Pulling the Information About Trauma-Informed Care Together

We have spent time exploring the basics of becoming trauma-informed and examined how mindfulness, neuroplasticity, and resiliency help form the tripod on which we begin to understand and defeat the consequences of surviving trauma.

In this article, we are going to explore together how all the writings we’ve published so far fit into the trauma-informed care model. We also shall look at how finding a therapist who is trauma-informed can enhance your healing.

A Brief Recap of Mindfulness, Neuroplasticity, and Resiliency

Mindfulness is the practice of remaining in the “now” and allowing yourself to feel emotions without judging them. Mindfulness also involves paying attention to your surroundings and enjoying the sensation of being safe and happy.

Although some compare mindfulness to meditation, it isn’t quite the same. While meditation is often used to practice mindfulness, it isn’t necessary to sit in the lotus position to be mindful. Instead, mindfulness comes when we walk in the woods, on the beach, or by merely retreating into our homes to think about that for which we are grateful.

Neuroplasticity is the ability of the human brain to make new pathways and memories based on new knowledge. Children are born equipped with billions of brains cells (neurons). Neuroplasticity allows them to make new connections (synapses) based on what they need, via learning information from caregivers and their environment. At different stages in brain development, we prune away links between the brain cells (synapses) that are being used and those that are not.

Because of neuroplasticity, adults who have pruned away billions of synapses are also capable of making new ones through mindfulness and other types of learning activities.

A Brief Recap of the Adverse Childhood Experiences Study

I realize we have covered the ACEs’ study in-depth in other pieces, but a reminder of this groundbreaking study, that changed the way mental health professionals see adverse childhood experiences, is essential.

In the years 1995-1997, a new study was conducted by Kaiser Permanente, an American organization in conjunction with the Centers for Disease Control (CDC).

The study followed Permanente’s obesity clinical study, which experienced a 50% dropout rate of those who were successful at losing weight in their program. Vincente Felitti, the head of Permanente’s Department of Preventative Medicine, interviewed with those who had left the program trying to find out the cause of the drop-out rate. Felitti conducted face-to-face interviews with 286 people and found a majority had experienced childhood sexual abuse.

So, in 1995, Felitti and Robert Anda from the CDC surveyed 17,000 volunteers and their findings alarmed the mental health community and shaped the treatment of patients with adverse childhood experiences.

Felitti and Anda asked the 17,337 participants, half of which were female, about their experiences with:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Exposure to domestic violence
• Household substance abuse issues
• Household mental health issues
• Parental separation or divorce
• An incarcerated household member

The findings of the two-year study were astonishing.

According to the United States Substance Abuse and Mental Health Association (SAMSHA), the ACEs study found the following:

• Adverse childhood experiences are universal. For example, 28% of study participants reported physical abuse and 21% sexual abuse. Many also reported experiencing a divorce, parental separation, or having a parent with a mental or substance use disorder.

• Adverse childhood experiences often occur together. Almost 40% of the original sample reported two or more ACEs, and 12.5% experienced four or more. Due to the fact that ACEs occur in clusters, many subsequent studies have examined the cumulative effects of ACEs rather than the individual effects of each.

• Adverse childhood experiences have a dose-response relationship with many health problems.

• As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong, graded relationship to many health, social, and behavioral problems throughout their lifespan, including substance use disorders. Many issues related to ACEs tend to be co-morbid, or co-occurring.

Approximately two-thirds of the subjects in the study experienced at least one adverse childhood experience and 87% reported experiencing additional ACEs.

Compared to an adverse childhood score of zero, having four ACEs created a 700% greater incidence of alcoholism, doubled the risk of having cancer, and increased one’s developing emphysema by 400%. An ACEs score above six created a 3000% increase in attempts to die by suicide.

The people who volunteered for the ACEs study by Felitti and Anda were followed and are still being monitored to determine how they fared after the original research.

The researchers found that within a decade 1,539 participants of the original ACEs study had died. They also found that the rest of the subjects with an ACE score of six or higher, when compared to a control group, had a risk of death 1.5 times greater than the control group who had an ACE score of zero.

