Trauma-Informed Therapy

Key takeaways

• Trauma-informed approaches can be applied to many forms of care, including medicine, social services, and therapy

• Trauma-informed therapy recognizes the long-term effects of trauma, which can make it more difficult to resolve mental health and emotional issues

• Trauma-informed therapy prioritizes meeting clients’ needs for safety, trustworthiness, autonomy, and avoiding re-traumatization

Understanding trauma-informed therapy

All mental health professionals should be trauma-informed to some degree. They all receive training on how trauma affects individuals and some ways it can impact a person’s experience of the world. When a therapist or counselor (or anyone else you might be working with) describes themselves as working in a trauma-informed way, they’re going beyond that core training. A trauma-informed professional is committed to recognizing and honoring their client’s trauma-related needs as an integral part of the service they provide.

Trauma-informed care isn’t restricted to therapy or to mental health professionals. A trauma-informed physician may show extreme care to minimize touch with traumatized patients. A trauma-informed yoga teacher is prepared for emotional reactions from students with trauma and welcomes those. A trauma-informed vocal coach recognizes that many people who have experienced trauma feel silenced and may prioritize helping a client feel safe expressing themselves over technical work on pitch or volume.

You can seek trauma-informed therapy for problems that are not directly related to your trauma. Someone who has trauma after a car accident can still benefit from working with a trauma-informed therapist when they are struggling with their romantic relationships.

What do we mean by trauma?

When we’re talking about trauma-informed therapy, we are using a relatively broad definition of trauma. Conditions such as PTSD use a relatively narrow definition, requiring that a person has experienced severe trauma such as sexual violence or the risk of death.^[1] For trauma-informed therapy, the threshold for trauma is substantially lower.

A traumatic experience causes powerful feelings of distress and, often, powerlessness. It could be a single event, a series of events, a situation or relationship, or a consistent pattern of interactions. Experiencing trauma makes you feel unsafe, physically, emotionally, psychologically, or socially. Trauma also stays with you for a while after the event or situation is over. You might have strong, unpleasant feelings when you remember the traumatic experience or dislike things that remind you of it.

There are also different types of trauma. Examples include

• Childhood trauma, such as neglect or abuse.

• Collective trauma, such as the events of 9/11.

• Racial trauma, which results from encountering racism.

• Secondary trauma, from seeing others harmed.

Although we talk about sources of trauma, trauma is actually your emotional response to something that happens. If two people can experience the same event, one might experience it as traumatic while the other doesn’t.

Being traumatized by something you have experienced isn’t a sign of weakness, and it’s not something you can control. You also can’t know whether someone else experiences an event as traumatic unless they tell you.

Is trauma-informed therapy the same as trauma therapy?

Trauma therapy usually describes therapy that is directly aimed at resolving trauma. This might mean treating disorders such as post-traumatic stress disorder (PTSD) or borderline personality disorder (BPD), which have developed as a consequence of trauma. Even if someone hasn’t developed a mental health condition as a result of their trauma, trauma therapy can help them deal with their feelings and experiences.

Trauma-informed therapy can be utilized for other issues besides trauma. It aims to recognize how trauma may play a role in the present problem and how it can complicate efforts to resolve those issues.^[2] Someone who has had successful experiences with trauma therapy may still benefit from trauma-informed therapy for other challenges in their life.

How it works

Trauma-informed therapy comes from an understanding of how trauma can create important needs in people. Therapists working in this way try to meet those needs, allowing clients to then work on their chosen issues.

These needs aren’t unique to people with trauma. These are needs that everyone has, but they take on increased importance for people who have been traumatized. Having experienced those needs not being met, they don’t have a baseline assumption that they will be. Someone taking a trauma-informed approach shows the ways they are working to meet those needs, which can reassure clients.

Here are some of the key needs that are prioritized in trauma-informed care.

Safety

Anyone who has experienced trauma has been in a situation where they did not feel safe. In many cases, they have also experienced powerful negative consequences of not being safe. They may have been hurt, humiliated, or otherwise harmed. This can change how they view the world. Outside of obvious risks, such as walking alone through a dark alleyway at night, people typically believe the world is reasonably safe. Experiencing trauma challenges this belief, often leaving people with the feeling that nowhere is safe.

As well as making it harder to feel safe, trauma can increase the need for safety. Trauma can make people more risk-averse, prioritizing safety above possible rewards.^[3] Safety can be physical, emotional, social, or psychological. Following trauma, people might avoid saying anything that could upset other people because they feel emotionally unsafe. When a client does not feel physically or emotionally safe, they will struggle to be as open, honest, and vulnerable as therapy requires. A trauma-informed therapist focuses on meeting their client’s need for safety before beginning work that requires vulnerability.

Trustworthiness

Trustworthiness is closely linked to safety. Someone who has experienced trauma, especially that caused by another person, may have learned that others are not necessarily trustworthy. If they have experienced abuse and gaslighting, they might not trust their own assessment of whether someone is trustworthy. In some cases, they might feel as though no one can ever be trusted, or as if they don’t deserve trustworthy people

A trauma-informed therapist recognises that they can’t, and shouldn’t, expect their clients to trust them automatically. They consistently demonstrate trustworthiness by being open, honest, and treating the client with respect. This includes not pushing the client to disclose any part of their trauma that they are not ready to share. Building a trusting relationship is important for all therapy, but trauma-informed therapy recognizes that learning to trust and recognizing trustworthiness can be important therapy goals in themselves.

