Most of you, my readers, understand the definition of trauma having lived through more than enough as children. However, how many of you know what is meant by trauma-informed care?
In this article, we are going to explore what trauma-informed care is and the different ways it can be incorporated into a therapeutic relationship to help heal childhood trauma.
What Is Trauma-Informed Care?
To be honest, I’ve heard the term trauma-informed care, but until I researched for this article, I had no idea what that meant. So, I did a thorough search to find out the answer to the question what “is trauma-informed care?” So, bear with me as I tackle this subject.
Trauma-informed care is a structured treatment that involves understanding, recognizing and responding to the effects of all sorts of trauma. The therapist helps a traumatized client by creating a sense of physical, psychological and emotional safety for their client and themselves.
SAMHSA (Substance Abuse and Mental Health Services Administration) has spent a lot of time and money outlining how it sees trauma-informed care.
In one downloadable PDF, I found some beneficial information describing what trauma-informed care is all about. SAMHSA emphasizes the three E’s, events, the experience of events and effects of traumatic events.
Let me break that down for you.
Events. A traumatic event can occur anytime during a lifetime and include a sense of extreme threat of physical or psychological harm or severe and life-threatening neglect. A traumatic event may happen once in a person’s lifetime or be repeatedly perpetrated against a child or an adult.
SAMHSA gives the above description of a traumatic event that falls in line with what the Diagnostic and Statistical Manual of Mental Disorders Edition 5 (DSM-5) states.
Experience of Events. The way people experience a traumatic event is different for each individual. What is traumatic for one, may not be for another. A lot depends on how we interpret our physical and psychological well-being both during and after trauma.
One example is child sexual abuse perpetrated against a very young child where the child does not experience fear. Yes, it is very wrong and is later harmful to them as an adult, but if the child does not know that what they are experiencing is not supposed to happen, in the absence of fear they have no reason to interpret it as traumatic.
It is later, when the child becomes an adolescent or an adult, that the shame and guilt of what has been done to them arises. So, although they were not traumatized while children, a discovery that what was done to their bodies is the trigger for the trauma.
It is also essential to remember that although we may think of trauma as happening in childhood, trauma occurs to adults as well. Tornadoes, hurricanes, volcanic eruptions, car accidents, the sudden death of a child, all are horrendously traumatizing. Let’s not forget about the war. Many war veterans suffer horribly from the traumatic events and sights they were forced to endure in the service to their country.
Effects of Traumatic Events. Trauma has lots of long-lasting after effects, some of them life-altering. Although we are familiar with trauma creating chaos in someone’s life immediately after the event, sometimes the consequences can be delayed for decades.
Sometimes we are unable to connect the traumatic event or events to what we are seeing in our own behavior.
I experienced the childhood trauma I lived through as a series of events I conveniently forgot. I would just push it over there so that I could exist and carry on over here. Thus, I formed alternative egos to hold the memories with all the terror and pain. I didn’t begin to be traumatized until the memories of those events began to return almost three decades later spontaneously.
I experienced flashbacks, nightmares, losing time, and depression so deep that I was hospitalized more than thirty times, one of them lasting for over seven and a half years.
Other more typical examples of someone responding to trauma are having problems with relationships, managing thinking processes like memory, attention, and thinking and regulating the expression of emotion.
The Physical Changes from Trauma
Trauma that is experienced in childhood changes structures in our brain. Through fMRI imaging and other techniques researchers have found that adults who suffered trauma in childhood have measurably smaller hippocampi and amygdalae than average adults. In some people, such as those who have post-traumatic stress disorder or a dissociative disorder like DID, the differences are remarkable.
One scientific paper found on the US National Library of Medicine National Institute of Health website reported on just such a study. In it the researchers found DID patients to have 19.2% smaller hippocampal and 31.6% smaller volumes compared to healthy subjects.
The hippocampus is responsible for memory consolidation and retrieval. So, it is not unreasonable to think that because ours is not the correct size, the memory lapses we have during a split are connected to this size difference.
The amygdala is vital to our ability to interpret and respond to danger. Even if we do not at first succeed in identifying something as dangerous, this part of our brain is quick to respond. When a threat is detected, the amygdala sends out emergency signals to the rest of the body getting it ready to flee, fight, or freeze. It takes no leap of the imagination to see the correlation between a damaged amygdala and hypervigilance, flashbacks, and fugue.
