I saw my first therapist when I was a child, and have seen close to a dozen since. In Los Angeles, there’s no shortage of them, and while I was fortunate to work with some who were genuinely helpful, I’ve also had my share of experiences that were, at best, unhelpful and at worst, harmful.
Therapists are human. We make mistakes, we miss things, and it isn’t reasonable to expect that any one person will always know what to say, read every cue correctly, or meet every moment with exactly the right kind of care. But for people who have already lived through painful or difficult experiences, being consistently missed by someone who is supposed to help can do real damage of its own.
One of my early experiences in therapy was with someone I saw through my high school. Looking back, she was remarkable. She was attentive and curious, and she listened in a way that didn’t feel like she was waiting for her turn to respond. She said little, and when she did speak, it was thoughtful. She asked before offering feedback. And often, she just sat with me… in the hard feelings, and in hearing about some of the riskier things I was doing, which I suspect frightened her more than she ever let on. I didn’t understand at the time how rare that kind of presence was. It wasn’t until she stopped offering services through the school and I started seeing other therapists, that I realized what I had lost.
The shift was jarring. One therapist could tell I was struggling, but rather than taking the time to build enough trust that I might actually feel safe talking to her, she pushed. She made assumptions. She spoke as though she already understood exactly what I was going through, before I had told her much of anything. That kind of overstepping and the absence of real curiosity made me want to disappear from the room. And as a teenager, I was already skeptical of adults and was slow to trust; so that was enough. I stopped seeing her.
Shortly after, I tried again with someone new. When I finally felt comfortable enough to share that I was having a hard time imagining a future for myself, she got scared. Instead of trying to understand what was going on for me or what I needed, she tried to frighten me out of what I was feeling. That was the end of it for me. I didn’t see another therapist for years, convinced that most would be similarly unhelpful.
When I eventually reached out again, it was a mixed bag. There were still therapists who missed me, those who offered advice too quickly and were off the mark, and one who framed her own opinions as clinical fact, seeming more interested in getting me to live by her values than in understanding mine. But I also found therapists I felt genuinely connected to, and they shared something in common: they were curious. They took time. They offered support while respecting my limits, and they seemed interested in understanding all the different things that had shaped me, without judgment and without rushing to fix me before they’d really listened. In fact, they didn’t think I needed to be fixed. They helped me understand my current challenges, and the ways I had learned to cope were responses to things that would have been hard for anyone to carry.
That first therapist gave me a template for what attunement could feel like, and what I now understand is trauma-informed care. Later, it became something I knew to look for. And eventually, it became something I tried to emulate.
What does it mean for therapy to be trauma-informed?
It’s common to be caught off guard by our own reactions. Perhaps you’ve noticed patterns in yourself, like shutting down during conflict (as we discussed last month), feeling debilitatingly anxious when things are uncertain, or focusing on keeping others comfortable even when you yourself are overwhelmed and in need of support.
Trauma-informed therapy begins by exploring those responses with curiosity, rather than rushing to fix or change them. In this approach, understanding emerges through the process of inquiry itself, and solutions are discovered by staying open and attentive to what those reactions might reveal.
Trauma-informed therapy is a framework: a lens for understanding, rather than a single technique or modality. It recognizes that a person’s past experiences can continue to shape their body, emotions, reactions, relationships, and sense of self in the present. While anxiety, depression, self-criticism, emotional shutdown, substance use, or relationship struggles are frequently described as “symptoms”, trauma-informed therapy also considers them as possible adaptations. At one point, these patterns may have served as ways to cope, stay safe, avoid pain, maintain connection, or survive overwhelming circumstances.
A trauma-informed therapist does not assume every struggle is an adaptation or comes from trauma. Instead, they stay curious about how a person’s past experiences may still be shaping their present-day self. In practice, this involves being attentive to a client’s sense of safety, building trust, supporting choice and collaboration, fostering empowerment, and considering the cultural or historical factors that may influence a person’s healing process.
