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Episode Description
You can know everything there is to know about PTSD and still run a practice that leaves clients feeling powerless. Knowing about trauma and being trauma-informed are not the same thing.
In this episode, Ashley Charbonneau and Morgen Villegas take on one of the most overused phrases in mental health: trauma-informed care. It’s on websites, job postings and mission statements. But a weighted blanket and a line on your website don’t make you trauma-informed.
Ashley and Morgen trace where the framework came from. They walk through SAMHSA’s four Rs and six guiding principles and explain each one in plain language. Then they show what trauma-informed care looks like in the therapy room, inside agencies and in the bigger systems our clients live in.
IN THIS EPISODE:
SAMHSA’s four Rs: realize, recognize, respond and resist re-traumatization
The six principles, from safety to cultural, historical and gender issues
Small choices that give clients back a sense of control, like asking how they want the lighting
Why labels like “non-compliant” and “the angry client” miss what’s really going on
Why no one should ever be forced to talk about their trauma
How trauma-informed care keeps boundaries and accountability in place
What trauma-informed supervision looks like
Simple changes you can make tomorrow
Transcript
Trauma Informed Hype
Morgen V.: Welcome back to The Art of Being a Therapist: The Space Between Training and Real Life. I'm Morgen.
Ashley C.: And I'm Ashley. And today we're talking about a phrase that gets used so, so often in mental health, trauma informed care. You see it on websites, in job descriptions, mission statements, continuing education trainings.
Morgen V.: Ashley, do you think that everyone is trauma informed?
Ashley C.: Should I hide my face? That's a good question. No. But I don't mean to laugh, but I think that question is harder to answer than it is on the surface because all therapists might say they are. And perhaps diving deeper into this topic will tease this out a bit more.
So what does trauma informed care actually mean?
Morgen V.: I can tell everyone what it's not, so we can start with that. Does that work?
Ashley C.: Yeah.
Morgen V.: Okay, cool. It's not just I'm nice to people who have trauma or I get it. Sorry that sounds really patronizing, but it kinda can feel patronizing honestly if it's not truly trauma informed.
So it's like I get it, everyone has trauma, or I treat trauma, or I am trauma trained. But it's not necessarily just having a weighted blanket in your office, right? It's not just knowing what the vagus nerve is. It's not necessarily even asking every client about adverse childhood experiences. And it's definitely not putting trauma informed on your website and calling it a day, okay?
So today we're just gonna break down, like, where does the framework come from? What are the major principles? And what do they mean in everyday human language? 'Cause that's always really important to us on this podcast, right? What those principles look like inside of the therapy room, and then we're gonna zoom way out to see what it looks like in systems.
Ashley C.: This is one of the huge things that I think gets lost between training and real life. So many of us learn trauma-informed or trauma-informed care, and probably not all of us actually do it.
Morgen V.: So we're going micro, meso, and macro with this one today. Very social worky of
What It Really Means
Morgen V.: us. Let's just start really simply.
What does trauma-informed care even mean?
Ashley C.: At its core, it means we operate from an awareness that trauma is common, that trauma can profoundly affect how people experience themselves, other people, authority, institutions, relationships, and safety. And it also means that we operate from an awareness that systems intended to help people can accidentally hurt or re-traumatize them, or purposefully hurt or re-traumatize them.
Let's be honest here.
Origins and Four Rs
Ashley C.: The Substance Abuse and Mental Health Services Administration, or SAMHSA, is an agency within the US Department of Health and Human Services, whose aim is to advance the behavioral health of our country. That is a whole nother rabbit hole I could go down with you, Morgen. But for today, SAMHSA describes a trauma-informed system through big four actions or four Rs: realize, recognize, respond, and resist re-traumatization.
So first, we realize how widespread trauma is. Second, we recognize signs and effects of trauma. Third, we respond by integrating that knowledge into the way we work, and fourth, we actively resist re-traumatization.
Morgen V.: So the four Rs remind us that trauma-informed care isn't just about knowing that trauma exists, right?
So you can know everything there is to know about PTSD and still operate in a way that is incredibly disempowering. This shows that knowing about trauma and being trauma-informed aren't necessarily the same thing
Ashley C.: Not at all. Someone can be, like you said, an expert in trauma or a diagnosis or trauma treatment and still have a policy that says, "If you're five minutes late three times, you're automatically discharged," or, "You don't get to know what's in your treatment plan," or, "Don't question me, I'm the professional," or, "We're gonna make decisions about you without including you."
