What Is Trauma-Informed Therapy?

Patient and counsellor wearing face masks during a therapy session during the COVID-19 pandemic.

FatCamera / Getty Images

What Is Trauma-Informed Therapy?

Trauma-informed therapy involves accounting for clients’ trauma and its impact on their behavior, mental health, and ability to engage in treatment. Trauma-informed therapists assume that a client could have a trauma history and will take steps to avoid inadvertently triggering or re-traumatizing the client in treatment.

What Is Trauma?

“Trauma” can mean many different things, and there is no one set type of trauma or one way that people will respond to a traumatic event. The same event will have different impacts on different people, and not everyone who experiences a traumatic event will have trauma afterward.

In general, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines trauma as: “Exposure to actual or threatened events involving death, serious injury, or sexual violation in one (or more) of the following ways:

  1. Directly experiencing the events.
  2. Witnessing the events in person as they occur to others.
  3. Learning that the events occurred to a close family member or friend.
  4. Experiencing repeated or extreme exposure to adverse details of the events."

The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Insurance continue to study the impact of ongoing stressors on children, known as Adverse Childhood Experiences or ACEs.

According to this research, Adverse Childhood Experiences can lead to conduct issues in children and adolescents and can have lifelong consequences. Adults with high ACE scores are at greater risk than those with lower scores for physical health issues, mental illness, and early death.

The researchers identified 10 Adverse Childhood Experiences:

  1. Physical abuse
  2. Sexual abuse
  3. Emotional abuse
  4. Physical neglect
  5. Emotional neglect
  6. Family member or caretaker mental illness
  7. Family member or caretaker substance abuse
  8. Witnessing violence against the mother
  9. Having a relative sent to jail or prison
  10. Losing a parent due to separation, divorce, or death

Additional research suggests that racial trauma should also be considered an Adverse Childhood Experience for Black children.

The initial study indicates that more than 46% of children have at least one Adverse Childhood Experience, highlighting the need for trauma-informed care.

When a therapist is trauma-informed, they are knowledgeable about trauma and understand the potential impact of trauma on each of their clients. Trauma-informed therapy emphasizes not asking, “What is wrong with you?” but instead asking, “What happened to you?”

Techniques of Trauma-Informed Therapy

Trauma-informed therapy is not about a specific intervention but rather tailoring interventions in the context of the individual’s trauma history, triggers, and specific needs. It is a lens through which the therapist views their clients, taking into account the impact of trauma on emotions, regulation, and behavior. They will also consider the effects of intergenerational trauma on clients.

Trauma-informed therapists emphasize the following areas in their practice:

  1. Physical and emotional safety. A trauma-informed therapist will take steps to ensure that clients feel both physically and emotionally safe in their sessions.
  2. Collaboration. Trauma-informed therapists aim to empower clients by educating them about their options and giving them an active role in their care.
  3. Transparency. Trauma-informed therapists are open and honest with clients.
  4. Competency. Trauma-informed therapists make sure that they are educated and up-to-date in research and best practices for working with clients who have experienced trauma. They are also aware of the unique cultural considerations that each client experiences.

What Trauma-Informed Therapy Can Help With

As the name suggests, trauma-informed therapy is beneficial in working with any individual who has experienced trauma, either in childhood or as an adult. Even if you are not in treatment specifically for your trauma, this approach can ensure your emotional safety in your sessions.

Although not everyone has experienced trauma, a trauma-informed approach will not harm someone who does not need trauma-informed care. This is why many providers take a trauma-informed approach in all sessions and not just when the presenting concern is related to a specific trauma.

The Effectiveness of Trauma-Informed Therapy

Although trauma-informed therapy does not refer to a specific set of interventions, this approach to care has been shown to increase the effectiveness in youth and adults who have experienced trauma.

Trauma-informed therapy can also address issues of guilt and shame that trauma survivors often carry.

Things to Consider When Starting Trauma Therapy

If you think that trauma-informed care is a good fit for your needs, you want to seek therapy from someone with the appropriate training. Here are some things to consider before you begin trauma therapy.

Not All Therapists Are Trauma-Informed

Most therapists are exposed to trauma work in their training, but not all therapists are trauma-informed.

When finding a therapist and determining if their trauma training is a fit to your unique needs, you might ask the following questions:

  1. What training have you done in trauma-informed care?
  2. Do you consider yourself trauma-informed, and what does this mean to you?
  3. What is your approach to therapy with clients with trauma history?
  4. What kinds of clients do you work with, or what kinds of trauma do you work with?
  5. Are there any types of trauma that you do not feel comfortable or competent to work with?
  6. At what pace do you go when treating trauma?

Many therapists will list several specialties in directories or biographies, and not everyone who selects "trauma" as an area of expertise has the same level of training or comfort in trauma-informed care. It is OK to ask questions and find a therapist with whom you feel comfortable and safe.

You May Be Asked About Your Trauma History During the First Session

In an intake appointment, therapists typically need to gather extensive information about your history in order to make appropriate recommendations for your care. This may include questions about your trauma history. If you feel uncomfortable sharing certain details, it is OK to tell the therapist. A trauma-informed therapist will address your concerns and make adjustments based on your needs.

Some therapists might ask clients not to dig into the details of their trauma in a first session. This is because they want to ensure that the client has the skills to cope with whatever feelings come up before exploring the trauma itself. A trauma-informed therapist will communicate their approach to you and guide the session to fit with this approach.

If you begin sharing these details and your therapist decides to redirect the session, this does not mean that you have done something wrong. Your therapist might have sound reasons that they should explain to you if this comes up.

Therapy can be exhausting work because it involves exploring emotions and memories that you are not used to thinking about. Imagine that your trauma is a physical wound that you have been ignoring—you need to clean the wound so that it can heal properly, even though you know cleaning it is going to be painful. Be gentle and patient with yourself as you go on this healing journey.

A Word From Verywell

If you're dealing with the effects of trauma, there is no shame in reaching out for help. A trauma-informed therapist will validate your emotions and equip you with the healthy coping mechanisms that are necessary to safely process your trauma.

6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). 2013. https://doi.org/10.1176/appi.books.9780890425596

  2. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245-258.

  3. Bernard DL, Calhoun CD, Banks DE, Halliday CA, Hughes-Halbert C, Danielson CK. Making the “c-ace” for a culturally-informed adverse childhood experiences framework to understand the pervasive mental health impact of racism on black youthJourn Child Adol Trauma. 2021;14(2):233-247.

  4. Zettler HR. Much to do about trauma: a systematic review of existing trauma-informed treatments on youth violence and recidivismYouth Violence and Juvenile Justice. 2021;19(1):113-134.

  5. Bloomfield MAP, Yusuf FNIB, Srinivasan R, Kelleher I, Bell V, Pitman A. Trauma-informed care for adult survivors of developmental trauma with psychotic and dissociative symptoms: a systematic review of intervention studiesThe Lancet Psychiatry. 2020;7(5):449-462.

  6. Capone C, Norman SB, Haller M, et al. Trauma Informed Guilt Reduction (Trigr) therapy for guilt, shame, and moral injury resulting from trauma: Rationale, design, and methodology of a two-site randomized controlled trial. Contemporary Clinical Trials. 2021;101:106251.

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.