Trauma-Informed Care: Recognizing & Treating Toxic Stress Part 2
How to Manage Traumatic Stress with Trauma-Informed Care
Sometimes people experience situations that threaten their sense of safety and wellbeing. Often, traumatic stress is the result.
Trauma-informed care recognizes the impact of the toxic stress on the mind and body of a person living with trauma
People who experience traumatic stress may develop trouble with substance abuse, depression, anxiety, and relationships. They may desperately want to feel better. They don’t want to hurt themselves or others. They are coping as best they can. They want to make things better, but struggle to know what to do.
Part 1 explored why so many people live with high levels of stress, and don’t recognize trauma as part of the problem. Many physical and mental health issues have roots in unhealed trauma.
Part 2 explores how the trauma-informed therapist helps people develop new skills and resources. Trauma-informed care helps people recover, even if they don’t see trauma as part of the problem.
Why the Approach to Healing Traumatic Stress Needs to Be Trauma-Informed
Few people understand the impact of traumatic stress. When something overwhelms a person’s sense of safety, it’s tempting to think everything will be fine when the danger is gone.
Why then, is it hard to feel normal after certain kinds of experiences?
A person can experience trauma from an event as violent as rape, a car accident, physical abuse or an accident. A person can also experience trauma from subtle, invisible events like loneliness, emotional neglect from a parent, or feeling misunderstood and alone.
A person’s mind and body respond differently after the experience of trauma. Even if the overwhelming trouble is gone, you may find it difficult to manage certain situations. You may feel your emotions become either too intense or dead. You may find it hard to care for yourself well, or connect with others, and long to make things better.
The journey toward mental wellness and self-care can be especially challenging for trauma survivors.
Trauma-informed therapy helps people learn to develop and relationships and resources to make life feel good — by helping people safely process traumatic stress.
Many people don’t see their stress as trauma-related. And it isn’t necessary to see yourself as a trauma survivor to benefit. You can learn a great deal from the resources you gain in trauma-informed therapy.
Grounding and Resourcing
The trauma-informed approach is about building a relationship first, and then developing grounding and resourcing skills. Grounding techniques are tools that help you to stay mindful of the present place and time, and speak for your emotions without uncontrollably flashing back or reliving the trauma.
Building a list of resources means becoming aware of the support and strengths available to you, inside and out. This is the strengths-based approach, which is part of trauma-informed therapy.
You develop awareness of the skills and abilities you have, and how to use them to respond in new ways. Therapy helps you see qualities such as courage and persistence, and healthy ways to self-soothing that you can build on.
You identify outside sources such as support groups, understanding friends, family members, co-workers, and organizations you trust to support your healing and mental health.
Your resources can include new, healthier ways to calm and soothe strong emotions. You may be surprised to discover how helpful it is to:
- Work with mandalas – detailed patterns to color, which has a deeply calming effect
- Reach out to people you trust
- Discover CARESS, a set of techniques to help manage emotions when moving beyond self-destructive behavior (Communicate Alternatively, Release Endorphins, Self-Soothe), developed by Lisa Ferentz, LCSW.
- Rely on new-found strengths, such as a love of nature, music, meditation, reading, or journaling to calm distress
Some people seek help to stop using substances such as drugs, alcohol, pornography, or food. Some want to change using behaviors like gambling or self-harm as coping mechanisms.
A trauma-informed therapist works with you to help you establish sobriety and safety. To safely process what has happened, we begin with a foundation of trust, and clean and sober stability.
New Coping Skills and Concepts
We know that recovery is most successful when you have learned some new coping skills to manage intense thoughts and emotions, which allows you to have other options.
No one wants to feel pain and anxiety. Healing means learning to develop and rely on other healthier resources that make life better as you go.
There’s no single cure-all to make life’s challenges manageable. That’s why trauma-informed therapy focuses on helping you find as many resources as you need.
Some people work with a trauma-informed therapist and a psychiatrist, because therapy may involve medication for a time. Medical therapy can help stabilize the brain chemistry to provide a foundation for other forms of therapy.