And those are organizational practices, and that's where trauma-informed care gets much bigger than a therapeutic modality or framework.
Morgen V.: It's so great that we're talking about this, honestly, and I'm curious if you wanna expand more on where trauma-informed care even originated from.
Ashley C.: The framework emerged from decades of trauma research, feminist and survivor advocacy, mental health reform, work with survivors of violence and abuse, and growing recognition that people entering mental health and addiction systems have incredibly high rates of trauma histories.
A particularly influential article from 2001, and yes, I am a nerd and I love research, but a particularly influential article from 2001 is by Maxine Harris and Roger I don't know how to say his last name. I should have Googled this. Fallot or Fallot, maybe? Morgen, do you know?
Morgen V.: I do.
Ashley C.: That is not very trauma-informed of me to not know how to pronounce someone's last name.
They, in the very first paragraph of their article, said that most clients seek mental health treatment for presenting problems, immediate problems, that are tied to whatever service they are seeking, which makes sense, right? Someone has a problem, they need help, they ask for help. But these same clients report high rates of childhood abuse.
Their next paragraph begins with, "Systems serve survivors of childhood trauma without treating them for the consequences of trauma." And then, "To be trauma-informed means to know the history of abuse of the consumer or client with whom one is working. This allows more holistic and integrated treatment planning.
It also means we need to understand the role violence and victimization plays in the clients of mental health and substance use disorder services, and use that information to design service systems," so macro systems, "that account for this." This is different, like you said, Morgen, than a trauma-specific service or a trauma-specific modality or treating trauma.
The goal of the trauma-informed approach is to return a sense of control and autonomy to the client. The authors emphasize principles including trust and safety, choice, collaboration, and empowerment.
Six Principles Overview
Morgen V.: Wow. So I'm reading here, this is quite interesting, that eventually SAMHSA expanded and formalized this framework, and the current widely used framework includes the following six guiding principles.
Okay, so everyone listen up. Maybe you wanna write these down. Safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and cultural, historical, and gender issues. And these are the six that we're gonna go ahead and walk through a little bit more
Safety in Practice
Ashley C.: Principle one, safety, means do people feel physically and emotionally safe here?
What does this environment feel like to the person walking into it? So are, is the way we think safe, the way we verbalize our thoughts safe, and spiritually safe? The, is what we believe and our expression of those beliefs, are we safe to share that in this room?
So safety really means intentionally creating conditions where a client has enough physical, emotional, relational, and psychological safety to even participate in treatment.
That includes boundaries, predictability, confidentiality, attunement, clear expectations, appropriate pacing, and avoiding unnecessary exposure to experiences that replicate powerlessness or threat.
Morgen, can you give me some examples of all of that?
Morgen V.: Oh my goodness. There are so many. I'm just gonna go through a couple that I've just come up with on the, off the top of my head So you tell a new client where the bathroom is, you explain where they can sit.
You can tell them whether the door will be open or closed. You don't stand between a trauma survivor and the exit. You ask before dimming lights or just ask about lighting in general. You don't unexpectedly touch someone or you just don't touch anyone at all. You tell someone before beginning a grounding exercise and you would seek consent around any kind of exercise like that, 'cause grounding can be pretty activating for some people.
You explain what EMDR bilateral stimulation will involve before doing it. You don't suddenly ask, "Tell me exactly what happened during the assault." You say, "We don't have to get into the details today and we can kinda do a headline experience if that works, or even provide some kind of containment exercise if that helps the person," again, through explicit consent.
You don't interpret a freeze response as resistance. You allow someone to sit farther away. You let them know that they can ask to pause or stop, and we're talking about not just bilateral stimulation through EMDR but any kind of dialogue or conversation. You explain confidentiality before asking highly sensitive questions.
You keep your office reasonably predictable in terms of decor and that kind of thing or just even furniture and placement. If you're gonna be gone for several weeks, you tell people rather than just disappearing. So really, honestly, emotional safety means being able to disagree with your therapist as well.
Ashley C.: So what I'm hearing you say, Morgen, is helping the client orient to their surroundings, especially if they're a new client. Where's your office? Where's the waiting room? Where's the bathrooms? Is there a kitchen? Is there water somewhere? And then once they're in your room, what is appropriate or allowed or expected or boundaries.
