Trauma: a very difficult or unpleasant experience that causes someone to have mental or emotional problems, usually for a long time; a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury; an emotional upset; an injury to living tissue caused by an extrinsic agent
Many individuals seeking mental health or addiction services have experienced some form of trauma in their lives, yet there is still a disturbing lack of education on its pervasive influence. The trauma-informed treatment model, set forth by the Substance Abuse and Mental Health Services Administration (SAMHSA), is designed to improve outcomes and encourage a shift towards individualized, holistic care. Two Dreams has been using this model for years to provide the highest quality of care to clients from every walk of life.
The trauma-informed treatment model was developed with a list of six key principles in mind:
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical, and gender issues
These principles reflect a commitment to general guidelines of care, as opposed to a particular set of procedures. Creating a prescribed set of steps, a procedural document entitled “How to Handle a Patient with a Traumatic Background Involving ________,” would be nearly impossible. Each patient has their own story to tell with their own emotions, behaviors, and beliefs. We make sure that each treatment plan is unique in order to get at the root of each client’s issues. Using the six key principles to guide the creation of each treatment plan is more effective than keeping collections of potential scenarios stashed away in hopes that a client will fit a premade profile. Widespread, generalized preparation is the key; our staff members are prepared to address anything that emerges clinically.
Any trauma-informed plan should be general enough for implementation in a wide range of service settings with a wide range of traumatized individuals. The plan should be distinct from trauma-specific intervention, in that it should be created for care beyond the sole purpose of addressing known trauma and its consequences.
SAMHSA also recommends that a trauma-informed plan should:
Realize the widespread impact of trauma and understand potential paths for recovery.
Providers need to stop treating trauma as an afterthought when it is oftentimes the central reason individuals seek out mental health and addiction recovery services. Facilities should not only be prepared to handle any trauma-related issues that appear; they should also be willing to stay flexible and change treatment plans on short notice. Two Dreams hires professionals from many different fields to stay prepared for any scenario that might arise. Treatment plans are reassessed at least once a week and our clients can provide input at anytime. SAMHSA says that providers need to “change the paradigm from one that asks, “what’s wrong with you?” to one that asks, “what has happened to you?”” We investigate the latter at Two Dreams; we listen.
Recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system
Trauma can lead to a wide array of psychological disorders, but also physical disorders such as HIV/AIDS, chronic health conditions, eating disorders, substance abuse, etc. It can also lead to incarceration, homelessness, poverty, isolation, and many other undesirable social consequences. It is important to listen to individuals involved with the system and really try to understand why they are in their position. The symptoms of trauma can be managed, but not if they stay unacknowledged. At Two Dreams we ask that clients use group therapy sessions as a time to share their experiences with others in a safe, welcoming environment. They have a chance to talk through their traumatic experiences and ultimately feel the acceptance and validation that they deserve.
Respond by fully integrating knowledge about trauma into policies, procedures, and practices
For example, healthcare professionals should recognize trauma as a primary and/or co-occurring diagnosis. Behaviors incited by trauma may appear to be symptoms of a personality disorder, bipolar disorder, schizophrenia, etc. Upon closer inspection, though, many of these “symptoms” may actually be non-pathological coping mechanisms. Integrating knowledge about trauma into practice should help to address the over-diagnosis of psychotic disorders and the lack of proper assessments for trauma during treatment. We thoroughly assess our clients for substance use related behaviors and delve into their histories before making clinical diagnoses. We have had enough experience in the field to know when a client is, say, acting out because of mania vs. when a client is acting out to get attention.
Seek to actively resist re-traumatization
Providers should deliver services with an understanding that individuals have different vulnerabilities requiring sensitivity and support. The treatment environment should be based on collaborative care, as opposed to “compliance” and all triggers should be neutralized during the healing process. Staff should be trained on the psychology behind client behaviors and should be able to respond to them appropriately. Two Dreams employees undergo an orientation process to enhance their knowledge about best practices for mental health care. They also learn to better address client cases with compassion and consideration.
Above all, trauma survivors should feel safe.
We remind our clients of their innocence if they blame themselves. We tell them they did the right thing if they feel guilty for walking away from bad situations. We listen to their stories and validate their experiences and emotions. We let them know that they don’t have to justify their actions; the experience of trauma is real and never invalidated by the choices the survivor makes. We respect the client’s boundaries and emphasize that they deserve better and will have a happy and healthy life again. We discuss forgiveness of others as a choice, and forgiveness of the self as a necessity.
Survivors might carry their scars forever, but trauma-informed treatment can make the pain of the injury disappear over time.