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Saturday, June 10, 2017

Trauma Informed Care

trauma informed careThe awareness of trauma and stress related disorders and the importance of developing sound treatment approaches for these disorders has grown in recent years. It is essential for practitioners and agencies that deliver substance use and mental health treatment to enhance their understanding of the complexities of trauma related disorders and how to treat them. Furthermore, it is important that care providers deliver efficacious and empirically evaluated forms of treatment.

Trauma and stress-related disorders are among the most prevalent disorders treated by mental health professionals. Within the general population, a lifetime trauma incidence of 40% to 90% has been reported, and the overall lifetime prevalence for PTSD ranges between 7% and 12%. Needless to say, practitioners must ensure that they have the competency, training, and support to effectively treat trauma-related disorders.

Many studies have reported the efficacy for the psychological treatment for PTSD in conjunction with psychopharmacological treatment of PTSD. These studies have shown that psychological treatment is more effective in reducing symptoms of PTSD than medication alone. These studies have focused on several different modalities of treatment in order to determine which approaches seem to be most effective. Among the most researched and effective treatments for PTSD are trauma focused CBT (TFCBT), EMDR, Exposure based therapy, and Cognitive Processing Therapy. These approaches are widely used by practitioners in the treatment of trauma related disorders.

TFCBT combines trauma-sensitive interventions with cognitive behavioral techniques, family approaches, and humanistic principles. EMDR is a treatment approach that facilitates the accessing and processing of traumatic memories and seeks to bring these memories to a more adaptive resolution. Exposure therapy involves gradually exposing the client to the feared object and/or situation without any danger as a way to overcome stress-related symptoms. Cognitive Processing Therapy (CPT) is also considered to be a best practice model. CPT is an adaptation of cognitive behavioral therapy and incorporates trauma specific cognitive techniques to assist clients in moving past erroneous beliefs and maladaptive thoughts.

While applying evidenced-based treatment approaches to trauma services is absolutely necessary, there are additional things to consider when working to develop a trauma informed approach to treatment. To become trauma informed, practitioners and agencies not only need to be aware of evidence-based and efficacious forms of treatment, they must demonstrate an understanding of and competency in working with trauma exposed clients. Training of all staff within an agency as well as ongoing training for practitioners is essential in order to deliver sound and effective services. Ongoing supervision, training, and an emphasis on creating an environment of safety, trust, choice, collaboration, and empowerment are necessary components of creating competency and effective treatment of trauma related disorders.

When delivering treatment for PTSD, physical and emotional safety are the foundation for effective therapeutic work. This includes providing a safe physical environment, education, and information about the pervasive effects of trauma. Trust is an essential part of emotional safety when treating trauma. This includes establishing and maintaining appropriate boundaries, honoring confidentiality, consistency, clarity, and predictability. These components are absolutely necessary when delivering trauma treatment and creating a safe environment in which to procure services.

Cultural awareness and competency are also important to consider when utilizing various techniques to establish trust and safety. For example, practitioners must have knowledge of culturally appropriate nonverbal cues and norms that enhance safety and trust within that particular culture. Agencies and practitioners must be aware of culturally appropriate interventions and ways in which to communicate trust and safety in a culturally sensitive manner.

A competent treatment approach and a trauma sensitive environment also places value on client choice and one’s ability to have a voice in his or her recovery process. Emphasizing choice and supporting the client’s unique voice, allows the client to assume an active role in his or her treatment. This involves mutual collaboration between the client, practitioner, and/or agency in which a cooperative relationship is built based on the value of each individual’s unique experience and expertise. The practitioner’s experience and expertise are not valued over the client’s unique experience and expertise, rather both engage in a mutual exchange of respect and trust.

Finally, empowerment is a key component to effective trauma treatment. This concept argues that clients should be actively involved in the planning, delivery, and evaluation of services. A practitioner can empower clients by providing resources, information, education, and engaging them in interventions. It is important to build on a client’s strengths and his or her inherent resiliency as a means to empower him/her in the recovery process.

In addition to implementing evidence-based treatment, and adhering to principles of safety, trust, choice, and empowerment, trauma informed practitioners and agencies must be aware of the specific challenges and risks associated with trauma treatment. These challenges include but are not limited to personal attitudes, resistance, developing appropriate policies and procedures, and the potential for staff members to suffer from vicarious trauma. Trauma-informed clinical and staff support has been recognized as a primary protective factor for trauma reactions experienced by providers. Specifically, trauma sensitive coaching and staff support must include the same principles necessary for effective trauma treatment: safety, trust, collaboration, choice, and empowerment.

As awareness continues to grow regarding the complexity and pervasive effects of trauma, it is imperative for practitioners and mental health agencies to develop an understanding of and competency in trauma informed practices. This not only includes ongoing training and the implementation of evidence based practices, but a sensitivity to and awareness of the key components that comprise an effective therapeutic relationship based on safety, trust, collaboration, and empowerment.

Marie Tueller, MEd, LPC
CCR-OTC Blog
June 8, 2017 

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