Question 1. As a sole practitioner I aim to follow all the guidelines except, of course, those that are irrelevant to a private practice like mine. That’s the way I was trained, and it’s my personal belief system as well. That being said, one area I wish I could offer better is providing a physical environment that’s more consistent with trauma-informed care. My office is EXTREMELY small (my walk-in closet at home is just about the same size), and that could be a trigger for some clients affected by trauma. If siblings, a couple, or a parent-child dyad are there together, the sit right next to each other, which also might be re-traumatizing for some. I don’t believe that has been an issue for my clients, but I really can’t be 100% sure. I always check in with them and ask directly about “physical closeness” issues, but trauma survivors may not always speak up about their discomfort. Thankfully, the majority of my work is with individuals. I try to make the space homey and non-threatening in every way I can, but–well, you never know.
Question 2. Again because of my training, experience, and personal values, I am extremely person-centered and resiliency/recovery-centered as well as skilled at developing therapeutic alliances which involve shared responsibility for decisions. I also automatically screen and assess for trauma history and trauma-related disorders with every client, despite what they identify as their “presenting problem” and even if they never use the word “trauma.” In fact, many people are surprised when that word comes up because they never thought of their experiences that way, no matter how horrific or abusive they were/are. One area I’d like to work on more is my experience (and competence) in delivering trauma-informed and trauma-specific evidence-based interventions that reduce symptoms. New evidence-based practices are being developed all the time and I’d like to stay current on these. Another area I’m not sure how well I’m doing with is clinician self-care practices that prevent or lessen the impact of Secondary Trauma Stress. I plan to read the Fact Sheet that I printed out from this week’s material, so we’ll see.
Question 3. I felt that Larry’s approach with his client was NOT consistent with TIC because it completely ignored that aspect of her experience. Larry’s clinical supervisor’s feedback and recommendation also ignored the issue of trauma, which is problematic for the client’s recovery so I would have brought that up and tried to provide coaching on recognizing and respecting the client’s trauma experience and how it relates to her SUD, and getting her agreement to integrate it into her recovery plan, if at all possible.