Trauma-Informed Care: How Rehab Can Support Post-Traumatic Growth
Trauma-Informed Care: How Rehab Can Support Post-Traumatic Growth
by Kayla Gill on July 20, 2021
Trauma can be an isolating experience. When you go through something so painful that it changes you, it’s natural to feel like no one else can understand your new reality. You may have trouble connecting withl the people around you, or no longer enjoy activities you once found meaningful. No matter how hard it is at first, remember: this is not the end of your story. You can always create a new beginning.
By going to rehab, you can get help from experts in trauma, PTSD, and CPTSD. The simple fact that these experts exist is proof that trauma is extremely common. You may feel isolated, but you’re certainly not alone. Depending on your program, you can also spend time in rehab building community with people who have life experiences like your own.
This process can teach you a great deal about your own perspective. There are countless kinds of trauma, and everyone’s response to it is unique. For the most part, however, people whose mental health has been severely impacted by trauma are diagnosed with PTSD and/or CPTSD.
Post-Traumatic Stress Disorder1 (PTSD) normally develops in response to trauma that occurred in a discrete, specific amount of time. It’s often diagnosed in veterans and survivors of sexual assault. This condition is characterized by many symptoms, including but not limited to the following:
PTSD can be overwhelming. You may have the sense that one moment, or one brief period of time, permanently changed your emotional capacity. And that might even be true. But it doesn’t mean you’ll always be in pain.
Complex Post-Traumatic Stress Disorder2 (Complex PTSD or CPTSD) is similar but not identical to PTSD. This describes people who have experienced prolonged trauma, such as long-term domestic abuse or long-term childhood trauma. While many veterans who served only one tour have PTSD, those who spent years in active service, and especially those who were detained in Prisoner of War camps, may in fact have CPTSD. The term may also apply to people who grew up in violent neighborhoods or spent time in prison.
CPTSD is not yet officially classified as a diagnosis by the DSM-V (the American Psychiatric Association’s manual for assessing and diagnosing mental health conditions). However, many clinicians use it as a framework for discussing their clients’ experience. The term has been in use since at least 1988, when Dr. Judith Hartman of Harvard University suggested that the symptoms of long-term trauma may require a different kind of treatment than those of PTSD. She referred to a number of specific symptoms:
Although CPTSD is not yet classified as a medical diagnosis, a growing number of healthcare providers use the concept as a therapeutic tool. It may very well be included in a future version of the DSM. Even now, many people in recovery identify with the term. Like any diagnosis, this is not only meant as a way of explaining ineffective or damaging behavior. Instead, it can help you define your experience in order to chart a path away from destructive patterns.
“Trauma-informed care”3 refers to a variety of healthcare practices that take into account the unique experiences of people with a history of trauma. Providers may be experts in treating PTSD and CPTSD, and they may offer special accommodations for certain clients. For example, when a survivor of assault sees a massage therapist who offers trauma-informed care, the therapist might make it a point to ask for verbal consent before touching any new area of their body. The provider’s goal is to treat the client with respect, making sure they feel as safe as possible throughout the healing process.
Trauma-informed care takes the client’s past, present, and future into account. It’s not productive or even possible to ignore the original traumatic event while trying to move forward. Jan Garber, the CEO of Paracelsus Recovery, explains, “When we’re looking at trauma, we often look at family of origin to understand how people were shaped and how that then informs how they react in life and how they relate to others. If someone’s coming to us, most of the time they’ve identified a set of symptoms that’s saying, ‘Hey, stuff in life isn’t well, or it’s not working the way it could.’ So that’s the smoke, and where there’s smoke, there’s fire. So we want to really look at where that fire is and how the fire started.”
Looking at the root cause of trauma is not about assigning blame. It’s unlikely that you caused your own trauma, and it’s certainly not true that you’re responsible for other people’s behavior. You did not make this mess; or at least, you didn’t make it alone. Whatever or whomever the source of your pain may be, though, healing is your responsibility. That can feel very daunting, especially for people who experienced childhood trauma. Remember that you are not the first person to feel this way. There is a great deal of research that can guide you through PTSD and CPTSD, and your healthcare providers are there to help you navigate it.
Trauma-informed care is sensitive to triggers. This word has been co opted and even denigrated in recent years, so it’s important to define it in this context.
A trigger is an inciting event that elicits a strong emotional reaction which may be disproportionate to the present moment, but is a reasonable response to the past trauma you’ve experienced.
It is not true that being triggered means you are weak, or fragile, or maladjusted. On the contrary, triggers exist for good reason. The extreme emotional reactions they cause used to serve you well. With time, effort, and therapy, many people can overcome these disproportionate reactions.
Triggers are unique to everyone. Some are very common; for example, many survivors of physical violence have trouble looking at gorey images. However, they can also be hard to predict. A bouncy pop song might be triggering if it was playing when you got in a terrible car accident. If you struggle with your family of origin, you may be triggered by a funny sitcom about a happy family.
Simply avoiding triggers is both impractical and ineffective. Even if you never play the radio in your home, that same bouncy pop song might come on the speakers while you’re at a grocery store. Isolating yourself from situations in which you might be triggered can prevent you from living the life you want. The long-term goal of trauma-informed care is not to protect you from triggers—although that may be a useful short-term strategy. You will instead learn how to regulate your emotions and tolerate difficult situations.
The first step toward building habits is to acknowledge your current patterns. From there, you can decide which of them are still helpful. The skills that got you to this point served an important purpose, but they may not be the skills you need to build a better life.
