In recent years, the terms trauma-informed and trauma-responsive have gained prominence in therapeutic settings. While often used interchangeably, they represent different approaches to understanding and treating trauma. A trauma-informed approach emphasizes awareness of trauma’s impact, while trauma-responsive care takes this knowledge further by actively adjusting therapeutic interventions to meet the specific needs of traumatized individuals. The distinction is crucial because being trauma-informed without being trauma-responsive can inadvertently perpetuate harm rather than facilitate healing.
Below, I draw from the work of leading trauma researchers and clinicians, including Judith Herman, Stephen Porges, Bessel van der Kolk, Peter Levine, Richard Schwartz, Gabor Maté, and the framework of Relational-Cultural Therapy (RCT), to explore the nuances between these two approaches. It will also examine the dangers of failing to respond appropriately to trauma and outline examples of trauma-responsive care in practice. Additionally, resources and frameworks from the Substance Abuse and Mental Health Services Administration (SAMHSA) will be incorporated to highlight best practices for implementing trauma-informed and trauma-responsive care.
Trauma-Informed vs. Trauma-Responsive Therapy: Defining the Terms
Trauma-Informed Therapy
- A trauma-informed therapist understands the widespread impact of trauma and recognizes the signs and symptoms in clients. This approach is grounded in knowledge about trauma’s physiological, psychological, and emotional effects. Judith Herman’s seminal work, Trauma and Recovery (1992), was foundational in shaping this perspective, emphasizing the need to acknowledge trauma’s pervasive influence across various domains of life.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines four key components of trauma-informed care: realizing the widespread impact of trauma, recognizing its signs and symptoms, responding appropriately, and resisting re-traumatization (SAMHSA, 2014).
Trauma-Responsive Therapy
- Trauma-responsive therapy takes trauma-informed principles a step further by actively modifying therapeutic practices to meet the needs of traumatized individuals. It involves tailoring interventions to promote safety, trust, and empowerment. A trauma-responsive therapist not only recognizes trauma but also adapts their behavior, therapeutic techniques, and the environment to support the client’s healing process.
- This concept aligns with Stephen Porges’ Polyvagal Theory, which emphasizes the role of the autonomic nervous system in trauma responses. According to Porges (2011), trauma-responsive care must create a sense of safety at a neurobiological level by engaging the ventral vagal complex, fostering connection, and mitigating threat responses.
The Dangers of Being Trauma-Informed Without Being Trauma-Responsive
Understanding trauma’s effects is not sufficient if therapeutic practices do not adapt accordingly. A therapist may be well-versed in the theoretical underpinnings of trauma but without appropriate responses, risks:
Re-Traumatization
Therapists who understand trauma intellectually but fail to adjust their interventions can inadvertently re-trigger traumatic responses. For example, pushing a client too quickly into exposure therapies without establishing a foundation of safety violates the pacing necessary for trauma work, as emphasized by Peter Levine in Waking the Tiger (1997).
Violation of Trust and Safety
Trust is central to trauma recovery. Relational-Cultural Therapy (RCT), developed by Jean Baker Miller and colleagues, highlights the importance of mutual empathy and relational safety in healing trauma (Jordan, 2010). If a therapist does not actively foster a relational environment characterized by empathy and attunement, clients may feel misunderstood or dismissed.
Neglecting the Body’s Role in Trauma
Bessel van der Kolk, in The Body Keeps the Score (2014), argues that trauma is stored in the body and must be addressed somatically. Therapists who are trauma-informed but fail to integrate somatic practices such as grounding techniques or body awareness miss crucial opportunities for healing.
Pathologizing Trauma Responses
Without trauma-responsive care, therapists may pathologize normal trauma responses (e.g., dissociation, hypervigilance) rather than viewing them as adaptive survival mechanisms, as discussed by Gabor Maté in In the Realm of Hungry Ghosts (2008). This risks reinforcing shame and self-blame in clients.
Theoretical Foundations for Trauma-Responsive Care
Polyvagal Theory (Stephen Porges)
Porges (2011) emphasizes the importance of creating neurobiological safety in therapy. Trauma-responsive care involves understanding clients’ autonomic states and adjusting interventions to facilitate a sense of safety and connection.
Somatic Experiencing (Peter Levine)
Levine’s work focuses on helping clients gently discharge trauma energy stored in the body. This requires therapists to be attuned to subtle bodily cues and to pace sessions according to the client’s tolerance.