On average, the people from the original ACEs study had lost twenty years of their lives, dying at around 61 years, which was much less than the average age of death for the control group at 79 years.

The Importance of Building Resilience

We investigated together, in a previous article, the importance of building resilience. If you remember, we found that resiliency isn’t something humans are born with, but rather something we learn from our early experiences with the world.

Deprived of the teaching of resiliency in childhood, we grow up to be adults who are confused and overwhelmed by the events we encounter in our lives.

Developing resilience would seem to be an easy goal to achieve for some, however, that is not the case. One does not establish a resilient lifestyle by accident. It takes hard work and determination to overcome the trap of feeling a deep pity for oneself that often chains us in the quagmire of our traumatic history.

In the book The Psychology of Pierre Janet, Elton Mayo discusses Janet’s discovery that “complex trauma is not reconcilable in the psychic apparatus of children, and this lack of ability to integrate the traumatic experience is believed to be the basis of psychiatric disorders in adults.”

Janet conveyed that because children were not capable of understanding or reconciling what was happening to them during traumatic events, that meant they could not place those events into the context of their mental picture of themselves.

These children then face the decision of accepting that the very people who were supposed to care for and nurture them were, in fact, harming them, or pushing this reality away by not acknowledging what was happening.

The result of this irreconcilable conundrum sets children up for a lifetime of dissociation, mental health struggles, and ill physical health.

For children to acknowledge that the people they love are dangerous is akin to emotional suicide.

As children, we faced events that, because of their traumatic and painful nature, were kept hidden. This secrecy was to become the basis for an inability to cope later in life.

The Power of Trauma-Informed Care

Have you ever wondered why therapy could be such a powerful force for healing? What in psychotherapy, where we engage with another human being, aids us in healing from traumatic childhoods full of adverse experiences?

There are many answers to these questions, but one of the most important and influential aspects of therapy is telling the story we were forbidden to tell. In telling our secrets, we remove the power from those who harmed us and put it back where it belongs, with the survivor.

A therapist who is trauma-informed understands the power of breaking the silence and telling secrets. However, they face a hard task in that they must be cautious so that their care isn’t harmful, but helpful.

We touched on the tenants of trauma-informed care briefly in a previous article. However, the factors that come into play when working with a trauma-informed therapist are essential to understanding clients with CPTSD.

According to SAMHSA, these four principles outline the trauma-informed approach for trauma-informed therapists to follow:

1. Realize the widespread impact of trauma and understand potential paths for recovery;
2. Recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
4. Seeks to resist re-traumatization actively.

The trauma-informed approach helps to aid therapists to plan the right treatment plan for the individuals who seek their help.
All the principles help guide the trauma-informed therapist in finding the right treatment plan to help a client who comes to them with complex trauma.

The Six Key Principles of Trauma-Informed Care

Trauma-informed care involves the delivery of help to a traumatized client through an increased understanding of the impact of complex trauma on an individual’s life.

Since therapists cannot tell at first glance who is living with the effects of complex trauma and who isn’t, these six key principles should apply to everyone who comes into their office.

 

It is only by following the six key principles that a therapist can avoid re-traumatizing their new client.
The six key principles of trauma-informed care are:

1. Safety
2. Trustworthiness and Transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice, and choice
6. Cultural, Historical, and Gender Issues

SAMHSA offers a beautiful explanation for each principle:

Safety–The Therapist makes sure their client feels physically and psychologically safe.

Trustworthiness and transparency–The therapist ensure all decisions are conducted with transparency and a goal of building and maintaining trust between the client and their family members if any are involved.

Peer support and mutual self-help – These are integral to the healing of the client and are understood as a critical vehicle for building trust, establishing safety, and empowerment. The therapist will attempt to help their client seek either group therapy inside the clinical setting or outside, such as a 12-step group.

Collaboration and mutuality – There is a true partnering, and leveling of power differences, between therapist-client. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.