I appreciate that you named lights actually because I hate the fluorescent lighting overhead. It really gives me headaches and so my lights are always off and when I meet with a client for the first time I do say, "If you prefer the lights to be on, please let me know. I will turn them on and make sure that we are catering to your needs.
I keep them off because I don't like them but this is about you." And so something that's very small or seemingly very small can actually restore agency, right? Mm-hmm. I'm explaining why something in the office is the way it is. I'm giving them a choice and then I'm letting them know- their choice is more important than mine related to this
Morgen V.: Yes.
Yes, and you're speaking to something I think even beyond trauma-informed care, but I think it's still related, is neurodivergent affirming care. Mm. And so it's actually stuff that I've incorporated into my paperwork. I'll just ask explicitly, "How do you prefer lighting? Do you have any sensitivities to fragrances or any kind of other sensory input?"
Fill in the blank, right? Let me know and I will try to do my best to accommodate those, those experiences so that it doesn't feel overwhelming when you're in the room. So safety at an organizational level might mean, dun-da-da-dun, adequate staffing.
Ashley C.: I shouldn't laugh, but holy cow, yes.
Morgen V.: I know. I mean, that's why I just did a little drum roll there because it's, who doesn't have an experience of being, like, the last therapist left in the building with a client?
And just I've worked with clients around figuring out a safety procedure to leave the building. Yeah. There's times where we've had to really explicitly discuss that. Clear procedures for crises, well-lit parking areas, private spaces for sensitive conversations, waiting rooms where people aren't publicly asked why they're there, staff being trained in de-escalation, policies reducing unnecessary restraint and seclusion, employees having somewhere to debrief after critical incidents, like not in a hallway right out somebody else's office, a predictable complaint process or grievance process, protection from workplace harassment, supervisors who don't publicly shame employees.
Ashley C.: Yeah, that's a lot, and I will say I've experienced or witnessed all of those, unfortunately. And SAMHSA's framework actually explicitly talks about clients, families, and staff in recognizing trauma and its effects. And so an agency cannot say, "We're trauma informed with clients," while not supporting or even traumatizing its employees.
Morgen V.: Yes, because honestly, just speaking as a client, like, I'm super in tune with what's happening around me, and so that would create a, in a sense, like a retraumatization if I'm witnessing employees being treated poorly at an agency or at any kind of workplace. I'm learning as I go here with the SAMHSA framework.
But a- but, like, the other pieces here, like safety at a macro level could mean designing shelters where people can secure belongings, creating disaster response systems that account for trauma, developing policing or emergency response practices that reduce unnecessary escalation, making schools physically and psychologically safe, creating public spaces accessible to people with disabilities, protecting people from discriminatory violence, investing in safe housing, because it's really hard to regulate your nervous system when you're actively unsafe in general.
Trust and Transparency
Morgen V.: So then the next piece here is trustworthy and transparency. So let's have a little bit of a translation, Ashley.
Ashley C.: If I had to distill it down to a couple sentences, say what you're going to do, then do what you say. And if something changes, explain why.
Morgen V.: Yes. I love that so much. So in therapy terms, trustworthiness means creating predictable, clear, honest therapeutic relationships.
Really what we're naming is just being extremely explicit in all of these things, like saying the thing out loud.
Ashley C.: In the therapy setting, for example, if we are going to diagnose someone, we need to tell that person and explain why. If we are writing something down, the client should generally understand what documentation is for.
Certainly if we're required to make a report, it's best practice to explain why we have to make a report and what we can about the process In, uh, my line of work, clients ask, "Will you tell my probation officer everything I say?" And we aren't necessarily trained explicitly on how to answer that question, but we shouldn't respond vaguely.
If someone, any client, is asking, "Will you tell so-and-so what I tell you?" You need to be able to tell them exactly what information may or may not be shared with any sort of third party. If you charge a late cancellation fee, we need to make sure that is explicitly explained and the client has explicitly agreed to that sort of policy.
If you're running 10 minutes late, acknowledge it. If you make a mistake, say, "I got that wrong."
Morgen V.: They all, and especially this last one, feels really trauma-informed.
Ashley C.: Huge. Trust can't be built by pretending we as professionals never make mistakes. It's built in part by demonstrating what happens when we do make mistakes and how we respond to that.
Morgen V.: Okay, so let's look at organizations as well. Publish clear eligibility requirements for participation. Explain wait lists honestly. Tell staff how decisions are made. Explain how promotions work. I would even say talk about salaries and just be open about that kind of thing. Yes. Have transparent grievance procedures.
