Facilitating Safety Though Trauma Awareness

“The traumatic moment becomes encoded in an abnormal form of memory, which breaks spontaneously into consciousness, both as flashbacks during waking states and as traumatic nightmares during sleep. Small, seemingly insignificant reminders can also evoke these memories, which often return with all the vividness and emotional force of the original event. Thus, even normally safe environments may come to feel dangerous, for the survivor can never be assured that she will not encounter some reminder of the trauma.” - Judith Herman M.D., Trauma and Recovery 1992

I had a new client attend my clinic recently who had "seen my spiel" somewhere online and found her way to my booking page. In her past, she had used massage therapy to manage tension in her body with great success. More recently, she had begun working with her own traumas, bringing them closer to the surface. While she wanted massage therapy, she needed to work with someone trauma informed, who would respond appropriately if she started having a trauma response. When she saw my stuff she thought "this person should work."

Living with a trauma disorder is difficult. There are times when the troublesome beast seems to be sleeping. One is able to go about their days as though it is not even there. As the beast sleeps, they feel free. But as it seems to go, history can revisit us in the shape of present day relationships or experiences that have hints of the betrayals or atrocities in the past. The beast stirs in its slumber, wakes, and an intense internal struggle for self regulation and self preservation ensues. Choosing to work specifically with one’s traumas, the impacts the adaptations learned have on the current person and their relationships, can feel like setting about deliberately to wake the beast. Living with my own trauma disorder, I certainly understand how raw it feels to turn and face those painful histories and how volatile we feel, easily sublimating with rage, terror and suspicion.

And the thing, perhaps, that can be most worrisome is having a trauma response publicly. Whether it is a complete loss of emotional regulation with an outburst of inexplicable rage and fear, or a flashback event, the overwhelming ferocity of the intrusion is enough to result in restricting activities to limit the risk of exposure to triggers. Re-experiencing the feelings, sights, sounds and sensations of a traumatic event is horrifying enough it outweighs the potential benefit of the activity. Thus, choosing to participate in an activity that has the threat of triggering a trauma response requires a great deal of courage; choosing to share that activity with another requires trust that they will be competent and compassionate. The last thing a person experiencing an intrusion needs is to have to perform care taking for the other person(s) in the room.

Considering how many Canadians live through interpersonal traumas in which the natural course of intimacy and trust is perverted, trauma awareness as a health care provider means being present to the barriers this particular part of the Canadian population faces in accessing your care, and being accessible to a population whose ability to trust is compromised. We know the therapeutic alliance is important to quality health care and ruptures in that alliance can negatively impact patient outcomes. For persons living in the aftermath of interpersonal violations, that relationship can be far more delicate, hard won, and the most rewarding. Health care centres are sanctuaries where people can show up exactly as they are and expect to receive the best possible care that can be given so they can do the difficult work of recovery. Trauma awareness in health care settings, provides assurance that, should an intrusion occur, the professional will neither blame the service user nor burden them with the task of making the professional feel better. Instead, the service user can focus their attention on climbing their way back to the present moment and recovering from the intrusion.

The mirror to that skill of holding calm is knowing yourself well enough to know what traumas of your own are prone to being triggered in your office or clinical setting, and knowing how to contain them when necessary, and deal with them appropriately, later. Developing this degree of self awareness is well supported by having a therapist for one’s self and a peer support person to discuss your practice. With these supports in place, you can adapt your own behaviours and conduct in the treatment space to ensure that the professional focus in the room is always on the patient as well as find what you need to have in place - be they boundaries, policies or personal self care practices - in order to adhere to the requirements of your therapeutic alliances.

My new patient, upon reading my “spiel,” recognized my competence in providing massage therapy through a trauma informed framework and could trust that relationship to remain solid and unflinching in the event of a trauma response. And more than that, that the relationships would be structured and flow in such a way as to diminish the possibility of trauma response events from occurring in the first place. This built a sense of safety before she even stepped foot in my clinic making the courage to do so easier to gather.