Creating a Trauma-Informed Care (TIC) Foundation: Essential Practices for Clinicians, Group Practices, and Treatment Centers/Agencies
As mental health therapists and medical professionals – whether you are an LCSW, LPC, LMFT, LMHC, PA, ARNP, etc. our work is deeply rooted in the care, compassion, and well-being of our clients. For those working with trauma survivors (and my bias speaks here and states “everyone has navigated less than nurturing experiences”), understanding and implementing Trauma Informed Care (TIC) is not just beneficial; it is essential and necessary. Trauma-informed care provides the bedrock upon which all effective clinical work can be built, particularly when utilizing trauma-focused modalities such as EMDR, Somatic Experiencing, Psychodrama, Brainspotting, and other embodied modalities. This post explores the six tenets of Trauma-Informed Care and why they must precede any trauma-focused interventions.
What Is Trauma-Informed Care?
Maxine Harris and Roger Fallot in 2001 [later adopted by The Substance Abuse and Mental Health Services Administration (SAMHSA)] are the pioneers who formulated and created the (6) tenets of Trauma-Informed Care, which is an approach that recognizes the widespread impact of trauma and prioritizes safety, trust, and empowerment in therapeutic relationships. It ensures that clinical practices do not inadvertently re-traumatize clients. Importantly, this framework must be the foundation before delving into trauma-focused treatments, as skipping these principles can risk harm and diminish the effectiveness of therapy. We, as practitioners, hold an absolute responsibility to reduce the risks of harming those who seek our support and services.
Additionally, the framework of Trauma-Informed Care also becomes applicable to staff members – not just clinicians. This symbiotic microcosm allows for leadership to step into the tenets, all staff members to feel supported and held by leadership, which then steps down to clients feeling that as well. Dr. Scott Giacomucci highlights the symbiosis of leadership, staff, and clients; and how if clients are not being held in a TIC way, staff will feel that from clients, and then leadership will feel and experience the same ‘harms’ from staff – and then of course the inverse effect takes place (leadership to staff to client). (If you are interested in short informational videos by Dr. Scott, find his YouTube series and give them a whirl – they are worth it). It is so vital that agencies and group practices continue to seek training, be assessed and assess themselves, and step into honesty and authenticity as they evaluate themselves and the practice/agency they operate within. As we know, treatment does not operate within a vacuum.
The Six Tenets of Trauma-Informed Care
Safety Creating a safe environment is paramount. This involves physical safety, such as a welcoming and calm therapy space, and emotional safety, ensuring clients feel respected and heard. Trauma is an experience that disrupts an individual’s sense and experience of safety. Trauma is the opposite of safety.
Trustworthiness and Transparency Therapists must communicate clearly and consistently, fostering trust. Transparency about treatment plans and therapeutic goals helps build a collaborative relationship. Trauma is often relational, and those who were supposed to protect and nurture someone failed to do so, so we have an opportunity (if not an obligation) to foster a corrective experience “in relationship” with our clients. Here, we also consider the roles of staff trusting leadership with decisions and being informed of their decisions – transparency becomes synonymous with trust.
Peer Support Drawing from the lived experiences of peers can offer clients valuable insights and validation. Peer support also normalizes recovery as a shared journey. Are we inviting co-regulation between our clients if they are in a treatment center? Support between peers invites the notion of empowerment. Are we co-regulating between staff members and our colleagues? Are staff members and our colleagues processing burnout and the vicarious traumas from working in the field?
Collaboration and Mutuality Therapy ought to be a partnership. Clients are the experts of their own lives, and mutual decision-making empowers them to take an active role in their healing. Are we considering and addressing the power dynamics that often exist within the provision of services? Are employees and support staff being empowered within the agency?
Empowerment, Voice, and Choice Clients ought to feel a sense of control in therapy. By honoring their autonomy and validating their experiences, therapists foster empowerment and self-determination. Are we helping a client claim that power back, giving them voice and choice in how they receive services – as we know often trauma does not involve choice. Do we ask for feedback and hear the voices of our clients and our employees?
Cultural, Historical, and Gender Issues A trauma-informed approach must be culturally responsive and recognize the impact of systemic oppression, historical trauma, and identity on mental health. Are we considering the broader systems that a staff member and/or client comes from – and how are we incorporating that in our services?
Why Trauma-Informed Care Must Come First
Jumping into trauma-focused modalities without a trauma-informed foundation can inadvertently cause harm. For example, processing traumatic memories through EMDR or psychodrama without first establishing safety and trust can overwhelm clients, leaving them feeling retraumatized rather than supported.
In my practice, I have seen the transformative power of taking the time to build a trauma-informed foundation. Clients often come to me eager to "dive into the deep work." By focusing initially on creating safety and collaboration (and engaging in positive resourcing), we uncovered underlying needs that were pivotal for their healing—needs that might have been overlooked in a rush to address the trauma directly.
Integrating Experiential Techniques with Trauma-Informed Care
Experiential techniques like somatic experiencing, expressive arts, and in-action modalities align seamlessly with the tenets of trauma-informed care. For instance:
Somatic Experiencing focuses on creating safety within the body, helping clients regulate their nervous systems and feel grounded before addressing trauma.
Psychodrama fosters collaboration and empowerment by allowing clients to explore their stories actively and creatively.
Expressive Arts offers a culturally responsive, nonverbal way to process emotions, honoring diverse experiences and identities.
By embedding these techniques within a trauma-informed framework, therapists ensure that interventions are both effective and compassionate.
Practical Applications for Therapists
Therapists can take several steps to implement trauma-informed care effectively:
Assess Your Practice: Reflect on your therapeutic environment and interactions. Are they fostering safety and trust?
Seek Training: Pursue continuing education in trauma-informed care and experiential modalities.
Supervision and Consultation: Engage with peers or supervisors to deepen your understanding and application of trauma-informed principles.
Collaborate with Clients: Regularly check in with clients to ensure they feel safe and empowered in therapy.
Engage in your own healing work: Doing ‘your own work’ is a sure way to prevent countertransference from inadvertently harming your clients and allows you to travel next to your clients to those heavily wounded spaces with more flexibility – as you have gone there yourself.
Conclusion
Trauma-informed care is not a step in the therapeutic process; it is the foundation upon which all clinical work should be built. By prioritizing safety, trust, and empowerment, we create the conditions for true healing to occur. Before diving into trauma-focused modalities, let us commit to building this foundation with care and intention.
If you are a therapist seeking to deepen your trauma-informed practice or explore experiential techniques, consider pursuing specialized training or consultation. Together, we can ensure that our work honors the resilience and dignity of every client we serve.