While the understanding of the role of trauma in some aspects of social work is increasing, and with that, the training offered and policies changed, not everyone sees this as a positive development. Others do welcome the change in principle, but are disappointed or frustrated with the practice, or worried about the feasibility. That is why I want to address some of the objections that are raised against trauma-informed practice in social work.
One argument is that, really, the principles of trauma-informed practice – such as emphasising trust, safety, and empowerment – are at the basis of social work anyway, so what is the added value of a trauma focus? There is a grain of truth in this. When you look at the core principles of social work, they should inherently lead to a largely trauma-sensitive approach. However, unfortunately, that does not mean this happens in practice. Claiming that it is already being done is similar to claiming that if we just hire people on merit, the best people will get the job, regardless of whether they are from a marginalised community or group. In theory, that is true. It should be true, but practice has shown a very different reality. In some cases, the lack of implementation of what could be said should be inherent in social work may be due to insufficient training. More often, it has to do with policy leading to excessively high workloads, focus on performance reviews based on quantifiable outcomes and closing cases as soon as possible, as well as high staff turnover that stands in the way of slowly building up the reliable relationships of trust needed for trauma-informed practice. The claim that it might be a better use of resources to address these staff shortages is an either/or argument that fails to see that both things can be true. It is, in fact, a very good investment with an excellent return to ensure the resources for both are made available, by only investing in one or the other, the return on investment reduces considerably.
At times, there is a misunderstanding about the difference between trauma-informed social work, which provides social and relational support that in itself can play an important healing role, and specialised trauma therapy, which is outside the scope of social work. The suggestion being that if the latter is not provided by social workers – and this should not be added to their burden of responsibility – then they cannot do anything for people with trauma anyway. First of all, having the skills and knowledge to be able to recognise unresolved trauma and to make informed referrals to a specialist when this is needed is an important aspect of social work – and requires appropriate training and trauma-informed frameworks. Secondly, having the skills and understanding of how to not inadvertently retraumatise someone, escalate situations to the point where collaboration is no longer possible due to having activated trauma-related triggers, or encourage someone to (continue to) suppress what they need to resolve requires awareness and training with a trauma focus. Thirdly, as alluded to before, in many cases, if a social worker is able to build a deep sense of safety, trust, and empowerment in someone with unresolved trauma, this may be sufficient to set them on a path to resolve their trauma.
Some fear that a ‘trauma label’ will just make people feel like they are victims, broken, and hopeless. They see a danger that this will stand in the way of these people being able to see a future for themselves or believe in their ability to develop and grow in positive ways. This may be true, at least initially, for some people. However, both in my own experience and in that recounted by many of the experts whose work I have studied in researching for my book, more commonly people who carry unresolved trauma feel broken and hopeless to begin with and actually feel less so once they are given an explanation of the physiological processes involved and the understanding that what they are struggling with was once a necessary adaptation for survival, it has just outlived its usefulness. In fact, currently, coping strategies like addiction, internalising behaviours – such as depression and anxiety -, and externalising behaviours – such as aggression and reduced impulse control – are pathologised and seen as brokenness and dead-end situations that can at best be somewhat managed. Whereas recognising that there is an underlying trauma causing this, which can be resolved, provides hope and a way of overcoming a difficult situation. In fact, social workers telling people in need of support that they are not equipped to handle trauma is what risks sending the message that their situation is beyond hope of improvement or that they are not important enough to warrant the support they need. While for the few people who really are severely triggered by the use of the word trauma, it is entirely possible to provide trauma-informed care and have clear communication about it without ever using the word. Philippa Perry’s book ‘The Book You Wish Your Parents Had Read’ is an excellent example of this.
The regularly heard claim that a focus on trauma leaves no room for anything else is very reductive. It is possible that in some places this is the practice, and even that some policies do not leave room for much else. However, this is not an inherent problem with trauma-informed practice, but rather a problem of limiting implementation. Social work must always have a holistic approach to the life, the strengths, and the challenges of the person in need of support. Including a trauma focus would ideally be foundational to the work but not to the exclusion of other aspects of a person’s abilities and needs.
When it comes to providing social workers with trauma training, there have been concerns that discussing trauma as part of the course material may be triggering or retraumatising for students who carry unresolved trauma. However, while it may be helpful to notify students of sensitive material being covered to help them prepare and regulate themselves, there is no evidence that providing training on trauma has harmful effects on students. Personally, I would add that anyone who is unable to cope with theoretical discussions of trauma is not likely to be equipped or suitable to work with people carrying unresolved trauma in their job. In a way, a negative reaction to this kind of course material may be a useful form of self-elimination for the profession. Many people who choose social work as their profession have had traumatic experiences. They want to work in this field to be able to help others in similar situations. This is wonderful and valuable. However, it is useful to be aware that if you have not processed your own trauma – or are in the process of doing so – you are likely to be triggered often and have a higher than average risk of being (re)traumatised through what you encounter in the people you work with. In a way, being confronted with the difficulty of learning about trauma and trauma-informed practice may be a useful reminder of the importance of seeking help to make a start with processing any unresolved trauma.
In some places, trauma-informed practice is new. In some places, it has been increasingly attempted. However, there is an often heard complaint that, on the one hand, the focus on trauma seems to be everywhere – without room for anything else. Yet, on the other hand, even with all the training, and workshops, and awareness-raising events they have to sit through, they are not seeing any results in significantly improved outcomes. These complaints are absolutely valid. One of the problems is that, in practice, there is a lot of training and material to create trauma awareness, but this does not automatically lead to an ability to implement trauma-informed practice. This is particularly true when the information of underlying reasons and mechanics is not or hardly provided.
It is a situation that reminds me of when I was learning to drive a car. At one point, the driving instructor told me that I should look in the rearview mirror before hitting the brakes when approaching a traffic light. The expectation was clearly that I would just comply and go through the motions as instructed. However, my autistic mind was not able to go with that, it needed to know more. I asked what I was supposed to do with the information I got from looking in the rearview mirror. How should that inform my actions? The instructor was taken aback by the question and needed a moment to process and find the answer, but he did give one, which helped me. This is illustrative of too many training situations, regardless of what is being taught. It leads to professionals going through the motions as they have been taught and then getting frustrated because it does not have the desired results. It cannot have the desired results if you do not have enough background knowledge to know how to effectively and appropriately adjust your responses and actions to what is needed in a given situation. Trauma-informed practice cannot function as a tick-box exercise.
This lack of proper information is something I still cannot deal with and therefore my approach is different. My aim is to break through the frustration and lack of effectiveness by looking under the hood and helping professionals really understand what they are seeing and what this means.
Jill Levenson points out: “Social workers who are familiar with the pervasiveness of early adversity and the damaging impact of these experiences on presenting problems across the life span will be able to deliver services in a more trauma-informed fashion. The research literature indicates that a warm, interested, and validating therapeutic alliance is more influential in facilitating positive therapy outcomes than theoretical framework, professional discipline, or specific counseling.”
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