When you experience trauma, it’s natural to develop coping mechanisms that are appropriate to use in emergencies. These strategies are very important; they are designed to help you survive and ultimately escape. But life isn’t always an emergency. Some of these habits can become harmful if you keep using them after the danger has passed. For example, a person who grew up in a violent home might have learned to mistrust their family members. That skill was probably a very important defense mechanism during their childhood. In adulthood, however, that same skill has the potential to damage a romantic partnership.
If you’re living in an unsafe situation, it’s normal to want to escape. If physical escape is not an option, you may turn to other means of escape, such as substance use. Researchers have found “that there is high comorbidity between PTSD with substance abuse disorders4 and other mental disorders.” Because of this well-understood connection, many rehab centers are well-equipped to offer trauma-informed care.
“Even if the person doesn’t define for themselves that they have trauma history, we assume that they do,” says Dr. Monika Kolodziej, Program Director of McLean Fernside. “What that means is being very respectful of space. It means being a clear communicator. It means not overstepping boundaries. And it means introducing the possibility that treatment for trauma might be an important part of their recovery. So in addition to being sensitive and interacting with the person in a way that’s respectful, that doesn’t overstep boundaries or is not aggressive or confrontational, it also means providing treatment and skills.”
PTSD and CPTSD can also co-exist with or even cause other diagnoses, such as anxiety and depression. Scholars have also suggested a link between CPTSD and Borderline Personality Disorder (BPD)5; some even suggest that we stop differentiating between these two conditions6. If you’re living through ongoing trauma, and develop an additional mental health issue as a result, it can be even harder to get out of danger. And once you do arrive at a safer place, these conditions can complicate the healing process.
Trauma-informed care takes these many complexities into account. Rehab is a place to not only move past substance use, but also learn to cope with the underlying cause that led you to use substances in the first place.
Rehab is designed to be a safe, protected environment in which you can begin healing from trauma. You’ll have access to experts who can help you process your past experiences and learn new skills to use in the future. Without the added responsibilities of work, school, or caring for your family, you’re free to focus on yourself. This dynamic is especially important for people with a history of domestic violence, and anyone whose trauma has caused them to struggle with interpersonal dynamics.
PTSD and CPTSD can be extremely isolating, both during and after the original trauma. That isolation can even be a key indicator of whether or not you’ll develop one of these conditions in the first place. For instance, if a person gets in a car accident and then has to wait for hours before an ambulance arrives, that waiting period might be just as emotionally damaging as the accident itself. After that traumatic event, it could also be hard for them to explain why they’re triggered by sitting quietly at the side of a road.
Rehab offers clients the opportunity to inhabit a safe and protected environment, without isolating them from care. By connecting with your cohort and your team of providers, you can learn how it feels to simultaneously exist in a private space and benefit from community support.
Various rehab facilities offer different types of therapy for people with a history of trauma. Behavioral therapy is a particularly effective treatment. This approach provides clients with very specific tactics for navigating difficult situations, coping with triggers and urges, and living in accordance with their personal values. Some common styles of therapy for healing from trauma7 include cognitive-behavioral therapy (CBT), exposure therapy, and eye movement desensitization and reprocessing (EMDR).
Each of these kinds of therapy looks at trauma from a slightly different vantage point, and it’s important to choose the one that’s right for you. EMDR, for example, aims to restructure the way memories are stored in the brain. As Meena Lavender, Family Therapist and EMDR Practitioner at Camino Recovery, describes it,
“…if you had a filing system in your brain, it would house traumas in different sections of your brain. What EMDR does is access it one by one and processes that to eliminate the emotional charge it has.”
EMDR is just one example of trauma-informed care that simultaneously treats the mind and the body. This holistic approach can be helpful for clients who experience physical symptoms as a result of their emotional experience. In some cases, these symptoms can be extreme: panic attacks can be mistaken for heart attacks, and dissociative episodes can put a person at risk of physical harm. As Ryan Soave, Director of Program Development at All Points North Lodge explains,
“We hold trauma in our body, and stress is really the symptom of trauma. we can start working some of that stress out of the body, utilizing things like yoga, breath work, meditation, massage, the sensory deprivation tank, exercise and other types of functional movement, then when that stress is released from the body, it makes it easier to deal with the stressors that are going to come on a daily basis.”
Imagine that, at the moment you originally experienced trauma, someone handed you a box. Inside it, you find a bouncy ball and a big red button, which is mounted on one of the sides. Whenever the ball hits the button, you’re reminded of your painful experience. That may mean you get triggered, feel anxious, and/or have the urge to engage in destructive behavior.
At first, the ball and the box are almost the same size. The ball is constantly pressing down on the button, and you spend most of your time feeling the effects of what you’ve been through. This acute phase of healing from trauma can be very overwhelming. Without effective tools to regulate your emotions, it’s unfortunately easy to fall back on unhealthy coping mechanisms.
Over time, though, you learn. You grow. The box gets bigger, and the ball has room to bounce around. It spends less and less time pressing on the button. Your feelings may still be intense every time the button gets pushed, but you’ll have some space to breathe in between those moments. You’ll develop skills to manage your own reactions, and be better prepared for the next time the ball hits.
This metaphor was originally developed to describe grief. And the process of healing from trauma is not unlike the process of grieving8. Often, though, what you’re grieving is a version of yourself. As painful as that is, there is a well-charted path forward.
Trauma-informed care offers people the space they need to get to know themselves again. This is your opportunity to redefine yourself, your life, and your values. Healing is a-linear, and there will always be good days and bad days. This process is intended to help you navigate them both.
To learn more about your options for care, see our collection of residential rehabs offering trauma treatment here.
Reviewed by Lisa Misquith