Tell clients who can access their records. Explain why policies exist. Give notice before major program changes. Avoid suddenly eliminating services without communication, because unpredictability can feel super threatening.
Ashley C.: And again, this shouldn't just be for clients. It should be for staff, for organizations, for communities.
And it does seem simple or that all of this should be assumed, and it's not. Again, I've worked at agencies where there aren't clear norms around how decisions are made, or the social workers or therapists are told how decisions are made, but then leadership does the opposite. And that, again, is unpredictability, and if we are working in an unpredictable environment, how do we treat our clients in that same unpredictable environment?
Oof, you could get me all worked up, Morgen. Oh my gosh.
Morgen V.: So much, and it's, if you're a clinical social worker in grad school and you're in your community social work class- If you remember, talking about agencies and assessing them for organizational, essentially organizational deficits. Like, really think about how this, how these things happen, and really think about before you make a commitment to an agency.
Think about how structurally they support people, because if you feel supported as a therapist and it feels trauma informed at an organizational level, it is so much more likely, I believe, that you'll have a sustainability in your career in that place as a trauma informed person, as a trauma informed therapist.
Anywho, let's continue.
Ashley C.: I completely agree, but I will continue to number three.
Peer Support and Collaboration
Ashley C.: Peer support. So essentially, boiled down, that is sometimes the person who can communicate, "I've been there," right? So someone who offers something that a professional can't always.
In therapy speak, peer support involves people with lived experience contributing to healing, hope, connection, advocacy, and service delivery.
SAMHSA specifically identifies peer support as a vehicle for promoting safety, trust, collaboration, and recovery. So some micro examples are support groups, recovery communities, peer mentors, survivor-led groups, parent-to-parent support, veterans supporting veterans, people with lived experience of psychosis working as peer specialists, a new mother hearing from another mother who experienced postpartum depression.
And this isn't the therapist saying, "I know exactly how you feel." That's different. Peer support is really an intentional use of lived experience, right? Not therapists centering themselves. And as therapists, we p- usually don't disclose a ton, so we aren't doing this necessarily, but hopefully we're aware of what exists in our community so we can connect our clients to other resources.
On the larger level, this can look like hiring peer specialists, including former clients on advisory boards, paying people with lived experience to consult on program design, creating recovery-oriented peer programs, having employee peer support after workplace crises, funding survivor-led organizations, including people directly affected by policies in the policy making.
What? That should always exist, but we know it doesn't. Not designing homelessness policies without people who have experienced homelessness. Similar to incarceration reform, we should be including people with lived experience in our discussions around how to reform that system, which I would love to see reformed in my lifetime, by the way.
And same with other populations, right? The people who are being served by a service should be included in how that service delivery and the service themselves are designed.
Morgen V.: Absolutely. This is gonna be a really silly example, but there's a park across the street from my kids' school, and it has absolutely zero shade.
And so all the parents just joke with each other. They're like, "Did they consult one parent about how to design this park?" Similar to the design of organizations and systems and policies, right? Like, how are you going to know what you're missing unless you directly consult with the people that it impacts?
Ashley C.: Yes.
Morgen V.: Okay, so number four, collaboration and mutuality. What is the simplest version here?
Ashley C.: We are doing this with you, not to you or even for you
Morgen V.: Okay. And what are the therapy terms there?
Ashley C.: The therapist has expertise, right? This is our job, but the client also has expertise. The therapist might understand treatment, but the client understands their own life, and trauma-informed care tries to reduce unnecessary power differences and create meaningful partnership between professional and client, right?
Trying to bridge that gap.
Morgen V.: Yes. I love that. I'm really thinking right now from an EMDR IFS lens, like even introducing those modalities or collaborating on where to start next with a client, instead of, "You need to do EMDR," which I can't even say that, like, in this podcast. It just sounds so icky to me. You could try, "Here are several approaches we could consider," right?
"Let me explain them and hear what feels right to you." And we can even check in, right? We can even just say, "You maybe just take a couple weeks to think about this, and here's more information about it." So just really looking at treatment plans as well. Like, instead of telling a client what a goal is, "Your goal is emotional regulation", you could ask with curiosity, "What would you like to be different in six months from now?"
