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A large part of trauma-informed care is the therapeutic relationship the forensic mental health practitioner builds with their patient or client. It’s about treating people with respect, providing information, and empowering people to make informed choices in a safe space. It requires an understanding that people are wounded, an emphasis on curiosity and collaboration, and a need to help clients develop healthy coping skills.
Dr. Jill Levenson highlighted four of her co-authored research papers during her December 5, 2024, International Forensic Psychiatry Lecture Series talk. She stressed that people have unique experiences of trauma. (You can watch a recording of the lecture online.)
The first step in providing trauma-informed care is understanding what trauma is.
What Is Trauma?
Trauma can come from a single event like a serious car accident or a prolonged exposure to something like physical, sexual or mental abuse. It’s usually unexpected and out of the person’s control. The physical or psychological threat to the person or others overwhelms the person’s existing coping skills, trapping them, resulting in intense fear, helplessness, or horror.
Lifelong trauma can lead to maladaptive survival skills and unhealthy coping skills to avoid painful emotions and situations. This can result in criminal or abusive behaviour.
Repeated trauma increases a person’s risk. People who experience chronic trauma can feel constantly on edge and struggle to control their emotions and reactions. This can result in an intense fight, flight, or freeze response that overwhelms the person’s ability to think logically.
- People in fight mode may seem combative, overreact, or go from one crisis to another. That’s because they have learned to defend themselves throughout their lives.
- People in flight mode tend to avoid being vulnerable, including avoiding relationships and intimacy. They may self-medicate with drugs or alcohol.
- People in freeze mode may be passive and have difficulty setting boundaries, remaining in unhealthy or abusive relationships.
Forensic mental health professionals need to remember that people in flight and freeze modes may not disagree with what they are being told to avoid confrontation or appear compliant.
What Is Trauma-Informed Care?
Trauma-informed care considers trauma as an explanation for behaviour. It shifts the focus from “What is wrong with you?” to “What happened to you?”
Dr. Levenson discussed the principles of trauma-informed care outlined by the Substance Abuse & Mental Health Services Administration (SAMHSA) in the United States. She highlighted that our past experiences shape our behaviours, thoughts, and feelings. Trauma can manifest in maladaptive efforts to meet needs. Meeting those needs addresses the cause of the behaviour.
Trauma-informed care focuses on the traumatic event or events, including the context in which it was experienced. The context could include the realities of the person being part of marginalized groups based on race, ethnicity, religion, ability, sexuality, class, gender, and age.
It also addresses the meaning the person attaches to their experiences, including shame, learned helplessness, fear, and anger. This needs active listening skills and asking questions with curiosity and compassion.
Part of what feels threatening or scary in an environment is not knowing what will happen next. So, tell people what you will do or what will happen next.
“Helping relationships should feel safe. And safe relationships are predictable, consistent, and non-shaming. We should be modelling respectful boundaries, language and use of power, and really making sure that we’re paying attention to not reproducing disempowering dynamics that might be similar to those in abusive families,” Levenson said.
Unfortunately, some social and health interventions, child welfare, psychiatric criminal justice and medical interventions can be disempowering, oppressive, or threatening, which can be traumatizing. People in the forensic mental health system are often treated with contempt by professional helpers, which can be re-traumatizing.
She encourages forensic mental health professionals to work collaboratively with their patients or clients to define their treatment goals to meet their individual needs. Helping them understand their options and valuing their voice and choice can empower them. It encourages them to learn how to self-correct maladaptive coping behaviours rather than being overly punitive.
Peer support through group therapy and informal online groups allows people to talk with others who have experienced similar trauma, not only for support and information sharing but also for validation of their experience.