What other therapy frameworks exist, and how does trauma-informed therapy differ?
Now that we understand trauma-informed therapy as a framework, we can look at other lenses that may guide a therapist’s work. A framework shapes what a therapist pays attention to, what questions they ask, and how they understand the concerns someone brings into the room.
A diagnostic or medical framework begins with symptoms. A therapist working primarily from this lens may consider whether someone’s experiences meet the criteria for major depressive disorder, generalized anxiety disorder, PTSD, or another condition, and then use that diagnosis to guide treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which clinicians use to classify mental health conditions, is an example of this framework in practice.
A cognitive behavioral framework focuses more closely on the thoughts and behaviors that may be contributing to someone’s current distress. A therapist might help a client notice anxious predictions, patterns of avoidance, or behaviors that provide temporary relief while perpetuating a larger problem. This approach tends to be structured and oriented toward developing coping skills and changing present-day patterns.
A solution-focused framework is more focused on what someone wants their life to look like. This framework may explore what is already working in someone’s life and what small changes could move the client closer to their goals.
These frameworks can all overlap with trauma-informed care. A therapist may diagnose a condition, work with thoughts and behaviors, or help someone identify practical next steps while remaining trauma-informed.
What the trauma-informed framework adds, and what makes it distinct, is a consistent returning to questions of safety, trust, pacing, choice, and power, including the risk of re-traumatization in the therapeutic process itself.
What kinds of experiences can lead someone to seek trauma-informed care?
Someone might seek trauma-informed care after enduring an experience that felt overwhelming, frightening, violating, destabilizing, or inescapable. The SAMHSA framework describes trauma as having three components: the event itself, how the individual experienced that event, and the lasting effects that follow. This distinction matters because trauma is not defined solely by what happened, but also by how each person experienced it and the ongoing effects it had. Even when two people face similar events, their internal responses and the ways those experiences shape their lives can be profoundly different.
Traumatic events can include experiences such as assault, accidents, natural disasters, sudden loss, medical emergencies, or acts of violence. Large-scale research has shown that trauma is common across many countries, and that events like sexual assault, stalking, violence, and unexpected death have a profound and lasting psychological impact.
Others seek trauma-informed care because of experiences that were ongoing rather than singular. This can include childhood neglect, emotional abuse, growing up around addiction or instability, intimate partner violence, bullying, discrimination, or years of feeling unsafe in important relationships. Research on complex PTSD shows that going through trauma repeatedly or over a long period of time can lead to more complicated struggles, such as trouble managing emotions, low self-esteem, and challenges in relationships.
Trauma-informed care may also be helpful for people whose pain has been shaped by cultural, racial, historical, or systemic harm. For example, research on racial trauma describes how repeated exposure to racism and discrimination can affect mental health, the body, identity, and a person’s sense of safety in the world. Experiences like medical trauma, serious illness, chronic pain, or complicated grief can also lead to lasting changes, sometimes leaving people with feelings or struggles that are difficult to describe or fully understand.
The point is that trauma-informed care is not only for people who have a clear memory of one catastrophic event. It can also support people who have spent years adapting to environments where they felt unseen, unsafe, powerless, or alone.
What does a trauma-informed therapist pay attention to in the therapy room, and what do they do differently?
A trauma-informed therapist pays attention to everything happening in the therapy room, not just the words a client shares, but also their emotions, body language, sense of safety, and the overall atmosphere. They understand that healing is shaped by subtle experiences and careful attunement, not merely by discussing the past. The therapist listens to what their client says, while also noticing when it becomes difficult for their client to speak, when connection is lost, if the pace feels too fast, or if the work is starting to feel overwhelming.
