More than support – 9 things trauma-informed therapists always provide

People need support. Absolutely. Providing support is a foundational principle to a therapist’s role because, as said beautifully by Brené Brown, “what we don’t need in the midst of struggle is shame for being human.”

Trauma-informed therapists, however, need to be more. They need to create a safe space for healing, always, which means being more than just supportive.

People come to therapy when their survival strategies are no longer working, right? They are in distress, and looking for things to be better, or at least less bad. If a client tells us they are using substances, self-harm, or disordered eating behavior to manage their pain, and we, as therapists, simply support — and don’t gently challenge, compassionately ask questions while holding that safe space, or even educate — then we’re not really doing our jobs. Sometimes, we may even need to refer for a higher level of care, which is rarely wanting to be heard. If not, this could leave our clients without a path forward on the healing journey and even worse, leave them at risk!

As we know, trauma survivors often live in a triggered state — fearful — and have learned to survive in any way possible, even if that means using coping mechanisms that can actually harm them. Coping mechanisms, such as use of substances or alcohol, self-harm, and eating disordered behaviors — are rooted in emotional pain and trauma!They are ways to seek relief.

In trauma-informed therapy, the goal is safety first, then healing and growth to move forward.

Therapy that is supportive alone can enable the behaviors that put our clients at further risk.

A trauma therapist’s role is about being supportive, AND ALSO:

1. Look at the whole picture. A therapist’s job is to look at the whole picture — not just the part the client projects. This means looking at all sides of behaviors. Looking at the entire system — self and relationships. Considering what might be harmful or a roadblock to our client’s healing. If our client is having relational problems, feeling anxious, feeling depressed, restricting calorie intake, or overeating, or using anything to feel less badly, it is our job to look at how that is impacting the big picture and their goal. Is our client currently safe?
2. Start with Safety and Stabilization, using the 3-step approach to trauma therapy. Our role is to help clients build healthier coping behaviors, to gain safety in the here and now. If a client has dealt with emotional pain by using a dissociative mechanism to not feel it — they are also not feeling joy. We must help to establish what safety could even look like. We must help grow the ability to cope with life stressors, so they can be in the window of tolerance, and in the present, so their wise adult brain can be part of making decisions. It is important to help a client assess for safety while using their survival strategy. Healing must start here – always safety first!
3. Understanding and holding “what happened to you.” This looks like helping our clients understand that their behaviors make sense given their history. Trauma was not their fault! They did whatever they could to survive — and some of those behaviors have stuck! We must help clients hold that concept without shame and move towards: What do you do with that now? What’s right with you now?

1. Compassionate inquiry. By understanding that every behavior serves a purpose, we also wonder what the protective mechanism of that behavior is. If they are regularly using food, food restriction, exercise, drugs, alcohol, or pornography to feel less or change their emotions, that probably is serving another purpose. What do they gain from the use of the behaviors? Getting to be numb? Less energy for other things? Plus, with those coping mechanisms often come other issues, like relational issues, depression, anxiety, or health issues that we cannot ignore. We must inquire: What have you tried? What’s working and what’s not? For example – exercise is wonderful, AND how do you feel when you know you are doing too much exercise or using it to avoid other things? It’s a trauma therapist’s job to help their client consider:
   • How does this behavior serve me?
   • How are my actions or reactions helping me? Harming me?
   • Am I covering up something?
   • Am I feeling defensive or protective?
   • Am I creating a crisis?
   • Am I trying to prevent or avoid?
   • Am I making excuses?
   • Am I too scared to look at some behaviors or ask some questions or see other sides?
   • Do I just not want to feel? Do I want to feel differently?

1. Gently challenging cognitive distortions or distorted thoughts. A client’s thoughts may feel true to them — but are they actually true in their life today? What do they notice on the inside when the thoughts show up? We must help clients assess the feelings, thoughts, and beliefs that are not currently serving them, with their adult brains, while grounded in the present.

1. Educating and setting boundaries. Therapists need to provide psycho-education. Have our clients ever learned what healthy coping or emotional regulation even are?  Do they know how to have that for themselves? Do they feel allowed to set boundaries in their life?  Everyone must learn, be taught, or have a mentor, if this wasn’t taught in childhood.

1. Always keeping the end goal — of healing (whatever that means for the client) — in mind.

1. Working to activate and empower the client’s voice, authority, and agency in their life. Helping the client understand they have a say — that their voice matters in their life. They matter!
   
   
2. Monitoring progress. On the road to helping a client heal, we are looking for mile markers along the way, aware that progress is not always in the big moments — the seemingly little ones matter too. And progress is rarely linear. We are tuned into improved mood, decreased level of anxiety, behavior change, and satisfaction in relationships and in life — and of course, always tuning into safety and stability!

As trauma therapists, our job is to safely help our clients be curious about their healing and growth, while we hold space for them to do the work to get there. It’s about noticing how clients can be in the window of tolerance and feel their feelings — without numbing them — and know they will be okay.

Because remember, this client wants to feel better! And like Brené Brown beautifully articulates, “We cannot selectively numb emotions, when we numb the painful emotions, we also numb the positive emotions.”

Trauma Informed therapists need to be more than just supportive.

Resources:

• How to be trauma-informed given today’s important issues?
• This Missing Love Language Is the One Trauma Survivors Need Most — Safety
• Addiction Recovery: Why the Best Therapy is Trauma-Informed
• Understanding that trauma includes emotional injury will help more people get the care they deserve
• Why You Need a Trauma-Informed Therapist, Even if You Don’t Think You Have TRAUMA
• Why I Take a Mind-Body Approach to Trauma Recovery
• How to Find a Good Therapist