Trauma-Informed Therapy Explained (& 9 Techniques)

Trauma varies significantly in its effect on individuals.

While some people may quickly recover from an adverse event, others might find their coping abilities profoundly altered, affecting their self-perception and interactions with their environment and in their relationships.

Trauma-informed therapy represents a paradigm shift, focusing on understanding the root causes of distress by asking, “What happened to you?” rather than “What’s wrong with you?” This approach emphasizes understanding a client’s complete history — both past and present — to provide effective therapeutic care.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free. These science-based exercises will equip you and your clients with tools to manage stress better and find a healthier balance in your life.

Trauma-Informed Therapy: A Definition

The diversity in origin and effect of trauma necessitates a deep understanding of its nature and the subtleties of its influence on the human psyche.

Trauma-informed therapy is a therapeutic approach that recognizes and understands the pervasive nature and impact of trauma (Evans & Coccoma, 2014). It emphasizes the physical, psychological, and emotional safety of the client and helps survivors rebuild a sense of control and empowerment.

The goals of trauma-informed therapy are to address the symptoms and behaviors resulting from trauma and empower individuals with the skills and understanding necessary for long-term healing and resilience (Black et al., 2012).

Types of trauma

Trauma is an intricate and deeply personal experience, leaving invisible wounds that often go unnoticed.

These life-changing experiences can be:

• One-time acute trauma from a single incident
• Chronic trauma from repeated and prolonged stressors
• Complex trauma stemming from exposure to multiple traumatic events
• Vicarious trauma
• A result of generational or historical injustices

Each type of trauma leaves a unique imprint on an individual’s emotional and psychological state that shapes our mental and emotional landscape (Evans & Coccoma, 2014; Knight, 2019).

8 Key Principles of Trauma-Informed Care

Trauma-informed care, a vital approach in mental health, acknowledges trauma’s impact and aims to establish a safe, healing environment (Menschner & Maul, 2016).

It is based on a number of crucial principles that are essential for successful therapy: (SAMHSA, 2020)

1. Safety first
   The primary focus is creating a physically and emotionally secure environment, including maintaining confidentiality and establishing clear boundaries, to help survivors regain control and trust.
2. Trustworthiness and transparency
   Essential in trauma therapy, trust is built through honesty, reliability, and clear communication, forming the bedrock of the therapeutic relationship.
3. Empowerment and choice
   Addressing the powerlessness often felt by trauma survivors, autonomy involves providing choices, involving them in treatment decisions, and recognizing their strengths to restore their sense of control.
4. Cultural sensitivity
   Acknowledging and respecting cultural differences is key, as trauma experiences and responses can vary significantly across cultures.
5. Avoiding re-traumatization
   Trauma-informed care involves being mindful of potential triggers to prevent re-traumatization, ensuring a safer therapeutic journey.
6. Understanding the impact of trauma
   Recognizing the profound effects of trauma on mental, emotional, and physical health, including common responses like hypervigilance and dissociation, is critical for effective treatment.
7. Collaboration and coordination
   A multidisciplinary approach, coordinating with various professionals and services, is essential to providing comprehensive care to trauma survivors.
8. Self-care for caregivers
   Caregivers must prioritize self-care to avoid burnout and vicarious trauma, ensuring their capacity to provide the best possible care.

These principles collectively form the foundation of trauma-informed therapy, guiding therapists to support clients through their trauma with empathy, understanding, and effective strategies.

Find out more about treating post-traumatic stress disorder in our related article.

2 Trauma-Sensitive Considerations to Practice

In the realm of trauma-informed therapy, sensitive assessments and a robust therapist–client relationship are pivotal in guiding individuals through their journey of healing. By adopting these approaches, therapists become not just guides, but partners in their clients’ journeys toward healing and growth.

Doing assessments with sensitivity

Assessments are critical steps in understanding an individual’s mental health needs and strengths (Lincoln et al., 2013). However, such evaluations must be conducted with sensitivity, especially in the context of trauma-informed care.

1. Creating a safe space
   A sensitive approach in assessments establishes a safe, nonthreatening environment, essential for building trust and rapport, particularly with trauma survivors.
2. Avoiding re-traumatization
   By identifying potential triggers during assessments, sensitivity in the process prevents re-traumatization, allowing individuals to share their experiences safely.
3. Understanding the whole person
   Sensitivity in assessments entails recognizing the client’s unique experiences, cultural background, and identity, leading to a more comprehensive understanding and personalized care.
4. Reducing stigma and shame
   A sensitive approach helps diminish the stigma and shame often associated with mental health issues, encouraging clients to be more open and honest, which facilitates more accurate and effective assessments and interventions.

Building the therapist–client relationship

At the heart of trauma-informed therapy lies the therapeutic alliance, a collaborative and empathetic partnership between therapist and client (Andriopoulou, 2021; Bucci, 2016; Janzen, 2008; Mallinckrodt, 2010).

