Beyond the Buzzwords: What Does Trauma-Informed Care Truly Mean?

Rachel Levy, LCSW
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4012

On March 4, 2020, Rethinking Psychiatry (in Portland, Oregon) met for our monthly meeting. The topic was “Beyond the Buzzwords: What Does Trauma-informed Care Really Mean?” This subject turned out to be even more relevant, as we are now facing a global pandemic that is causing massive trauma.

This was to be our last in-person meeting for the foreseeable future. We are continuing to meet online. Both our April and May meetings were held via Zoom and both were well-attended and generated great discussion. Our facilitators and participants did a great job adapting to the online format.

March’s meeting was a rich discussion of what trauma-informed care means. It is an important idea but can be an empty buzzword. Our goal was to have a deeper, more meaningful conversation on what this term really means. A diverse group from the local community attended and we had a really interesting, thoughtful discussion.

The talk was recorded and posted on our YouTube channel, but we edited out the comments of the participants, other than Rethinking Psychiatry’s core members, to protect their privacy. We started with a discussion of the official definition of trauma-informed care, and then talked about what the term meant to us. We also talked about the four R’s” of trauma-informed careRealize, Recognize, Respond, and Resist retraumatization. Here are the highlights of the participants’ comments on how these principles can be applied.

Trauma-informed care realizes the widespread impact of trauma and understands potential paths for recovery.

Trauma-informed care takes into account how terrifying it can be to face trauma. People with trauma are often frozen, stunted, in survival mode, and unable to verbalize what happened to them. They may do things that might not make sense to other people, but that are adaptive survival strategies. The idea of holding multiple truths is important. Trauma is complex and there are no simple “one-size-fits-all” strategies.

Trauma-informed care recognizes that trauma can take many forms. Some are not generally recognized or acknowledged as being traumatic—for example, medical issues are often overlooked as a source of trauma. It is important to recognize there are many different kinds of trauma, and that there is variation in what different people consider traumatic. It is up to an individual to say what was traumatic for them.

We discussed the groundbreaking study on Adverse Childhood Experiences, which showed how incredibly common childhood trauma is and the strong correlation between ACE scores and a wide variety of problems in adulthood.

One participant said they wonder, “What are the ACE scores of people who rape the earth [and do other terrible and abusive things]?” We talked about how many people who do harmful and abusive things have their own trauma. In the acclaimed, groundbreaking book on trauma,The Body Keeps the Score,” Dr. Bessel Van der Kolk talks about people who do terrible things after being traumatized themselves. Trauma is a complicated thing. Despite being considered an expert on trauma-informed care, Dr. Van der Kolk was asked to step down from a leadership position in the center he founded after multiple employees alleged that he had bullied them. It can be hard to wrap our heads around how complex and contradictory people can be.

True trauma-informed care shows an understanding of the nervous system and the body’s response to trauma. Trauma-informed care does not ask the question, “What’s wrong with you?” but instead asks, “What happened to you?”

A trauma-informed care provider takes things slowly, has humility, approaches care with gentleness and without judgment, and allows people to be vulnerable. A trauma-informed care provider understands that trauma is complicated and painful.

Trauma-informed care recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system.

Trauma-informed care recognizes the impact of historical and intergenerational trauma. In recent years, more attention has been paid to how trauma is passed through generations. For example, Jewish psychiatrist Dr. Rachel Yahuda pioneered the field of intergenerational transmission of trauma by studying how children of Holocaust survivors were affected by their parents’ trauma. Native American social worker Dr. Maria Yellowhorse Braveheart studied similar patterns in indigenous communities, and African-American social worker Dr. Joy DeGruy expanded on this work and coined the term “Post Traumatic Slave Syndrome.” Adaptive responses to trauma that are passed down are often pathologized by people of privilege. Trauma-informed care recognizes trauma on many levels.

Trauma-informed care responds by fully integrating knowledge about trauma into policies, procedures, and practices.

