For those who haven’t experienced it firsthand, mentions of trauma-informed social work are usually relegated to a short blurb following news coverage of a crisis. We’ve all heard some version of the following: “Trained counselors/social workers are standing by to help victims and their families.” For social workers intending to work with trauma victims, it’s important to understand that the effects of traumatization are fluid. It’s not a singular event, and recovery requires a tailored solution. Below are listed some of the most fundamentally important and commonly misunderstood elements of trauma-informed care.

Trauma Is a Spectrum

Both the trauma itself and the victim it affects are highly variable, which directly affects the nature, frequency, intensity and duration of the victim’s responses. Some trauma sufferers will exhibit chronic symptoms that clearly fit into DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria, like PTSD. Others will display episodic, unpredictable symptoms. This presentation relies heavily on the type of trauma, which often is the result of:

  • Child or spousal abuse

  • Rape

  • Death of a loved one

  • Near-death experiences

  • Natural disasters

  • Shootings

  • War

  • Current or prior substance abuse

  • Severe injury or illness

 

This is not an exhaustive list, but it covers the bulk of trauma incidents. In addition to the unpredictable nature of trauma itself, no two victims react to the same trauma in the same manner. Age, gender, past experiences, stress, mental illness, and other mitigating factors can affect one’s response to trauma. With so many moving parts, how do social workers narrow down their approach? It starts by respecting the survival state.

Survival Comes First

Trauma is often defined as a situation in which a person has no control over a potentially lethal threat. The brain is already equipped with a response system in this scenario, commonly known as the “fight-or-flight” response. This response system quickly floods the body with pure adrenaline and other powerful hormones. In our nervous system, where nerves “turn on” and off at blinding speed. Hormones tend to linger after their usefulness has expired – especially if the perceived threat is not completely eliminated.

Why does this matter in trauma-informed social work? Respecting the survival state matters because, without the support to make it through this initial shock, a victim cannot begin to process, overcome, or even acknowledge the trauma. If the trauma has occurred recently, the victim needs to be immersed in a stable and supportive environment. Instead of bringing the trauma up first, it’s more effective to create and reinforce a feeling of safety. This may mean:

  •  bringing in friends and family members

  • communing with other victims

  •  physically removing the victim from an area they associate with the trauma

  •  anything else that will reinforce the sense of safety.

If a trauma victim is still in the acute survival response, they may display one or more of the following signs:

  • Increased muscle tone (straining at the neck, clenched fists common)

  • Rapid or irregular breathing

  • Rapid speech, low attention span

  • Sweating and/or stomach ache

Trauma Is Self-Perpetuating

Research has proven that trauma begets more trauma. This means that victims are both more sensitive to certain triggers and statistically prone to substance abuse and other harmful coping mechanisms. As such, social workers must think of trauma as a state of being, not a singular event. Without this appreciation of the secondary effects, a social worker may focus only on overcoming the source of the trauma without also addressing the problems it created.

Many trauma victims develop anxiety, depression, and asocial behaviors without realizing it. This is why screening is instrumental in trauma-informed care. Vigilant screening will expose sources of trauma, identify related symptoms, and prevent re-traumatization if used properly. Knowing a victim’s triggers, another benefit of screening, will add clarity and direction to treatment.

Recovery Is Multi-Faceted

In addition to the psychological and physical ramifications of trauma, social workers can facilitate recovery on a social and financial scale. Trauma victims often lose out on work, school and social interaction while they are in the coping process. Included in the purview of most social work arenas, not just trauma, is the use of community resources to help people in this situation. Timing is an important factor in this stage of recovery, because if a trauma victim is not yet ready to resume their obligations at full capacity, an unsuccessful reintegration attempt may worsen symptoms.

Even after what seems to be a full recovery, trauma victims are often left with skewed perceptions and phobias that relate to the circumstances of their trauma. A strong fear of swimming, for example, may affect someone who survived a near-drowning incident. These phobias and perceptions can form strong triggers that interfere with daily life. Once again, trauma screening is helpful in identifying avoidance behaviors so that social workers and counselors may address them.

The Ripple Effect

When building a support network around a traumatized individual, it’s important to consider the effect that their experience has had on their loved ones. Even if family members weren’t present at the traumatic event(s), they can become traumatized as they empathize with the victim. According to the Council on Social Work Education, it’s often beneficial to counsel family members and loved ones as well as the victim, so that the support network remains strong.

This idea of the ripple effect also helps social workers to identify groups and individuals who may need their services. People are often hesitant or embarrassed to seek counseling for the first time. They’re more likely to do so when they are being asked as part of a group. It’s important to avoid tunnel vision in cases of trauma by screening the victim’s support group as well.

To review, traumatization is a state of being, not an event. It requires an approach that shifts the victim into an unconditionally positive and safe environment. Immediately following trauma, victims will likely not be receptive to any attempts to work through it.  Instead, they should have their immediate needs met.

  • Everyone reacts to trauma differently

  • Trauma can impact people who weren’t present

  •  Recovery requires a multi-faceted approach.

Tim Kalantjakos

B.S. Sociology | University of Nebraska at Omaha

A.S. Physical Therapy | Clarkson College

July 2019

Related Articles: