Trauma-Informed Care in Practice: Case Scenarios (Part Two)
Last week, we lay the foundation for STOP-IT’s trauma-informed approach by exploring how the use of language helps develop rapport and communicates empathy with survivors of human trafficking, exploitation and abuse.
A big takeaway from our post last week was how an individual’s verbal description of their lived experience looks different from person to person, and that mirroring their language back allows for our participants to speak in their own terms about their story.
This week, we will examine three different scenarios that shed light on how language can be transforming or diminishing in various settings. For purposes of confidentiality, names and stories have been altered.
Case Scenario #1
Molly, 21, experienced sex trafficking at the age of 19 and has a prostitution charge on her record. She is working with an attorney to get the charge expunged so she can apply for jobs. Molly disclosed her story to the attorney and used the word, “boyfriend”, to describe her trafficker. How should the attorney respond?
- “If he was your boyfriend and cared for you, he would not exploit you.”
- “When you say boyfriend, you mean trafficker?”
- “Sounds like he is not someone to be in a relationship with.”
- “Tell me about your experience with your boyfriend.”
The Most Trauma-Informed Response: (D). Here’s why.
Answer (A) places blame on Molly for her trafficking experience and implies that Molly’s choices are wrong because she picked him to be her boyfriend.
Meanwhile, Answer (B) imposes a label on Molly that she did not identify herself. Molly verbalizes that her trafficking experience was with a boyfriend, indicating that there was and still may be a relationship. By using ‘trafficker’, the attorney is interpreting a negative relationship when Molly may not see it that way.
Answer (C) also places blame on Molly for her experience and places judgement on her for continuing the relationship.
As the most trauma-informed response, Answer (D) allows Molly to disclose what she wants from her story, mirrors Molly’s language of ‘boyfriend’ to demonstrate that the attorney respects her perspective, and exemplifies that the attorney is interested in better understanding the situation through Molly’s own lens.
Case Scenario #2
Zoe, 25, escaped her experience of trafficking and comes to her primary care doctor for follow-up appointments related to past injuries. She has used substances after enduring physical abuse. Zoe wants her physical pain to go away and asks the doctor to write a prescription. How should the medical provider respond?
- “Considering your history of substance abuse, you might become addicted again.”
- “I think you need to try other alternatives.”
- “Based on my medical experience, this would be a bad idea.”
- “It seems like you need something to help your pain. In the past, it sounds like you used substances to help you survive the pain. Is that what you are looking for now?”
The Most Trauma-Informed Response: (D). Here’s why.
Answer (A) uses the term ‘substance abuse’, which for those who do not view their experience with substances as negative, is a harmful and stigmatizing term. Additionally, it assumes Zoe has been addicted in the past and anticipates she will be addicted in the future if she uses any medication again.
Meanwhile, Answer (B) disregards Zoe’s needs and disqualifies any perspective she has on the decision making process. Zoe may be defensive now in working with the doctor or feel inadequate to make decisions for herself.
Answer (C) highlights the power imbalance between medical providers and human trafficking survivors. A doctor providing medical guidance might be well-intentioned, but this feels controlling, reinforces the inherent power imbalance in a healthcare context, and often mimics ways in which traffickers exhibit control by speaking and making decisions for survivors rather than with them.
As the most trauma-informed response, Answer (D) tries to get to the heart of what Zoe is asking for and highlights in a survivor-centered lens why she may have used in the first place. The doctor asks for confirmation of Zoe’s need and allows Zoe to answer on behalf of herself.
Case Scenario #3
Norman, 43, is receiving counseling services from a local mental health clinic. He is currently working with an immigration attorney and is in the process of applying for his T-Visa. When his counselor expresses wanting to work through his trauma, Norman discloses that he was not physically restrained but his documents were withheld. How should the counselor respond?
- “Why didn’t you just leave?”
- “You didn’t go through physical abuse, which is good.”
- “It seems like you went through a lot of trauma when you were there. How are you processing through it?”
- “I think we can get through hard times, I’m sorry.”
The Most Trauma-Informed Response: (C). Here’s why.
Answer (A) is victim blaming and assumes that he had the choice to leave because he was not physically restrained.
Meanwhile, Answer (B) tells Norman that the manipulation and emotional abuse he endured is not as significant and traumatizing as physical abuse.
As the most trauma-informed response, Answer (C) acknowledges that what Norman faced was very difficult. It leaves out any assumptions and allows Norman to speak about his own story and the emotions he experienced. It allows him to process his trauma in his own language and to steer the counseling session in the direction he wants.
Answer (D) is sympathizing with Norman rather than empathizing. It takes away from Norman’s story and current emotions, while stating and assuming that trafficking is relatable to other types of trauma.
Trauma-Informed Care Takeaways
As stated by Meggie in Part One of this series, “Because language is complex, multidimensional, and bound by culture, time, and place…”, trauma-informed care is a practice that takes effort to understand and apply. We may not always say the right thing or it may come out differently than intended, but understanding that our language has impact is the first step in working toward a more trauma-informed practice.
Most importantly, working within a trauma-informed philosophy and putting it into practice in our day-to-day work is imperative to the healing process for survivors.
Language is just one tenet of trauma-informed care. For more resources and training on this subject, check out http://www.traumainformedcareproject.org/.