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The Power of Being Trauma-Informed: Transforming Therapeutic Relationships

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It is well known that most individuals experience trauma during their lifetime (SAMHSA, 2014). Trauma is a widespread problem that deeply affects every individual, regardless of age, background, or community. Generally defined as an experience that exceeds an individual’s coping capacity, trauma can result from a series of adverse experiences, including:

  • Physical or sexual abuse,
  • Domestic violence
  • Neglect
  • Loss
  • Natural disasters
  • Systemic oppression
  • War

Regardless of its source, traumatic experiences can significantly alter an individual’s emotional, physical, and cognitive state. Furthermore, trauma, whose effects are not limited to psychological distress, often leads to permanent disruptions in neurobiological development, interpersonal relationships, and behavioral regulation (Shonkoff et al., 2012; Perry, 2004). While many individuals exposed to trauma exhibit few or no lasting symptoms, those who experience repeated, chronic, or multiple traumas are highly likely to exhibit distinct symptoms and outcomes such as substance abuse, mental illness, and health problems (SAMHSA, 2014). The need for a trauma-informed approach becomes particularly relevant at this point. In recent years, as awareness of trauma has increased within society, there has been a valuable shift from traditional care models to trauma-informed approaches that prioritize recognizing, understanding, and responding to the effects of trauma. The trauma-informed approach provides evidence-based and best-practice information for behavioral health service providers and managers who wish to work more effectively with individuals who have experienced acute and chronic trauma and/or are at risk of developing traumatic stress responses (SAMHSA, 2014). The trauma-informed approach addresses trauma-related prevention, intervention, and treatment issues and strategies in behavioral health services using basic principles related to trauma. The current therapy sketch will outline the background and principles of the trauma-informed approach, assess its role in the therapy room, and explore its benefits from the perspectives of both clinicians and clients. Through this analysis, we aim to advocate for a sensitive and human-centered trauma-informed approach model that promotes healing, empowerment, and long-term well-being while respecting the experiences of trauma survivors.

What is a Trauma-Informed Approach?

To begin with, the definition of trauma, according to the American Psychological Association, is an emotional response to a horrific event such as an accident, crime, or natural disaster. On the other hand, the Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) defines individual trauma as follows: Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. Trauma is known as any disturbing experience that is intense enough to result in significant fear, helplessness, dissociation, confusion, or other destructive emotions that have a long-term negative impact on a person’s attitudes, behaviors, and other aspects of functioning (APA). Traumatic events include those caused by human behavior (e.g., rape, war, industrial accident) as well as those caused by nature (e.g., flood, earthquake), and they often challenge an individual’s view of the world as fair, safe, and predictable (APA). In recent years, public health and behavioral health systems have increasingly recognized that unaddressed trauma is a key determinant of poor health outcomes. Indeed, the Adverse Childhood Experiences Study (Felitti et al., 1998) found that childhood trauma is associated with a wide range of adult health problems, including substance use, depression, anxiety disorders, cardiovascular disease, and chronic conditions such as diabetes. Similarly, an epidemiological study involving 17,000 participants found that traumatic experiences during childhood and adolescence have long-term negative effects on adult health risks, mental health, healthcare costs, and life expectancy (CDC, 2013). Additionally, Co-Occurring Disorders and Violence Study (Clark and Power, 2005) is another critical study that highlights the role of interpersonal and other traumatic stressors among women and the interplay between trauma, violence, and co-occurring substance use and mental disorders. Indeed, these studies (Centers for Disease Control and Prevention, 2013; Clark and Power, 2005) are recognized as two influential works that laid the groundwork for the development of a trauma-informed approach (SAMHSA, 2014). Thanks to these studies highlighting the broad impact of trauma, there has been a shift in focus from symptom-based treatment models to a more comprehensive framework that seeks to understand the root causes of the client’s distress, namely, a trauma-informed approach.

A trauma-informed approach refers to a framework that acknowledges the prevalence and profound impact of trauma on individuals and actively incorporates this understanding into procedures and processes. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a trauma-informed approach is defined as follows: A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to resist re-traumatization actively. As can be understood from SAMHSA’s (2014) definition, the trauma-informed approach has four ‘’Rs.’’ These four ‘’Rs’’ encompass the key assumptions of the trauma-informed approach. Let us now continue with the definition of these key assumptions:

Realize: In a trauma-informed approach, all people at all levels of the organization or system have a basic realization of trauma and understand how it can affect individuals, families, groups, and communities. Whether the individual’s experience occurred in the past (a client who was abused as a child), is currently occurring (a person living with domestic violence at home), or is related to emotional distress caused by hearing about someone else’s first-hand experiences (secondary traumatic stress experienced by someone close), are understood in the context of coping strategies designed to survive difficult and overwhelming conditions.

Recognize: People within the organization or system may also recognize the signs of trauma. These signs may be gender, age, and context-specific and may be elicited by individuals seeking or providing services in these contexts.

