The phrase “trauma-informed” is being thrown around all over the internet, but what does it actually mean?
Being trauma-informed goes beyond simply acknowledging the existence of trauma and its effects on mental health. Trauma-informed therapy is an actual approach to care that revolves around specific core principles. What a skilled therapist does with those principles, and how they implement them in the therapy room, will vary.
How we generate trust, safety, choice, collaboration and empowerment for our clients depends on what you have experienced in the past and what you might need now. (It’s those. Those are the principles.) This involves a deliberate and thoughtful approach to therapy that influences every choice we make as a therapist, both in session and when setting up our practice.
If you’re seeking therapy or if you’re a therapist yourself, it’s crucial to understand this concept so that you know how therapy works — and if it’s working for you.
Who invented trauma-informed care?
First, a little background. Maxine Harris and Roger Fallot are credited with formalizing trauma-informed care in 2001.
“They introduced the term “trauma-informed” to refer to social, behavioral, and mental health services that account for the possibility that clients may have experienced some form of past trauma.[…] The core characteristics of which are: trust, safety, choice, collaboration, and empowerment.” (Knight, C. Trauma Informed Practice and Care: Implications for Field Instruction. Clin Soc Work J 47, 79–89 (2019).)
This approach recognizes that almost everyone we meet has likely experienced at least one form of trauma in their lifetime. We should assume that it is present and adjust how we work with someone, even if we’re treating anxiety, relationship issues, or something else. The impact of trauma is likely present, and it’s more risky to ignore that possibility than to adjust accordingly.
I often say that one thing we provide to clients in therapy is the opposite of what they get everywhere else. This is a core element of trauma-informed care. As a therapist, I’m deliberately behaving in ways that don’t further traumatize my client.
If you’ve been frequently invalidated within your family, therapy works through validation. If you struggle with boundaries in your personal life, therapy shows you not only how to maintain a safe distance, but that autonomy can feel safe and regulating to your body. If you feel like you have to protect others from “the real you” so that they don’t go running in the other direction, a therapist who helps you let your guard down can show you how to be vulnerable with others in your life.
The principles of trauma-informed therapy
The principles of trauma-informed care are safety, trust, choice, collaboration, and empowerment. Many of us also include cultural context. Why are these important and how do they help?
Yes, I create safety and build trust. But that will feel different to each of my clients.
Some clients are assured by knowing some personal details about me, others feel more safe not knowing anything at all. Knowing some of my background can help some clients trust me and feel less worried about being judged. It might give them permission to share their background too. While others would rather not know anything about me, in order to avoid leveraging those details in our relationship. If you’re a chronic over-achiever, you might try to use those details to make sure you are “winning” therapy.
I encourage my clients’ agency and leave their choices up to them. This is why therapists won’t give you advice or tell you what to do! I won’t presume to know what’s best for you; instead, I aim to help you uncover your needs and how to address them.
But that also means I won’t just keep my methods a secret and not explain what I’m doing. This is what makes people think therapists are always analyzing them, or that we can tell some secret knowledge about you that we’re holding back. (I might do this when I’m out at a party, but I will never do this in a therapy session!) The principle of collaboration means I will tell you what I’m thinking and why — and we can work through it together. The principle of choice means you do with that new insight what you will.
Being trauma-informed also means that I consider your personal history, family background, cultural context, and societal factors. These elements play a significant role in shaping your experiences and responses to trauma. The expectations and social conditioning that are put on you will affect how you respond to therapy. Every choice I make as a therapist is informed by these factors, recognizing how they can contribute to trauma and grief.
What makes a therapist trauma-informed?
Now we know what the principles are. But how do I put these in practice as a therapist?
Every decision I make in therapy, and even in how I set up my practice, is intentional and oriented toward those principles. Here are just some of the considerations that can significantly impact our work together:
Professionalism
Me being too casual can feel unsafe for a client. You might think, “I don’t know how much I can trust this person with my pain.” If you’ve been hurt by people not taking you seriously, a too-casual therapist can shut you down. But performing rigid norms of hierarchy in the name of “professionalism,” especially those that ignore cultural norms, can make you feel disconnected from me. If you are someone who tends to resist authority, you may resist therapy. If you are someone who feels like a “hot mess,” however, you might really appreciate having a more formal therapist who doesn’t match that energy.
