Nick,
Thanks for your thoughtful post. Your overarching point reminds me of the concept of accountability in restorative justice. While the restorative justice approach is often very specific to a population of adolescents and teenagers being served in a school setting, I think it might serve as a model for how practitioners can ask both questions: What happened to you and what's wrong?
I wrote briefly about how restorative justice is part of the violence-prevention and healing approach in Oakland, Calif. (here is the story link), but I wonder if other ACEs Connection members have examples of other programs or interventions that focus both on accountability and healing in a trauma-informed manner. The state of Illinois has a good primer on using restorative justice in schools, and in the meantime, I invite other members to share other examples from different disciplines of how to achieve the delicate balance you've mentioned.