Ashley C.: I don't assign a lot of homework. I don't wanna set clients up for failure. So similar to the treatment plan example you just gave, instead of saying, "Your homework is identify three cognitive distortions and three ways you challenge them," collaborating on how is the client gonna practice what you guys have been working on between sessions or outside the room.
So again, asking with curiosity, what would actually feel doable this week?
Morgen V.: What actually feels doable this week? I absolutely love that question. I ask it, I feel like I ask it a lot. And even on a larger level, like if you think about things in terms of implementation systemically, having clients participate in treatment planning, like what are their goals?
Really consult with them. Have staff participate in organizational change. Have frontline employees be included when administration changes workflows. Again, like involving people who are impacted by systemic situations. Having a family consultation to help shape programs, have community members sit on boards.
People who are affected by policies, allow them to have actual decision-making authority, not just BS lip service from leaders. Sorry, y'all. But just ones that say people underneath them have authority, but they actually don't. Do participatory community planning. Have community advisory councils. Use restorative practices.
Ashley, I know you're a huge fan of that, and I am, too. I think it is so incredibly powerful. Include neighborhood residents in decisions around redevelopment or include youth in school policy discussions.
Ashley C.: Such good ideas. And again, I know that there are people out there doing this work and advocating for policy reform and the implementation of these policies where and when they do exist.
So thank you to everyone else out there who continually seeks to change policies like these.
Empowerment and Cultural Lens
Ashley C.: Number five, empowerment, voice, and choice. So this means giving people as much control, and I don't mean control in a negative way here, but giving people as much control over their own lives as you reasonably can.
We know that trauma often involves a loss of control, so care should not unnecessarily recreate that experience.
Morgen V.: So just in more therapy terms, right, like we emphasize strengths, autonomy, informed consent, self-determination, client preferences, and opportunities to make meaningful choices. So would you rather meet in person or telehealth?
Would you like the door open or closed? And if you don't have that option, maybe talking about what would help to feel more comfortable. Do you want to start with a relationship issue or what happened at work? Or what feels like is most active in your system right now? What feels like a good place for us to start today?
Would you rather use tapping, eye movements, or another form of bilateral stimulation? Do you want direct advice? Would you prefer resonance or reflection, or just a space to talk right now? You can tell me if this doesn't feel useful. You don't have to answer that question today. So just like giving, again, like informed choice around really, I think throughout any kind of therapy session.
It's not just like at the end, right? It's interspersed and woven in all of the, the different phases of treatment.
Ashley C.: And choice doesn't mean infinite options. Trauma-informed care does not mean clients get whatever they want. Sometimes there are boundaries, and there should be. Sometimes there are legal requirements or ethical things we have to adhere to.
Sometimes there are safety limits, and we can still communicate, "Here is what I cannot change. Here is what you do have control over." And that can be very powerful. In terms of organizational policies, looking at flexible appointment options, multiple ways to fill out paperwork even. I know a lot of us, we live in 2026, and we send our forms through portals and just ask clients to sign them.
But recognizing some people still like paper copies. Some people still like to flip through something before they sign it. Some people prefer to sign it with you or in front of you. Some people wanna ask questions or don't like screens, and I think again, we assume, "Oh, I can just send paperwork to a client," and sometimes that is not trauma informed.
We are making an assumption that a client reads and writes okay, that they have access to a screen or email, that they can read on a screen or email. And again, right off the bat, if we are assuming certain things about a client, how can we de-center our assumptions or challenge our assumptions or challenge the way we always do things?
Other ideas at the agency level are clients and employees having control over who they are allowed to talk to if things go wrong. So who can I talk to next? Staff having meaningful participation, which we've talked about in policy development, and that example I know we've mentioned throughout the other tenets of trauma-informed care, and it shows that all of these tenets overlap with one another.
But I also want to highlight, so many policies are not trauma-informed and need to be. Like, I love that we're talking about this in every single aspect of this episode. And even an agency offering multiple therapists or multiple treatment modalities when possible, right? We specialize. We offer certain things.
We don't need to generalize or offer everything, but again, when clients might meet with someone and they're like, "I don't know about that person or that modality," is there an option for them to meet with someone else who might be a better fit? And then macro examples, voting access, which I could go on and on about.
Accessible transportation, housing choice, neighborhood resources, language access, disability accommodations. These are all part of empowerment and voice and choice, and I'll leave it there, but I could go on and on.
