4 R's of Trauma Informed Care
- James Saxton
- 4 days ago
- 2 min read
Updated: 4 days ago
Trauma Informed Care can sometimes seem like a buzz-phrase in today's therapy lexicon. While it is not a modality in and of its self, it is a framework that can help in the idea that 'all behaviors make sense'. And while this may be hard to conceptualize from the outside looking in, it helps to shift this perspective to an understanding that behaviors can be a result of attitudes/beliefs manifested in actions. Central to the idea of trauma informed care are the 4 R's of trauma informed care. In collaboration with the three E's referenced in previous post and the 6 principals, a perspective and framework can be developed.
The full list of the 4 R's, 6 Principals, and 3 E's can be found on SAMHSA website. The following is my interpretation and application of the 4 R's.
R # 1 Realize -- A realization of the presence of trauma and the impact it has on individuals and various systems. Trauma can take many forms and when unacknowledged and unrecognized, it can create buried impacts. The ACE study and subsequent screening tool is a beneficial tool for realizing various forms of trauma and how they occur.
R # 2 Recognize - Recognition of trauma occurs when it is addressed and processed in a safe manner. Trauma is a personal topic and can be covered in layers of feelings including anger, guilt, and shame. Intense responses and feelings are often guide posts to underlying indicators of trauma. Recognition also includes working to personally understand how trauma is impacting and showing up. Screening for mood disorders (anxiety, depression, etc) can be helpful in this process.
R # 3 Respond -- This is to be read as responding, not reacting. Often times in working with trauma, the individual is used to a 'reactionary' response from others that can have a further impact on psychological safety. Responding is, in essence, the ability to respond and to be done in a compassionate, caring manner. Responding creates an atmosphere of curiosity and openness and allows for the natural processing of trauma.
R # 4 Resist -- Resisting re-traumatizing an individual and working to create safe exploration. This takes a conscious awareness regarding tone, words, and actions. Being self-aware and accountable throughout the process is essential in this principal. Understanding the areas of trauma in the individual also helps to support this as to avoid any presentation of similar actions.
In my work, this begins with the ACE screening along with PHQ 9 and GAD 7. This also includes taking a family history using a genogram and addressing the trends of mental health, substance use, and other factors within the home environment. Psychoeducation regarding trauma, stigmas, psychosomatic indicators, and belief systems are then engaged. Helping the other to understand some of the causes/conditions in a blame free manner that promotes autonomy and healing is the fist step in this process.
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