This includes the therapist paying attention to body language. Some people become quiet, tense, distracted, numb, restless, apologetic, or suddenly unsure of what they feel when they are approaching something painful. Research on nonverbal cues in trauma-related clinical settings has found that posture, eye contact, emotional withdrawal, avoidance, and other physical signs can offer meaningful information when considered alongside what a person is verbally sharing. A trauma-informed therapist does not treat these cues as proof of anything, but instead as invitations to slow down, check in, and make time and space for what may be happening internally.
A trauma-informed therapist also pays close attention to the therapist-client relationship. Research on the therapeutic relationship in PTSD treatment found that the quality of the therapist-client relationship is heavily connected to treatment outcomes. (Maybe we can link our past article on this?)
Trauma-informed therapists are also meant to be attentive to culture and context. Trauma does not happen in a vacuum. A client’s race, gender, sexuality, immigration history, family system, religion, class, disability, and experiences with institutions all shape one’s concept of safety. Work on cultural humility in trauma-informed care emphasizes that therapists need to approach these realities with openness, accountability, and respect.
How can trauma-informed therapy help?
As someone starts to understand the roots of their reactions, it becomes easier to notice those patterns in the moment. To name a few examples, they might notice the feeling of rising tension or constriction before shutting down, realize when fear is informing how they hear someone’s words, or recognize why setting a boundary stirs up guilt. With that kind of awareness, there becomes more space to pause, share what they feel or need, reach out for support, or choose a more aligned response.
Understanding our reactions in this way can also soften the shame we carry around them. Instead of seeing ourselves as overly sensitive, difficult, or incapable of change, we can begin to recognize how we adapted to the circumstances we’ve lived through. From there, it may become easier to approach ourselves with compassion as we learn and practice new ways to cope and connect. This is integral to the work.
Across studies, trauma-informed care has been connected to reductions in post-traumatic stress, depression, and anxiety, as well as improvements in emotional regulation, relationships, and behaviors that may place someone at risk. Because trauma-informed care is a broad framework that can be practiced in a variety of ways, the results vary across settings and individuals.
For people who have experienced abuse or violence, healing can lead to feeling more confident in their decisions, feeling a greater sense of control and agency in their lives, and developing relationships that feel safer and more reciprocal.
Over time, trauma-informed therapy can help us feel like the past does not dictate our decisions, relationships, and overall lives. Our reactions may not disappear entirely, as growth will always be nonlinear, but we can start responding to them with more intention.
How do you know if trauma-informed therapy might be right for you, and what questions can you ask a therapist before beginning?
Sometimes people come to therapy knowing exactly what they want to work on. More often, they arrive with a feeling they can’t quite name… a recurring pattern, a reaction that seems out of proportion, a sense that something old keeps showing up in their current life without an obvious explanation.
Trauma-informed therapy may be worth considering when your reactions feel tied to experiences that left you feeling afraid, powerless, unseen, or unable to protect yourself. But you don’t need to have that mapped out before you begin. SAMHSA has noted that many people seeking support don’t initially connect what they’re struggling with now to what they lived through earlier. You can come in not knowing how to name it, or not even sure that what happened to you “counts.”
Finding a therapist can take time, and that process can itself feel defeating. When you do have a consultation or are meeting with a new therapist for the first time, it can help to ask how a therapist understands trauma-informed care in their own work, how they think about pacing when someone is approaching difficult material, and what they do when a client becomes overwhelmed or shuts down in session. Asking how much say you’ll have in what you focus on is also worth doing.
But pay attention to more than just the answers. Notice whether they seem comfortable with your questions or whether something in the conversation already feels rushed. Notice if you feel heard. You likely won’t feel fully at ease after one conversation, and that’s reasonable. Trust between a client and therapist takes time to build. Still, a first meeting can tell you something real about whether there’s room for your uncertainty, your pace, and your questions.
Reaching out for support requires its own kind of courage, especially when you’re not yet sure what you’re reaching toward. We would be glad to support you in figuring that out while taking things at your pace. If you’re looking for a trauma-informed therapist, we hope you consider contacting us.