Trauma-Informed Therapy
As a mental health nurse, CBT and trauma therapist, my practice is deeply rooted in the core values of trauma-informed care: safety, trust, choice, collaboration, empowerment, and sensitivity to cultural, historical and gender related factors.
This means, amongst other things, that I work in a particular way to support your wellbeing during therapy. You might notice this in the way I collaborate with you, in how I work to ensure your choice, control and sense of emotional, physical and nervous system safety in the therapy process, and in how I use my therapy room and environment to support this. I am also aware of the harm, or re-traumatisation, that can arise from invalidating, discriminatory, abusive, or dismissing care or service experiences; and the sense of fear, vulnerability or shame that can be activtated by reminders or 'triggers' in certain situations, environments, or interactions.
Trauma-informed therapy recognises the multiple types of trauma that individuals can experience, from early life onwards, and their impact on thinking, memory, emotions, sense of self; nervous system and body; attachment and wider interpersonal relationships. Experiences like watchfulness / hypervigilance, dissociation, hyper-independence or emotional numbness are not "abnormal" or a sign something is "wrong" with you. They are natural adaptations of your nervous system designed to protect you.
The areas below represent some of the foundations of mental health and well-being that can be impacted by trauma and difficult experiences, but which can also be strengthed during trauma therapy to support personal, relational and physical recovery, wellbeing, and growth.
Safety & Stabilisation
Identifying triggers for stress, distress or nervous system overwhelm, and learning to cope with difficult emotions, memory gaps or intrusions, and process difficult experiences. Recognising that freezing, hypervigilance, self-criticism, people-pleasing, or avoidance are protective survival strategies.
Trust
Learning to trust your inner wisdom and developing confidence in your own judgement to guide your relationships and boundaries, with yourself and others. This can also be about gradually developing trust in the predictability and safety of the therapy environment and process.
Autonomy
Being in charge of your own life and regaining personal agency, choice and control. Being able to make choices that are based on what's important to you. Feeling comfortable communicating in your own style, and processing interactions or experiences at your own pace.
Confidence
Building trust in your own inner capacity and resources for healing and growing, and changing old patterns of self-doubt.
Identity
Reclaiming and affirming your internal sense of worth and self image, that doesn't depend on other people's approval, or society's expectations, of you.
Reconnection
Identifying what really matters to you and rediscovering purpose, meaning, interests or relationships. From surviving to thriving.
What to look for in a trauma-informed therapist
'Trauma-informed' has become a bit of a buzzword in many people-facing services. Here are just some of the basic features you would expect to see in trauma informed counselling or therapy.
Physical & Environment Safety
The therapist or counsellor:
Offers you details on how to find their therapy practice, any parking and access arrangements, and what might be asked of you upon entering the building - such as signing in or to sit in a waiting area.
Offers you choice in use of lifts or stairs, and seating, heating, lighting and door proximity in the therapy room.
Respects your physical boundaries -won't do sudden movements, and will check in with you when moving around, and check where you prefer they sit in relation to you.
Won't ask you to close your eyes during relaxation exercises, unless you wish to, and won't touch you unexpectedly, or at all.
Maintains predictability - like room layout, session start and finish times, and session 'flow'.
Collaboration and Therapist Power Shift
The therapist or counsellor:
Explains the purpose of any exercises, and seeks your permission before starting these, and will respect your choice.
Sees you both as as equal collaborators, recognising that you are the expert on you.
Models healthy relationship boundaries and communication.
Makes sure you feel seen, heard and respected, and that you feel in control of the therapy process.
Treats you as a whole, resilient person, not as 'symptoms' to be fixed, but to support your personal growth.
Doesn't make you do anything you don't want to do or feel uncomfortable with, and checks in with your comfort levels during session.
Regularly invites your feedback or experience of therapy with them.
Nervous
System Regulation
The therapist or counsellor:
Notices any activation of your nervous system, or change in body language, and offers support in a sensitive way.
Will check out with you the best ways to help you re-regulate, recognising that deep breathing, for some people, may make things feel worse, and will use trauma-sensitive methods of grounding instead.
Normalises any need you may have to move around or pause.
Recognises the mind-body connection and how they influence each other.
Therapy Approach and Language
The therapist or counsellor:
Focuses on "What happened to you?" instead of "What is wrong with you?"
Will respect your personal, relational and emotional boundaries - won't use coercive ('You must') or dismissive ('It could have been worse') language, and won't share or try to influence you through their own experiences ('I went through that trauma too, this is what worked for me').
Respects diversity of experience and doesn't judge or make assumptions about your experiences, or how you feel or react in relation to these.
Doesn't ask for information about you or others that is not relevant to your therapy.
Doesn't promise things they can't provide, and provides evidence-informed interventions only.
Is mindful of the potential for any trauma or difficult experiences you may have previously experienced, including within wider services.
Trauma-informed employers and organisations
Employers and public-facing organisations can benefit from becoming trauma-informed, partly using some of the principles above.
Belittling punishment in schools, bullying or impossible expectations of the system in the workplace; invasive procedures or use of restraint in healthcare; removal of children to foster care and its impact on families; frequent attendance at MDT meetings where abuse, traumatic accidents or death are discussed in detail in health, education, social care or police settings, can all be experienced as traumatising, with lasting impact on wellbeing.
Implementing trauma-informed approaches in workplaces and organisations can be done through leadership and cultures that are Compassionate, Curious, and promote Trust, Involvement and Empowerment through information sharing, transparent and supportive polices, staff and public or service user Collaboration.
Creating a sense of Autonomy, Choice and Control as well as genuine Respect and Dignity can further help increase psychological safety and reduce potential for trauma.