Trauma-informed care reframes the way care professionals administer services to clients on an intrapersonal and organizational level to avoid retraumatization. A trauma-informed approach is a mindset that acknowledges the pervasiveness of trauma among most, if not all, of us. This approach posits that clients are more likely to participate fully in treatment plans because they feel safe and are invited to play an active part of their own care services. By providing trauma-informed care training to all staff and administrators on an organizational level, care providers become aware of policies and programs at the organization that may cause re-traumatization for patients, and address them so as not to cause further harm.
Instead of reducing a patient to a diagnosis or health challenge, a trauma-informed approach considers a patient’s life history, including past and present, to provide the most effective personalized health care possible in a safe healing environment. Trauma-informed care is considered the gold standard among care professionals because it has been shown to increase patient engagement and adherence to treatment, yields better outcomes, and helps maintain clinician and staff wellness.
Trauma Informed Care shifts thinking from “What is wrong with this person?” to “What has happened to this person?”
Re-traumatization can occur when a situation or a setting resembles an original traumatic event, which can cause negative emotions to arise in an individual. Examples of re-traumatization within systems include:
- Having to tell and retell your story, and being forced to tell your trauma story in full
- Being seen only as a label (e.g., “addict,” “bipolar”)
- Having no choice or collaboration in decision making around treatment
- Being treated as a number rather than a whole person
- Not being given an opportunity to provide feedback about a clinical experience
Re-traumatization can also occur when a relationship between a care professional and a patient resembles a past traumatic experience. Examples of relational re-traumatization include:
- Violating trust
- Being non-collaborative
- Doing things for an individual rather than with them
- Using punitive treatment and oppressive language
- Not creating space for patients to be seen or heard, or give feedback
- Failing to ensure emotional safety
Trauma-informed care doesn’t seek to treat the original trauma, whether it was sexual, physical, or emotional abuse that caused it. Rather, it is designed to provide support and care in a way that feels safe and accessible to folks who have experienced traumatic events in the past. This is important because if re-traumatization occurs within a care setting, a patient could become much less willing to adhere to or engage with a treatment—which will in all likelihood decrease the effectiveness of the treatment. In addition, individuals who have experienced more than one trauma throughout their lives are at a higher risk for re-traumatization, and are more likely to be unwilling to adhere to treatment.
One of the core tenets of a trauma-informed approach is to develop trust and a sense of safety with the patient. If a client feels safe with one care professional, but not with another, trust in the whole organization could be broken. Because of this, in order to be effective, trauma-informed care has to be implemented throughout the organization.
According to the Buffalo Center for Social Research and the Institute on Trauma and Trauma-Informed care, there are five principles that constitute a framework for how care organizations can create conditions within their care procedures to reduce the likelihood of re-traumatization in patients. These principles can be applied across a diverse variety of environments.
The Five Principles of Trauma-Informed Care
- Safety: Creating an emotionally and physically safe environment for an individual to receive services and care is a foundational first step.
- Trustworthiness: Trust between a patient and provider is essential in building a successful partnership. Trust can be built in many ways: for example, by establishing boundaries and upholding them consistently, or by providing clarity on expectations in regards to tasks or activities.
- Choice: Having choice and control over a care service experience is also important for establishing trust with a patient. The more choice an individual has over their treatment or the services they receive, the more likely it is that they will buy into the treatment, leading to a more effective and collaborative healing experience.
- Collaboration: Collaboration between patient and care provider is vital. In a collaborative healing environment, power is shared among all roles to create a healthy and balanced decision-making process, so that power is not consolidated in any one area or individual.
- Empowerment: Another benefit of a collaborative healing environment is that it empowers patients to find their own voice. Prioritizing skill building, self-determination, self-regulation and allows individuals to sit in the driver’s seat of their own care and healing. Patients learn to build their own strengths and trust their intuition to make decisions.
Why Is Trauma Informed Care Important for Treating Addiction?
The majority of individuals who live with substance use disorders often have experienced trauma. In fact, according to the Hazelden Betty Ford Foundation, there are estimates that individuals who have been diagnosed with post-traumatic stress disorder (PTSD) receive treatment for substance use disorders (SUDs) at a rate five times higher than the general population.
When treating folks who are recovering from addiction, a trauma-informed approach centers a sense of hope, safety, power, and worth for the client. It is important for clients to reconnect with their strengths so they can lean on those strengths in case they experience setbacks in their recovery process, and so that they understand that the recovery process isn’t always linear.
Giving clients information about their trauma symptoms is another way of sharing power with them. Educating clients on how their trauma affects their nervous system empowers them to better understand their reactions to triggers. Once clients understand better how their trauma symptoms affect them biologically, they are better equipped to create new pathways in the brain to cope in healthier ways (rather than turning to a substance to numb negative emotions). Through gaining an understanding of their symptoms and learning to respond in different ways, clients feel a deep sense of accomplishment, and their sense of hope of recovery is strengthened.
Trauma-Informed Care at Magnolia
Trauma-informed care is at the core of the services and the environment that Magnolia provides our clients. The following are a few ways that Magnolia Recovery Programs has committed to being a trauma-informed organization:
- SAFETY: Physical surroundings and creating a home. Dr. Linda Stewart, founder of Magnolia, says, “Many of the women who come to Magnolia have never experienced a safe, relaxing, comfortable home. I want them to experience that here so that when they leave, they have a new sense of normal, and can recreate that for themselves.” Dr. Stewart envisioned a facility that feels like a home and took great care to make the environment of the facility as warm, homey, and inviting as possible. She personally chooses the clients’ bedspreads and ensures that the beds have comfortable memory foam mattresses. “I didn’t want Magnolia to feel like a prison,” she says. But these choices aren’t about beauty or feeling luxurious. Her reasoning is that if clients feel as if they’re safe and at home at Magnolia, and if it doesn’t feel like an institution, their therapeutic outcomes will likely be much better.
- EMPOWERMENT: The women of Magnolia learn life skills by taking care of their own space. Clients at Magnolia are expected to do their own cooking and cleaning of their rooms as well as the communal kitchen. Having to do these tasks themselves paves the way for them to take pride in their space and get into the habit of taking care of their space. This practice also gives clients hands-on experience living in a clean and safe environment, with the hope that when they leave Magnolia, they will have the skills and experience to maintain a clean, safe, orderly living space on their own.
- TRUSTWORTHINESS: Many Magnolia staff members have struggled with addiction in the past and are in addiction recovery themselves. This creates a sense of trust from the clients’ perspective—not only that the staff won’t judge them when they walk through Magnolia’s doors, but also that the staff acutely understand what they’re going through. With this foundation of trust and empathy, clients are much more likely to adhere to their treatment plan at Magnolia, and graduate from the program.
There are many more ways that Magnolia practices trauma-informed care than listed above.
Taking a trauma-informed care approach is an ongoing process which requires continuous training, sensitivity, assessment, feedback, and learning on the part of staff and organizational leadership.
Centers for Disease Control and Prevention. “Infographic: The 6 Guiding Principles to a Trauma-Informed Approach.” Last revised September 2020. https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm.
Center for Health Care Strategies. “What Is Trauma-Informed Care?” Updated 2021. https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/.
University at Buffalo, Buffalo Center for Social Research. “What is Trauma-Informed Care?” http://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html.