Trauma-informed care should be about power with, not power over. We live in a trauma-filled society that is based on domination, and power and control. That in itself is traumatizing. Trauma-informed care is about collaboration, not control.

All too often people in positions of power are the gatekeepers of what kind of help trauma survivors can access. Sometimes insurance will only pay for “evidence-based treatment” such as CBT (Cognitive Behavioral Therapy), even if that is not a very effective treatment for survivors of severe trauma. There is often a lot of circular reasoning in this approach—agencies won’t study treatment that is not “evidence-based,” so then they can say that there is no evidence of a particular approach working. Truly trauma-informed care provides a variety of options and respects people’s rights to self-determination.

Trauma-informed care resists retraumatization.

Our system often involves professionals making decisions for other adults in a way that is disempowering and invalidating, especially for marginalized people. It is retraumatizing when people are treated as a problem rather than treated as being capable of healing and making progress. Not having one’s trauma acknowledged is traumatizing on the most basic level.

We discussed how our society and the systems in place are not built to be trauma-informed. Systemic oppression creates trauma. Due to systemic oppression, people seeking help are often forced to choose between one traumatizing position or another. This is especially true for unhoused folks and other people who are oppressed and marginalized.

Systems often use the term “trauma-informed” without substance. Being forced into treatment but then told it’s “trauma-informed” is a form of gaslighting (gaslighting is also a subject that Rethinking Psychiatry has previously covered). Trauma-informed care must respect people’s opinions and choices and avoid gaslighting.

Sometimes our mental health and medical systems are extremely retraumatizing for these reasons—especially when police or other authorities become involved. For example, people who felt powerless from childhood abuse are often retraumatized when police show up and have all the power. Contacting police should be treated as a very last resort, and true trauma-informed care is built on collaboration and trust. Police can do some things to reduce retraumatizing people—for example, by taking a respectful and helpful approach instead of an aggressive and domineering approach. A social worker can be retraumatizing by using a dismissive and invalidating approach.

Training can be contradictory and an agency’s culture can be not at all trauma-informed. Mental health and social services can often give mixed messages, don’t always provide true informed consent. and claim to be far more progressive, client-centered, and culturally sensitive than they actually are. (One participant referred to the phenomenon as Portland nice,” though this phenomenon is certainly not isolated to Portland.)

We discussed how creating a safe environment for both workers and care providers is vital. This includes both physical safety and emotional safety. However, the idea of emotional safety can be complicated. It should not mean assuming fragility or avoiding difficult but necessary topics. Care providers should be able to hear difficult feedback. Several group members pointed out that sometimes providers can be close-minded and unaware of their own privilege.

We discussed how trauma-informed care needs to extend to providers. Many people who work in the mental health or medical field have their own trauma, and the work in itself can be traumatizing. Sometimes there are many barriers to care providers seeking their own treatment. Providers sometimes are not even aware of what they are struggling with, which leads to burnout and retraumatizing clients. There is a lot of stigma around providers struggling and seeking their own treatment.

There is a lot of classism built into the mental health system, which is also retraumatizing. Social work has gotten away from its roots and has become more professionalized, which can lead to being out of touch. Frontline workers often deal with poor wages and unsafe, exhausting working conditions, and this is traumatizing instead of trauma-informed. Our medical and mental health system is so focused on liability, which often leads to practices that are counter to being trauma-informed.

Trauma-informed care acknowledges people’s pain, as well as their capacity for growth and resilience. We discussed how some people heal and grow after major trauma. We talked about the idea of post-traumatic growth. This is a controversial idea and participants expressed mixed feelings. It is important to foster an environment of healing and resilience but also to avoid Toxic Positivity,” which can be retraumatizing.

Trauma-informed care is complicated, and our system is filled with obstacles. Being trauma-informed does not mean having to be perfect. This goes for care providers and care recipients.

