Safety, Recovery & Growth in Trauma Informed Care
Written by Emma Ketley and originally published by Allied Health Support in August 2019.
Three little words “Are you safe?” found their way to me from the UK
Further text messages followed, each time illuminating my phone in a bright blue light that cut through the darkness of the Western Australian night: “Everyone over here is concerned… I need to know that you are OK”. The urgency made me respond immediately: “Yes we are fine, thank you. The bushfires are some distance away from us”.
Later on, I thought about my NSW friends and tried to call them. Meanwhile, more overseas messages found their way to me, all asking the same thing: “We’ve heard about the bushfires… are you guys OK?”
I left voice messages for NSW friends to call me, whilst I watched the constant stream of news coverage of the bushfires. The car radio provided updates, and my ‘forever present’ phone beeped with news alerts as the bushfires spread. I texted my friends, desperate to hear they were okay. I knew they were usually busy, but in my heightened vigilance I feared that this time their lack of response could indicate danger. Without their contact, I started to try to track the path of the fires. Everything seemed to focus on the devastation; the orange skies, the houses destroyed, the wildlife in danger.
I sought information yet was overwhelmed by the constant stream of it. My need to establish their safety fed by newspaper headlines, social media, and 24-hour news channels.
Four days later I got the message I needed: “yes, we’re fine and have evacuated”. And with that, I was reassured.
However, hundreds of Australians have had direct experience of the trauma of the bushfires with “actual or threatened death” of themselves or loved ones. Informed by events such as the 2009 “Black Sunday” bushfires, the Australian Government are directing $76 million towards Mental Health services to support individuals and communities impacted by the fires.
Responses to trauma can vary, although individuals experiencing symptoms such as difficulty sleeping, reduced concentration, increased anger/irritability, increased alcohol/substance use, and/or prolonged anxiety should seek Professional Mental Health support. These symptoms may indicate underlying mental health conditions such as Acute Stress Disorder [ASD], Post-traumatic Stress Disorder [PTSD], Anxiety, Depression, or Substance Use Disorders [i]. The psycho-social burden of these conditions will affect a “person’s thinking, emotional states and behaviours, disrupts ability to work or carry out other daily activities, and to engage in satisfying personal relationships”.
The longer individuals take to access treatment and support, the slower recovery can be. Recovery in mental health is “not synonymous with cure. Recovery refers to… hope, healing, empowerment and connection”
Recovery will be the path to overcoming challenges and building new purpose.
Recovery informed by a Trauma-informed Care model will be a three-phase process:
Adapted from Judith Herman’s work on Trauma and Recovery
It is essential that “Phase one” – establishing safety - has been met before Trauma informed therapy can commence. This can include asking clients if they feel safe, and asking about social supports and current coping strategies. Emotional regulation skills such as self-soothing, grounding, and mindfulness may be taught in Phase one in preparation for future work. Basic self-care such as healthy diet, sleep hygiene, and substance use reduction should be established at this stage.
Phase two is where the loss and grief of the trauma will be acknowledged. Due to the potential for further harm through uncontained re-traumatisation, this stage requires the support of a qualified and experienced professional working in a safe designated therapy focused space.
The therapist’s use of self will enhance in-session stability for the patient in the early stages of Phase two. As Herman states “Trauma is contagious” with risks of vicarious trauma for the treating professional. Therefore, Professionals working within Trauma must establish their own self-care routines to manage the emotional demands of holding the safe space for their clients/patients. With this in mind, we encourage you to:
Seek increased professional supervision– to debrief and to set realistic expectations
Check in with your professional networks to share knowledge and stories of hope
Maintain contact with your own social supports
Practice self-compassion
Schedule pleasant and fun activities
limit caffeine
Balance your time- ensure regular breaks and end of day time keeping.
The final phase of Trauma informed care recovery is “Reconnection and Integration”. In this stage, Post-traumatic Growth may occur, with greater self-determination and social connection, and a renewed sense of purpose.
“The paradox of Trauma is that it has both the power to destroy, and the power to transform and resurrect”
Further Reading:
There are many books on trauma-informed care, but these texts provide a sound foundation for understanding the effects of Trauma:
Trauma and Recovery: The aftermath of Violence- from Domestic Abuse to Political Terror – Judith L Herman
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma – Bessel Van Der Kolk On Post-traumatic Growth
Upside The New Science of Post-Traumatic Growth – Jim Rendon
Flourish – Martin Seligman
Key national 24/7 crisis support services include:
Lifeline: 13 11 14 www.lifeline.org.au
MensLine Australia: 1300 789 978 www.mensline.org.au
Beyond Blue: 1300 224 636 www.beyondblue.org.au
headspace: 1800 650 890 www.headspace.org.au
