Everyone has trauma. Everyone has experienced something that has hurt them and from which they need to recover – and they may never recover completely. There may always be that soft spot in their soul where they were hurt so deeply that no healing can find its way. Trauma-Informed Healthcare Approaches seems to transform healthcare organizations in ways that minimize the retriggering of those who have been traumatized and to heal their hurts.
The Meaning of Trauma
Before we get too far, we must deal with the fact that we use the word “trauma” to apply to both the event and the outcome. The bike accident is a trauma, and so, too, are the lacerations (cuts) that are sustained as a part of it. This is important, because when we’re speaking of trauma-informed healthcare, we’re speaking of a system that recognizes and responds to the outcomes. The emergency department is there to address the event, but the whole organization needs to respond to the outcome and support the healing process.
In Hurtful, Hurt, Hurting, I explained the difference between actions designed to hurt, feeling hurt, and the climb out of hurt. Trauma is much the same way. There’s the event, and there’s the need to recover from it.
One of the problems with trauma is that it ruptures relationships. It can be that quickening of pulse as you get into the car after an accident or the sweaty hands when you see a German Shepherd. It can also be a response to a person who traumatized you – the feeling when your ex calls on the phone. The goal for trauma-informed care is to facilitate the healing of relationships to people, animals, and things.
Healing the relationships is sometimes desensitization, as Albert Bandura first explained. This is done with a carefully controlled set of circumstances that makes people feel safe while moving closer to the area of their trauma.
Experiencing someone else’s trauma by hearing their story has multiple names. It’s sometimes called vicarious trauma, secondary traumatic stress, and compassion fatigue. (See Is It Compassion Fatigue or Burnout? for comparing burnout and compassion fatigue.) The fact is that listening to other people’s trauma all day takes its toll on you. It’s hard to be fully open to others’ emotions and not pick up some of the residual. That’s one of the reasons why it’s particularly important that people who are in caring professions learn how to manage their trauma effectively. They’ll be receiving it consistently and will need to effectively process it before doing their next shift.
Sometimes, it’s not yet time for someone to reveal a trauma. It’s too new or too raw, or you’re not perceived as safe enough. This places healthcare workers in the delicate position of needing to allow people to avoid discussing their trauma – and to signal care and concern that makes it safer for the person to be able to share in the future.
There’s no one answer to how to address this with patients – and people. It’s a combination of the allowing and reaching into the discomfort enough that there’s a chance to resolve it.
Wayfinding through Trauma
The best thing that organizations can do is to make it easier for people to find their way through trauma. This means sending clear signals that it’s okay to discuss, recognize, and work through trauma. Simple things like allowing space for sharing and providing trauma-specific resources can go a long way to discovering many Trauma-Informed Healthcare Approaches.