What is Trauma-Informed Care?

By Aiesha Lee, doctoral student, and Charles "Rip" McAdams, Ed.D., professor of counselor education

As our world experiences a global crisis, counselors continue to provide care to the general population. Currently, our communities are experiencing a collective trauma related to COVID-19. To help clients cope, providers must understand and implement trauma-informed care. To properly care for traumatized clients, counselors must understand trauma, how it is defined and treatment strategies.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, the manual mental health providers use to diagnose clients, defines trauma as: Exposure to actual or threatened events involving death, serious injury or sexual violation in one (or more) of the following ways:

1. Directly experiencing the events.
2. Witnessing the events in person as they occurred to others.
3. Learning that the events occurred to a close family member or friend.
4. Experiencing repeated or extreme exposure to aversive details of the events.

Essentially, trauma results from events that seriously threaten or violate the safety of a person or a person’s loved ones. Examples of traumatic events include (but are not limited to) mass shootings, sexual assaults, natural disasters or car accidents.
The ongoing Adverse Childhood Experiences (ACE) study initiated in 1998 by the Centers for Disease Control and the Kaiser Permanente Insurance managed care agency has shown that many children have experienced trauma, and that trauma has serious detrimental impacts on children. The more adverse childhood experiences children have, the more likely they are to develop depression, unsafe behaviors such as drug or alcohol abuse, and chronic illnesses such as heart disease. Because many people have at least one adverse childhood experience, the risk for these health concerns and others is widespread.

What does this mean for mental health providers? Many people seeking counseling may be suffering from the impact of traumatic experiences. Consequently, counselors should remain sensitive to their client’s histories of trauma, but they must also take care not to traumatize clients further during the treatment process. Preventing additional trauma occurring during treatment is a primary goal of trauma-informed care.

Trauma-informed care is care in which mental healthcare providers engage with a client in a manner that allows for implementation of an effective treatment process without retraumatization. Trauma-informed care requires understanding that the trauma people experience in the past can negatively impact their current life. A trauma-informed approach involves adherence to principles for practice that ensure understanding and sensitivity to trauma-related issues regardless of an individual’s current presenting concerns. The Substance Abuse and Mental Health Services Administration (SAMHSA), a leading national organization for mental health and substance abuse research and practice, outlines the following principles of the trauma-informed approach:

1. Safety: Providers and organizations should make the physical counseling environment safe and engage in counseling behaviors that allow clients to feel safe.

2. Trustworthiness and Transparency: To allow clients to feel safe, counselors must be open and honest about the counseling process and the rules that govern counseling service delivery.

3. Peer Support: Incorporating into the counseling process the stories of others who have experienced trauma can help clients to feel safe, trust the counseling process and begin to feel hopeful about their own recovery.

4. Collaboration and Mutuality: Counselors should serve as partners, not authorities, who assist rather than direct clients in their healing journey.

5. Empowerment, Voice and Choice: To assist clients with recovery, counselors must recognize and encourage clients’ voices, choices and strengths. Counselors must work from the belief that clients are resilient and can take charge of their healing process.

6. Cultural, Historical and Gender Awareness: Counselors must be aware of and set aside any pre-determined assumptions about clients’ cultural identities. Specifically, counselors must not respond to clients based on their assumptions about clients’ cultural experiences, but instead, they must respond based on the unique cultural narrative clients provide to them. The key to implementing these six principles lies in counselor exercise of four skills in their counseling services delivery: realization, recognition, response and avoiding retraumatization. Counselors using a trauma-informed approach realize both the impact of trauma and the potential for recovery, recognize the symptoms of trauma, respond according to the trauma-informed approach principles, and strive at all times to provide a safe environment and counseling experience that does not contribute to retraumatization.

The first step to implementing a trauma-informed approach is to become knowledgeable about trauma. The American Counseling Association (ACA) and the Professional Education Systems Institute (PESI) both provide continuing education opportunities that can increase a counselor’s understanding of trauma and trauma-informed care.

Counselors and clients alike stand to benefit from counselors applying their knowledge of trauma when providing counseling services in any context. For example, clients who have experienced trauma from others may be hesitant to form trusting relationships with others. Counselors who are knowledgeable of this impact of trauma are likely to be more understanding when their traumatized clients are having a difficult time forming a trusting counseling relationship. Although the steps taken to implement each principle of trauma-informed care may appear different depending on a client’s situation, counselor attention to safety, trustworthiness and transparency, peer support, collaboration, empowerment and voice, and attention to cultural differences are the keys to providing effective trauma-informed care.

At William & Mary, the faculty in our Online Master of Education in Counseling program draw from years of experience and research in their fields. Whether students choose to pursue the Clinical Mental Health Counseling concentration, the School Counseling concentration or Military and Veterans Counseling specialization, they will gain the competencies and skills to be a counselor who can make a difference.

References:
Butler, L. D., Critelli, F. M., & Rinfrette, E. S. (2011). Trauma-informed care and mental health. Directions in Psychiatry, 31, 197–210.Centers for Disease Control and Prevention. (2020). Adverse Childhood Experiences. Retrieved from cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.htmlAmerican Psychiatric Association. (2013). Trauma and Stress Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). doi.org/10.1176/appi.books.9780890425596Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Retrieved from store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884