For more about the work of Rethinking Psychiatry, visit: http://www.rethinkingpsychiatry.org/

For more about trauma-informed care, visit: https://traumainformedoregon.org/resources/resources-individuals-families

33 COMMENTS

  1. Sounds like it was a good meeting with lots of interesting takes on the topic.

    “Contacting police should be treated as a very last resort, and true trauma-informed care is built on collaboration and trust”
    Until family, friends and carers are taught how to understand ‘non-drug induced extreme states’ so they are de-mystified and the fear factor is removed and then those people are taught how to help the person thru those states, people are naturally going to call in help. Those states definitely can be overwhelming and scary the first time one sees them, even as an outsider, and that just adds to the fear of the person experiencing it. Fear feeds fear, but if the carer can remain calm, then the one in those states can learn to feed off that, as well.
    Sam

  2. The entire DSM based “mental health” system is a gas lighting system, intended to cover up trauma, especially child abuse and rape, and it’s all by DSM design.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    The fact that NO “mental health” worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, unless they misdiagnose all ACEs survivors – and over 80% of your clients today are misdiagnosed ACEs survivors – is an easily fixable problem within the DSM. Make helping child abuse survivors a billable “disorder,” so the “mental health” industries can stop misdiagnosing ACEs survivors and their concerned family members on a massive societal scale. Why hasn’t this blatant DSM problem been fixed yet? (Not $$$)

    I do agree, “Not having one’s trauma acknowledged is traumatizing on the most basic level.” Thus the “mental health” industry’s systemic covering up of child abuse and rape is downright evil, not to mention it is illegal.

    And your belief that “Contacting police should be treated as a very last resort,” when it is the police whose job it is supposed to be to arrest the child molesters, is insane. That is exactly where you should go with a child abuse survivor. Since we need to start getting the satanic pedophiles arrested, instead of the “mental health” industries continuing to neurotoxic poison the child abuse victims and their legitimately concerned family members.

    You may be glad to know the “mental health” system’s obsessive focus on liability is absurd, since you’ve successfully bought out the lawyers and judges already. But this does also mean the “mental health” industries were central in getting rid of the rule of law in America, which is destroying our country.

    And, thanks largely to the trauma denying, “all distress is caused by chemical imbalances” believing, systemic, by DSM design, child abuse and rape covering up “mental health” system, our country does now have huge pedophilia and child sex trafficking problems, even according to world leaders.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines
    https://www.washingtonpost.com/local/trump-signs-executive-order-to-combat-human-trafficking-as-some-advocacy-groups-boycott-summit/2020/01/31/420284ce-4456-11ea-aa6a-083d01b3ed18_story.html
    https://worldtruth.tv/putin-the-west-is-controlled-by-satanic-pedophiles/

    The DSM based “mental health” system can’t be fixed, it needs to be gotten rid of, because it is at it’s core a child abuse covering up system, and the entire system is scientifically “invalid” as well. The “mental health” industries are at their core, a criminal group of industries, whether you know it or not.

  3. So tired of grand unifying theories about the “cause of mental illness”.

    I’ve had spiritual experiences that while forged by bad circumstances I will not be told are traumas. I will not be told the most beautiful and profound experiences of my life are traumas or brain diseases. The brain disease model of “mental illness” is a sham but the idea it can be simply replaced by “everything’s a trauma’ is not okay either. People have been persecuted by psychiatry for having health issues, for dreaming, for being happy, for political reasons, for holding unusual beliefs, being “weird”, for being shy, or as was the case for one guy I knew for simply daring to talk back to them. Or they can persecute someone “just because I can” ie for no reason at all, or to keep money coming in. Everyone’s “problem” is not trauma.

    Maybe we ought to call mental health services “trauma generating services”.

    “Contacting police should be treated as a very last resort, and true trauma-informed care is built on collaboration and trust. ”

    How is this for collaboration?

    Where I live hospitals hide behind privacy laws and will refuse to let people know if someone is being held there or not. So the reality is unless you saw the person being checked in after being assessed in emergency or you are next of kin on the file you may have no idea where they went. (And even if you are next of kin you may not find out.) And they can release the person and you may be led to believe they are still in there.