Morgen V.: Absolutely. I was renting an office somewhere for a while, and they didn't have accommodations for disability to get up a level of stairs, and that was a reason why I decided to leave, because it was just like I can't offer my services somewhere where they don't value every single human, regardless of ability to walk up stairs.
So anyway, I definitely was trying to be a thorn in their side, but they still didn't, they didn't change it. Last but not least, number six, cultural, historical, and gender issues. So translation, people do not experience trauma outside of culture, history, identity, and power, and we've talked about this many times on our podcast, that these are things that intersect in all of our lives.
Ashley C.: In therapy terms, trauma-informed care considers how racism, sexism, colonization, poverty, ableism, homophobia, transphobia, antisemitism, other forms of religious oppression, immigration experiences, and again, the list is infinite, but all forms of systemic inequity, how do those influence trauma exposure, access to care, trust in institutions, and healing?
SAMHSA explicitly includes cultural, historical, and gender considerations among its six principles.
Morgen V.: So just to make some concrete recommendations here, just ask about identity. Be curious. Don't assume. Ask, "Are there any parts of your identity or community that you think I need to understand in order to work well with you?"
Don't pathologize family closeness because it doesn't match individualistic Western norms. Learn how historical relationships with medical or governmental systems may influence trust. Don't assume every trauma survivor wants police involvement, and don't assume everyone's concept of healing is individual.
It could be more related to instead of, like, self-care, it could be related to communal care or familial care. Don't make the client educate you about everything either. Some of these things are on us. Actually, a lot of the things I just mentioned, all of it is on us to really educate ourselves and not put the onus on the client to try to teach us
Ashley C.: And zooming out, going to a broader trauma-informed lens, a question might be: what makes sense about this person's response given what they've experienced and the environment that they are currently
Real World Examples and Wrap Up
Ashley C.: in?
Morgen V.: And let's go ahead and move into some real-life examples. So a client misses three appointments. A word that I think is thrown around a lot, is this client non-compliant, quote, unquote?
Ashley C.: Trauma-informed curiosity says, what's happening? Do they have transportation? Are they terrified of therapy? Is their partner controlling where they go?
Do they work an unpredictable job? Is executive functioning difficult? Did something happen in therapy that made coming back feel unsafe? And accountability can still exist, but curiosity should come before judgment. And again, we shouldn't be assuming that a client is non-compliant. I just, I hate that word.
Morgen V.: I really do, too. As I said it, I was like, "I gotta make sure I qualify this as quote, unquote," 'cause I just, I, it's been a minute since I've actually said that.
Ashley C.: Morgen, next example. Again, quote, because I don't say this, but the angry client.
Morgen V.: So a client raises their voice. Tr- the traditional interpretation is they're aggressive.
A trauma-informed interpretation would be something's happening. I need to maintain safety and boundaries, and I want to understand what's underneath this. Is this aggressive? Is that sense of anger something that we can really use therapeutically, right? Is it something that we can use as a tool? Is it a part of the client that's really protecting them from something that's underneath?
Can there be compassion that I can extend to that client, or is it something that I do need to address with some kind of deescalation? It really depends on the situation and the client and my understanding of the person that I'm with, but it's not just, "Oh my God, the client's being aggressive." It's really, again, like taking a more expansive view on that dynamic.
Ashley C.: I, I love what you said at the end there because angry does not equal aggressive. Those are two different things. Angry is a mood or an experience. Aggression should be described as some sort of behavior, and we cannot conflate those two things. So another example, the client who won't make eye contact.
This could be for so many different reasons, and I think some people would interpret this as poor engagement or they're not focused. But this could be related to shame, to culture, to symptoms of certain mental health disorders, to fear, to submission, right? We're still in a position of authority as a therapist, so recognizing there, there might be a submissive feeling that a client is experiencing.
It could be related to anxiety or trauma. Maybe they just don't like eye contact, and that's okay. Maybe they truly aren't used to it either, and that's also okay.
Morgen V.: I really do not like eye contact, honestly, and I don't, I hardly ever look direct- I'm talking about when I'm the client. And I will talk about that with clients too.
Sometimes I do avert my eyes because of the, the being perceived piece with my neurodivergence.
Ashley C.: What about a client who refuses to talk about trauma?
Morgen V.: Quote unquote, Ashley- Yeah, quote unquote ... 'cause oh my gosh. Okay, rein it in here. If they're in trauma therapy, shouldn't we talk about it, quote unquote?