Internal Family Systems (Richard Schwartz)
IFS therapy views the psyche as composed of different parts, some of which hold traumatic memories. Trauma-responsive therapists help clients befriend and unburden these parts rather than forcefully confronting traumatic material (Schwartz, 1995).
Relational-Cultural Therapy (RCT)
RCT posits that healing occurs in the context of relationships. Trauma-responsive care involves mutual empathy, authenticity, and respect for clients’ lived experiences, forging growth-fostering connections (Jordan, 2010).
Trauma-Responsive Care in Action
Case Example 1: Recognizing Somatic Responses
A client with a history of childhood abuse begins to dissociate during sessions. A trauma-informed therapist might recognize dissociation as a trauma response, but a trauma-responsive therapist will pause the session, guide the client back to the present with grounding techniques, and create a plan to address dissociation in future sessions.
Case Example 2: Adjusting the Therapeutic Pace
A client in early recovery from complex PTSD expresses discomfort with exploring traumatic memories. Rather than pushing forward with trauma processing, the trauma-responsive therapist focuses on stabilization, emotional regulation skills, and building a sense of safety, following the phased model outlined by Judith Herman (1992).
Case Example 3: Relational Safety
In working with a client who distrusts authority figures, the therapist practices non-hierarchical, collaborative therapy, emphasizing the client’s autonomy and choices in therapy. This aligns with Relational-Cultural Therapy’s emphasis on power-sharing and mutual respect (Jordan, 2010).
Incorporating SAMHSA’s Framework for Trauma-Informed and Trauma-Responsive Care
To further enhance the distinction between trauma-informed and trauma-responsive care, it is essential to explore SAMHSA’s comprehensive resources and frameworks. These materials not only define trauma-informed care but also provide practical strategies for implementation, ensuring that care is both informed and responsive.
SAMHSA’s Six Key Principles of Trauma-Informed Care
In SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, six key principles are outlined to create a trauma-informed environment (SAMHSA, 2014):
- Safety: Prioritizing physical and emotional safety for both clients and staff.
- Trustworthiness and Transparency: Building trust through transparent processes and open communication.
- Peer Support: Utilizing peer support to foster recovery and build community.
- Collaboration and Mutuality: Reducing power imbalances and fostering collaborative relationships between clients and providers.
- Empowerment, Voice, and Choice: Encouraging client empowerment, providing options, and recognizing individual strengths.
- Cultural, Historical, and Gender Issues: Recognizing and addressing cultural, historical, and gender-related factors in care.
These principles provide the groundwork for organizations and clinicians to ensure they not only understand trauma’s impact but also actively integrate these principles into their practice to prevent re-traumatization and promote healing.
Practical Guide for Implementing Trauma-Informed Approaches
In addition to the conceptual framework, SAMHSA offers the Practical Guide for Implementing a Trauma-Informed Approach (2023), which outlines steps for organizations to put trauma-informed principles into action. Key strategies include:
- Leadership Engagement: Organizational leaders must actively champion trauma-informed policies and practices.
- Staff Training and Support: Continuous training and reflective supervision help staff remain attuned to trauma-responsive principles.
- Policy Development: Policies should reflect trauma-informed values by emphasizing safety, collaboration, and empowerment.
- Continuous Evaluation: Ongoing feedback mechanisms ensure that practices are effective and evolve based on client and staff input.
By following these strategies, therapists and organizations can move beyond trauma-informed awareness to create environments and therapeutic relationships that are truly responsive to the needs of trauma survivors.
Beyond Information: Responsive Trauma Treatment
The distinction between trauma-informed and trauma-responsive therapy is critical in ensuring that clients receive effective, compassionate care. Being trauma-informed means recognizing the impact of trauma, but trauma-responsive care demands active, adaptable interventions that foster safety, trust, and healing. Drawing from the works of Judith Herman, Stephen Porges, Bessel van der Kolk, Peter Levine, Richard Schwartz, Gabor Maté, and the principles of Relational-Cultural Therapy, as well as SAMHSA’s comprehensive frameworks, underscores the necessity of moving beyond awareness to embodied, relational practices that truly support trauma survivors.
Sources:
Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Practical Guide for Implementing a Trauma-Informed Approach. HHS Publication.
Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. Basic Books.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W.W. Norton & Company.
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
Schwartz, R. C. (1995). Internal Family Systems Therapy. Guilford Press.
Maté, G. (2008). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Knopf Canada.
Jordan, J. V. (2010). Relational-Cultural Therapy. American Psychological Association.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication.
