The majority of adults that social workers deal with are trauma survivors. This trauma frequently occurs during childhood. The impact of past trauma on present problems can easily be overlooked by social workers and other professionals not trained in trauma theory and trauma-informed care.
The immediate problems that social workers seek to resolve when working with a client are often caused, or made worse, by the underlying trauma. Recognizing how this trauma affects the way clients respond to events, the life choices they make and their fundamental understanding of the world, is the basic principle of trauma-informed care.
In addition to providing an approach to the immediate social problems being dealt with, trauma-informed principles also apply to the relationship between the social worker and their client. The nature of the trauma may lead to specific vulnerabilities and emotional trigger points that the client responds to. It’s also possible that the client’s previous traumatic relationships with authority may play out or repeat in their relationship with their social worker unless the latter takes informed steps to avoid this happening.
Defining trauma
The American Psychiatric Association defines trauma as: “Any disturbing experience that results in significant fear, helplessness, dissociation, compulsion or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior and other aspects of functioning.” Traumatic events can be caused by human action or by natural events and make those affected feel that the world is unsafe, unfair and/or dangerously unpredictable.
Causes of trauma may include exposure to violence in one’s family or community, war, natural disaster, a serious accident or a criminal attack. Often the trauma may be sexual in nature. Trauma can be caused by incidents other than those involving physical assault. Emotional or mental violence can be equally traumatic for individuals, especially children.
Traumatized people may feel intolerable emotional stress in certain situations, leading to negative behavior. Social workers therefore need to consider how chaotic family backgrounds or negative experiences in childhood may affect a client’s present behavior and life choices.
Trauma-informed care
The basic principles of trauma-informed care are safety, trust, choice, collaboration and empowerment. These are applied by social workers from the earliest stages of intake and assessment, through engagement, treatment and finally termination of the contract. By consistently observing these principles, social workers can help to bring the trauma into the light and gradually work to minimize its influence on the client’s present behavior.
Learning more about trauma theory and adding it to your skill set as a social worker are among the reasons to study for a more advanced qualification in your field. If you already have a bachelor’s degree in social work (BSW) then you can pursue a master’s degree (MSW) while still working full-time, thanks to the online degree program at Keuka College. MSW benefits include access to a higher salary, greater opportunities to specialize in your chosen area and greater confidence in your ability to identify and respond to trauma-influenced cases in the course of your work.
Gaining trust
Gaining the client’s trust and forming a collaborative practice with them may in itself be an act of profound emotional healing or adjustment. It challenges the client’s negative presumptions and expectations that were formed as a result of early trauma and distorted by that experience.
Firstly, social workers must exhibit sensitivity and understanding in relation to how a client’s present situation and difficulties are informed by their past trauma. These difficulties may include reluctance to cooperate with the social worker, or even outright hostility towards them.
Trauma-informed practice involves acknowledging the client’s feelings and experiences as valid and helping them to understand the emotional impact of trauma from many years before. Following this, they are encouraged to think of themselves as survivors rather than victims, and to find better ways to manage their lives. At the same time, the social worker will help the client to appreciate how the trauma that occurred to them has shaped their worldview and continues to affect their present circumstances.
Approaching trauma
Validation by a social worker can help a client to feel less isolated and alienated. The social worker may encourage them to remember positive ways that they have responded to challenges in the past, and to use these as a model for present and future behavior. In this way, the client starts to believe in their own ability to transcend trauma, rather than relying solely on outside agencies — and remaining, in their own minds, a victim reliant on external help rather than a self-empowered survivor.
If the client is uncomfortable or unwilling to talk directly about their trauma, then approaching it through journaling or art may be a positive and appropriate method for bringing it into the light. It’s important that the client is able to proceed at their own pace and isn’t pushed into discussing the trauma before they’re ready. If the social worker presses for too much detail, or for the client to express emotions in a context that they feel is inappropriate, then the client may ‘shut off’ and withdraw from cooperation.
