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Are Trauma-Informed Care services the same as trauma recovery services?

Updated: Jan 28



Short answer? No. One is a means of doing something -- pretty much anything -- and one is a service with a specific end goal, recovery from a traumatic experience.


The long answer?


Anyone in any practice, from parenting or personal relationships to a professional gig, can work in a trauma-informed way. Trauma-informed care is based on the 4R's* and seeks to facilitate a healthy and secure relationship between two entities. It does this through following the 6 principles of trauma-informed care -- safety, trust and transparency, collaboration and mutuality, empowerment, voice and choice, peer support, and social intersections (culture, gender, and historical issues). All this can be applied in any relationship or in any profession.


My favourite example is accounting. To most people accounting seems like it's just dealing with numbers, but what if you are an accountant serving someone who has emerged from intergenerational poverty, or someone who went through a bankruptcy? This person's history changes how they are about money in the here and now. They may have thoughts, feelings, and beliefs about money that influence the way they will interact with the accountant and their finances in the present. We live in a culture that harbours a lot of shame about poverty and bankruptcy that can be very damaging to a person's sense of self and their ability to trust money and themselves. Their relationship with the accountant may be very different than the relationship had with someone who has never had such financial struggles. The accountant who is aware will proceed with compassion, gentleness, and the ability to recognize when someone needs different or additional supports and guidance for their financial goals.


Trauma-recovery services are services that focus on recovering from a potentially traumatic experience or a post-trauma disorder. These services can be physical (think recovery from major surgery, illness or injury) or psychological in nature (recovery from domestic violence, childhood adversity, or the psycho-social impacts of major illness or injury) and are intended to facilitate healing from the experience. This can look like receiving prescription medications, occupational therapy, and/or manual therapy for symptoms like pain and immobility, or psychological interventions like EMDR, talk therapies, or cognitive and behavioural therapies for symptoms like nightmares, anxiety, or depression.


It may sound weird but trauma-recovery service providers can actually work outside of the trauma-informed lens. As an example from my own recovery, I recall a psychotherapist telling me "but if you spent a year grieving you should be better by now. Grief is about letting go, how are you still so affected?" What this therapist didn't understand is grief is not necessarily a one time thing and once you have shed your tears, and rolled your way around some acceptance its all over and you move on. Some things remain painful, some things remain infuriating and in the same ways a badly broken bone from a long time ago can sometimes cause a limp or pain, a badly broken heart from a long time ago can cause a limp and pain (metaphorically). While he was working in a trauma-recovery service and had a lot of information about how the mind and brain work, he did not see me or my struggle through a trauma-informed lens and did not appear to really understand the way trauma impacts how a person functions nor what his role in my recovery process was.


How does this apply to massage therapy? Well, in the way an accountant may need to have some sensitivity about the ways intergenerational poverty or bankruptcy can impact how a person will behave with their money and their accountant, major life altering illnesses, injuries, or abusive relationships can alter the way a person views massage therapy, the massage therapist, and themselves and their body.


Let's consider the Motor Vehicle Accident (MVA) clinics. The RMT working in a clinic that services a lot of MVA patients is working in trauma-recovery. These RMTs likely see serious whiplash injuries, people recovering from crush and impact injuries or surgery, and brain injury as well as less devastating injuries. Most people who have been in an accident -- even a catastrophic one -- will not develop post-trauma disorders. Though 75-90% of the population has likely experienced a potentially-traumatizing-experience (PTE) only about 25% of people having these experiences go on to develop PTSD symptoms beyond one month. So an RMT working in MVA care can likely expect about a quarter of their MVA practice to include people that may be dealing with PTSD related to the crash. While the RMTs are not attending to the psychological injuries and emotional pain of a devastating car crash, they may encounter the behavioural presentations related to those injuries while they focus on the physical recovery process. What can make this work trauma-informed is having a basic awareness of the potential for impact on the patient that encompasses more than their bodies and how the work the RMT and patient do together may need to be adapted to accommodate those other impacts and a nervous system that is more likely to be defensive and primed for fight/flight/freeze responses.


These people may struggle to "let go" of their bodies on the table, they may be afraid of certain movements or unable to allow passive movement and may not trust you to handle them with care. They may not even believe that recovery of any kind is possible. They may struggle a lot with home exercise because of pain, grief, frustration, anger, fatigue, or fear. This person can mistakenly be written off as "noncompliant" with their care plan, or just plain difficult to deal with. But all of this is a pretty normal reaction to a devastating and painful experience. It makes sense that a person who was injured in something as scary as a car accident might be vigilant about how they move their bodies, about how other people touch their bodies, or uncomfortable sensations in their bodies that are reminiscent of their injuries.


In trauma-informed care we frame these people as having difficulty, not being difficult. We hold their non-consent to the care plan (in whole or in part) or inability to perform various tasks we prescribe as truths we need to honour. We remove ourselves from the healing role as "controllers" who dictate what they need and instead become facilitators who are open to hearing what they say they need to heal, adapt our care plans to what they can tolerate, taking a collaborative approach. We hold space for the reality that recovery is non-linear and has no formulaic timeline. We accept damage control or harm-reduction strategies when pushing for more progress and change may not be accessible for the person. We don't argue with them or their bodies and demand behaviour they can not perform, instead we accept what is reality right now, find their current strengths and ability, and provide encouragement that we truly do believe it is possible to make forward progress. We recognize when more supports are needed and readily make connections available so they can access those supports. Ideally, the clinic has connections to psychotherapists who understand how bodily injury or events that were highly frightening for the patient can affect their physical recovery.


Trauma-informed care is a method of working with people that honours limits, and allows the receiver to be the person who determines what they need. While it is ideal for trauma-recovery services to be trauma-informed, they are not necessarily co-occurring. Similarly it is possible for trauma-informed services to not participate directly in the processing of trauma recovery. It can be as simple as providing a service that is sensitive to the ways trauma may have changed the person we are working with, and treading lightly in people's lives. It can be applied in any relationship and can do more to facilitate recovery, sometimes, than trauma-recovery services that lack the trauma-informed lens. A line from SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) says "one does not have to be a therapist to be therapeutic." And that's the magic of trauma-informed care. <3


*The 4Rs as described by SAMHSA: realize trauma is wide spread and has broad impacts on persons, organizations, and communities, recognize the signs and symptoms of trauma, respond with systemic adaptations that focus attention on mitigating those impacts, and resists trauma and retraumatization within the system and those who interact with it.


Reference

Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) 


Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J. P., … Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981

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