Counseling Today, From the President

From the President: The alphabet of trauma-informed treatment

By Gerard Lawson October 2, 2017

Gerard Lawson, ACA’s 66th president

As I am writing this, American Counseling Association members from across the country are preparing to deploy to Texas and other Gulf states in response to the historic flooding that accompanied Hurricane Harvey. Our thoughts and prayers are with those affected by this storm — a storm that has a historic twist. Following Hurricane Katrina in 2005, about 35,000 individuals who were displaced from Louisiana and Mississippi ended up in Houston. Some of those people remained there and have now experienced another epic storm. This serves as a reminder that many of us carry a trauma history with us that may not be visible to the casual observer. But counselors are not casual observers.

It is my belief that we are all doing trauma work these days. Sometimes those who seek our services have experienced a “capital T” trauma such as a hurricane, flood, school shooting or military combat. These events are almost universally recognized as potentially traumatizing. But every day, counselors are also working with individuals who have endured “lowercase t” traumas. These include the child who has experienced persistent bullying at school, the survivor of intimate partner violence and the person who has sustained a serious injury or illness. We don’t always recognize those experiences as traumatic, but they certainly can be. In an effort to avoid retraumatizing our students and clients, we need to be trauma informed.

When considering trauma, the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests the Three E’s. Trauma is the result of an Event (or events) that is Experienced as harmful or life-threatening and that has lasting adverse Effects on the individual’s functioning across domains.

Research suggests that most of us will experience an event in our lifetime that is potentially traumatizing. Traumatic experiences shatter our belief that the world is a safe place and can cause us to behave in ways (rational and otherwise) that help us feel safe again. Trauma masquerades as mood disorders or addictive behaviors and may show up in counselors’ offices as difficulty in relationships, at school or at work. Sometimes clients can recognize the connection between their experience of the trauma and their current thoughts, emotions and patterns of behaviors, but not always.

SAMHSA also suggests that trauma-informed care is built around Four R’s. To be trauma informed as counselors, we must Realize the widespread experience and impact of trauma. Next, we must Recognize the signs and symptoms of trauma, which is sometimes trickier than it seems. Especially in children, trauma responses often appear to be oppositional behaviors when, in fact, they are self-protective behaviors based on previous traumas. So, counselors with this awareness Respond by building their practice around policies and procedures that actively integrate the knowledge of trauma and then work to avoid Retraumatizing individuals who come to see them.

The hopeful part of this story is that people who have survived a trauma need safety, connections and coping skills, and these are areas where counselors shine. We help our clients find safety by understanding what their emotions and thoughts are trying to tell them and responding in ways that are healthy and constructive. We can help them reestablish connections and build new relationships with natural supports. We can also help our clients fill their toolboxes with strategies for handling the day-to-day challenges that emerge from traumatic events as they work toward establishing a new way of living in the world.

The last, and in some ways most important, consideration for trauma-informed treatment is self-care. We have to recognize the toll that bearing witness to the suffering of others can take and be active in caring for ourselves. Sadly, there will be more traumas, and good client care begins with good counselor self-care.

 

 

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