe childhood trauma often have distorted realities and may struggle with emotional regulation, trust, and emotional permanence. They may also experience comorbid conditions like depression or anxiety disorders.
When treating someone with C-PTSD or complex trauma, it can be vital to understand concepts like attachment, dissociation, relationships, and memory. These individuals may struggle to trust their therapists, connect with and label their emotions, and understand what they feel or sense in their bodies. Pushing clients to discuss traumatic details too quickly or when dysregulated may worsen this dysregulation and cause an unhealthy therapeutic relationship.
- Understand How Identity And Trauma Intersect
It can also be essential to understand how identity and trauma intersect. Some communities are more likely to experience specific traumas due to having a marginalized identity or living in an area where these traumas are more common. For example, women are more likely to be survivors of almost all crimes, including domestic violence, sexual assault, and emotional abuse. They are also two to three times more likely to be diagnosed with PTSD than men.
In addition to these statistics, the numbers increase when an individual is Black, Brown, or Indigenous (BIPOC), Latinx, an immigrant, LGBQ+, disabled, over 50, or transgender. Some people may experience traumas specific to their community, such as homophobia, transphobia, or racism. People from certain countries may also have trauma from war crimes, poverty, or disease.
When a client comes to your office with a traumatic past and a marginalized identity, it can be helpful to look at studies about this person’s identity and its intersection with PTSD or mental health challenges. There could be unique aspects of their experience that you don’t understand that might be necessary to discuss and validate to promote healing.
- Practice Being Non-Judgmental
People with traumatic pasts may struggle to care for themselves. Some people with traumatic pasts use substances to cope, which can cause homelessness, a lack of personal hygiene, and difficulty speaking coherently.
In all cases, it can be crucial to be kind, open-minded, and non-judgmental with your clients. Telling someone they “need to take a bath” or “need to learn how to clean” or similar statements may cause them emotional pain. Living with a traumatic memory or memories can cause individuals to develop learned helplessness or complete dissociation and executive dysfunction, which may lead to difficulty with daily tasks.
When teaching clients how to re-focus on these tasks as adults, it can be helpful to remind them that they’re not alone, disgusting, or failing at life. Instead of pressuring them as they may already pressure themselves, suggest that they give themselves a break to focus on their emotional healing. Remind them that they deserve to feel safe and that it makes sense to struggle to care for themselves when they have experienced a lack of safety.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
How To Find Formal Trauma Training
If you’re ready to learn more about becoming trauma-informed, there are a few resources you can use, including the following:
- Continued Education Courses (CEUs)
Most states require counselors, social workers, psychologists, and therapists to take continued learning courses. If you can choose the topics that you learn about, consider taking a course from an expert on trauma. A few topics you might try to learn more about can include the following:
- Somatic experiencing techniques for healing trauma
- Attachment theory
- Trauma and the body
- The immune system and trauma
- Complex and developmental trauma
- Lectures From Experts
If there are lectures from psychologists or other experts in the field of trauma psychology, consider signing up to attend. Lectures offer a way for mental health professionals to connect with other therapists, discuss trauma treatment methods, and interact with new research on mental health topics.
There are hundreds of podcasts on topics of mental health and wellness, and some of these podcasts are made for therapists by therapists. Consider listening to a podcast episode about trauma and how trauma experts support their clients most effectively. If you don’t like podcasts, a YouTube video may have similar effects.
- Research And Books By Experts
New research on trauma and PTSD is often released in journals and books by experts. For example, a popular book about trauma that may offer insight into trauma-informed care is The Body Keeps the Score By Bessel van der Kolk, MD. Van der Kolk is a psychiatrist who founded a prominent trauma clinic in the US and was one of the first people to study PTSD and complex developmental trauma.
- Become A Certified Clinical Trauma Professional
The International Trauma Training Institute (ITTI) offers a certified clinical trauma professional (CCTP) course in trauma therapy training, which delves into topics like the following:
- Development in the field of traumatic stress
- How to have a safe therapeutic relationship with clients
- Understanding PTSD
- Trauma-informed skills
- Neurobiology and trauma
- Trauma healing and trauma responses
- Clinical skills to treat trauma in children and adolescents
- Sensorimotor psychology
Therapists can become trauma-informed providers by taking courses like these and receiving credentials. However, note that you don’t need a certificate in a trauma course to be trauma-informed.
How Online Therapy Can Help You Become Trauma-Informed
If you’re a professional desiring to become trauma-informed, you might consider connecting with a licensed therapist through a platform like BetterHelp. BetterHelp has a database of thousands of providers, each specializing in different areas of study and treatment. If you’re not sure where to begin as you learn more about trauma, having a skilled and knowledgeable therapist to lean on could be helpful. With online therapy, you can speak with a provider from anywhere at anytime. Although you might be busy with school, work, or other obligations, online therapy can make getting the support you need more convenient and accessible.
The Efficacy Of Online Therapy For Trauma
Trauma can have lasting impacts, often leading to conditions like PTSD. Research has shown that online therapy can be just as effective as face-to-face interventions for managing and treating trauma and other concerns. In one study, researchers discovered that trauma-informed guilt reduction therapy was effective in reducing symptoms of PTSD and depression as well as feelings of trauma-related guilt among combat veterans. Those who participated in the intervention were also more likely to lose their PTSD diagnosis altogether.
Becoming trauma-informed can take time and effort, but it is possible as more research and tools become available to therapists. Anyone can use trauma-informed practices in therapy. You don’t have to specialize in PTSD to understand the effects of trauma on mental health, as it can impact almost any mental illness or mental state. If you want to learn more about trauma, consider signing up for CEU courses on this subject or looking into current published works from experts. Additionally, you might try speaking with a certified therapist online who specializes in PTSD, trauma, or other areas of interest.