    And if you try to find out where they are you will wind up in a kafkaesque nightmare dealing with a faceless soulless bureaucracy that answers to no one.

    The word I’m thinking of here is conspiring. “Collaboration’ has far too positive a connotation for what is going on where I live. If you look at the torture centers where I live you will also notice that whereas when people see most other kinds of doctors there is a front desk with a secretary where you can ask questions, when it’s the psych ward, there is no one to talk to. Tell me that’s an accident? It’s done deliberately, it’s an impenetrable wall behind which they can hide what they are doing.

    Also does anyone besides me think that part of the great problem with psychiatry (and therapy for that matter) is the entire idea of farming someone out to a stranger when they are at their most emotionally vulnerable? If the person does have others they can talk to who can help them what is with this entire concept of “but the right thing to do is make or encourage them to see a stranger”? I mean obviously some choose to go, and some have no one to talk to so if they go of their own volition then that’s up to them but really if you won’t just go tell some random guy on the street what your problems are, why are we continually asked to pretend like it’s an endlessly good idea to do that with professionals?

    And also healthy relationships involve reciprocity and accountability. There is no accountability for psychiatrists or psychologists usually. They can do as they see fit and nothing you do will make them be responsible for their actions.

    Psychiatry is never having to say you’re sorry.

  4. Trauma is a basic element of life under capitalism, and all of us have been systematically traumatized as part of our upbringing. Most of it is repressed, but it is essential to achieving the state of alienation and dehumanization necessary to keep us operating as units of production, rather than experiencing the joy of being human, which is bad for business. Since psychiatry’s function is to keep people locked into the mindset of capitalism (or whatever system of social control is in power), it is not in its interest to recognize this bedrock of trauma inherent in us all, as the system has nothing to gain by doing so. So when we hear terms like “trauma-informed” the trauma being acknowledged is more “excess” trauma, i.e. trauma that goes beyond that required for social regimentation and becomes counterproductive.

    If anyone is following me please say so, I need to know if I’m being clear.

    • Trauma is a basic element of life in a body!
      But you want real trauma? To get a hint of what it looks like, inspect the torture machines used during the Middle Ages. Or imagine being burned at the stake! (To say nothing of watching it happen to your mother or daughter).
      ECT has also done a pretty good job at imitating real trauma.
      Losing an income? Losing a job? Yes, “traumatic” in our world, but not at the same level.
      At this point, psychiatry is totally hopeless to deal with this issue.
      And psychology still has so much to learn!
      The average person, “treatment” survivor or not, remains largely befuddled.
      I yearn for a day when this will not be so.

      • It’s a shame that Barak Obama didn’t stand by his word and release ALL the photos from Abu Ghraib.

        And while we can look at sketches of torture machines from the middle ages, just a quick look at what is invloved in waterboarding seems to make people reconsider what is meant by the line between coercion and torture. So imagine what it’s like when they do cross the line with what they’ve got. Waterboarding whilst ECTing someone considered medicine? We might get that past the public given what they already accept as not being torture. Makes it look more like a medical procedure?

        I believe the video of the coercion of Abu Zubaydah was available for a while but …… not the sort of thing you post on Youtube with an M rating.

    • You’d hardly call the former Soviet Union, or commie Mao’s China “Capitalism/t”, would you? Yet in each, psychiatry was, and IS, inextricably linked. Your continued belief that psychiatry and capitalism are conjoined twins is counter-productive, IMHO.

      • Also, Pol Pot’s socialist/communist Khmer Rouge Utopia….no capitalism. No psychiatry. Tell me how much you’d love to live there, oldhead. And how sad to see it go. Somalia has also been capitalism & psychiatry-free at least for decades. And North Korea….Yes, I REALLY want a reply, oldhead.
        ….”sick and tired of your ism schisms”….
        as Bob Marley sings in Get Up, Stand Up”….

