We should be sceptical of trauma-informed care

TW: mentions of childhood sexual abuse and iatrogenic harm.

Trauma-informed care wrecked my life. There. I said it. 

So, what really is the “care” that turned my life upside down? Why should we be sceptical of it? What are the dangers of embracing this practice uncritically? 

Whilst the principles of trauma-informed care are not new, the advent of trauma-informed care being articulated in writing can be traced back to Harris and Fallot’s seminal 2001 paper in which they advocate for universal trauma screening, a holistic approach to supporting traumatised patients, and extra care being taken to avoid re-traumatisation. 

There is no one single definition of trauma-informed care but it is essentially the practice of ensuring that there are sensitive, compassionate ways to support victims/survivors of trauma and acknowledging the impact that trauma has upon them. Patterson (2014) described trauma-informed care as “a system development model that is grounded in and directed by a complete understanding of how trauma exposure affects service user’s neurological, biological, psychological and social development”. 

My experience of trauma-informed care could not have been further from the idealised model I hear about at conferences, in research papers, and on every NHS mental health trust’s website. From the outset, the care I received from a specialist complex trauma service was woefully inadequate.

I was met with physical and emotional intimidation from the first session whereby my therapist deliberately moved her chair to be just centimetres away from mine. As an autistic person who has experienced childhood sexual abuse, this invasion of my personal space immediately sent me into a state of terror. I cried. I shook. I hyperventilated. My therapist refused to move and merely smirked, sighed, and rolled her eyes. This set the tone for the next five months of therapy before I was discharged for “dissociating too much”, despite this idea contradicting treatment guidelines for my diagnoses. 

In therapy, the worst moments of my life were reduced to “difficult teenage experiences”, my trauma was weaponised and re-played back to me in the most grotesquely distressing ways, and I was left unsupported when flooded with overwhelming memories I previously had amnesia for. 

The onus was on me. I had to “take responsibility”. I “had capacity”. I was responsible for the breakdown in the therapeutic relationship. I was simply “critical of mental health services”. When your therapist is acclaimed as being a pioneer of trauma-informed care, who will believe a young trauma survivor that her “care” bore no resemblance to the care her therapist speaks about at international conferences?

This is the “trauma-informed care” that the shiny Twitter/X pages of mental health trusts won’t tell you about. Trauma-informed care is hailed as the panacea to all trauma-related symptoms, it’s lauded as the approach that all practitioners should be enacting. But the crux of the issue is – not all mental health professionals “do no harm”. Whilst iatrogenic harm can be both intentional and unintentional, it is harm nonetheless. Harm is harm, but harm under the guise of being trauma-informed is reprehensible. Complacency facilitates harm too. A few days of trauma-informed training is not necessarily enough to equip mental health professionals with the relational and therapeutic skills to be genuinely trauma-informed. For me, being trauma-informed is a mindset, it’s a way of being and existing in the world. It’s not just a set of skills that can be reduced to a tick box exercise and a certificate for your LinkedIn. 

The worst thing about this is that I am not a unique case. I know countless people who have experienced similar and, when daring to complain about their experiences, were gaslit and told that their perception of reality is wrong because trauma-informed care can do no harm. This is what happened to me when I submitted a complaint about my care. I was the problem.

You may say, “well the treatment you received wasn’t actually trauma-informed care”. If enough people are being subjected to abuse under the guide of trauma-informed care, then at what point does trauma-informed care become a product of the people it re-traumatises?

If trauma-informed care caused me more trauma, then what type of therapy can I – a trauma survivor – seek out? 

Trauma-informed care left me terrified of interacting with mental health services. Trauma-informed care stole my trust in “the system”. Trauma-informed care shattered my already precarious sense of safety.

Mental health professionals and services delivering trauma-informed care are routinely re-traumatising already traumatised people. 

I deserved better. We all deserve better.

Chloe Apter (she/her) is an autistic ADHDer with dissociative identity disorder and other long-term conditions. She is a psychiatric system survivor who is interested in using genuine co-production to improve services for people like herself. Her Twitter/X is @ChloeSApter.