Trauma-informed practice: Recognising long term difficulties

Last Updated on March 5, 2025

Exposure to trauma in the care sector means an increased risk of developing serious, detrimental conditions. Andy Holmes explains how to recognise trauma-associated symptoms and how to adopt a trauma-informed practice in the workplace to help those affected and yourself.

Sarah, an experienced care home manager came to counselling when she realised her outlook on life had changed from a happy caring person to one who viewed life as unsafe, filled with suffering and loss. She felt her empathy was “being diluted” and she struggled to find a work-life balance. Her sleep was poor, her cognitive function was affected and she developed various health anxieties.

It became clear that Sarah was experiencing trauma-associated symptoms even though she had not personally suffered directly from the issues that her service users had.

Working in the social care sector undoubtedly means exposure to trauma, either directly or indirectly. Care staff risk developing burnout, compassion fatigue and/or secondary trauma – the consequences of which impact on every aspect of care, from service delivery to work-related absence.

Trauma Informed Practice (TIP) is an approach that recognises these long-term difficulties. TIP requires a combined organisational and individual commitment. It broadly includes the 5 principles of safety, trust, choice, collaboration and empowerment (Fallot & Harris, 2006).

The truth is that some organisations are better at following this approach than others and even when they do, the very nature of social care leaves care staff exposed to sadness, death and pain. For managers of care facilities, the problem is compounded by the extra pressures of complaints, staffing issues and safeguarding investigations, to name a few.

Trauma Informed Practice is a holistic and collaborative approach that identifies trauma risk within an organisation and implements policy and processes, training and aftercare to minimise the impact of such exposure.

Trauma in the workplace – three main types.

In its simplest form, trauma can affect us in three ways:

1. Secondary traumatic stress (often called compassion fatigue) is stress that has originated from cumulative exposure to other people’s trauma. It is often manifested in behaviour and maladaptive coping strategies.
2. Vicarious trauma is demonstrated by a change in the way the carer may see the world, just as Sarah saw the world as dangerous and a heightened feeling of being unsafe.
3. Burnout is a term that arises from emotional exhaustion. Care staff may become disillusioned, may become less empathetic or give a minimum service, not through choice but through necessity to reduce exposure and to meet ever-increasing demands.

For Sarah, it wasn’t clear to her why she felt different, but she felt it crept up on her over many months if not years. The important point is that she identified something within her and decided to seek help. It doesn’t need to be a counsellor in the first instance, perhaps a friend or colleague, but processing the emotions and sharing them with someone can help make sense of them.

If Sarah hadn’t had the insight, hopefully, her colleagues would alert her to any change in her behaviour and give her examples to help her realise that she needed help. For Sarah, the fact that she was listened to without judgement and felt validated by her counsellor allowed her to work through her feelings. It’s never too late to reach out for help and if the issues become complex, then therapy can help.

Self help strategies

Notwithstanding the need for organisational commitment, it is crucial that individuals take personal responsibility to maintain or build resilience to minimise the effects of trauma.  Such personal care may include;

• Talking to someone – as simple as it sounds, the benefits of sharing your concerns in a safe environment can be a lifesaver. Many clients who come to counselling do little more than talk through their issues yet leave the session feeling in a much better place. For others, just sharing with a friend or colleague may be all that is needed.
• Exercise and healthy eating – almost a cliché but so important. It’s not how much we eat but what we eat that matters. Serotonin is mostly created in a healthy gut, so replace the processed food with those high in Vitamins D and Omega 3.
• Practice self-care – anxiety lives in the future and trauma from the past, so try and stay present. Use grounding techniques, mindfulness and relaxation. This allows the immune system time to recover and gets rid of those nasties like excessive cortisol and adrenaline.
• Build resilience – have a mental clear-out. What is no longer important? What can be changed? What needs to be accepted? What can wait? What won’t matter in a week, month or year?
• Don’t take it home – this is particularly important for managers who work from home. Research following Covid found that some professions who worked from home had no psychological disconnect from work. Avoid working in your bedroom – try working from a designated ‘office room’ or in a coffee shop (bearing in mind confidentiality and internet security). When leaving work, make a list for tomorrow, physically shake off the day or change your clothing as a mindful reminder that you have left work.
• Use Employee Assistance Programs or counselling services as needed – sometimes we need professional guidance to help deal with trauma, work-related stress and overload.
• Escalate the problem – as difficult as it is to present a problem, it’s everyone’s responsibility to let their supervisor know about a risk to the organisation, including psychological injury such as trauma. Early identification should lead to early resolution or mitigation and as a manager, there is a duty of care to highlight any concerns relating to health and safety.
• Reduce alcohol consumption – alcohol can make anxiety and depression worse, so reduce or avoid it when you are feeling anxious or in a low mood.

Ending on a positive

In most organisations, trauma-informed practice is already embedded in policy and procedure, but it is important to schedule regular reviews as with any risk management approach.

Working in the care sector is definitely rewarding and with a trauma-informed approach, teamwork and individual accountability, trauma can be managed and care staff can get on with what they do best – caring for those who most need it.

Oh, what happened to Sarah? Well, during counselling she realised the importance of self-care, re-evaluating her life values and connecting with others when feeling isolated. She went on with her career in a much better place and negotiated a work-life balance that reduced the exposure and impact of working in the care profession.

(‘Sarah’ is a pseudonym and has given permission for her experience to be retold)