In recognition of how common trauma is in society and in an effort to help address its devastating consequences on people’s mental health, clinical psychology has shifted towards becoming more trauma-informed. In the UK at least, it is an area of interest that candidates are being asked about more often during their doctorate interviews. Therefore, if you want to work in clinical psychology and if you’re an aspiring clinical psychologist then trauma-informed approaches are a critical area to understand. In this psychology podcast episode, you’ll what makes a psychologist trauma-informed, what are the 6 core principles of trauma-informed approaches and more. If you enjoy learning about trauma, mental health and clinical work then this is a great episode for you.
Today’s psychology podcast episode has been sponsored by CBT For Anxiety: A Clinical Psychology Introduction To Cognitive Behavioural Therapy For Anxiety Disorders. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What Is A Trauma-Informed Approach?
As I mentioned in the introduction to today’s episode, there is a big move within clinical psychology to become more trauma-informed. Due to psychologists need to be trauma-informed in recognition of how common trauma is in the world and as psychologists we need to respond to this harsh reality that trauma causes. For example, if I go off my own experience here, I’ve been through two types of trauma, one a single event and another form of trauma that stretched on for over a decade. As well as trauma is a wide-ranging umbrella term for different traumatic situations that might not affect some people but they might affect others. These can include child abuse, sexual violence, witnessing a murder, being a soldier and so on.
Therefore, being trauma-informed means psychologists need to be aware of how trauma can impact an individual personally and societally too as well as psychologists need to anticipate how trauma survivors might respond to our actions and words so we don’t compound the damage and suffering that the trauma causes.
In addition, this concept connects to the idea of secondary traumatisation. This is normally seen in forensic psychology where victims of crimes are traumatised again by going through the criminal justice system. Yet I see no reason why this cannot be extended to clinical psychology because if you have a clinical psychologist who isn’t trained in dealing with trauma and they make a mistake with a client by saying the wrong thing. Then I can easily see how this would retraumatised the client.
For example, let’s take a personal example and talk about my child abuse during my adolescence and let’s use this situation in when I went to therapy last August. If my therapist wasn’t aware of trauma or LGBT+ issues and she said something that was blaming me for my abuse, my mental health and my situation then that would have been extremely damaging and it would only add to my trauma. Since in my mind, if a therapist cannot accept me and support me being gay and all the trauma I’m experiencing around it then no one can accept me. So my mental health would continue to decline.
This is why psychological training is so important as well as having trauma-specific training is critical.
Ultimately, being trauma-informed means psychologists are helping to create a world that can foster a client’s resilience, growth as well as healing.
What Are The 6 Core Principles of Trauma-Informed Approaches?
As you can probably imagine, all of us aspiring and qualified psychologists can say we want to be trauma-informed as much as we want but this intention isn’t enough alone. Also, when we consider just how many different examples of traumatic experiences there are and all the different types of trauma survivors, it’s very difficult to land on a narrow set of clinical guidelines that are going to be useful in every situation. This is why clinical psychologists have managed to come together to create a set of 6 guiding core principles that we can apply flexibly to each client as well as situation.
The source behind these guidelines are the Substance Abuse and Mental Health Service Association (SAMHSA) in 2014, and now we’ll look at these 6 core principles.
What Is Trustworthiness And Transparency In Clinical Trauma Work?
The first principle we’ll look at isn’t directly linked to client work but trustworthiness and transparency is a principle focusing on helping clients to feel more willing to engage with the mental health service that we work in. When it comes to being trustworthy, this means we need to keep our promises, be reliable and we need to clearly show this towards our clients. Such as, we might say to our clients one thing and then follow up with the client with evidence to show that we’ve done this for them. One example is that if you say you’re going to email a medical doctor for some reason then you could show them the email you sent, of course whilst sticking to data protection and any other rules your service has in place.
Furthermore, transparency helps clients to understand what your intentions and priorities are so the clients know where they stand with you as well as the mental health service. One way of putting this concept is it is the equivalent of “showing your work” when you try to solve a problem, so you might tell your client your thought process and what factors you considered when trying to make the clinical decision.
Personally, I only just realised how brilliant transparency is because when I went for my counselling assessment for my sexual violence therapy, the psychologist doing the assessment told me a lot of “extra” information. For example, she explained why I wouldn’t be suitable to see a placement or trainee counsellor and she would talk to me and tell me what she was thinking as she was making notes. Therefore, she might have “only” been a psychologist assessing me but because she was completely transparent with me and she kept me informed of everything she was thinking, I felt really comfortable. And I am really looking forward to working with the service whenever I come off the waiting list.