Autonomy and choice

Trauma often involves powerlessness, with people unable to control their own fate. In therapy, clients need to be able to make decisions about themselves and their care, and to have those decisions respected. Trauma-informed therapy is careful not to impose treatments or approaches on clients, instead giving them information and support to make their own informed decisions.

A trauma-informed therapist will also be aware that some clients, especially those who have experienced coercive control or domestic violence, may feel overwhelmed by having autonomy. They help such clients work through those feelings and help build empowerment. Clients are shown their strengths and resilience from the perspective of a compassionate outsider, building their confidence and capability.

Avoiding re-traumatization

One of the challenges of experiencing trauma, especially if this occurred early in life or was long-term, is that it can increase the risk of experiencing trauma again. People who have been traumatized may develop behavior patterns or expectations that make it easier for other people to harm them.

A trauma-informed therapist is aware of those patterns and conscious of specific behaviors that might accidentally re-create some of the experiences of trauma. They will try to avoid those as far as possible, but they will also be alert for signs that a client is starting to have a trauma reaction and take steps to help.

Techniques used in trauma-informed therapy

Trauma-informed therapy isn’t restricted to any single approach. A trauma-informed CBT therapist will use CBT techniques, such as challenging beliefs or exposure therapy. A trauma-informed psychodynamic therapist will use techniques to explore unconscious processes. A trauma-informed humanistic therapist will use unconditional positive regard.

Trauma-informed therapy will often involve learning how trauma impacts you, including how it affects emotional reactions, physical responses, and social relationships.

What can it help with?

Trauma-informed therapy can be used to help with any problem you might be facing in your life. It can be especially helpful for topics that have some connection to your trauma, such as

• Relationship issues.

• Problems with confidence and self-image.

• Substance use or addiction.

• Fear and anxiety.

• Anger.

• Bereavement.

What a first session will consist of

The first session of trauma-informed therapy will be much like any other first therapy session. You will talk about what you can expect from therapy, their rules around confidentiality, and other practical issues, such as their cancellation policy. Your therapist will also encourage you to explain, in your own words, why you are there, and as much as you feel comfortable explaining about your history.

A trauma-informed therapist might also mention some of the things they do to increase your safety, and ask about any other needs you might have. For example, they might check that you feel safe in their waiting room and explore other options if this makes you feel uncomfortable.

Because trauma-informed therapy focuses strongly on trust and safety, the first sessions might feel slower than you expect, and it might take several sessions before you start talking about what you think of as the core problem. For some clients, these can feel simultaneously unproductive and emotionally intense. This is normal and may be a sign that you need this time to feel safe. If you feel this way, it is helpful to share this with your therapist.

Effectiveness and limitations

Trauma-informed therapy can be extremely effective in helping people who have experienced trauma access mental health support, and taking a trauma-informed approach can help improve the effectiveness of therapy for these groups.

Just because a therapist works in a trauma-informed way doesn’t mean that they will be a good fit for all clients with experiences of trauma. Trauma-informed care emphasises the importance of a client feeling safe and comfortable. If the client-therapist relationship isn’t able to provide that feeling of safety, it might be necessary to find a different therapist who also works in a trauma-informed way.

A trauma-informed therapist doesn’t usually work exclusively with people who have experienced trauma. Being trauma-informed is integrated into the way they work with their clients, but prioritizing the needs of safety and autonomy can be valuable for all clients.

Trauma-informed care is widely considered to be best practice, but it has not been extensively studied. Trauma-informed care in substance abuse disorders has received substantial attention and has been shown to help patients complete therapy and achieve positive outcomes.^[4][5] Most other studies into trauma-informed care on mental health have focused on conditions directly related to trauma, such as PTSD and dissociative disorders, where it has again been shown to be effective.^[6][7]

Trauma-informed principles have also been explored in other healthcare settings, where it is associated with better mental and physical health for patients.^[8]

Finding trauma-informed therapists

Trauma-informed therapists have usually put a great deal of effort into understanding how trauma affects clients and learning how best to help them. They’re keen to let potential clients know that they will be safe and welcome in their practices, and this is reflected in their descriptions of themselves and their services.

Look for a therapist who speaks openly about the type of work they do and uses the phrase “trauma-informed.” Some trauma-informed therapists will work primarily with certain types of trauma, and they will usually mention this in their description as well.

Tips for finding the right therapist for you

The therapeutic relationship is one of the best predictors of successful therapy. If you find a therapist you trust and work well with, you are more likely to achieve your goals, irrespective of their way of working.^[9] This is especially important for trauma-informed therapy.

Consider any aspects of your experiences that might affect your ability to trust and feel safe with a particular therapist. If you have racial trauma, for example, you may feel more comfortable talking to someone of color. Women who have experienced sexual violence may feel more at ease working with a female therapist. These feelings are intensely personal, and there’s no right or wrong way for someone who has experienced trauma to feel. If those factors don’t feel important to you, that’s completely normal as well.

Finding a therapist, especially following trauma, isn’t something you have to get right the first time. Therapists recognize that they won’t be the right match for all clients, and it’s normal for clients to have one or two sessions with a therapist before deciding that they’re not a good fit. People with borderline personality disorder (BPD), who have almost all experienced trauma, typically see around 6 therapists before finding one who meets their needs.^[10]

If you are seeking trauma-informed therapy for a problem unrelated to your trauma, check that the therapist you’re looking at is experienced with that issue as well. If it’s not listed on their description, send them an email or arrange a short call to see whether they are able to meet your needs.

Final thought

Trauma-informed therapy can help people access therapy and support when this might otherwise be difficult. Feeling safe and supported allows you to work through your problems and overcome challenges.