Uncovering repressed memories
The client may initially seem to be unaware of the trauma or may remember the event but dismiss it as trivial. It’s common for traumatic memories to be repressed, altered or compartmentalized. The client may also avoid talking or thinking about the traumatic event because of associated emotions of shame, guilt or confusion.
Often, traumatic events occur in early childhood but continue to define the adult personality and behavior, even if the traumatized individual is unaware or only partially aware of this. Social workers may also find themselves dealing with clients whose traumatic event is more recent. There may be several discrete or related traumatic events, each one serving to reinforce the negative impact of the others.
Wider context
Working with trauma, one must also consider the wider cultural and social framework in which the trauma took place, and which may still be in place in the client’s life, as well as the specific incident(s) believed to have caused the trauma. For instance, this may involve understanding that specific incidents of trauma must be understood as part of a wider pattern of structural racism or systemic oppression.
The social worker should refrain from making judgements that seem to minimize or sidestep the trauma. At the same time, exaggerating its importance in order to fit a preconceived theory can be equally unhelpful. No two cases are the same, and although trauma theory provides a universal framework for understanding cases, discretion should be used in how it is applied.
Choices and consequences
Ensuring that the client feels safe, building an atmosphere of trust and working in collaboration with the client are all essential methods employed in trauma-informed care. The goal is to empower the client while also encouraging them to recognize and accept the consequences of their actions.
The client should be encouraged to see that they have multiple choices and to take responsibility for those choices. They are not at the mercy of their trauma, “the system” or the social worker’s own dictates. At the same time, recognizing the way that social or other structures restrict their choices is also important. The client may be faced with limitations, but they choose how they respond to those limitations.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is classified as an anxiety disorder. Symptoms can include flashbacks, insomnia, nightmares and difficulties concentrating. It can also manifest in a variety of different ways, including avoidance or overreaction to environmental stimuli that recalls the trauma, or symptoms such as withdrawal, mood swings, rage, depression and anxiety. Self-medicating through alcohol and drugs or engaging in behavior designed to mask the trauma in similar ways, from promiscuity to over-controlling in relationships, are also common.
The four classic symptoms of PTSD are intrusive memories, avoidance, negative changes in thinking or mood and changes in physical and emotional reactions. PTSD can often be successfully treated by medication or therapy.
Trauma as a spectrum
Not everyone who experiences trauma develops PTSD. Social workers should not be too quick to diagnose post-traumatic stress disorder, as trauma can still affect a client without developing into PTSD.
It can be useful to consider trauma as a spectrum, based on the intersectionality of different types of events, the frequency of those events in a client’s life and their response to them. Acute trauma is often used to describe the effect of a single traumatic event, while chronic trauma may describe the impact of multiple or repeated traumatic events. Individuals experiencing chronic trauma are more likely to develop complex post-traumatic stress disorder (C-PTSD), which affects an individual’s core sense of self and emotional regulation.
The impact of childhood trauma
If trauma occurs to a child, then this can have an impact on the rest of their lives unless the trauma is properly addressed and treated. The causes of trauma may not in themselves be unusual. They could include relatively commonplace incidents, such as bullying at school, the death of a close family member, exposure to conflict or violence within the family, parental divorce, serious childhood illness or personal injury.
Experiencing poverty and/or prejudice, including racism, systemic oppression or discrimination, while growing up can also be traumatic. The trauma doesn’t need to be experienced directly, as witnessing violence or abuse being perpetrated on another person, especially if they’re a friend or relative, can also be traumatic and may be compounded by additional feelings of guilt and shame because you were not the one suffering.
Trauma can be generated by the absence of positive influences such as love and care, as well as by the presence of negative influences. Emotional neglect, a primary caregiver disappearing from a person’s life when they are young, or the caregiver being preoccupied with problems of their own during periods of a person’s childhood and so being emotionally absent, can be traumatic even if no key incidents can be identified.
Transforming present behavior
Trauma-informed care in social work doesn’t seek to directly address past trauma, but rather to understand and address present behavior and problems in the context of the client’s traumatic experiences. To do this, broad knowledge of trauma theory is required in order to recognize how antisocial, disruptive or negative behavior might relate to or derive from past trauma and how present problems might appear more challenging to a client because of the trauma they’ve previously experienced.
