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Why ‘trauma-informed’ care is spreading from the therapist’s office to yoga classes and tattoo parlors

Trauma awareness is especially appropriate in settings where physical contact may happen, such as a yoga class, says one expert. (iStock)
8 min

For years, psychiatrists, psychologists, social workers and mental health counselors have practiced trauma-informed care, an approach that acknowledges that people have traumatic experiences and that those experiences can affect their behavior and understanding of the world. The goal of trauma-informed care is to offer more effective therapy by acknowledging trauma, recognizing the signs of trauma, responding to those signs and avoiding re-traumatizing the patient.

Now, professionals and service providers of all kinds outside the mental health field are adopting a trauma-informed mind-set. Lawyers, yoga teachers, photographers, career coaches and tattoo artists are educating themselves about the effects of trauma, approaching their work with this new knowledge in mind and labeling their businesses “trauma-informed.”

Although mental health professionals take coursework from and receive certification by academic and professional organizations that specialize in trauma-informed training, those outside the field seldom have access to similar instruction. There’s no consensus on how to vet professionals outside of the mental health arena, nor is there any governing body that regulates trauma-informed programs. That means that non-mental health professionals could receive inadequate training.

Vaile Wright, senior director of health-care innovation at the American Psychological Association, said the risk this poses is twofold. “If consumers are expecting a trauma-informed yoga teacher to heal their trauma or treat their trauma, I think that you run the risk of that expectation clearly not being met, and therefore a consumer might not reach out for help in other ways, like [with] a professional. At its very worst, it could end up being re-traumatizing.”

When there is no available training, interested professionals such as Rosie Valentine, a photographer in central North Carolina who labels their services trauma-informed, are creating their own curriculum.

“I really care about my clients’ emotional experience and their safety. I recognize that I cannot create a 100 percent-safe space all the time. That’s just not humanly possible,” Valentine said. “I don’t know folks’ individual triggers to all of the nuanced extent that they exist as living, complex people, and their lived experience.”

Valentine’s trauma-informed approach involves consent, communication and boundaries. For portrait clients in particular, Valentine makes themself available for hours of consultation before the shoot, where they agree on what kinds of poses, interaction and language the client is comfortable with, when and where the shoot will take place, and how Valentine can make the experience a positive one. Valentine said photo sessions often begin with a moment of silence. “It’s typically a pretty tender and vulnerable experience for folks being photographed. … It’s a pretty vulnerable space together.”

As the increasing interest in offering trauma-informed care suggests, trauma is common. One survey of 2,900 participants found that up to 89.7 percent of adults in the U.S. have experienced at least one traumatic event, and exposure to more than one is the norm. According to the Substance Abuse and Mental Health Services Administration, childhood trauma is common: By age 16, more than two-thirds of children report at least one traumatic event.

Traumatic events can include community, school, racial and domestic violence, physical or sexual assault, psychological abuse, loss of a loved one, neglect, natural disasters, and refugee or war experiences, though this list is far from exhaustive.

The effects of these events can be profound and long-lasting and can appear in a number of ways, including anxiety, depression, inability to concentrate, self-harm, violent behavior, thoughts of suicide, intense and intrusive memories of the traumatic event, dissociation, sleep disorders, and avoidance of emotions and sensations associated with the traumatic event.

To be trauma-informed, said Carol Tosone, a professor of social work at New York University who co-directs its trauma-informed clinical practice program, is to assume “that trauma is fairly ubiquitous, it’s widespread, that anybody could be experiencing it, and you need to be sensitive to the fact that anybody could be experiencing it.” She also noted that what one person registers as trauma, another may not.

Aaron Skinner-Spain, a licensed clinical social worker who co-directs NYU’s trauma-informed program with Tosone, characterized the approach as one that asks, “What happened to you?” and not “What’s wrong with you?”

