More often than not, clients who seek mental health services have experienced some type of trauma, at some point in their lives. When we hear the word trauma, we may think about something dramatic, such as war, a life threatening illness/accident, domestic violence or a natural disaster. While these are most definitely traumatic experiences, trauma can also present in other ways that may not be readily identified as traumatic.
First and foremost: What is trauma?
The word “trauma” is used to describe experiences or situations that are emotionally painful and distressing, and that overwhelm people’s ability to cope, leaving them powerless.
(http://www.nonviolenceandsocialjustice.org/FAQs/What-is-Trauma/41/)
With this definition in mind, the concept of trauma extends far more broadly than we may have originally thought. Imagine the adolescent who is bullied, the long-term employee who is released just prior to retirement, the person whose life’s savings are lost in a market crash, the child who has lost a parent to death or abandonment or the spouse whose marriage ends due to infidelity. All of these scenarios represent trauma, insomuch as they have caused emotional distress which has overwhelmed the person’s ability to cope and exercise power. With this in mind, imagine how many people can identify a traumatic experience in their own lives. Can you?
In the spirit of providing optimal treatment, trauma-informed care is a whole-system approach to client care. It is a design based on the premise that clients will heal more fully if they are able to address their trauma, understand its impact on their lives, regain control and feel empowered about the direction their lives will take. Additionally, it entails the creation of a sensitive and nurturing environment in which the client can do this work. Unlike trauma-specific services, where clients interface with health-care professionals trained to work through specific areas of trauma (ex domestic violence counselor, grief counselor), trauma-informed care addresses the entire system within which the client will seek and receive services and all of the people with whom s/he will interface, including his/her own natural supports. In a sense, trauma-informed care is a wrap-around approach, with the client as key member of the team.
Trauma informed care is about creating a culture built on five core principles:
- Safety: Ensuring physical and emotional safety
- Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries
- Choice: Prioritizing consumer choice and control
- Collaboration: Maximizing collaboration and sharing of power with consumers
- Empowerment: Prioritizing consumer empowerment and skill-building
It is a client-centric vs system-centric approach, designed to empower clients and not re-traumatize them.
For example, let’s imagine that a female domestic-violence survivor seeks mental-health services. She has a long history of being verbally and physically abused. She enters the lobby of a secure facility, hearing the door lock behind her. There are no signs indicating it is a secure facility or the purpose for these locks. She tenses and looks around for other exit doors. (trigger #1 – at one point her abuser had held her captive) She encounters a tall male client engaged in a a heated discussion with the female receptionist who is sitting down. The radio is blaring in the background. She tenses further, starts to sweat and her breathing becomes shallow (trigger #2 – her abuser was taller than her and used to yell regularly; this used to happen after Monday night football which he would watch on TV in the living room with the volume at a maximum). The receptionist, now flustered, turns to her without a smile and asks her abruptly “what do you need?” She opens her mouth and it feels like the words won’t come out. (trigger #3 – she has lived without a voice for so long that her needs have become unclear; she is not used to being asked for her opinion). The clinician then comes out to greet the client, gets very close to her and raises her hand to say hello. The client cowers slightly. (trigger #4 – her abuser use to get right up in her face, raise his hand and slap her across the cheek) She breathes deeply and becomes nauseous at the scent of the clinician’s mint gum (trigger #5 – her husband would use mouthwash to cover the smell of the alcohol on his breath) Now let’s fast forward to the actual session. The clinician asks the client to go over details of her abuse repeatedly. While some of this may be clinically necessary, it is critical that the clinician consider that every repetition represents a moment of reliving for the client. As such, care should be taken with the type and intensity of inquiry.
These are simple but real examples of how seemingly innocuous things can compromise an already compromised state of mind – and mental health services have not yet even commenced. It is important for interpreters to be mindful of this, as you are part of the treatment team, albeit for a moment in time. Every member of a treatment team, including the interpreter, can add to or detract from the client’s experience. Consequently, without a trauma-informed mindset, this same team can unwittingly re-traumatize the client if care is not taken. Think ahead about your manner of dress, your perfume/cologne, your hand gestures, the tone of your voice, the physical distance between you and the client and the importance of your active listening skills. Additionally, if time permits, ask the clinician for any tips to help the client feel more comfortable.
http://www.thenationalcouncil.org/areas-of-expertise/trauma-informed-behavioral-healthcare/
In the posts to follow, I will explore different types of trauma that clients may have experienced prior to seeking mental health services. Please be aware that these posts may, possibly, trigger feelings in you. If, at any time, you feel uncomfortable it would be prudent to take a break from the material. These posts are meant to be informational and assist interpreters in preparing for mental health assignments. That being said, it is important to take care of yourself, understanding what your own triggers may be.
Kind regards,
Diane
(photo – dorleem.com)
Through My Mind's Eye 