Learn / Trauma-Informed Care: Finding Support and Understanding in Rehab
Trauma often changes how you interpret the world—and it’s easy to feel that no one understands. But it’s a rather common human experience: “70% of adults in the U.S. experienced some type of traumatic event1 at least once in their lives,” according to the National Council for Behavioral Health.
Given how prevalent trauma is, the need to properly address it is growing increasingly important in the behavioral health services field. Treatment providers that take a trauma-informed approach to care acknowledge that trauma exists and emphasize a treatment setting that promotes safety, fosters trust, and prevents retraumatization.
When trauma affects your life, it might be hard to foresee a path to recovery. Receiving knowledgeable, empathetic, trauma-informed care can be the start of a new chapter in leading a happier and more productive life.
Trauma-informed care (TIC) is an approach2 in the health and human services field that recognizes the role trauma plays in someone’s life. It calls for empathy and awareness of an individual’s trauma and ways to address it in order to deliver care as effectively as possible.
Clinical Instructor at Harvard Medical School Dr. Monique Tello, MD, MPH, explains: “The first step is to recognize how common trauma is and to understand that every patient may have experienced serious trauma.3 We don’t necessarily need to question people about their experiences; rather, we should just assume that they may have this history and act accordingly…Trauma-informed care is the open-mindedness and compassion that all patients deserve, because anyone can have a history that impacts their encounter with the medical system.”
For many people, trauma is a barrier to seeking addiction treatment.4 In some cases, a patient has already received treatment in which trauma wasn’t properly addressed, causing retraumatization. The aim of TIC is to reduce these blocks and provide services in an accessible and appropriate manner.
Everyone in the treatment facility, including patients and staff, should feel physically and emotionally safe.
Transparency is emphasized throughout the organization, with the objective of promoting and maintaining trust among staff, patients, and their family members.
The term “peers” in a trauma-informed setting refers to individuals who have lived experiences of trauma. Peers play an important role in trauma-informed care. They can help develop trust, provide a sense of safety, and empower others through their stories of shared experiences to promote recovery and healing.
This principle acknowledges that “one does not have to be a therapist to be therapeutic.”5 Everyone has an equal role to play in a trauma-informed approach, whether you’re a patient, therapist, or support staff member.
The treatment provider honors the strength, resilience, and ability of everyone involved in promoting recovery. Empowerment throughout the organization is key. Staff are trusted to deliver their best work and clients are empowered with choice and decision-making. Staff members serve as facilitators, rather than controllers, of rehabilitation.
The organization deliberately pushes past cultural prejudices and biases in order to provide culturally sensitive treatments, identify and resolve historical trauma, and maximize the healing benefits of traditional cultural relationships.
According to the U.S. Centers for Disease Control and Prevention, “adopting a trauma-informed approach6 is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level.” A quality treatment provider will continually assess their trauma-informed approach and make improvements when necessary.
Trauma-informed care isn’t considered a form of therapy. Instead, it’s an approach that guides how providers deliver your care. Providers that are trauma-informed apply an empathetic understanding of trauma to all areas of treatment.
Consistently applying a trauma-informed approach offers several key benefits:7
One of the hallmarks of trauma-informed care is providing a sense of safety throughout. You should feel physically and emotionally secure in any location in the facility. Feeling safe not only avoids retraumatization, but can help you be more present and comfortable while participating in your treatment program.
People often feel isolated and alone in their struggles following a traumatic event. Trauma-informed care brings together individuals who’ve had similar experiences, creating opportunities for mutual support. This is helpful for several reasons. Seeing the positive impact of sharing your experiences with others can give you a sense of purpose. And listening to what others have gone through provides assurance that you’re not alone; others are by your side on the journey towards recovery.
In traditional treatment settings, clinicians may decide on a treatment with little opportunity for patient feedback. But in trauma-informed treatment, collaboration is key to patient empowerment. Rather than a doctor or therapist telling you what you should or shouldn’t do, patients have a say in their own therapy and play an active part in decision-making. This satisfies the 5th guiding principle of trauma-informed care: giving clients a voice in treatment. Feeling ownership of your treatment process can be a strong catalyst for following through and getting the most out of your time in therapy.
