The importance of trauma-informed practice

In ensuring clients are supported after life-changing injury, and in protecting treating professionals, trauma is a key topic for consideration across the whole spectrum of neuro-rehab. Here, we learn more about how Think Therapy 1st’s focus on trauma is enabling clients to achieve life-changing outcomes, while also ensuring its team have support on both a professional and personal level

Whenworking with people after serious or life-changing injury and in devising a plan for their rehabilitation, very often, given the circumstances of what happened to them, trauma will also be a key factor for professionals to address.

Trauma can impact every aspect of a person’s recovery, and if not addressed with bespoke support, can be central in hindering the progress they may otherwise make in rebuilding their lives.

But trauma is a deep and multi-faceted topic. While the circumstances of their injury may have been traumatic in themselves, this can revive memories of experiences in people’s pasts which can exacerbate their current state of psychological distress. And while trauma is most associated with seriously injured clients, the same principles also apply to those tasked with delivering their care and rehabilitation. For professionals continually exposed to traumatic details and injuries, and delivering the support needed for clients to rebuild their lives, this can be a heavy burden to carry. Furthermore, for any who have had traumatic experiences in their own lives, their roles can present triggers which amplify existing psychological distress.

For both clients and professionals, Trauma Informed Practice (TIP) is critical to ensure that all steps are taking to ensure their wellbeing, and for rehabilitation to progress in the most positive way possible.

At Think Therapy 1st (TT1st) this is a topic which carries great importance. Committed to person-centred care, while also protecting their team, trauma is a key focus for every aspect of what is delivered. With its specialist rehabilitation occupational therapy (SROT) approach ensuring every activity is geared around rehab and positive recovery, TT1st has built a reputation for the life-changing outcomes it secures - and identifying and appropriately supporting with trauma is a key aspect in achieving that.

“I tend to think of trauma by using the ‘invisible backpack’ analogy – everyone carries their emotions, their fears, past experiences and current concerns.

We don’t know what hides in another person’s backpack, or how heavy it is, or the impact of what is in there on the person’s life,” says Aimee Crane, Operations Director at TT1st.

“We have to be very mindful of trauma in the service that we are delivering to clients. It is very likely they will have been through very traumatic events with their injury - but what has happened in their lives previously may be something we don’t know initially, and it may take some time to find out.

“Equally with our team, we’re very aware of the psychological impact our jobs can have, and are committed to the wellbeing of our clinical and operational team.

“We have also had circumstances where the work of our OTs with clients has re-traumatised them from something that has happened in their own lives. That is something else we need to be very aware of, and we have procedures in place to support with that.” TT1st is introducing a new programme of in-depth training for its clinical and support team, to make them aware of trauma, the signs to look for, and how to make the necessary interventions to assist with that.

“This is so important for us, it’s central to us being able to deliver the genuinely life-changing outcomes that we do, so we are doing all we can to protect the team, while also enabling them to do the very best for their client,” says Aimee.

Trauma-informed practice for clients

After sustaining life-changing injury, the circumstances of what happened, and the sense of loss so often felt around the life they used to have can have profound psychological consequences. While in some circumstances a client will present with acute trauma and symptoms of PTSD, that is not always the case. And while they may appear to be coping, trauma can manifest in a number of ways.

“We have to be very mindful of how we approach every client so as not to re-traumatise them, so we are very careful in how we work with people, especially at first,” says Aimee.

“Dealing with a client and knowing the circumstances of what has happened to them, but not knowing at this point what is in their backpack, can be difficult and it can be complex to unpick.

“Trauma can make people feel powerless, and the therapist-client relationship is a risk here because there is a power imbalance. A therapist in doing their job does have ‘power’ over the client, but for us, we always make sure this becomes a collaboration and a partnership, rather than a therapist appearing to be in control.

“This is an important thing to address to ensure we are building a positive relationship with the client and are supporting them in every way possible.”

For Aimee in her role as an OT, she comes across trauma in clients oftenbut the complexities around that can be ongoing, presenting new challenges as rehabilitation progresses.

