The term ‘trauma-informed care’ is increasingly common in the mental health field, and for a good reason. Trauma is more prevalent than many people realise, and it significantly affects how people think, feel, and behave and we see it in the therapy room all the time. Whether it stems from childhood experiences, systemic oppression, or recent global events, trauma unfortunately shapes lives. That’s why integrating a trauma-informed approach into therapy isn’t just beneficial, it feels essential.

So, What Exactly is Trauma-Informed Care?

Trauma-informed care (TIC) is an approach that acknowledges the widespread impact of trauma and recognises that it plays a significant role in people’s lives. It shifts the focus from asking, “What’s wrong with you?” to “What happened to you?” and this perspective helps us understand that behaviours and symptoms we see, might be adaptations to cope with past trauma.

TIC is grounded in the idea that trauma affects not just the mind, but also the body, emotions, and relationships. It recognises that trauma can stem from various sources, such as abuse, neglect, violence, or discrimination, and that it can have long-lasting effects on an individual’s health and well-being. Importantly, TIC involves creating a therapeutic environment where clients feel safe, empowered, and respected, without fear of being judged or re-traumatised.

In the UK, trauma is a common factor in mental health. Research indicates that a significant percentage of people accessing mental health services have experienced trauma. For example, a study published by the British Psychological Society (BPS) found that trauma is associated with a higher risk of mental health disorders, including depression and anxiety (BPS, 2020). Given this, adopting a trauma-informed approach is crucial for providing effective and compassionate care.

Understanding SAMHSA’s Role and Framework

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a U.S. government agency that plays a leading role in advancing the understanding and implementation of trauma-informed care. Although SAMHSA is based in the United States, its guidelines and research on trauma-informed care have had a significant influence worldwide, including here in the UK.

SAMHSA defines trauma-informed care as a framework that involves understanding, recognising, and responding to the effects of all types of trauma. According to SAMHSA, a trauma-informed approach should be guided by four key assumptions, known as the “Four Rs”:

1. Realisation: Recognising the widespread impact of trauma and understanding potential paths for recovery.

2. Recognition: Identifying the signs and symptoms of trauma in clients, families, and others involved in the system.

3. Response: Integrating knowledge about trauma into policies, procedures, and practices.

4. Resist Re-traumatisation: Actively working to avoid triggering or exacerbating trauma responses in those who seek help.

In addition to these assumptions, SAMHSA outlines six core principles that should underpin any trauma-informed approach: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and cultural, historical, and gender sensitivity. These principles are designed to create an environment that supports healing and reduces the risk of further harm.

In the UK, this framework has informed practices in various settings, from mental health services to schools and community organisations. The NHS and other healthcare providers are increasingly adopting these principles to ensure that care is delivered in a trauma-sensitive manner. For therapists, incorporating SAMHSA’s framework means consistently considering how trauma impacts clients and adjusting practices to meet their needs in a holistic and empathetic way.

Why Should We Care About TIC?

The reality is that most clients have experienced some form of trauma. In the UK, research by Mind, a leading mental health charity, shows that trauma can lead to various mental health issues, such as post-traumatic stress disorder (PTSD), depression, and anxiety (Mind, 2019). Given this, adopting TIC is essential to addressing the needs of clients more effectively.

Moreover, TIC isn’t just beneficial for clients; it also enhances therapeutic outcomes. Studies have shown that trauma-informed practices can lead to better engagement, increased trust, and improved recovery rates. For therapists, this approach allows for more meaningful and sustainable results.

So, How Can We as Therapists Bring This into Our Practice?

As an Ecotherapist and creative counsellor, I have long recognised the healing power of nature and creativity. When I began exploring trauma-informed care, it became clear, that these approaches could be powerful tools for helping clients process trauma in a gentle and non-invasive way.

For instance, I often incorporate creative methods like drawing and figure use into my sessions. One client, whom I’ll call Sarah, came to me with severe anxiety, rooted in childhood trauma. Traditional talk therapy had felt challenging for her, because verbalising her experiences often triggered intense emotional responses and she felt exhausted and “done-in” after her sessions with ensuing nightmares. Recognising this, I introduced drawing as a way for Sarah to express her feelings without the pressure of finding the right words and with her background in art, she seemed to take to this more freely.

In one session, I asked Sarah to draw how she felt when she thought about her trauma. She created an image of a small, dark figure surrounded by heavy clouds. As she described the drawing, she began to connect with the emotions she’d been holding inside from the past. Over time, this non-verbal exploration allowed her to process her trauma safely, gradually leading to a reduction in her anxiety. This experience reinforced for me, how creative techniques can provide a safe pathway for clients to explore and express deep-seated emotions. Definitely something I bring out regularly from my counselling toolkit.

Trauma can be unpredictable, so I knew I needed to think about the structure of my sessions with my traumatised clients, that felt both flexible and secure for them. I start each session by checking in with how they’re feeling that day, allowing space for them to express any immediate concerns. This helps me gauge where they are emotionally and whether they might be approaching a trigger. From there, I proceed at their pace, always prioritising their comfort and readiness to explore difficult topics at their own pace, an important consideration to avoid pushing too hard.

One technique I’ve found particularly helpful is regular reflection. Throughout the session, I make a point to reflect back what the client is sharing. Obvious as it may seem, this not only helps them feel heard and understood but also allows us to clarify their thoughts and feelings together, them often not having heard themselves tell their story or divulge certain experiences ever. It’s a simple yet powerful way to build trust and ensure that the therapeutic process remains collaborative.

In terms of exploring trauma, I’ve learned to approach it gently and respectfully. Trauma often lies beneath layers of defence mechanisms that clients have developed over the years. Rather than diving directly into painful memories, I focus on creating a safe space where clients feel in control of their healing journey, how I style my room being an important part. Comfortable chairs, a soft rug, a blanket, water, tissues, objects to hold and move. We might start with grounding exercises to help them stay connected to the present moment, especially with clients who are feeling stressed, anxious or panicked. Also, useful is explore how their body responds to stress, which can offer valuable insights without immediately confronting the trauma itself and often I find that traumatised clients present with health issues, such as digestive issues or back pain, providing me the information that they have experienced long-term stress.

What about us as therapists?

I’ve made peer supervision a regular part of my practice. Discussing clients who have experienced trauma with colleagues provides me with fresh perspectives and third-party feedback, which is so valuable for my growth as a therapist. These sessions are like gold dust for ensuring I’m approaching each case with the care and consideration it deserves and helps me to feel grounded, knowing I am going in the right direction and enhancing my practice using their ideas.

Recognising the emotional toll that comes with working with trauma survivors, I’ve also made self-care a non-negotiable part of my routine. After particularly intense sessions, I take time to decompress, and this can be through meditation, which can simply be partaking in a practical workshop not related to therapy, walking, or simply stepping out for a bit and listening to a podcast. Self-care isn’t just about relaxation; it’s about maintaining the emotional resilience needed to support my clients effectively and without paying that attention, it can take its toll.

Trauma-informed care is essential for creating a supportive and effective therapeutic environment. By understanding and applying its principles, you can help clients feel safe, understood, and empowered on their path to healing. In a world where trauma is increasingly recognised as a key factor in mental health, adopting a trauma-informed approach isn’t just beneficial, it’s the right thing to do.

Whether you’re working in private practice, the NHS, or community services, integrating trauma-informed care into your practice will ensure that you provide the most compassionate and effective support possible.