What skills do I need to support my clients with trauma?

With an increasing focus on sensitively handling clients who have experienced trauma, it is necessary to understand the extent to which your education and training has equipped you to do this. There are different levels of expertise when it comes to working in this space; however, they are often combined together under the most commonly used label, ‘trauma informed’.

A better way of understanding the spectrum of trauma education is to separate it into three categories:

• Being aware of and sensitive to trauma (trauma aware)
• Being informed about how to engage with people who have experienced trauma (trauma informed)
• Being qualified to provide trauma renegotiation/resolution to people who have had trauma (trauma qualified)

What does it take to be ‘trauma qualified’?

Let’s start with the simplest definition. Being trauma qualified means that you have taken a formal training or qualification in resolving trauma to be able to support clients to safely work through all the pieces of their trauma and heal. 

In today’s fast-paced, multi-focused world, short courses are an appealing option. However, even a one-year course only provides a solid introductory level of trauma education to prepare you for working with trauma. 

To be suitably qualified to support complex trauma clients, 3-10 years of education and clinical experience working with a range of traumatic conditions is necessary, as well as the skills and experience to be able to identify what is trauma and what is not. 

Most people who have dipped their toes into trauma education are either ‘trauma aware’ or ‘trauma informed’. It can be useful to differentiate them from trauma qualified in this way: trauma informed and trauma aware education focuses on thinking and talking about trauma, whereas effectively working with trauma requires leaning away from knowledge and trusting your experiential awareness. 

It is now widely accepted that traumatic memories are mediated by the reptilian structures of the brain and that trauma qualified practitioners must intervene at the body level for long-term change. Body-based interventions can be movement or breath-related (e.g. tai-chi), or can target the brain from the bottom-up by increasing body awareness and strengthening the neural pathways in the areas of the brain dedicated to noticing the body. 

Although top-down (cognitive) therapies might help someone know they are safe, bottom-up (body- based, somatic) therapies recalibrate the nervous system so the body feels safe. Therefore, to be considered trauma qualified, we have to move away from ‘knowing’ to ‘experiencing’ and become skilled in working with the body to help someone heal from trauma.

What does it mean to be ‘trauma aware’?

Being aware of trauma means being able to empathise with someone else’s experience and correctly identify when they are reacting to a situation that has caused them to become distressed and their nervous system dysregulated. You might focus on their emotional response and try to calm that, but not really notice the nervous system issues in play.

You may be able to recognise that someone has experienced trauma, and you may be able to relate to the way they have reacted. However, you may not necessarily be aware of and recognise the range of potential responses someone may have to the same situation. Traumatic responses often don’t have a logical, linear explanation. 

If someone has personally experienced trauma, they are already trauma aware up to the extent of their personal experience. They may be able to empathise in helpful ways, but it doesn’t mean they are qualified to support someone renegotiate trauma – or even to understand how it has affected the person’s relationships, identity, and sense of self. 

To be considered trauma aware, you would need to understand and be mindful that a traumatic experience would have an impact on a person’s life in varying and unconnected ways, but not necessarily be able to identify the specific areas in which that person may experience that impact.

“The key difference between being trauma aware and trauma informed – the next level of trauma education – is understanding that seemingly random responses are actually connected to the traumatic event and not simply indicators of ‘bad behaviour’ or erroneous thinking.”

Safe ways to support your clients while being ‘trauma aware’

When you are trauma aware, you understand that affirmations, motivational self talk, and positive psychology sound like criticism, shame, and blame to a trauma survivor. 

Being positive feels and sounds toxic to someone who is still amid their traumatic experience and fake to someone who has already begun to heal from trauma. 

Someone who has been frequently put down (or put on a pedestal and then taken down), told they are not good enough, or that they didn’t deserve a more loving childhood because there is something bad or inherently wrong with them, would have one of two core responses:

• Feeling like their right to exist was being threatened.
• Feeling a need to protect their vulnerability because their True Self was not being validated or welcomed.

Positive psychology tells a trauma-affected brain that the way they think is the problem, but because the traumatised person is merged with their thoughts (to keep them in their heads and protect them from feeling uncomfortable body sensations), the traumatised person believes they are the problem, which feels like a no-win situation. For someone who has experienced childhood trauma, the feeling of ‘not being able to win or get it right’ reminds them of their family dynamic which caused them to feel hopeless, helpless, and unlovable on a daily basis because they couldn’t change who they are. 

For people who haven’t been belittled, gaslit, shamed and excessively criticised when they did something wrong – words of encouragement inspire them to improve. They feel motivated by phrases like, “Try it!” or “Take a risk!” or “Feel the fear!” or, “What’s the worst that could happen?”. But these same words are terrifying to someone who has a history of developmental/relational trauma. Exactly what those words invoke is different for each person, but the contraction in the body is the same. Some might experience a knot of dread, a chill of terror, or a blind rage of protest, but underneath their unique set of emotional and physiological responses is a nervous system collapse and withdrawal of the true self. 