How Does The Safety Principle Make A Psychologist Trauma Informed?
Whenever it comes to trauma, it is very common and a natural response for people not to feel safe. For example, me and my best friend were talking the other night because they asked me a question from the kitchen, they found it weird that whenever they asked me something I stop everything immediately and “ran” to them. I said that it was because if I didn’t come quickly in the past to someone asking me a question or if I didn’t do something quick enough then I would be shouted at or occasionally worse, and my best friend wanted me to learn that I am safe with them in our new house. And the same goes for the intense social anxiety I often have because of my sexual assault.
It can be extremely difficult for trauma survivors to feel safe but without a feeling of safety clinical work is often doomed to fail.
As a result, safety encourages clients to focus on the psychological intervention and support that is being offered so clients can feel emotionally and physically protected from danger. Also, it’s important that psychologists understand what makes clients feel unsafe so this can be very different across different trauma experiences and across different cultures. Such as when it comes to what makes me feel unsafe due to my sexual assault, big crowds, a dimly lit room and large men make me feel very unsafe. Then again before I dealt with my abuse, homophobia and older straight men would make me feel very unsafe, so it is different depending on the situation.
In addition, it’s worth noting that safety doesn’t mean that things will always be easy for the client or even comfortable and it’s important to make this distinction at times. Since the idea of safety is built on the idea that a lot of trauma survivors lack a basic sense of safety (this is why I have so many panic attacks when I’m in public and meeting new people), and a lot of non-trauma survivors take their basic sense of safety for granted.
As a result, when it comes to applying the safety principle in clinical work, it’s about levelling the playing field so all your clients can enjoy a basic sense of safety whenever they’re with you. So an individual might report feeling safe when they’re able to just stop scanning their environment for any threats or dangers for the hour they are with for you, and they’re no longer having to focus on defending or protecting themselves.
And it is this basic sense of safety which causes me a lot of issues in my life at the moment because whenever I’m out and in a busy place, I am hypervigilant and hyperfocused on scanning my environment, watching out for anyone who would hurt me and so on. I understand that these are all illogical thoughts but it is still scary.
How Does Empowerment, Voice And Choice Make A Psychologist Trauma-Informed?
Our next principle focuses on making sure psychologists help clients to use their voice and power. Since trauma is a very disempowering experience so clients can be fearful and reluctant to step forward so it is up to psychologists to gently help and support clients to develop skills in this area that will help them become more empowered. For instance, helping to develop a client’s assertiveness and advocacy. As well as the interesting thing about all 6 of these core principles is that the more you embody all of them, the more likely clients are to be empowered too.
As a brief personal example, one major issue I’ve had following my sexual assault is my disempowered and my inability to make decisions. For example, there are times when I simply cannot make decisions at all, including really tiny ones like in what cupboards to put my kitchen stuff in when I moved into my student accommodation. I simply couldn’t make a decision because I didn’t trust myself, I didn’t have self-worth and so on. And there are lots of different examples of disempowerment in the past few months and it is absolutely horrible. I don’t wish being paralysed with fear so you cannot function and make basic decisions on anyone.
How Does Mutuality And Collaboration Make A Psychologist Trauma-Informed?
In addition, our next principle takes this even further because it encourages clients to focus on who has power and who might be vulnerable to its misuse. Due to this principle is about a psychologist embodying collaboration and mutuality, a psychologist can help a client to reduce this power differential and its risks by engaging in more active collaboration across different levels of the service between clients and staff. For instance, a mental health service might get clients to give their input on the service (Collaboration and Mutuality) when considering a new policy or procedure then share how that information was used when the service was making its final decision (transparency).
Ultimately, I think this connects to all clinical work and the importance of the therapeutic alliance. I know all therapy work is effectively a collaboration depending on the therapy module being used, but in trauma work, this is even more important because trauma survivors are already so disempowered. Then if a psychologist walked in, did a lot of things to the client without working with them and then kept doing this then the trauma survivor wouldn’t see any benefit because nothing would change. This so-called clinical work would only be a continuation of their disempowerment and trauma without anything changing.
How Does Understanding Cultural, Historical And Gender Issues Make A Psychologist Trauma Informed?