Eventually, maybe, but honestly, like forcing disclosure is absolutely 100% not trauma informed. I cannot reiterate enough that it is okay if someone does not want to talk about their trauma in therapy, and even for the entire span of therapy, it is okay.
Ashley C.: And say that again for the people in the back. We do not force people to talk about their trauma.
Morgen V.: Ever.
Ashley C.: Ever.
Morgen V.: And people can still get better. Did you know that? They can still get better. There's actually a protocol in EMDR when the, the therapist doesn't know specifically what target they're working on, but they do the entire protocol without knowing... They just know the name of the target, but they don't know exactly what kind of trauma it is.
And so it's just a beautiful witnessing without having to completely explicitly name what happened.
I'm gonna have to look that up because that sounds beautiful.
Yeah.
Ashley C.: Okay, here's a good one. Substance use
judge and blame and shame and make assumptions about clients and people in general-
who use certain substances.
Morgen V.: Absolutely. So instead of, "Why don't you just stop using?" Which I don't know if that's ever come out of my mouth, maybe as a younger therapist it could have, but now it doesn't. It's more, again, about getting curious. What is the role that this substance plays in your life? What does this substance do for you?
Does it help you sleep? Does it numb traumatic memories? Does it help to connect socially? Does it reduce panic? Does it allow function? Understanding function does not mean that you're endorsing it, it just means that you're understanding what kind of distress it could be creating. You might even get curious about any negative consequences of use of substance, but you're not sitting there trying to force the client or trying to convince the client to quit.
Ashley C.: And it might be new for some of our listeners to hear, but addiction can also be understood from a relational perspective. A client has a relationship with a substance, and the relationship is usually not, quote-unquote, "all bad". We heard from Lindsay a couple episodes ago that she doesn't like to use the words good and bad, and I will highlight this with substance use specifically.
And I think it is our role as therapists to understand how does this substance help you? What is your view of this substance? How do you experience this substance? And again, there's a lot I've had to learn on my own about substances as well and that's on us to learn outside of session too, especially those of us who are addiction counselors.
Morgen V.: Yeah. And in the IFS world we conceptualize addiction as what we would call firefighter parts. Oh. So firefighters really do just this unbelievable amount of work to try to protect people from feeling deep pain. And so that's another thing to really get curious about is what kind of pain could be underneath this choice to use?
Ashley C.: Here's another one I hear all the time or I read in records. A child keeps leaving class. A punitive approach would be detention. The trauma-informed approach is, again, that curiosity piece. What happens immediately before the student leaves? Noise, conflict, embarrassment, sensory overload, academic difficulty, fear?
And can we intervene on what is actually happening and not the behavior of a student leaving the, a classroom?
Morgen V.: That helps so much to hear about that, just thinking about even working with kids, right? Just, like, all the different factors at play. So I really wanna talk about this because I think trauma-informed care sometimes gets misinterpreted as never make anyone uncomfortable, right?
No, we don't need any boundaries. We don't have any expectation. We're just throwing that all out, and that's really not what we're trying to say here
Ashley C.: Yeah, so the example of the child leaving class, this doesn't mean no consequences, no boundaries, no expectations, no accountability, never challenging the student or the parents or the other people involved, like teachers.
It does not mean letting abusive behavior continue. It does not mean agreeing with everything a client says, and it certainly doesn't mean avoiding difficult conversations. It means sometimes we have to really challenge ourselves to understand what a client is going through before we know how to intervene without re-traumatizing them.
Morgen V.: So really saying, "I can really understand why you're angry," or, "I can understand why you want to leave class," is this example, right? "And you can't threaten people," or, "And we can't let you leave and potentially walk into the street, because that's not safe," right? So it's like the two things can be true.
Ashley C.: Yeah, both those things can exist simultaneously, and so your behavior makes sense in context, and your behavior still has consequences.
That trauma-informed care piece adds understanding, but it doesn't remove accountability. And in fact, a trauma-informed system has a very high level of accountability. There's a hierarchy, a predictable one, a safe one, one that makes sense, where expectations are clear and consequences are clear. That provides safety.
And when we are safe, what happens next, Morgen?
Morgen V.: Oh, well, we can help people heal. Okay, so we talked so much about this, right? But it's like this, the reason why we're really, I think, bringing this up today is the desire to really support people on their healing journey. We want to implement systems that are clear.