The corrective experience aspect of the therapeutic relationship is foundational for healing (Copley & Carney, 2020). Those with attachment trauma may have learned to associate relationships with pain, fear, or abandonment. In trauma-informed therapy, the therapist–client relationship can offer a chance to rewrite these narratives (Cronin et al., 2014; Degnan et al., 2016).

Here’s how:

1. Secure attachment
   Therapists foster secure attachment by mirroring healthy dynamics and enhancing empathy and reliability to develop clients’ sense of security.
2. Reparenting
   Therapy provides reparenting for those who experienced early neglect, helping clients nurture themselves and develop self-care skills.
3. Boundary repair
   Therapy offers a safe space for those with attachment trauma to learn and practice healthy boundaries, promoting safety and autonomy.
4. Emotional availability
   Therapists demonstrate emotional availability, teaching clients it’s safe to express and regulate emotions, especially for those used to suppressing feelings.

To help you decide how to begin therapy to reduce the likelihood of re-traumatization and overwhelm for the client, we recommend this video

Understanding Trauma Triggers and Responses

Trauma, in its various forms, can leave a lasting imprint on an individual’s mental and emotional wellbeing. One significant aspect of trauma is the way it can sensitize a person’s nervous system, leading to heightened responses to certain stimuli.

These stimuli, known as trauma triggers, can evoke powerful emotional and physiological reactions that are deeply ingrained in our biology and psychology (Evans & Coccoma, 2014).

The trauma response system

Trauma responses are complex and varied, extending beyond the widely recognized categories of fight, flight, freeze, and fawn.

While these four responses represent the primary ways individuals might react to threatening situations as immediate survival mechanisms, they are not exhaustive. In the field of trauma studies, experts have identified additional, less commonly known reactions such as fright, flag, and faint (Bracha, 2004; Schauer & Elbert, 2015).

Recognizing these varied responses is crucial for therapists in diagnosing and treating trauma-related conditions, as it acknowledges the diversity in individual experiences of trauma and stress. Such knowledge is instrumental in developing more nuanced and effective treatment strategies for those affected by trauma.

Stress responses and dysregulation

The body’s stress response system is designed to help us cope with threatening situations (Frothingham, 2021; Reddon et al., 2021). However, in the context of trauma, these responses can become dysregulated, making it difficult to manage emotional and physiological responses appropriately.

Trauma survivors may find themselves oscillating between these responses. For example, a seemingly harmless trigger, such as a specific scent or a certain tone of voice, can activate the fight response, leading to intense anger and aggression.

Alternatively, it might trigger the flight response, causing a sudden urge to escape the situation. This dysregulation can lead to emotional turmoil, relationship difficulties, and even physical symptoms.

Understanding such responses is crucial for trauma-informed therapy, as it informs therapeutic interventions aimed at helping individuals regain control over their reactions and move toward healing and emotional regulation. For more techniques that will help your clients develop self-regulation skills, refer to our article 21 Emotion Regulation Strategies and Worksheets.

Training in Trauma-Informed Therapy

Trauma-informed therapy is a crucial area of specialization for mental health professionals working with trauma survivors. It’s important to choose training that is reputable, evidence-based, and aligned with your professional goals. Some examples are below:

PESI

PESI is a leading organization for continuing education for mental health professionals. The Integrated Trauma Therapist is an online course that teaches how to seamlessly integrate the most effective clinical methods and trauma treatments, ensuring improved outcomes and client healing.

The Embody Lab

The Embody Lab offers online certifications and advanced training in a range of programs.

These include Somatic Attachment Therapy, Somatic Stress Release™, Embodied Social Justice, Applied Polyvagal Theory, and Integrative Somatic Trauma Therapy, aimed at promoting embodied education, self-discovery, and healing for global transformation.

Training per modality

You can also train under a specific modality, such as the examples below:

1. Somatic Experiencing

This Somatic Experiencing professional training program offers a comprehensive framework for trauma physiology, blending theory with experiential learning. This training, which includes lectures, live demonstrations, practice sessions, case studies, and readings, equips professionals with practical skills for immediate application in their practice.

2. Eye movement desensitization and reprocessing (EMDR)

EMDR therapy basic training, essential for its effectiveness and client safety, includes lectures, demonstrations, and supervised practice led by EMDRIA-approved trainers, with options for specializing in either adult or child and adolescent tracks.

3. Internal family systems (IFS)

The IFS Institute offers tiered internal family systems training from beginner to advanced levels, equipping mental health professionals with the necessary theory and techniques to apply IFS across various therapeutic settings.

When choosing a training program, it’s important to consider the specific needs of your client population, your personal interests, and the specific requirements for certification or licensure in your area.

9 Trauma Therapy Techniques

Learning trauma-informed therapy techniques provides the foundation for helping traumatized clients safely navigate the process of emotional regulation and regain a sense of security in relationships.

By understanding and applying these techniques, therapists can create a therapeutic environment that acknowledges and respects the client’s traumatic experiences and actively supports their journey toward healing and rebuilding trust in relationships.