Flexibility vs. Rigidity
Similarly, it creates trust and safety to know where you stand with someone. There is a lot to be said for a therapist who is consistent and keeps their promises. This requires some rigidity. But there is also a case to be made for making exceptions for human circumstances. It may sound strange, but for many people, paying the fee for a last minute cancellation feels better than the guilt of having to bail on your session at the last minute. For others, however, a therapist giving grace and making an exception to this rule can help people give themselves more grace too.
This is why I think it’s important for therapists to have a rationale for every policy and practice in their work. It means they have thought about it and there is a therapeutic reason for it. (It’s not just because that’s how they learned it from someone else.)
Being trauma informed in this way means I keep my promises while also being adaptable to your needs. I will tell you what I’m doing and why. I will explain why my cancellation policy is what it is, or whether we meet at the same time each week like clockwork, or we take each session as it comes and decide together when our next session will be.
If I make an exception to my policy, will it come off as playing favorites, activating your golden child syndrome? Or will it help you feel understood and give you permission to let go of your own perfectionism?
Familiarity
Is it better for a therapist to be familiar and friendly, or is it better to be the neutral “blank slate” quiet type? Before you answer, consider this. A therapist being overly familiar, especially too soon in our relationship, can set off alarms in a client. If you come from an enmeshed family, it can quickly feel suffocating to have that in therapy. It can trigger the “teacher’s pet” in you to match my energy and share more than you normally would before you’re ready. That’s risky! But, a therapist being a more withholding figure would be painful for someone who had that type of upbringing.
Non-verbal communication
My facial expressions, whether I smile or maintain a neutral demeanor, can either put you at ease or cause mistrust. Many people think a smile is polite or friendly. But many others will read that as mocking or holding secrets. Let’s say your therapist is always leaning in and taking notes. That body language can communicate interest and warmth, or put pressure on you to say the right thing.
Self-Disclosure
Deciding how much of my own experience to share is another consideration that can influence our dynamic. Some people feel safer not knowing anything about their therapist. This approach is great for people who will use any details to leverage the therapeutic relationship so they can “win” therapy. But for others, it may help them feel at ease. If their therapist can show what it’s like to overcome a similar challenge, it can inspire hope. Or at least it means they won’t feel judged.
Communication Style
Does your therapist answer your questions directly every time? Or do they answer your question with more questions. While these are designed to get you to consider deeper issues, the timing needs to be right.
Does your therapist do more challenging and holding you accountable? Or do they focus more on validating your feelings and letting you challenge yourself?
Do you need time to vent and go over every detail of an incident until you feel better? Or are you tired of talking about it and really want your therapist to help you reveal the deeper issue at play?
These choices can all contribute to how you perceive our relationship and the therapeutic process, which is why it’s crucial to be mindful of them. And the list could go on…
The Evolving Nature of Trauma-Informed Care
I hear many therapists claim to be trauma-informed, but I worry that the term is losing its meaning. That’s why I’m sharing my perspective to help you understand what trauma-informed therapy truly looks like. It’s essential to recognize that being trauma-informed can look different for each client.
The decisions I make, from how I hold boundaries around policies to how I respond to your questions, are all rooted in a desire to be more trauma-informed. They are all in service of creating safety, trust, choice, collaboration, empowerment, and integrating your personal cultural context.
So while every therapist seems to have a different answer, it’s true that being trauma-informed is not a one-size-fits-all label. It requires a thoughtful approach, a willingness to understand each client’s unique experiences, and a commitment to fostering a safe and trusting environment. The next time you’re doing a free consultation with a therapist who says they are trauma-informed, make sure they have an answer. As you seek therapy, remember that you have the right to ask your therapist about their approach and how they ensure that your therapy journey is supported in a trauma-informed way.
Read more about trauma therapy here.
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