The therapist recognizes everyone has a role to play in a trauma-informed approach.

Empowerment, voice, and choice – Throughout treatment, individuals’ strengths are recognized, built on, and validated through cultivating new skills, as necessary.

The therapist aims to strengthen the clients’ experience of choice and recognizes that every person’s experience is unique and requires an individualized approach.

This approach includes a belief in resilience and in the ability of individuals and communities to heal and promote recovery from trauma.

This approach builds on what clients have to offer, rather than responding to perceived deficits.

Safety. Major developmental theorists such as Abraham Maslow, Erik Erikson, and John Bowlby saw security as a core developmental need of infants. Maslow numbered it among the primary survival needs while Erikson understood that the first “psychosocial” crisis for any infant is the establishment of trust (based on a sense of being safe).

Cultural, historical, and gender issues – The trauma-informed therapist actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender-responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.

Trauma-Informed Care Isn’t Only the Therapist’s Responsibility

From the moment you walk into your therapist’s office the first time, until you leave them, you are accountable for how well you respond to the help they provide.

Healing from complex trauma is NOT your therapist’s responsibility, it is yours.

If the therapist you are seeing isn’t well-trained, i.e.acts inappropriately isn’t a good match, or is incapable of helping you, then you must prioritize your healing, and find another therapist that CAN help you.

There it is again. It is up to you to do what is right for you, NOT the therapist.

It is essential to do your part in your healing work by informing yourself of the diagnosis given to you and remaining hopeful in the process of your recovery.

It is vital for you to tell your therapist about trauma symptoms that often accompany complex trauma, such as substance abuse, eating disorders, depression, anxiety, and suicidal ideation or thoughts. Your therapist cannot help you heal if you are not honest with them.

There is no sense in sugar-coating it. Healing from complex trauma is a painful process, but it is just that. A process, so you will need a therapist who is trauma-informed, and willing to stay with you while you grieve the childhood you never had, as well as face the memories and reality that is your current life.

A trauma-informed therapist also needs to let the survivor know that they are respected and remain as transparent as possible within the limits of the therapeutic environment. Furthermore, they should believe in YOUR recovery, and understand that the expectation for all their clients who are survivors of trauma is healing.

The therapist needs to remain hopeful and believe in their client’s healing even if the client does not see it.

How the CPTSD Foundation Can Help

I hope you have enjoyed this series on trauma-informed care and that it will help you on your healing journey.
The CPTSD Foundation offers several services to help you work with your therapist better, provide you hope and give you the chance to heal with other survivors.

Our Daily Call Program is a revolutionary approach offered by the CPTSD Foundation,

where live calls with screen shares and downloadable information. The calls, led by certified coaches, licensed clinicians, counselors, and advocates in trauma recovery, are helpful.

Daily Calls involve a safe and supportive group atmosphere where no one is left out, and be heard, respected, and appreciated.

There is a cost involved with Daily Calls but is affordable, priced at as little as $50.00 (USD) per month.

Daily Calls occur 365 days per year.

The Healing Book Club is another program offered by the CPTSD Foundation. The club meets every Saturday evening at 4 pm EST and is held in a secure, online conference room.

We record The Healing Book Club so members can view it in the member’s area. The cost for each meeting is very affordable, $5.00 per month, and led by knowledgeable leaders who are members of the foundation staff.

The Healing Book Club studies books that are trauma-healing related and the group members decide together which books to read through member feedback.

Live CPTSD YouTube Q & A is held on our YouTube channel and is held every Monday by founder Athena Moberg. Athena interacts with the public by answering your questions on topics related to complex-related recovery.

The Q & A held in a safe and supportive atmosphere allows you to use your voice, and have your feelings validated. The format uses the chat box allowing survivors from around the world to interact and feel encouraged by learning they are not alone.

The staff, including myself, at the CPTSD Foundation, value you and your healing journey. We hope our programs, website, and articles enhance your healing and allow you to know that someone out here in Internet land cares about you.