Ethical counselling is being trauma-informed, and although there are some specific Trauma-therapy approaches, all Counsellors practicing any type of therapy can and should be trauma-informed. 

In its simplest form, being trauma-informed means being aware of the fact that therapeutic conversations, by their very nature, are capable of creating trauma-responses in the body, even while they are working towards healing.

Being trauma-informed therefore means that the therapist is trained in attending to the signs and symptoms of somatic (bodily) activation or deactivation in real time, during your counselling therapy session. This has important implications for both the safety of the therapy and its outcomes. At Nightingale we consider it a fundamental orientation and area of competency of all Counsellors regardless of their general and specific counselling practice.

Trauma research made a surprising discovery in the late 1990’s and early 2000’s. Researchers, doctors, and therapists asked the following question: “Why do some events traumatize some people and not others?” What they discovered was that trauma is NOT the event, but rather what happens in our brains and bodies after the event. 

Specifically, trauma can be at least partially defined as a dysregulation of certain bodily processes which are controlled by our nervous system. This dysregulation can lead to high-highs of activation—anxiety and panic—or very low-lows—characterized by diminished energy, foggy thinking, and dissociative experiences. These dysregulated processes can be “triggered” or “activated” by a variety of seemingly benign stimuli that in themselves are not traumatic but are powerfully coupled with the client’s trauma: smells, tastes, time of day or times of year, particular people, textures, emotions, etc.

These bodily responses play a key role in our ability to heal—not just healing from trauma, but for the wide variety of reasons that people come to therapy. 

1. These bodily responses tell us what’s important. If we can contain these experiences and keep therapy safe, we can use our trauma-informed observations to lead us towards what is important.

2. Conversation, dream, and memory can be interpreted by our emotional and affective systems as just as real as the event itself, and generate powerful nervous system and endocrine responses that can be overwhelming.

3. Safety is the bedrock of the therapeutic relationship, and uncontained dangerous experience is not safe, nor is it comfortable and inviting of our vulnerabilities.

4. It can be retraumatizing. At their most severe, these trauma responses can be a re-experiencing of trauma in such a way that we can become re-traumatized. It is essential that this be avoided, because it undermines the safety and containment of the therapy room. It is not the case that the therapeutic material around trauma cannot be discussed in the Counselling office, but it must be done so with great care, because to do so otherwise makes it increasingly difficult to stay open to possible paths towards healing.

The short of it is that trauma responses can become distressing and threatening internal experiences, and all of us will close ourselves off the source of these in an act of protection. But for therapy to work, we must be open, willing to explore intimate and vulnerable parts of ourselves and our stories in the name of healing. It is a foundational skill of therapists to maintain the absolute safety of the conversation. Being trauma-informed allows Counsellors to be attuned to the very subtle changes in affect, emotion, and soma — often the client is not aware of these changes — and to pace the therapy accordingly.

Our bodily responses fall into two general categories, “activation” or “collapse,” each existing on a large spectrum of intensity. Both of these are completely natural and normal, each being an organismic strategy to deal with danger. Again, this is what is so important about being mindful of these states: they are fundamentally threat responses, and therapy requires safety to be effective. Too much time spent in danger-feeling states is counterproductive to therapeutic progress.

Activation is something we are all familiar with. At first, activation leads to mild sensations of flushed skin, perhaps cold or sweaty hands, heartbeat speeding up, etc. But as activation builds it can lead to powerful feelings of constriction, wide-eyed fearfulness, anxiousness, and at its maximum intensity, panic. By being aware of the earliest signs of activation, the therapist can manage the course of therapy accordingly and with explicit consent.

So-called “collapse” is very common and natural, but for many people more unfamiliar than activation. What we are here labelling collapse can begin with a feeling of numbness, a sense of inattention and forgetting of what is being said, a feeling of things being a little surreal or like you’re not quite in the room anymore. At its most intense, the collapse spectrum leads to dissociative states such as depersonalization or derealization.

It goes without saying that therapy can not properly be conducted while a person is experiencing either panic or dissociation. So one task of trauma-informed counselling is to prevent these kinds of distressing experiences from happening. However, and just as importantly, by effectively tuning into the less intense states of activation or collapse, there are profound pathways to healing that open up.

If the dangers of therapy which do not take into account trauma theory and our bodily responses are now clear, what about the benefits of practicing this way?

Trauma-informed therapy opens the door for extraordinarily powerful approaches to change. In days past, talk therapy assumed that when we spoke about things “outside the room,” that’s all there was to it. Psychologists practicing under these auspices hoped to create change by generating new cognitive insights or by “processing” old memories. However, trauma-informed counselling goes beyond this.

The recognition that we are activated during therapy in much the same way that we are activated during our real-life experiences means that we do not need to just talk. We can actually activate the neural pathways and affective strategies that happen for you and work directly with them in the moment. It breaks down the barrier between what has happened outside the Counselling office and what is happening inside the Counselling office, because what happens with a therapist isn’t something other than “real life.” It too is real life. And this is why trauma-informed counselling can be such a powerful therapy.

Trauma-informed counselling allows us to safely and collaboratively learn to engage with these responses. Over time, we can increase our tolerance of strong triggers and strong feelings and work toward forms of mastery. When they are misunderstood and unmastered, nervous system responses feel chaotic, random, reactive, or compulsive. This often has a secondary dysregulating effect, wherein we can feel that our world doesn’t make sense, that we are beset by invisible forces, and that our body regularly betrays us.

But trauma-informed counselling provides a safe platform for you to discover just what is happening inside you and why. Over time, as tolerance grows and as safety and trust between therapist and client grow, you can literally learn to practice and play inside these once distressing affective states. Through this process, we can begin to reassert choice, agency, and ultimately mastery. 

At Nightingale, we uphold a higher minimum standard of expertise for our Counsellors than does the regulating body of counsellors in British Columbia. For us, being trauma-informed is fundamental to maintaining safety in the counselling room, essential to upholding the client-therapist relationship, and essential to creating positive outcomes. All of our Counsellors use trauma-informed observation, titration, pacing, and containment as part of their everyday  practice with all clients.