Trauma-informed therapy helps you understand and use new ideas for managing emotions. When you are able to think and feel at the same time and/or manage your emotions, you are likely in the ‘window of tolerance’.
Before therapy, you may have struggled with emotions that were too intense (or too numb) to live with. Learning to regulate your emotions and take good care of yourself are also part of the concept of living within the window of tolerance.
The window of tolerance is the term describing the way all of us would like to live most of our lives – in this place of being able to think and feel, be present and manage our emotions.
Processing the Trauma
Trauma-informed therapy is about developing the mindfulness, grounding and resources that allow you to review what happened without becoming traumatized again.
It takes time to feel safe with a therapist, to trust, to steady emotions, and ground yourself in a healthier relationship.
You and your therapist set the pace that feels safe to you. Once you have developed that foundation of safety and stabilization, the work of going deeper and processing the more traumatic experiences can begin.
You and your therapist will look at the details of what happened gradually and slowly. The therapist can use many trauma-informed tools and skills to help guide you. You may toggle back and forth between talking about the past and what you notice and, returning to the present and noticing your safety.
A trauma-informed therapist won’t ask for your whole story right away. Instead, he or she may guide your conversation to address the trauma, and then pull back and reground; then push a little bit further, and then pull back again. This way, you can see how to navigate painful memories and emotions within your window of tolerance, without being overcome by them.
One of the goals of trauma-informed care is to support a level of containment. This is another healing skill a good trauma-informed therapist can offer you. Containment empowers you to emotionally choose when the past hurts are in your mind. Containment is in the process of putting difficult emotions in a container and taking them out when you choose to and are feeling safe. Even after looking closely at events that have been toxic or traumatic, once you use containment skills you are able to leave the therapy session feeling a sense of stability and you are able to function in daily life.
As you progress, you may learn more about the nature of your own trauma and understand that:
- You do not need to feel ashamed or ‘crazy’ for what you are going through
- You can take the time you need to review and recover (the trauma will not be resolved by the fourth session, for example, and your pace is okay – trauma therapy takes time)
- You have support and can use reliable resources
- You can understand and learn to set healthier boundaries and use self-care
- You can feel hope
A Trauma-Informed Approach Inspires Hope
The process of repair or recovery begins only when you have the resources — skills, strengths and support systems in place — that you can rely on going forward.
As a therapist, the trauma survivors I see in my practice are often amazing people. They have been through so much hardship, and they have developed tremendous personal strengths. In spite of everything they have been through, they often possess keen intuition, sensitivity, empathy and ability to support others. They are incredible survivors!
I am inspired to see so many take up the hard work of therapy despite tremendous obstacles – collaborating and connecting, creating a place for themselves of emotional safety, and beginning to learn to trust when it’s safe.
For Dr. Nadine Burke Harris, understanding the impact of trauma on health is “actually where the hope lies, because when we have the right framework, when we recognize this to be a public health crisis, then we can begin to use the right tool kit to come up with solutions.”
A trauma-informed approach helps all of us become more aware of the extent of trauma’s impact upon individuals we may know – including ourselves. It encourages us to develop the awareness to better support the healing process whether we are therapists, trauma survivors, or fellow human beings.
Resources for Survivors of Abuse
- Survivors of Incest Anonymous
Resources for Traumatic Stress, PTSD and Dissociation
- The Sidran Foundation
- The Trauma Center
- Letting Go of Self Destructive Behaviors, a Workbook of Hope and Healing by Lisa Ferentz (includes details about the CARESS technique)
- com, for dozens of free mandala pages to print
- “Doctor: Childhood Trauma Can Destroy Your Health Decades Later, Yet America Ignores It” by Nadine Burke Harris
- The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (Norton Professional Book) by Babette Rothschild
- 8 Keys to Safe Trauma Recovery: Take-Charge Strategies to Empower Your Healing (8 Keys to Mental Health) by Babette Rothschild
- Sensorimotor Psychotherapy: Interventions for Trauma and Attachment by Pat Ogden and Janina Fisher
- “The Healing Began” [poster], Bone Sigh Arts
- Trust After Trauma: A Guide to Relationships for Survivors and Those Who Love Them by Aphrodite T. Matsakis PhD