Health and Trauma 

By Ryan Hill MA Social Work , B. Psych.Sc

I have worked with a number of clients who have experienced past trauma in my counselling practice. Trauma-informed practice is imperative to prevent unwittingly retraumatising clients, however clinicians must always be aware they may unwittingly trigger clients defence mechanisms. Therefore an awareness of childhood and adult defence mechanisms is important. Care must be taken by clinicians to establish rapport,ensure the clients safety, and build the clients awareness of how the trauma has effected them. A person-centred approach to therapy involves respect, focusing on clients’ strengths and potential to learn and grow, whilst acknowledging the agency of the people we support as practitioners. Thus, the focus of the practitioner moves fromwhat is wrong with’ the client to ‘what has happened’ to this unique person I amsupporting.

As a private practice counsellor I align with UWA Social Work lecturers recommendations, advocating for a client-centred Rogerian approach to practice which acknowledges clients’ lived experience and focuses on their resilience and agency. Being client-lead in my practice I endeavour to ensure my clients have power and autonomy in directing their therapy. Indeed, ‘addressing trauma should not be the default’ approach to practice. My experience and prior education reflects clients come to affect tolerance when working through their trauma. Therefore I have accommodated clients’ exploration of the trauma in their own time. Certainly it is necessary to allow time in developing therapeutic rapport with clients who have experienced trauma and often appropriate to provide psycho-education on coping mechanisms and emotional regulation strategies prior to addressing the trauma. Still, ‘timing is all important’.

Further reflection for practitioners

For those working with people who have experienced trauma, you will know it can be very challenging as the practitioner. I have experienced vicarious trauma, and have certainly been triggered myself by hearing my clients stories. I feel it is very important to keep a track of how as practitioners we are personally travelling in this area. A useful resource is the ‘Professional Quality of Life Scale (PROQOL) – version 5 (2009)’ which can be used to measure and assess clinicians compassion satisfaction, burnout, and experience of secondary traumatic stress. One of my previous managers summed this sentiment up when he said to me “you cannot help others if you are not right yourself”. To believe that others experiences of trauma will not have an effect on a clinician who hears their story is delusional. Practitioners must consider their therapeutic relationship with their clients, being aware of transference and counter-transference. Likewise, practitioner self-care is of utmost importance when working with clients who have experienced trauma. Moreover, regular supervision is essential when working with people who have experienced trauma to examine cognitive obstacles or occurrences which are obscure to the practitioner. If you are someone you know is working with people who have experienced trauma, please, be brave, be bold, be humble and access support so that you, the practitioner, remains well and able to practice optimally.

Ryan Hill

Breathe Counselling Perth

ryan@breathecounselling.com