Trauma awareness is especially appropriate in settings where physical contact may happen, such as a yoga class, Tosone said. “You go to the studio, you’re doing your poses. The instructor may come over and correct your pose to help you deepen it.” For someone who has experienced trauma, she said, being touched can elicit a deeply painful or unpleasant response. “Now, in trauma-informed, what the instructor would be saying is, ‘May I approach you? May I put my hands on you?’”

Jenn Turner, a licensed mental health counselor based in Boston, founded Trauma Center Trauma-Sensitive Yoga, a program to educate yoga instructors in trauma awareness. The 300-hour certification course comprises classwork, mentorship, observation, evaluation and research, and it requires that participants pursue continuing education and annual supervision to maintain their credential.

For professionals like Valentine, the photographer, it can be difficult to find trauma-informed training. There are no licenses or certifications for photographers, so they have to create their own course of study. Valentine said they draw on their previous work at a domestic violence agency and their undergraduate coursework in subjects such as sociology, human rights and colonialism, in addition to staying apprised of current research. “I am consistently working to learn and grow in this area. I think it’s the thing that I will always be learning and growing in. I do feel confident in doing trauma-informed work at this point, but also recognize there’s so much expansive space there for growth.”

Professionals seeking to make their work trauma-informed often do so for deeply personal reasons. “As someone who has held a lot of trauma in my body and mind in life, it is really meaningful to me to support others with trauma services,” Valentine said, “and I'm really passionate about affirming people, particularly other people in the LGBTQIA community.”

Ruby Gore is a Philadelphia tattoo artist educating herself about trauma. Like everyone in her field, Gore spends a great deal of time in close physical contact with others, which can be difficult for someone who has had a traumatic experience. She said that when several clients started asking her for scar coverups, often the result of a traumatic event or its long-term effects, she recognized that she needed a specialized approach.

“I was like, you know, I've never done this before. It is something that's important to me. I'd like to learn.” Gore said she started by having a more experienced tattoo artist supervise and by doing her own research online. Now she’s working with a friend in social work to understand how she can help clients feel safe during the tattoo process.

Like Valentine, Gore’s motivation is personal. As someone who has experienced trauma herself, “seeing how [scar coverups] brought so much hope and light to the person that I had tattooed was … so rewarding on another level that I couldn’t even explain.”

Because there are few avenues for formal trauma education, not everyone receives adequate training. Skinner-Spain, with NYU, said the risk of someone outside of mental health educating themselves and labeling their work trauma-informed is that they may not be prepared to handle trauma responses or to hear about traumatic experiences. “Listening to stories of harm is difficult both for the practitioner, if you’re not equipped and experienced enough to handle that, and also the person, if you can’t contain the emotional charge and intervene appropriately.”

How professionals represent themselves matters, said New York psychotherapist Jennifer Benetato, who specializes in trauma and addiction recovery. It’s a good sign if they’ve received training from a mental health practitioner, but it doesn’t mean that person is qualified to say, “Please tell me all of your trauma, let’s heal all of that,” she said.

One of the most popular texts for those looking to develop trauma awareness is “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” which documents and explores the effects of trauma. The author, psychiatrist and trauma researcher Bessel van der Kolk, said he is heartened by the “quite important and quite revolutionary” growing awareness of trauma and its effects. He nevertheless expressed reservation about the trauma-informed label being used outside of mental health.

“I like to think that I know something about trauma,” he said. “I would never say that I’m a trauma-informed practitioner because I know that people have their own reactions, and you can get very unexpected responses.” He also noted that the term trauma can be over-applied.

Van der Kolk worries that some practitioners may be hiding behind the label, using it as a buzzword. If someone wants to claim trauma awareness, he said, there must be demonstrable change in the way they work with and relate to clients. “I would say, ‘What do you mean? What have you learned? How are you doing things differently?’

“I think the label doesn’t really tell me how good you are, but your results [do].”

Emily McCrary-Ruiz-Esparza is a freelance writer based in Richmond who covers workplace culture and policies and issues faced by women. Find her @emilymccrary.