Respond: Professionals and organizations respond by applying the principles of a trauma-informed approach to all areas of their work. Professionals and organizations recognize that traumatic events impact all individuals who are directly or indirectly involved in the experience. Within the context of a trauma-informed approach, language, behavior, and policies within the system are being reshaped.

Resist re-traumatization: The trauma-informed approach aims to resist re-traumatizing clients. For example, professionals within the trauma-informed system recognize that imposing restrictions on a person who has been sexually abused or placing a neglected child in an isolation room can re-traumatize the individual and hinder recovery and healing.

The trauma-informed approach, built on these four basic assumptions -realization, recognition, response, and resistance to re-traumatization- is further guided by six basic principles that serve as a framework for application in various settings. The ‘’Four Rs’’ emphasize systemic awareness and operational coherence, while the six principles provide a more detailed roadmap for creating safe, empowering environments that are responsive to the lived experiences of trauma survivors. In the following section, we will explore how each of these six principles contributes to a trauma-informed approach and supports the well-being of both clients and professionals.

Safety: All professionals working within the system make clients feel safe both physically and psychologically. The physical environment is safe, and interpersonal interactions promote a sense of security. Perceiving safety is a high priority (SAMHSA, 2014).

Trustworthiness and Transparency: All relevant processes are conducted transparently with the aim of establishing and maintaining trust with clients (SAMHSA, 2014).

Peer Support: Peer support and mutual self-help are fundamental tools for establishing safety and hope, developing cooperation, and supporting recovery through the use of stories and lived experiences. Peers are also referred to as ‘’trauma survivors’’ (SAMHSA, 2014).

Collaboration and Mutuality: Importance is placed on balancing the differences between each individual within the system; this demonstrates that recovery occurs through meaningful sharing of power and authority in relationships (SAMHSA, 2014).

Empowerment, Voice, and Choice: In the context of a trauma-informed approach, the client’s strengths and experiences are recognized and built upon. The professional focuses on the client’s resilience and supports their ability to heal (SAMHSA, 2014).

Cultural, Historical, and Gender Issues: The professional actively moves beyond cultural stereotypes and biases (race, ethnicity, sexual orientation, age, religion, etc.); provides access to gender-sensitive services; leverages the healing value of traditional cultural connections; integrates policies and processes that are sensitive to the racial, ethnic, and cultural needs of the individuals served; and acknowledges historical trauma (SAMHSA, 2014).

Six fundamental principles serve as the philosophical foundation of the trauma-informed approach, while its actual effectiveness is demonstrated in therapeutic settings through practical applications. Applying a trauma-informed lens to psychotherapy not only reshapes clinicians’ ways of conceptualizing and responding to client behavior; it also transforms the therapeutic environment itself into a space that promotes healing, autonomy, and resilience. The following section will explore how these principles are operationalized in clinical practice and how therapists integrate the trauma-informed approach into assessment, treatment, and the overall therapeutic alliance.

How is the Trauma-Informed Approach Applied in a Therapeutic Setting?

In a therapeutic context, the trauma-informed approach is not a specific set of techniques; it is a comprehensive framework that influences every aspect of the therapeutic process. At the heart of this approach is the question, ‘’What happened to you?” rather than “What is wrong with you?’’ (Bloom and Farragher, 2011). This reframing encourages empathy and contextualizes client behavior within past experiences, thereby reducing stigmatization and supporting participation. Some methods for applying a trauma-informed approach in a therapeutic context are as follows:

Ensuring Physical and Psychological Safety: Creating a safe therapeutic space is of primary importance in a trauma-informed approach. Safety encompasses both a calm, predictable, and comfortable physical environment and emotional safety developed through respectful and non-judgmental interactions (SAMHSA, 2014). The therapist is responsible for creating a therapeutic environment where the client feels safe in every sense.

Providing Strength-Based Intervention: Therapists who use a trauma-informed approach focus on the client’s strengths and areas of competence rather than their difficulties and vulnerabilities during sessions. By emphasizing the client’s resilience and coping strategies, the therapist enables the client to feel empowered and supported on their path to recovery (SAMHSA, 2014).

Establishing a Collaborative and Transparent Therapeutic Relationship: The trauma-informed approach is characterized by shared decision-making, transparency, and mutual respect. Rather than positioning the therapist as the sole expert, the trauma-informed approach values the client’s knowledge of their own experience and encourages collaborative treatment planning (Fallot and Harris, 2006). Knight (2015) suggests that clients’ participation in goal setting and determining the pace of therapy in the therapeutic environment increases their sense of agency and contributes significantly to trauma recovery.

Providing Culturally and Gender-Sensitive Practices: Trauma-informed therapists are trained to recognize that various factors such as race, gender identity, sexual orientation, and historical oppression significantly influence both the trauma experience and access to care. This awareness helps prevent clients from being re-traumatized through microaggressions or implicit biases (Bryant-Davis, 2007).

The integration of trauma-informed principles into therapeutic practice not only reshapes clinical interventions, but also transforms the therapeutic environment into a more sensitive, ethical, and effective one. The value of the trauma-informed approach extends beyond session structure or clinical techniques, yielding important outcomes for both clients receiving services and clinicians providing them. In the following section, the benefits of the trauma-informed approach will be examined in the context of clients and clinicians, and the approach’s support for the long-term well-being of both parties will be evaluated.