The Guidelines for Trauma-Informed Care
According to SAMHSA, trauma-informed care helps adults understand that their behaviors are coping strategies designed to overcome and survive adversities they have faced in life. Since the traumatic events are overwhelming and the survivor had no power to help themselves, they are acting out trying to protect themselves from a danger that no longer exists.
Remember, trauma doesn’t necessarily mean experiencing someone mistreating or threatening you. It can also take the form of hearing the traumatic events of another person being retold as they relive it. Thus, therapists are very much in the firing line of becoming traumatized themselves.
When treating children, trauma-informed care providers must utilize other healthcare and protective agencies to not only protect their small clients but to safeguard their own mental health.
The first step in treating someone who has been traumatized is recognizing that it has occurred. This can be more difficult and tricky than it sounds. Depending on their gender, age, and other demographic information, the person may be very protective of the information that they were the victim of trauma.
Sometimes people are forced into therapy by law enforcement, the court or by a partner who is threatening to leave. In these cases, the survivors may not understand themselves that they are a victim.
Men especially find it hard to disclose any type of abuse or trauma they are or have gone through. Men can be and are victims of violence in the home too and must not be forgotten in the trauma formula.
It can be tricky for providers to give their client a label of trauma survivor for one big reason. A therapist cannot ask about or imply that someone has a trauma history. To do so would jeopardize the treatment because they could accidentally implant the idea of trauma where none may not exist. They must wait to see what the client discovers on their own and be there to help them accept and later recover from it.
The 6 Principles of a Trauma-Informed Care Approach
SAMHSA outlines six critical principles for therapists to follow when offering treatment, trustworthiness, peer support, collaboration, empowerment and cultural/gender issues.
Safety. No matter the age of the person being treated, it is essential that the client feel physically and psychologically safe. This gives the client the ability to open up to their therapist and explore what happened, how it affected them, and how to heal.
Trustworthiness. This isn’t necessarily meant for the client, but rather to the therapist who needs to remain open and honest with their clients. Its only with this honesty that people like myself who have been so hurt by those who should have treated me well can learn to trust anyone, especially a therapist.
Peer Support. It is no secret that SAMHSA is a big fan of peer support. When people are in pain, they naturally want to turn to others who understand where they have been and what they are going through. A peer is someone with lived experience of trauma. Also known as survivors, we help each other by sharing what has worked for us and hold each other up when times get tough.
I found tremendous peer support through Ivory Garden DID Support Group. Found at IGDID.com, Ivory Garden helped me come to terms with my own DID, and I made some lifelong friends along the way. When I was diagnosed with breast cancer and faced having my right breast removed, my friends at Ivory Garden were there supporting me. Granted it is online peer support, but it was beautiful anyway.
Collaboration. This term is centered on the staff of the clinic or hospital that offers trauma-informed care. SAMHSA believes that good cooperation among all the staff of a center offering trauma support is crucial to modeling the sharing of power and equality of relationships to the clients.
They quote one expert as stating, “One does not have to be a therapist to be therapeutic.”
Empowerment. By recognizing that all people have strengths and abilities, the trauma-informed approach stresses these to try and build resiliency in their clients. The therapist recognizes that his/her clients have come to them for help and they endeavor to give assistance and support.
Cultural and Gender Issues. A trauma-informed therapist tries to move past cultural stereotypes and biases against any client for their race, ethnicity, sexual orientation, age, religion or gender identity. This type of therapist will incorporate processes that are responsive to the needs of their clients based on their needs and address historical traumas that they may have experienced.
I Know, a Little Dry Wasn’t It?
I realize that this topic is a little dry to chew on but understanding what trauma-informed care is more critical now than ever before. Therapists are more and more turning to this type of therapy model to help their clients, so it behooves us to try to understand the process and goals of it as much as possible.
As a trauma survivor, I hope that the understanding of what trauma does and how to prevent it in the first place becomes paramount in our world. If we can keep children from experiencing adverse experiences such as any type of abuse and help adults who have become victims, then we will have come very far indeed in stamping out unnecessary suffering.
Child abuse is preventable and so is domestic violence of any kind. That means that there need not be a massive world population of traumatized adults trying their best to survive.
“A controlled child also learns that the default human approach to interaction is forcing, threatening, or manipulating others. Alternatively, they may come to believe that they are ‘destined’ to be a giver who never receives anything back.”