There are a lot of historical, cultural and gender issues that exist in the world and the vast majority of these impact trauma survivors, so it is flat out critical to understand how these issues impact trauma-informed work. This is why psychologists need to pay attention to the culture and world we live in so we can see the strengths, core values, social connections and resources that people might ignore. As well as psychologists need to understand how a historical context or how a client experiences discrimination might impact them but also how these experiences might frame how a client perceives our actions or policies. Due to by understanding these historical issues, we can have a better understanding of how to implement the other core principles in this episode.
And when it comes to my personal trauma, these historical, cultural and gender issues are a major problem for me. Since my childhood trauma was caused by the cultural and historical issues around homophobia and how older people see and treat gay people. As well as when it comes to my sexual assault, the gender issue of being male and how the vast majority of people believe males don’t experience sexual violence is very challenging and it has compounded my trauma in more ways than I want to admit.
So please, try to understand the different cultural, historical and gender issues that will impact your clients. It is a fascinating topic and it is flat out critical for trauma-informed work.
How Does Peer Support Make A Psychologist Trauma-Informed?
Our final trauma-informed principle focuses on how peer support can help clients find opportunities to learn and grow with other people who have lived experiences of trauma. Before on the podcast I’ve spoken about the benefits of group therapy and peer support groups is one of the three types. Peer support can be useful because it gives trauma survivors a chance to develop a stronger sense of belonging and it can support empowerment too because it is normally easier to speak up as a group than as a single individual.
Clinical Psychology Conclusion
When it comes to trauma-informed work, this is flat out critical for aspiring and qualified psychologists because a trauma-informed approach isn’t just about the students or clients that we work with, to be honest. It is about our fellow psychologists, staff and our leaders at our mental health services, as well as ourselves, who could be trauma survivors. Our clients are not the only trauma survivors in the world.
Therefore, these 6 core principles can be used in everyday context and setting, even if you’re not working with trauma survivors explicitly, because all these principles can be useful in clinical work. As well as even when you’re working with your peers, it is always good to make them feel safe, be transparent and collaborate with them and more. Sometimes I feel like just knowing how to be more trauma-informed helps you to become a better person and after this podcast episode, I believe that even more.
To wrap up this trauma episode, it needs to be said that these principles need to be applied flexibly because chances are they will look very different depending on the type of trauma you are working with now or in the future. Yet they are still important because these principles have the power to transform and heal our relationships, our mental health services and maybe even ourselves if we’re trauma survivors.
Working with trauma might sound scary to a lot of people, but as a trauma survivor myself, yes what I experienced and went through was utterly terrifying. But I am not a victim that needs to be treated carefully, like a child or like I am anything other than a regular human being who has been through hell and back. I am simply a survivor trying to live my life as much as I can but I need psychological help for that and that is where all of us come in now or in the future.
Clinical trauma work might sound scary but it can probably be some of the most rewarding work we might ever do as psychologists. And we might transform lives for the better even more than usual.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
CBT For Anxiety: A Clinical Psychology Introduction To Cognitive Behavioural Therapy For Anxiety Disorders. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Champine, R. B., Lang, J. M., Nelson, A. M., Hanson, R. F., & Tebes, J. K. (2019). Systems measures of a trauma‐informed approach: A systematic review. American Journal of Community Psychology, 64(3-4), 418-437.
Chu, Y. C., Wang, H. H., Chou, F. H., Hsu, Y. F., & Liao, K. L. (2024). Outcomes of trauma‐informed care on the psychological health of women experiencing intimate partner violence: a systematic review and meta‐analysis. Journal of Psychiatric and Mental Health Nursing, 31(2), 203-214.
Cutuli, J. J., Alderfer, M. A., & Marsac, M. L. (2019). Introduction to the special issue: Trauma-informed care for children and families. Psychological Services, 16(1), 1.
Forkey, H., Szilagyi, M., Kelly, E. T., & Duffee, J. (2021). Trauma-informed care. Pediatrics, 148(2).
Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., ... & Wilson, P. (2021). Trauma informed interventions: A systematic review. PloS one, 16(6), e0252747.
Maynard, B. R., Farina, A., Dell, N. A., & Kelly, M. S. (2019). Effects of trauma‐informed approaches in schools: A systematic review. Campbell Systematic Reviews, 15(1-2).
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014
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