“I have a client who was subject to a targeted attack, she sustained a brain injury and many physical injuries and was clearly an exceptionally traumatic experience for her,” says Aimee.

“She went through a 12-month rehabilitation plan with us with wonderful outcomes, the progress she made was fantastic, but then within six months of being discharged, she made contact with us, reporting that she was no longer maintaining her therapy goals. We found that really puzzling because we have excellent outcomes, people are discharged, and our work enables them to thrive on their own, going on to maintain their gains, and, more often than not, raising to new challenges and achieving new goals, post-discharge.”

“When I reconnected with the client, I found out that the perpetrator of the attack had been released from prison and was back in the local community. Our client went from having rebuilt her life to living behind closed curtains in her house, and experiencing post traumatic effects, including re-experiencing (of the traumatic event), avoidance (of stimuli associated with the trauma) and hypervigilance, all of which impacted on her overall ability to function day-to-day.

“While we had addressed the traumatic aspects of her attack and some aspects from her past too, and we had made such brilliant progress, this had re-traumatised her all over again.

“Our work with her continues and is ongoing, but we will do everything we can to help her rebuild from the traumatic experience she has been through, as we did previously. My role is to help the client to lessen the effects of the traumatic event – we are doing this by introducing distraction techniques, self-soothing activities and mindfulness. It’s important to understand what meaning the client has attached to the event, and if appropriate, guiding them towards a more helpful and less damaging meaning.

Deep-rooted past trauma is a further factor to rehab, with TT1st supporting clients as best they can in rebuilding from this.

“While we often say ‘it’s good to talk’, actually for people who have been through historical trauma, it’s not necessarily something they want to open the lid on” says Aimee.

“Clients might mention something to us, which we can then be mindful of and understand the trauma they have experienced, but we'll absolutely respect a person’s decision not to want to bring it up. There is little evidence for the idea that if we talk about something then that in itself makes it less distressing.”

“There are so many aspects to trauma that people process things in very different ways. Through our approach to TIP, we can support them without being intrusive, but while putting together a plan to help them rebuild their lives.”

Trauma support for staff

While trauma is most associated with survivors of serious injury, the impact on the professionals supporting them through that can be significant.

“We hear TIP mentioned a lot, but that isn’t just about how we as therapists work with our clients. It’s also how we interact with other staff, and how we support our team,” says Aimee.

In addition to the often highly distressing situations rehab professionals support with, events in their own lives can have further impact.

For one TT1st OT, memories of a childhood trauma were revived by work they were completing with a client, which had a profound impact on them.

“We are exposed to all sorts of situations as therapists, but even with your own colleagues, you don’t know what they’re carrying in their backpacks from their own background and childhood.

“It was distressing for our OT, and while we’ve always been committed to our staff wellbeing and TIP is nothing new for us, it did make us think about what more we can and should be doing.

“We are constantly exposed to working with people who have been through all kinds of situations, and none of us will have gone through life with no low points or bad experiences, so you just never know how someone may be affected until you are in that position of having to support them through it.”

To help make all possible provision to support their team - both in their professional and personal ability to deal with trauma - TT1st is rolling out new training across its operation. Initially delivered to all in-house clinicians and operational staff, it will then bring in its OT network across the country.

“We will be covering the common effects of trauma and exploring ways to apply TIP in our clinical work, including considerations to ensure clients feel safe, empowered, have choice and control, whilst developing a trusting client-therapist relationship.

“We’ll also explore what makes a trauma-informed organisation, because we know that supporting our team in this way helps with our resilience and motivation to do the job, as well as our overall job satisfaction.

“Trust and safety are absolutely central to what we do at TT1st, not just with the clients, but internally with staff too. We want to make sure that everything is threaded through – our policies, staff one-to-ones and appraisals, for example. So the support structure is in place and everyone knows about it.

“It’s very important in terms of empowerment. That is something we focus on absolutely with our clients - for example, in their assessment form, the first thing we look at is the client’s voice being heard - but for our team, we want them to feel equally empowered.

“By knowing the support that is in place, not just for them in their professional roles but also in their own lives, we hope we are doing all we can to empower them as people.” tt1st.co.uk