Demonstrating respect, compassion and understanding is crucial. The social worker must honor and encourage the client’s desire for self-determination, while also making them aware of the consequences of their choices. Better and more appropriate coping strategies, interpersonal skills and self-awareness are all goals to aim for. The client should feel seen and listened to, and able to work on their problems collaboratively in an environment of trust.
While trauma-informed care may focus on changing the behavior of the client, this is always done in the context of appreciating the bigger picture. No concept of blame is attached, especially when factors such as poverty, oppression and injustice are real and present challenges. The client may be encouraged to take responsibility for any harm their actions may have caused in the past, and to take steps not to repeat these actions as well as to make amends if possible. This is done in a spirit of self-determination rather than shaming.
Adverse childhood experiences
Adverse childhood experiences (ACEs) affect a significant proportion of the population. The greater the number of ACEs in a person’s background, the greater the risk of many negative social behaviors, incidents and illnesses that social workers typically find themselves dealing with. These may include:
- Alcoholism, smoking and drug use.
- Obesity, heart disease and fetal mortality.
- Depression and suicide.
- Domestic violence, sexually transmitted diseases and unwanted pregnancies.
Adverse experiences in childhood can lead to ‘fight, flight or freeze’ responses when faced with related stimuli in later life. In addition, they can lead to an individual having difficulty in regulating their emotions and impulses and impair cognitive processing, leading to illogical or irrational thoughts and behavior. Poor social attachments in later life can also derive from adverse childhood experiences.
Adaptive behavior
Children quickly adapt (or maladapt) to negative conditions at home or in other institutions, developing a repertoire of learned behavior, responses and coping mechanisms that they may carry over into adulthood. When their environment changes, their essential outlook and by extension their behavior may not, so they continue to act in a way that’s increasingly inappropriate to their circumstances.
If a child regularly experiences betrayal, abandonment or cruelty, to the extent that these behaviors become normalized, then they may find it difficult to trust others or form healthy relationships in later life. Antagonistic attitudes towards authority, feelings of low self-worth or behavior patterns that repeat the abuse they experienced in early life, are all also common outcomes.
Setting boundaries
Social workers are not therapists. Their understanding of trauma theory and application of it in their work should not extend to providing psychiatric treatment. This is for the good of both the social worker and their clients.
Psychosocial development is affected by trauma of all kinds. Trauma-informed social workers recognize this but don’t attempt to perform trauma interventions for the client. The traumatic incident is acknowledged as an important part of the client’s life history without over-pathologizing it. The focus is on changing behavior and attitudes in the present and moving towards positive outcomes that the social worker and client have mutually agreed upon.
Social workers must practice self-care at all times and take steps to avoid secondary traumatic stress or vicarious trauma by setting clear boundaries in their work with clients.
Conclusion
Trauma-informed social work doesn’t merely address the problematic or negative behavior of the client but focuses on helping them to build healthier and more effective coping mechanisms. Social workers look at improving interpersonal skills and self-actualization. Trauma resolution therapy may be something that the client ultimately decides to pursue, and if so, the social worker may help them to access this service, but they are not to act as therapists themselves.
Initially, the social worker must gain the trust of their client. If at first the client appears hostile or evasive, this may be the result of previous negative experiences of authority rather than an unwillingness to engage. It’s up to the social worker to earn the client’s trust by displaying respect, empathy, understanding and patience.
Interactions between the social worker and their client should avoid replicating the dynamics of the client’s previous experiences. Sometimes, the client may unconsciously or otherwise manipulate the relationship to fit their expectations. A trauma-aware social worker should beware of this and patiently resist any attempts to push them into such a role.
Irrational or destructive behavior can sometimes be recontextualized as survival skills or mechanisms that have outlived their usefulness. Helping the client to see that these behaviors are now holding them back, while understanding how they were formed, is part of a trauma-informed practice.