  5. It still feels like a buzzword. This article is a lot of telling with almost no showing. It’s just “trauma-informed care is this” and “trauma-informed care is that”…but never telling us HOW it achieves anything. I am skeptical that it’s a truly different way of approaching people and their distress.

    Also, “trauma” is never defined. What is it? What defines it? Why should we believe that it is anything other than a buzzword?

    • There’s that too. Some even insist that the term “emotional trauma” is as invalid as “mental illness.” At the moment I still use it metaphorically since people seem to take it less concretely than they do “mental illness.” But it’s a debate-worthy subject.

      • Good point. I don’t think there’s anything inherently wrong with using the concept of “emotional trauma”–even if it isn’t the sort of thing that is empirical or can be proven or disproven–as long as we all recognize that it’s simply one way to talk about this and evaluate whether this gives us some advantage, some help, or whether perhaps it doesn’t. The difference from psychiatry and “mental illness” is of course that no one thinks “trauma” is a disease, or a physical illness, or a “chemical imbalance” that should be treated with chemicals.

      • PLEASE stop hijacking the discussion into pseudo-intellectual semantic gobbledygook. Yes, “trauma”, and “trauma informed”, DO look and seem like buzzwords, to some people. And some people will use them that way. And the closely-related concepts of “ACEs” are likewise. But it does nobody any good to allow one’s own ignorance and lack of understanding, knowledge, and experience to roadblock the rest of us….I’m very comfortable with my own traumas and ACEs. But I wouldn’t be, if I was still attached to my own bullshit. It was the Dalai Lama’s teachings on non-attacment in Buddhism that liberated me there. And the radical acceptance that I learned in Alcoholics Anonymous and the 12 Steps. Everything I got from psychiatry was either TRAUMA, or something like ACEs….

    • It’s not like emotional (mental) trauma is a new idea. I dare say (because I’m not extensively trained) that trauma is the foundation on which many therapies are built. Probably the biggest problem those therapies suffer from today is that psychiatry has rejected them. So now it’s an uphill battle to get people into therapy, to stick to it long enough, and to somehow get it paid for.
      Of course, it would be helpful if these therapies were more effective. But we seem to spend very little time these days actually talking about what is effective at making people well and happy. This may be because there are many practitioners who think that no such therapy exists!
      It’s a shame that psychology now has to fight to make its voice heard over the seemingly general public clamor for a pill that will make everything better. Of course, psychiatry had its hand in instilling this expectation in the public.
      It seems to me the only solution is a better-educated public. It is one thing to know it is vital to avoid psychiatric treatment. It is quite another to know what you really should do if you feel you need help. Some of the best resources have been reduced to derogatory terms by persons who probably don’t have our best interests in mind…
      Can this website play a role in changing that situation?

      • There used to be a crisis line whose name was “Let’s talk.” It seems like such an obvious thing. What do you do when you see a car wreck? First thing you do is tell someone, go over what happened and how you felt, they ask you questions, etc. It’s what you do when something scary happens. It is only massive propaganda that has moved people away from this basic, intuitive understanding of what people need from each other. Any “therapy” that isn’t primarily based on listening should be immediately shitcanned!

      • what is effective at making people well and happy isn’t therapy, though. it’s obvious crap like not living in capitalism, having community, access to healthy food and water, a relationship with nature that isn’t based on exploitation and consumption, a positive culture to live in and thrive in , etc.

        • You are entitled to your opinions for sure, but your “obvious crap” might not be my “obvious crap.”
          There are plenty of people I know who have learned to live with all the downside aspects of life on planet Earth and still remain well and happy. And most of them have had therapy! Not the kind most of us think about, but therapy of a sort nonetheless.
          It’s a very hopeless attitude to think that there is nothing we can do to help each other when we hit rough spots or even to move up to whole new levels of ability. There are things we can do to help each other. You don’t even need to be a psychologist to do them!

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