A safe response to someone who is in distress is ‘compassion’ as opposed to ‘toxic positivity’. “Look on the bright side”, “It could be worse”, “Aw…don’t be upset!”, “The same thing happened to me” are all toxic responses because they invalidate the person’s suffering. 

Conversely, the following responses may help someone feel seen, validated, affirmed, acknowledged and welcomed exactly as they are. 

• “I see you”
• “I hear you”
• “I accept you as you are”
• “This is a tough time”
• “How can I support you?”
• “I am here for you”
• “You are not alone”
• “Tell me more about it”
• “Feel what you need to feel”

Creating ‘trauma aware’ habits in your practice

Trauma victims often feel like trauma magnets because traumatic events continue to play out in their lives. Sickness, homelessness, poverty, unemployment, violence, loss… tragedy after tragedy seems to follow them. Being trauma aware requires: 

• comprehending that this pattern is not anyone’s fault.
• a non-judgemental re-frame of the pattern as dysregulation causing mental, physical, emotional, spiritual, and energetic distress which is trying to be worked through holistically by the person’s mind-body-energy system. 

A two-day course in trauma awareness is usually sufficient to explore and understand trauma and its effects. Often, these short courses also provide education in trauma-informed practice, although they tend not to have the time to dive deeply into lived examples, which is critical to understand and empathise as well as to move the bar from trauma aware to trauma informed and ground your knowledge.

What does it mean to be ‘trauma informed’?

Becoming trauma informed is an active practice of integrating trauma awareness to create an expanded and more empathic perspective so you can be more conscious of the lived experiences of others. Through acquiring knowledge of people’s lived realities, and the skills to work with people from different traumatic backgrounds – even if they are vastly different from their own – space holders and leaders can learn to honour the wholeness of the human they are sitting with. 

Being trauma informed means that you can appreciate that individuals with a secure attachment history are capable of accepting a person’s quirk or an inconsistency without interpreting it as a ‘threat’, but it could likely compromise a relationally traumatised individual’s sense of safety. For many people who have experienced relational/developmental trauma, safety is ALL or NOTHING. There is no ‘safe enough’ – as there is for persons with secure attachment systems – and this isn’t an accurate reflection of whether the person is safe. 

Creating ‘trauma informed’ habits in your practice

To create safe, trauma-informed habits for supporting your clients, it is necessary to understand the ways you can infuse your awareness of trauma and its impact into your healing spaces, expand your understanding of trauma beyond personal experience, and honour the lived experiences and full humanity of the people you serve. 

Guiding your clients and holding space with integrity is also vital and can be achieved through understanding the value and importance of:

• safety
• containment
• boundaries
• consistency
• keeping promises and not changing your mind arbitrarily or without a compelling reason
• understanding that, even with a compelling reason and prior discussion about what will happen, there will be trauma reactions
• not adopting a ‘go with the flow’ approach because uncertainty is unsettling for people with relational trauma

As well as being criticised, shamed, and blamed, here is a short – and by no means exhaustive – list of some formative childhood experiences that contribute to complex trauma:

• Having adult responsibilities at too young an age
• A parent who ignored you or gave you the ‘silent treatment’
• A caretaker who took your behaviour personally (e.g. when you misbehaved or when you got ill)
• Being praised for your accomplishments with little curiosity about your inner experiences

For someone whose individuality was appreciated, their boundaries acknowledged, and who experienced unconditional love, the damage the above examples could cause might be difficult to fathom. Being able to comprehend the effects and the potential damage – even if someone’s experience differs vastly from your own – and empathise with them over what happened, even if it triggers your own trauma, is being trauma informed and suggests a competency that could be developed through pursuing further education and becoming trauma qualified.

What doesn’t kill you… can break you

I think it’s important to mention that the phrase, “what doesn’t kill you will make you stronger” has been proven untrue. Sometimes what doesn’t kill you, breaks you – and trauma survivors know this. They might not comprehend it with their minds, but their bodies and their nervous systems know it all too well. Although their drive to survive is phenomenal – and the energy they can and will summon in service of surviving is truly awe-inspiring – it requires a lifelong, moment- by-moment dedication to survival that feels like death hangs precariously in the balance to be able to swing the pendulum from surviving to thriving. What feels like a blip to someone who had sufficient experiences of attunement, love, and positive regard can feel devastating – even catastrophic – to a trauma survivor. 

Some helpful resources

It is essential to be familiar with the major findings in the Adverse Childhood Experiences study (1995-1997) and the lasting effects on mental and maternal health, infection and chronic disease, risk taking behaviour, injury, and life opportunities.

More recent research inspired by the study into the link between childhood trauma and various health outcomes has also been conducted. 

• “The Deepest Well” – Nadine Burke-Harris
• “Scared Sick: The Role of Childhood Trauma in Adult Disease” – Robin Karr-Morse
• “Childhood Disrupted” – Donna Jackson Nakazawa

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