Trauma Informed Practice

Trauma Informed Practice

Trauma refers to the experience of a real or perceived threat to one’s life or bodily integrity or that of a loved one. Trauma causes an overwhelming sense of terror, horror, helplessness and fear. ‘Single incident’ trauma involves the experience of a single event in which an individual was under threat, whereas ‘complex trauma’ refers to cumulative, repetitive and interpersonally-generated stress (e.g. ongoing abuse in the context of family or intimate relationships).

Given the nature of the forensic client population, a large proportion of clients will likely have experienced significant trauma during their lifetime, although it is often difficult to determine whether a client’s presentation is the result of complex trauma or other factors (e.g. ABI/TBI or mental health difficulties).

Children who come from neglectful or abusive backgrounds, which is relatively common among offending populations, typically experience feelings of worthlessness, apprehension, anger, fear, isolation and loneliness. These feelings can result in difficulty establishing and maintaining relationships, trusting others or engaging in meaningful and healthy affection with others.

Impacts of trauma:

• Emotional symptoms (anxiety, fear, nightmares, sadness, isolation, worthlessness, helplessness, guilt, shame, anger, sleep disturbances)
• Behavioural & cognitive symptoms (confusion, concentration difficulty, withdrawing from others, mistrust towards others, loss of interest in activities, avoidance)

Trauma informed care refers to services that are aware of and sensitive to the dynamics of trauma. Despite the prevalence of trauma in our society, many people and organisations who provide professional support often do not consider or recognise the impact of trauma, and therefore do not respond in a way which is sensitive to an individual’s experience.

In custodial settings particularly, individuals may experience identity disturbance, affect dysregulation, relationship difficulties and will often have several historical diagnoses (e.g. borderline personality disorder, intellectual disorder). Embedding a trauma-informed approach to care and facilitation is therefore highly important in the correctional context. Trauma informed practice recognises the significance of trauma to the individual, and its impact on their emotional, psychological and social wellbeing. If trauma is overlooked or not treated sensitively, there is a risk for harm or re-traumatisation to the individual and also reduces the efficacy of the current treatment.

Aims of trauma-informed practice:

• Build a sense of control and empowerment, allowing individuals to begin to heal and move forward from their past victimisation
• Creates a physically, emotionally and culturally safe environment for all involved, minimising the potential for further harm or re-traumatisation
• Assists individuals in developing pro-social and healthy ways to manage strong emotions

Five key principles of trauma informed practice:

Safety – Clinicians and clients both feel physically and psychologically safe.

Trustworthiness– Feelings of mistrust, particularly towards figures of authority, is common. So, treatment should be based on transparency and openness, with the goal of building trust and security.

Choice– Drawing from strength-based approaches, choice in treatment allows clients to bring control back into their lives. Whilst there is a limit to choice for mandated clients, clinicians should be mindful of opportunities to provide choice where possible to clients such as in appointment times, location, treatment goals, preferred treatment strategies etc.

Collaboration– Partnering with clients to understand their needs, fostering respect, efficacy and dignity. Collaboration also refers to service at an organisational level, where all policies and interactions with clients should be done so within a trauma-informed framework.

Empowerment – People who have experienced trauma may feel powerless and hopeless in their current situation. Allowing the client to take an active role in treatment based on their own strengths, can foster resiliency, recovery and healing.

Addressing trauma revealed during treatment:

• Address and validate the feelings and experiences of clients
• Acknowledge the client’s trauma directly and respond empathetically
• Avoid probing for too much detail regarding the trauma (bringing up strong feelings in an inappropriate setting can lead to re-traumatisation)
• Respect disclosures by clients (avoid minimising the significance of the experiences of clients)
• Encourage self-efficacy and empower individuals to control their present lives
• Encourage a hopeful and optimistic viewpoint of the future
• Be aware that a client’s previous experiences may influence their willingness to engage in treatment or a therapeutic alliance
• Help the client frame their challenges within the context of past victimisation

How to develop a beneficial therapeutic relationship:

• Approach all therapeutic relationships in a trauma-informed manner (regardless of whether the client presents themselves as having experienced trauma)
• Prioritise engagement and rapport building from the beginning of treatment (clients may try to re-create problematic relationship dynamics they are used to)
• Create a safe therapeutic environment for the client and yourself
• Be transparent, genuine, consistent and reliable
• Ensure you stay within your role and maintain boundaries (a client’s sense of urgency can lead clinicians to act in a way that goes beyond their role)
• Work through relationship ruptures (e.g. when clients attempt to sabotage the therapeutic relationship)
• Foster a calm environment in which the client can avoid stress and can access higher order functioning (e.g. use grounding/mindfulness techniques, encourage exercise)
• Try to predict periods of destabilisation and plan accordingly (this can help clients to feel contained)
• Be aware of how the treatment environment may affect clients (i.e. clients may be sensitive to sensory aspects of the room such as noise level, ability to see others or for others to see them)
• Practice self-care regularly (if you can’t regulate, you can’t help clients regulate)
• Access supervision regularly
• Ensure treatment is culturally safe (understand any factors that may influence the client’s needs/presentation)