We want to implement ways in which we can support people in reaching their fullest potential that maybe they didn't get to tap into or reach because of certain traumatic experiences. And we know that therapy can be that place for them. It can be a place where they can finally just feel like there's something that is maybe beyond what they could have ever imagined.
So since we talked so much about supervision, what does trauma-informed supervision look like?
Ashley C.: Ooh, that's a big question. I think briefly establishing safety. Is the relationship safe enough where supervisees can admit they made a mistake or they don't understand what you're trying to teach them or supervise them to?
Trustworthiness and transparency, I think some brief examples are does your supervisee know that their performance is being evaluated? They should. Supervision is inherently evaluative, but what does that look like? And the transparency piece is if we are worried about a supervisee, how do we tell them that?
How do we communicate that, and what are we worried about? Peer support, do we have the opportunity to learn from each other? Collaboration, do we ask supervisees about a case before telling them what to do? Do we ask their perception of a case before telling them what to do? Do we even tell them what to do, right?
I think in a lot of cases we don't or we don't have to. Empowerment, the question I always ask myself is am I helping pre-licensed clinicians become independently competent or am I making them dependent on me? I want them to feel confident and competent over time such that they don't need me forever.
And cultural awareness, we should be talking about identity, power, bias, privilege, all those things in every supervision session, whether it's about the supervisee's identity, whether it's about their client's identities, whether it's about how our identity influences their work. There's so much we could talk about there.
Morgen V.: I totally agree, and I love the empowerment piece there. Sometimes I'll ask supervisees or consultees to say, "I wanna hear first, like, what you think you might wanna do or what kind of decision-making you feel like you wanna pursue, and then I might jump in and let you know some ideas that I have about it.
How does that sound?" Here's an uncomfortable one, shifting gears a little bit. An agency can't tell clinicians to create psychological safety for clients while supervisors lead through fear. Oof. What? Mind blown emoji.
Ashley C.: Yeah.
Morgen V.: Gosh, okay, I guess we're not gonna talk much more about that. It speaks for itself.
Ashley C.: Yeah.
Morgen V.: And let's just even break it down a little bit more, even gynecological care, right? Informed consent around any kind of procedure, that can absolutely be trauma informed. There's so many ways that this can be applied. I feel like it's, I think it can be applied anywhere. So let's make this really practical.
What can someone change tomorrow?
Ashley C.: Ooh, okay. Real quick. This, again, we could go on and on. Ask permission, right? Get someone's consent in the example that you just used. Offer choices even when choice may not explicitly exist. Explain why you're asking certain questions. Tell clients what's going to happen before doing it, and again, ask permission, and if you don't have their permission, make sure you can pivot pretty quickly.
Asking questions like, "Does that fit for you?" Telling people that they can disagree with you. Normalize asking questions. Avoid pathologizing language. Asking about culture and identity. Noticing where you hold power. Not making assumptions. Asking ourselves, am I doing something because I'm collaborating with this person or because I think this person needs it or because this is the way the agency has always done it?
So again, really asking those questions to yourself even. And so if you had to reduce trauma-informed care to one question, what would it be? How do we create safety without being controlling? How do we create structure without becoming rigid? How do we hold boundaries without shaming or blaming? How do we acknowledge trauma without reducing someone to trauma?
That's a huge one. And maybe to zoom out a little bit again, how do we help without assuming we know what's best simply because we are the professional?
Morgen V.: I really think that one of the reasons trauma-informed care matters so much is that it asks us to look beyond the person's symptoms
Ashley C.: and beyond the therapy room.
Oh my gosh. It happens all the time, and I think it's because we exist in a culture, state, country that is actively traumatizing people all the time. But we should be looking beyond the symptoms. We should be looking beyond the therapy room. We should be looking at the person in the environment, right?
Very social work-y piece of this again. The micro level is the client, the meso level is communities or families or even smaller agencies, and then the macro is big systems. So our goal is, one of our big goals as therapists is to help individuals regulate their nervous systems, but we need to be willing to examine the environments that keep dysregulating them.
Morgen V.: Okay, with that, we're gonna end. That was amazingly informative and also slightly exhausting to name out all of these things. But really, it's very empowering to know, and it's really been a pleasure to share all this with our listeners today.
Thanks for joining us for this conversation about what trauma-informed care really
means and what it asks of us as therapists.
If you enjoyed this episode, give us a follow, leave a review, or share it with someone who might appreciate the conversation. Until next time, take care of yourselves and each other.
