What About Trauma?
Samia Estrada, M. A.
Alliant International University
Let’s not forget trauma! The experiences of trauma can be found in the histories of adults, children, and even providers. Unrecognized trauma can mask itself as many different symptoms and/or somatic experiences. A provider who is unaware that trauma is underlying can end up wondering why treatment is not working and feeling frustrated with the lack of progress. When we know trauma is present, we can diagnose and treat properly. There’s a myriad of experiences of trauma that our clients, and possibly even ourselves, have endured and these experiences continue to grow. For example, with the recent political climate and unease in our country, we are seeing more cultural trauma and trauma that stems from racist and hateful acts. Knowing what we know about trauma, it is important to ask the right questions to find out what our client’s experiences have been. Many individuals don’t equate their experiences with trauma, so asking if the client has had a traumatic experience may not always provide the best results; questions should be specific. There are various trauma measures that are quick and easy to use and can also help with this task.
Knowing what to look for will also be of help when diagnosing and conceptualizing a case. In kids, trauma can manifest in many different ways. To the untrained eye, trauma can look like defiance, anger, aggression, ADHD, or worse. Children may have endured their own trauma or have had intergenerational transmission of trauma from a caregiver. Intergenerational transmission of trauma happens when a parent is a trauma survivor and, directly or indirectly, the parent’s trauma affects the way their child can deal with stressors and the way that parent disciplines (Schwerdtfeger, Larzelere, Werner, Peters, & Oliver, 2013). Furthermore, children who witness intimate partner violence are at a higher risk for trauma symptoms as they get older (Davies, DiLillo, & Martinez, 2004). Similarly, children who experience sexual abuse are at a higher risk for sexual assault in adulthood (Schwerdtfeger et al., 2013). In adults, symptoms of trauma can look very different for each individual. Different traumas can also yield different symptoms. For example, Stappenbeck et al. (2016) found that adult survivors of child physical abuse tend to be at a higher risk for symptoms of alcohol abuse, promiscuity, unsafe sexual practices, and dissociation. In addition, these individuals are at increased risk for revictimization and can have other interpersonal difficulties, such as lack of trust and a decrease in marital satisfaction, intimacy, and closeness in relationships (Fortier, DiLillo, Messman-Moore, Peugh, DeNardi, & Gaffey, 2009).
One of the best things you can do for a client with trauma is to encourage positive social support. Cohen & McKay (1984) found that coping increased when clients had a spouse that was consistently supportive. Supportive individuals can also challenge a client’s maladaptive thinking with regards to threats in their environment and contribute to a feeling of safety (Evans, Steel, Watkins, and DiLillo, 2014). Mental health providers can also increase a feeling of safety by providing space for clients to process cultural issues and providing resources for services that can help with legal representation, housing assistance, and other issues. Additionally, knowledge of the many ways trauma can manifest and common symptoms can help guide a treatment plan. In the above example about adult survivors of childhood sexual abuse, knowing that the prevalence of unprotected sexual encounters tends to be high would be information that one can use in order to incorporate psychoeducation about safe sexual practices.
As mental health providers, we can also help by becoming aware of our own trauma. Although research on this topic is limited, some research suggests that provider’s judgments and the way providers conceptualize cases can be influenced by trauma history (Cromer & Freyd, 2009, Esaki & Larkin, 2013, Jackson & Nuttall, 1994). In addition, providers who have a history of trauma are also more susceptible to secondary traumatic stress, vicarious trauma, compassion fatigue, and burn out (Esaki & Larkin, 2013). Some organizational factors can increase this risk, such as having inadequate supervision and support and not having sufficient client resources (Esaki & Larkin, 2013). At the organizational level, these are important factors to consider. Providers can also look out for one another for signs of secondary traumatic stress, vicarious trauma, compassion fatigue, and burn out. At the personal level, a provider can consider ways to increase self-care in order to mediate the effects of trauma in their work. Providers can try some of the following: Create a sense of meaning, participate in community activities, seek support from others, do something comforting, find ways to release stress, and many more. Warren, Morgan, Morris, & Morris (2010) recommend creative writing as a way to “maintain personal wellness.” There are many self-care ideas available online and in print.
As providers there are many things that we can and should do to care for ourselves and for our clients. Being curious about trauma can lead to improvement in session, accurate diagnoses, and appropriate treatment plans. Knowledge about trauma, and the many ways it shows up in our work, increases our understanding of our clients and of ourselves as providers. By taking care of ourselves, we can take better care of others. Lastly, remember to be kind to yourself. Trauma work can be very taxing but, at the same time, it can be very rewarding.
Cohen, S., & Mc Kay, G. (1984). Social support, stress, and the buffering hypothesis: A theoretical analysis. In A. Baum, S.E. Taylor, & J. E. Singer (Eds.) Handbook of psychology and health(pp. 253-267). Hillsdale, NJ: Erlbaum.
Cromer, L. D., & Freyd, J. J. (2009). Hear no evil, see no evil? Associations of gender, trauma history, and values with believing trauma vignettes. Analyses of social issues & public policy, 9(1), 85-96. doi:10.1111/j.1530-2415.2009.01185.x
Davies, C. A., DiLillo, D., & Martinez, I. G. (2004). Isolating Adult Psychological Correlates of Witnessing Parental violence: Findings from a predominantly Latina sample. Journal of family violence, 19(6), 369-377. doi:10.1007/s10896-004-0682-9
Esaki, N., & Larkin, H. (2013). Prevalence of adverse childhood experiences (ACEs) among child service providers. Families in society, 94(1), 31-37. doi:10.1606/1044-3894.4257
Evans, S. E., Steel, A. L., Watkins, L.E., & DiLillo, D. (2014). Childhood exposure to family violence and adult trauma symptoms: The importance of social support from a spouse. Psychological Trauma: Theory, research, practice, and policy, 6(5), 527-536. doi: 10.1037/a0036940
Fortier, M. A., DiLillo, D., Messman-Moore, T. L., Peugh, J., DeNardi, K. A., & Gaffey, K. J. (2009). Severity of child sexual abuse and revictimization: The mediating role of coping and trauma symptoms. Psychology of women quarterly, 33(3), 308-320.
Jackson, H., & Nuttall, R. (1994). Effects of gender, age, and history of abuse on social workers’ judgments of sexual abuse allegations. Social work research, 18(2), 105-114
Schwerdtfeger, K. L., Larzelere, R. E, Werner, D., Peters, C., & Oliver, M. (2013). Intergenerational transmission of trauma. The mediating role of parenting styles on toddlers’ DSM-related symptoms. Journal of aggression, maltreatment & trauma, 22(2), 211-229. doi: 10.1080/10926771.2013.743941
Stappenbeck, C. A., George, W. H., Staples, J. M., Nguyen, H., Davis, K. C., Kaysen, D., Heiman, J. R., Masters, N. T., Norris, J., Danube, C. L., Gilmore, A. K., & Kajumulo, K. F. (2016). In-the-moment dissociation, emotional numbing, and sexual risk: The influence of sexual trauma history, trauma symptoms, and alcohol intoxication. Psychology of violence, 6(4), 586-595. doi:10.1037/a0039978
Warren, J., Morgan, M. M., Morris, L. B., & Morris, T. M. (2010). Breathing words slowly: Creative writing and counselor self-care—The Writing Workout. Journal of creativity In mental health, 5(2), 109-124. doi:10.1080/15401383.2010.485074