April 14, 2021
Trauma-Informed Care, EMDR
Trauma is often thought of as a “deeply disturbing or distressing experience.” By this definition, it is hard to imagine a human being who has journeyed through life without answering yes to the question “Have you experienced any trauma in your life?” For some people, this may be a single occurrence such as a car accident or natural disaster. For others, there may be a life history that includes multiple, complex factors that have led to psychiatric distress, including adverse childhood experiences, abuse, neglect, or domestic violence.
The prevalence of trauma is profound. Many Hopewell residents have co-occurring diagnoses of PTSD or are experiencing trauma related symptoms that require specific consideration and care during treatment.
For many Hopewell residents, the answer to the question “Have you experienced any trauma in your life?” is often “Yes, my mental illness.”
Trauma-Informed Care is thus a critical component of treatment at Hopewell. Trauma-Informed Care is a means of organizationally structuring mental health care services with the supposition that most individuals receiving services have a trauma history whether or not they meet diagnosis criteria for PTSD.
Trauma-Informed Care requires changing the central question of treatment from “What is wrong with this person?” to “What has happened to this person?” [1] In doing so, communities such as Hopewell can find ways in which to create an environment that is sensitive to resident trauma histories and intentionally creates a community of support and understanding instead of unintentionally causing further harm through re-traumatization.
These are the six guiding principles of Trauma-Informed Care according to SAMHSA [2].
- Safety
- Trustworthiness & Transparency
- Peer support
- Collaboration & Mutuality
- Empowerment & Choice
- Cultural, Historical & Gender Issues
It is essential to provide for the physical and emotional safety of a resident while helping the resident learn to trust staff who are providing care. This trust leads to collaboration and cooperation with service providers and increases the likelihood residents will meaningfully engage in treatment services. A focus on resident strengths creates a culture of empowerment and provides residents with opportunities to learn strategies for coping with their mental health diagnosis as well create goals for the future that include sustaining mental health stability.
The Hopewell therapeutic community model creates opportunities for these six guiding principles in all aspects of programming. At Hopewell, we encourage residents to take an active role in their treatment planning and providers do not direct the course of treatment planning—we collaborate on a plan that is meaningful and sustainable to the resident and includes ongoing informed consent. Helping residents orient to staff and to the therapeutic community while encouraging consistency and healthy boundaries fosters a therapeutic rapport that is central to the healing community. We emphasize resident strengths and support residents in recognizing existing strengths while developing new skills with the goal of increasing independence. Staff receive trainings to increase multicultural competencies.
Our clinical team is passionate about furthering their understanding of Trauma-Informed Care both at the organizational and individual levels. Currently, Hopewell has two clinicians who have trained in Eye Movement Desensitization and Reprocessing Therapy (EMDR) and see residents for individual trauma therapy.
EMDR therapy utilizes the natural healing abilities of both the body and brain and can be an effective, evidence based therapeutic modality for the treatment of a wide range of mental health diagnoses.
First developed in 1987, EMDR emerged as an integrative therapy with proven efficacy in the treatment of individuals with Post Traumatic Stress Disorder (PTSD). As the understanding of trauma has deepened in current clinical practice and as research into the effectiveness of EMDR has grown, this therapy has demonstrated effective application for many mental health concerns, including depression, anxiety, addiction, and eating disorders.
Trauma can be thought of as an intrusion of the past into the present moment. Individuals with trauma histories may find themselves triggered by present day events and respond to them in emotional, cognitive, and physical ways that are maladaptive or painful—responses that are based on what happened in the past, not what is occurring in the present. An example may be an individual who experienced a car accident and is now unable to drive without anxiety, or is perhaps having nightmares about the accident, or has a flashback when hearing the sounds of heavy traffic. Additionally, there may be a blocking cognitive belief such as “I am to blame” or “I am in danger” that is hindering the individual from moving beyond the trauma. This blocking belief may be interfering with their growth in other areas of life as the traumatic event influences how they view their current life experiences.
EMDR therapy supports individuals in learning new coping strategies for traumatic stress and increases their ability to manage distress. Additionally, it provides a means for helping the brain and body “reprocess” the trauma so that it can be experienced less as a present day state of being and more like a past memory. While it may remain in the individual’s consciousness, it becomes less overwhelming and responses to the memory become less maladaptive. EMDR encourages development and strengthening of adaptive skills and beliefs.
EMDR combines elements of Cognitive Behavior Therapy, free association, imaginal exposure, and somatic experience to help individual’s process traumatic memories.
EMDR is unique in that it does not rely on an individual telling the story of the trauma---an act which in itself, for some, can be re-traumatizing. Instead, individuals work with the EMDR therapist to identify difficult memories, emotions, and cognitive beliefs and then utilize a process known as bilateral stimulation (BLS), often in the form of moving one’s eyes back and forth while recalling the traumatic memory, to engage the brain in reprocessing the memory. It is believed that these eye movements, similar to the REM state of sleep, aid the brain in processing the memory in a way not unlike how we process our day to day life during sleep.
The result is less emotional reactivity when the traumatic experience is recalled and a greater emphasis on personal strengths and resources that the individual can use to cope with distress. Ultimately, the individual is better able to ground themselves in the present moment and live more fully in the here and now.
The validity and reliability of EMDR has been demonstrated by ongoing research and it is a recommended by the National Center for PTSD and the US Department of Veteran’s Affairs.
- Harris, M. & Fallot, R. D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.)
- https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm
- (https://www.ptsd.va.gov/index.asp)