What are the Benefits of the Trauma-Informed Approach for Clients and Clinicians?

Trauma permeates nearly every aspect of human experience and can manifest itself in various behavioral, emotional, and physical forms. Therefore, a trauma-informed framework is of vital importance for any practitioner aiming to provide effective, ethical, and compassionate care. For clinicians, a trauma-informed approach increases diagnostic accuracy, therapeutic alliance, and positive treatment outcomes. Other benefits of a trauma-informed approach for clinicians, as a method that promotes empathy and reduces stigmatization, are as follows (SAMHSA, 2014; Perry, 2004):

  • Prevents clinical misinterpretation.
  • Improves therapeutic engagement and alliance by promoting both physical and psychological safety.
  • Enables clinicians to develop more comprehensive and sustainable treatment plans based on an understanding of the biological, psychological, and social dimensions of trauma.
  • Acknowledging the emotional labor involved in trauma work raises clinicians’ awareness of burnout and compassion fatigue.

The trauma-informed approach also has significant benefits for clients. The benefits of the trauma-informed approach for clients are as follows (SAMHSA, 2014):

  • Gives clients a sense of control over their lives and treatment, thereby empowering them.
  • Prevents them from being re-traumatized by focusing on their physical and psychological safety.
  • Accepts clients’ experiences, which facilitates the healing process.
  • Contributes to clients’ better participation in the process, alleviation of their symptoms, and greater satisfaction in the therapeutic context (Dekel et al., 2012).
  • For marginalized populations, including victims of interpersonal violence, LGBTQI+ individuals, and refugees, the trauma-informed approach also prevents systemic re-traumatization.

Takeaways:

  • Trauma is a common problem that can permanently affect individuals’ neurobiological development, relationships, and behavioral regulation, affecting everyone regardless of age, gender, or background.
  • Trauma-informed approaches provide evidence-based and comprehensive frameworks for mental health professionals who want to work effectively with individuals who have experienced acute and chronic trauma. 
  • Research highlighting the comprehensive effects of trauma on individuals has led to the development of trauma-informed approaches that focus on the root causes of the client’s difficulties, moving away from symptom-focused models.
  • A trauma-informed approach is a comprehensive system change aimed at realizing the widespread impact of trauma, recognizing its signs and symptoms, responding appropriately to support recovery, and actively working to resist re-traumatization.
  • The six core principles underlying the trauma-informed approach not only guide the individual therapy process but also adapt all interactions at the system level to be trauma-informed, thereby supporting the well-being of both clients and professionals.

References

  1. Substance Abuse and Mental Health Services Administration. (July, 2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.  https://library.samhsa.gov/sites/default/files/sma14-4884.pdf   
  2. APA. https://www.apa.org/topics/trauma
  3. Clark, H. W., & Power, A. K. (2005). Women, co-occurring disorders, and violence study: A case for trauma-informed care. Journal of Substance Abuse Treatment, 28(2), 145-146. 
  4. Felitti, V.J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study. American Journal of Preventive Medicine, 14(4), 245-258.
  5. Perry, B.D. (2004). Understanding traumatized and maltreated children: The core concepts. The Child Trauma Academy.
  6. Bloom, S. L., & Farragher, B. (2011). Destroying Sanctuary: The Crisis in Human Service Delivery Systems. Oxford University Press.
  7. Bryant-Davis, T. (2007). Healing requires recognition: The case for race-based traumatic stress. The Counseling Psychologist, 35(1), 135–143.
  8. Fallot, R. D., & Harris, M. (2006). Trauma-informed services: A self-assessment and planning protocol. Community Connections.
  9. Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43(1), 25–37.
  10. Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … & Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663 
  11. Centers for Disease Control and Prevention (CDC). (2013). The Adverse Childhood Experiences (ACE) Study. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/aces/index.html 
  12. Dekel, S., Ein-Dor, T., & Solomon, Z. (2012). Posttraumatic growth and posttraumatic distress: A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 94–101. https://doi.org/10.1037/a0021865 

While our physical offices are located in South Loop and Lakeview neighborhoods in Chicago, Illinois for in-person sessions, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more.  

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance, and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

Whether you’re seeking guidance on a specific issue or need help navigating difficult emotions, we’re ready to assist you every step of the way.

Contact us today to learn more about our services and schedule a session with our mental health professionals to begin your healing journey. To get started with therapy, visit our booking page.

First, decide if you’ll be paying out-of-pocket or using insurance. If you’re a self-pay client, you can book directly through the “Book Now” page or fill out the “Self-Pay/Out-of-network Inquiry Form.” If you’re using insurance, fill out the “Insurance Verification Form” to receive details about your costs and availability. Please let us know your preferred therapist. If your preferred therapist isn’t available, you can join the waitlist by emailing us. Once your appointment is confirmed, you’ll receive intake documents to complete before your first session.

This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.