1. Internal family systems: Parts work

IFS therapy recognizes that individuals have various “parts” within themselves, each with their own beliefs, emotions, and roles that can be brought into balance and harmony (Hodgdon et al., 2022).

In trauma survivors, these parts can become fragmented and cause self-sabotaging tendencies. Therapists can help clients identify and work with these parts, encouraging them to connect with their inner calm and wise self, a core aspect of IFS therapy.

By accessing their self, clients can learn to lead and guide their inner parts toward healing and integration.

2. Polyvagal theory: Nervous system regulation

Polyvagal theory emphasizes the role of the autonomic nervous system in trauma responses. It has profound implications for working with trauma survivors, emphasizing the role of physiological states in therapy (Porges, 2018).

Therapists can teach clients grounding and self-regulation techniques to modulate their nervous system, such as deep breathing exercises, progressive muscle relaxation, or mindfulness practices.

3. Attachment theory: Repairing attachment styles

Attachment theory highlights the influence of early relationships on attachment style (Andriopoulou, 2021).

Therapists can help clients explore and understand their attachment style, working toward more secure and healthier attachment patterns. This involves fostering secure attachment dynamics within the therapeutic relationship and demonstrating new techniques to address old patterns, creating reparative corrective experiences.

4. EMDR therapy: Installing resources

EMDR therapy is an extensively researched method that helps individuals process and heal from trauma. It uses bilateral stimulation to help the brain reprocess traumatic memories while integrating new positive beliefs into their experience (American Psychological Association, 2017).

This helps the client process and desensitize the trauma and also integrate new, empowering beliefs and resources into their experience.

5. Dialectical Behavior Therapy (DBT): Emotional regulation and mindfulness skills

DBT offers a range of practical skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness (Oppenauer et al., 2023).

These skills empower clients to manage intense emotions, reduce impulsivity, and navigate relationships effectively, while mindfulness exercises help to increase present-moment awareness and promote emotional balance.

6. Somatic Experiencing: Discharge the stored trauma energy

Somatic Experiencing, along with other body-focused approaches, guides clients through the process of releasing pent-up physiological tension that is associated with traumatic experiences.

This release can take many forms, such as shaking, trembling, crying, or even laughing. It assists individuals in releasing and moving past the physical tension that remains in the aftermath of traumatic events (Brom et al., 2017).

Ultimately, discharging helps reduce trauma-related symptoms and supports the client in regaining a sense of control and balance in their body.

7. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): Narrative processing and exposure

TF-CBT helps clients process traumatic memories and build resilience by using cognitive and behavioral techniques with trauma-sensitive interventions (Cohen & Mannarino, 2015).

Therapists can use narrative processing techniques and exposure therapy to help clients confront and reframe traumatic experiences. This process allows clients to gain mastery over their traumatic memories, reducing their emotional impact.

8. Accelerated experiential dynamic psychotherapy (AEDP): Four-state model

AEDP emphasizes the transformative potential of the therapeutic relationship and the healing experience of processing difficult emotional and relational experiences (Iwakabe et al., 2020).

One specific intervention is the use of the four-state model for therapeutic change, which guides the therapy process through stages of recognizing defenses and anxiety, exploring core emotions, experiencing transformative feelings, and ultimately reaching a state of calm and clarity.

9. Integration of psychedelic medicines for complex trauma treatment

An emerging field, psychedelic-assisted therapy involves the use of psychedelic substances, like MDMA and psilocybin, in controlled therapeutic settings, often alongside other therapeutic practices, to treat complex trauma (Elsouri, 2022).

PositivePsychology.com Therapy Tools

On our blog, we have a variety of tools instrumental in helping your clients deal with trauma.

A coping exercise is this Growing Stronger From Trauma worksheet, which encourages clients to recognize their strengths.

This valuable EMDR Worksheet provides several positive counterparts to negative cognitions, which can be used during EMDR therapy.

While assisting clients with exposure therapy, this Imaginal Exposure Worksheet will help clients keep track of their decreasing levels of distress.

In addition to these helpful worksheets, you might find the following related articles interesting to peruse:

• Neurofeedback: A Promising Approach for Trauma Healing
• 23 Post-Traumatic Growth Worksheets for Therapy (+PDF)
• Military Counseling & Helping Veterans Deal With Trauma
• Resilience Counseling: 12 Worksheets to Use in Therapy

If you’re in search of efficient and evidenced-based methods to assist others in managing stress, consider exploring our compilation of 17 verified stress management resources for practitioners. These tools are designed to aid in recognizing symptoms of burnout and fostering a more balanced lifestyle for your clients.

A Take-Home Message

Trauma treatment demands a nuanced, personalized approach, blending diverse therapies to meet each survivor’s unique needs.

As mental health professionals, it’s our duty to stay informed, flexible, and empathetic, evolving our practices to offer holistic and effective healing paths. This journey challenges us and highlights the remarkable human capacity for recovery and growth.

By acknowledging the deeply personal impact of trauma and providing tailored, compassionate care, we support individuals in reclaiming their strength and resilience, guiding them through their transformative journey toward recovery.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free.