At times, well-intentioned care providers can retraumatize trauma survivors. Forcing people to relive their traumas or pressuring them to open up can cause retraumatization. People are less likely to seek mental health and addiction treatment if they’ve experienced retraumatization. An important goal of trauma-informed care is to prevent this from happening.
We’ve discussed the essential principles involved in trauma-informed care, but how might providers put these into action? Essentially, patients should feel physically and emotionally safe from the moment they arrive.
Signs that a provider is taking steps to help you feel physically safe include having well-lit parking and common areas, security personnel to monitor who’s entering and exiting the building, a comfortable waiting area, minimized loud noises, and more.
Providers that practice TIC also take your feelings of emotional safety into account. They understand that going into an unfamiliar environment to receive treatment can feel intimidating, and create a sense of safety through communication. Communication follows a pattern of support and affirms a relationship of respect and partnership between you and your treatment team.
This can apply to scheduling as well. Because unexpected changes may be jarring for some, your team may aim to keep your schedule consistent and communicate any necessary changes in advance.
Mental health professionals often need to ask personal questions. In a trauma-safe context, they might explain what they’re about to ask and why it’s necessary. This same concept applies to physical exams. You should be told ahead of time why the examination is needed and what it will involve. You’re free to say “stop” at any time. This helps ensure your boundaries are respected. Your providers should always respect your humanity and treat you with compassion, and never compel you to endure something you’re not comfortable with.
Trauma screening is a key component of trauma-informed care. Different providers have their own opinions on when to deliver a screening. But the general consensus in the behavioral health field is that trauma screening should come after you’ve built up trust with your provider. When you initially contact a treatment facility, they tend to avoid asking about specific trauma until you’ve established a connection with someone from their team.
Providers are expected to be trained in trauma screening so they can offer the appropriate follow-up care and avoid re-screening patients. Part of this training includes sensitivity to cultural and ethnic issues.
If a provider practices trauma-informed care, their team should be trained in trauma-specific therapies. There are a wide range of therapies that address different types of trauma. Common therapies include trauma-focused cognitive-behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), and exposure therapy.
Triggers are taken into account in trauma-informed care. A trigger is an incident that produces a strong emotional response. The reaction may seem out of proportion to your current situation, but would be a normal response to the trauma you’ve experienced.
Having triggers doesn’t mean you’re weak or overly sensitive. We all have certain natural reactions to perceived threats. These reactions can serve us well when they drive us to act with urgency at the right time. But if the reactions are involuntary and disproportionate to your current circumstances, it can disrupt your way of life. The time and effort spent on treatment at a trauma-informed rehab can help you regain a measure of control.
Everyone’s triggers are different, and sometimes they can be difficult to anticipate. For example, you may have a strong emotional reaction around the anniversary date of a traumatic experience. The scent of a certain perfume may trigger unexpected anxiety, or hearing the song that played on the radio when you were in a car accident may cause unexpected panic.
It’s unrealistic and unproductive to try to avoid all triggers. Even if you never listen to the radio at home, the song you heard during the car accident might start playing in the car next to you at a red light. Making efforts to avoid triggers is an understandable temporary strategy. But the long-term purpose of trauma-specific therapies delivered in this setting isn’t to shield you from triggers. Instead, you’ll learn how to control your emotions and cope with distressing episodes.
Many complex issues are considered in trauma-informed care, and rightfully so. Access to safe, empowering, understanding interactions with others is instrumental in the healing process.
Some people avoid getting mental health or addiction treatment because they’re concerned about being forced to endure uncomfortable situations. A trauma-informed approach to recovery can help to change the negative connotations of participating in therapy. Quality providers recognize how trauma impacts feelings and behaviors, and apply this knowledge throughout their organization with the goal of providing a better experience for you and their team. Getting the support and understanding you deserve can open the door to more positive experiences in rehab.
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