Trauma-Informed Care and What It Means
By Ashley Charbonneau
Trauma-informed care is often talked about, a common phrase used in clinical settings, but not many of us are taught how to actually implement it. At its core, trauma-informed care means understanding that many people carry trauma histories and intentionally shaping our interactions, systems, and interventions so we can promote healing. We also want to ensure we are not retraumatizing our clients, whether unintentionally through our actions or through the broader systems in which we work.
This framework was developed by the Substance Abuse and Mental Health Services Administration, which outlines six key principles of trauma-informed care:
1. Safety
This refers to establishing a therapeutic environment that is sensitive to the impact of trauma. It includes both physical and emotional safety. Because we ask clients to share their innermost thoughts and feelings, we must create a space free from judgment, assumptions, or discrimination. Safety is the foundation of therapy.
To create safety when you first meet a client, consider the following:
Do you allow them to choose where to sit?
Some clients, for example, might want to sit close to a door, while others might care more about the comfort level of the couch or chair. If you provide virtual therapy, are you ensuring that clients are in a private space, and are you showing them that you are too?
Do you review paperwork with the client to ensure informed consent?
Consider verbally explaining important points such as confidentiality and its limits, fees, with whom their information and why, cancellation policies, and steps to take in case of a mental health emergency. Be sure to ask if they have any questions.
How do you start the intake? How do you start subsequent sessions?
Consider asking the client if there is anything they want to know about you or your practice before jumping into an agenda. Consider providing an overview of how sessions are structured, and then ask if there is anywhere they’d like to start.
What does your space look and feel like?
You want to make sure it appears inviting, warm, and non-threatening, as well as free of any major distractions or hazards, such as imagery that might imply power and control.
Trustworthiness and Transparency
Trust and safety go hand-in-hand in any relationship. Some clients may trust you quickly. Others will need time. Without trust, our discussions with clients might remain superficial, and they may be unwilling to go deeper. A major goal of the first few sessions is to establish trust; otherwise, progress can quickly stall.
To build trust, you must be willing to be transparent. This can start with an open and direct conversation about what therapy will like with you. Be clear about your background, approach, and boundaries. Offering a short introduction about yourself – like who you are and why you do this work – can go a long way, instill hope, and make the client feel like they’ve found someone who can help them.
Ultimately, it is our responsibility to create an environment where clients can share their pain and take risks by trying new things. Here is an opportunity to be curious and ask yourself about your ability to be trustworthy and transparent:
- How long does it usually take you to develop trust ?
- How do you establish trust with clients?
- Why do clients trust you?
- Have you ever done or said anything to make a client not trust you?
- Are you patient?
- How do you demonstrate that you are paying attention, that you are reliable, and that you are present?
Peer Support
This refers to the value of connection with others who have experienced trauma. While it is generally not appropriate for therapists to disclose their own trauma histories to clients, clients want to feel understood and know that they are not alone. Instead of sharing your own personal experiences, you can say, “I understand” or provide the client with resources about peer support groups. Become familiar with your local community so you can make these referrals when needed.
While peer support is based on relationships with equal balances of power, therapy requires a more structured dynamic. We must maintain boundaries in therapy, though we can facilitate mutual respect and shared power without self-disclosing (much) to our clients.
Some clients may specifically ask whether you’ve been through an experience like theirs. Often, these clients are trying to determine whether you can truly understand or work with them. They are likely wondering whether they are safe with you. They may believe that only a therapist with the same life experiences will be able to help them. If a client continues to press for this type of information, here are some ways you might respond:
Ask clarifying questions:
“Can you share with me why it is important for you to know that about me?”
“Would knowing this answer change your ability to work with me?”
Make a broad statement about your beliefs or experiences as a therapist in general:
“No one gets through life unscathed”
“I think most people experience some sort of trauma in their lifetime, but that experience looks different for everybody.”
Set a boundary:
“It’s not within my practice to answer that”
“I don’t think it’s appropriate for me to answer that.”
Delay answering:
“I write a bit about my cultural background and lived experiences on my website. Perhaps you can take some time to review that before our next session, and for now, we can focus on what is going on with you.”
