Trauma-Informed Therapy and Addiction Recovery

Trauma-informed therapy is therapy or counseling that is done with a person’s trauma history in mind. In the trauma-informed therapy model, a clinician assumes that all patients could be trauma survivors and approaches their patients with care and support to avoid triggering their trauma.

In this approach, the core question is not “what is wrong with you?” but instead “what happened to you?”[1] This method empowers the patient to be able to understand themselves apart from their trauma and set and manage their own goals in therapy. Therapists seek to create a safe, open environment that allows patients to process their trauma.

Trauma-informed therapy is not a specific type of treatment, but rather a lens through which providers see their patients. This lens helps them consider how trauma might be affecting their client’s behavior, responses, perceptions, and worldview.

The United States Substance Abuse and Mental Health Services Administration has outlined four assumptions that form the background of trauma-informed therapy.[2]

• Therapists start by realizing the potential effects that traumatic experiences have on an individual. (See our page on Post-Traumatic Stress Disorder for more information on trauma and how it affects a person’s behavior.)
• Therapists recognize the symptoms of trauma in the client.
• Therapists respond by integrating that knowledge about trauma into policies, procedures, and practices.
• Therapists seek to actively resist re-traumatization.

In trauma-informed therapy, therapists not only realize the impact of traumatic experiences in their clients’ lives, but they seek to help clients understand how trauma has affected them. When clients recognize that certain behaviors are a result of underlying trauma or are coping mechanisms for dealing with trauma, they can adjust those thoughts and actions in the safe space the therapist has created.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”[3]

According to Kilpatrick et al., almost 90% of adults in the U.S. have experienced traumatic events. Traumatic experiences can cause many adverse, trauma-related reactions, both physical and mental. These can include:[4]

• Hyperarousal
• Sleep disturbances
• Gastro-intestinal issues
• Emotional dysregulation
• Numbness or detachment
• Intrusive thoughts and memories
• Confusion or difficulty concentrating
• Flashbacks

Not all people who experience trauma will deal with PTSD or other adverse reactions, but the prevalence of trauma throughout our population demonstrates the necessity of having therapists who are able to help patients process their trauma in positive, safe environments.

Menschner and Maul define the key ingredients needed for a trauma-informed approach to therapy. These include:[5]

• Involving patients in the treatment process.
• Screening for trauma.
• Training staff in trauma-specific treatment approaches.
• Engaging referral sources and partnering organizations.

According to the Trauma-informed Care Implementation Resource Center, trauma-informed therapy can help patients feel more engaged in their therapy, help them take ownership of their healing, and improve relationships between clients and therapists. In doing so, trauma-informed therapy increases long-term health outcomes.[6]

Trauma-informed care can include many kinds of therapy. Effective treatment options may include Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and Prolonged Exposure Therapy (PET).

Even if your trauma-informed care involves different elements of the ones listed above, all trauma-informed therapy is built on the principles of safety, trustworthiness, transparency, collaboration, responsiveness, and peer support.