Do a “thought experiment”:
Ask the client, “What would it be like if I said yes? What about if I said no?” and allow for discussion. This can lead to valuable insight about the internal thought processes, such as their concern about trust or their fears about retraumatizing you.
Collaboration and Mutuality
Collaboration is about working together with the client, and mutuality is about sharing power and responsibility. You can establish collaboration from the start by affirming to the client, either directly or indirectly, that they are the expert of their own life and that you are here to walk alongside them in their healing journey. You can invite them to identify their own therapy goals instead of imposing an agenda on them. This models what shared power in relationships looks like, which is an important contrast to the lack of power and control they experienced during their trauma.
Collaboration also means we as the professional need to be open to client feedback. While this may seem daunting at first, you can use this feedback to guide treatment planning. For example, if a client really liked something about the session, try to repeat this in subsequent sessions. This could be something you did, like bringing up points from past sessions, or something about the setting. On the other hand, if a client shares a concern or expresses discomfort, you can actively address this in the moment and adjust your approach. For example:
- “I respect that you do not want to talk about this topic. Did something shift from our last session?”
- “I appreciate you honoring yourself and setting that boundary today. What would you like the focus of today’s session to be?”
- “That’s totally fair. Is it alright with you if I revisit this topic in session perhaps next week or the week after?”
Empowerment, Choice, and Voice
This principle is about encouraging clients to use their voice when discussing their experiences and their needs. We must allow clients to express themselves authentically and to choose how they want to create change in their lives. This requires shared treatment planning and decision-making throughout therapy. In this way, you facilitate healing rather than controlling the client’s healing process.
For example, when you write a treatment plan without the client’s input, you take away their autonomy, their choice, and their voice, even if unintentionally. Instead, consider ways to involve clients in this process and tailor the treatment to their individual needs. Remember, there is no one-size-fits-all therapeutic approach, so clients should have a say in their treatment.
Cultural, Historical, and Gender Considerations
Culture influences how people understand mental health, create meaning from trauma, and decide whether or not to seek help. As a result, it’s important that we take time to honor and affirm each client’s unique identities, how those identities intersect and interact with one another, and lived experiences. For example, we should be mindful of language barriers, religious or spiritual beliefs, family dynamics, and community values. This also means not imposing our own cultural norms, values, or assumptions onto our clients.
Additionally, consider acknowledging the role that historical and systemic trauma can play in your clients’ lives. Many clients have faced intergenerational trauma, systemic oppression, racism, or forced displacement. Being trauma-informed requires us to understand how these factors influence current symptoms, a client’s trust in systems (including the mental health system), and their ability to access care.
You may need to take a broader, person-in-environment perspective (where you look not just at the individual, but at the systems that surround them) and educate yourself about macro-level systems. On a more individual level, it is your responsibility to understand how both past and present experiences affect clients. Otherwise, you risk overlooking how a client’s background affects how they express emotion, how they cope, and how they show up in the therapy space.
Consider how gender, gender identity, gender roles, gender-based violence, and gender norms may shape your client’s experiences. Stereotyped gender roles and norms can influence how clients process trauma and its impacts. Again, we must create a safe place for clients to explore their identities. Creating a safe, affirming, and celebratory space involves validating the client’s gender identity and expression and helping them unpack the complex ways that gender expectations, power dynamics, and cultural norms have shaped trauma, unhealthy and healthy patterns, and therapeutic journey.
How We Can Help
Seeking out spaces where you can reflect, ask questions, and receive feedback helps ensure that a trauma-informed approach is being implemented. Supervision or consultation allows you to think more deeply about how each of these six principles show up in your work with specific clients. Schedule a 20-minute free phone consultation to learn more about how we can support you!
Author Bio
Ashley Charbonneau is a licensed clinical social worker, approved clinical supervisor, and blogger with Firelight Supervision. Ashley supports early-career and experienced therapists in building confidence, navigating clinical challenges, and growing their unique voice as clinicians. She specializes in trauma, addictions, clinical assessment, and supervision that’s rooted in authenticity and ethical care. Follow Firelight Supervision on Instagram and Facebook.
