Issue link: https://www.massageandbodyworkdigital.com/i/1464088
72 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 2 in a lower socioeconomic class (this is both a cause and effect of trauma), and they may have difficulty accessing adequate health care. Physicians and other clinicians who are not sensitive to the challenges of living with trauma can further alienate or even retraumatize these patients, which means they may be less likely to seek medical help unless it is a life-threatening emergency. TRAUMA, HEALTH, AND SOCIETY: EVERYTHING CONNECTS TO EVERYTHING The individual, community, and cultural impacts of trauma on health don't easily fit into a typical outline format. Instead, it may help to think of the experience of trauma as the center of a web, with strands to many other issues—personal and societal—that create self-fulfilling cycles of dysfunction. On the opposite page is one version of a trauma web that demonstrates how trauma is both a cause and an effect, linking numerous life and health challenges—many of which are commonly seen in massage therapy settings (see "Trauma: Everything Connects to Everything"). TIC: CONNECTION AND COLLABORATION The SA MHSA definition of trauma- informed care (TIC) is: "TIC is a strengths- based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment. It also involves vigilance in anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma, and it upholds the importance of consumer participation in the development, delivery, and evaluation of services." 3 This approach has been codified by some experts into the "Four Rs" of TIC: • Realize what trauma is and how it can affect individuals, families, communities, and societies • Recognize signs of trauma • Respond to trauma in practice and in general policy • Resist retraumatization by being sensitive and using good communication skills A close reading of the SA MHSA statement shows that skilled massage therapists could be confident providers of trauma-informed care. We learn early on the importance of creating "physical, psychological, and emotional safety for both providers and survivors." When we encourage our clients to make decisions for their sense of comfort and safety, we are "avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma." And when we invite feedback about pressure, comfort, and technique, we promote "participation in the development, delivery, and evaluation of services." None of this requires that we be deeply educated in principles of psychotherapy or that we know anything specific about our clients' backgrounds. "TIC does not require that clinicians know the exact nature of the trauma a patient has experienced. Instead, by promoting sensitivity and focusing on trust, TIC provides a set of principles to help clinicians create a safe environment in which survivors feel comfortable returning in the future." 4 In short, when we are present and invested in being client-centered with our work, we deliver trauma-informed care. TIC is about making deep and true connections, conveying that our clients are important and deserve our full attention. In that process, we can help safely reconnect our clients with themselves and their physical experiences in ways that other interventions may not be able to do. In addition, TIC is a collaborative process because it is based on a relationship where partners work together. It is a mutual journey: As we walk together, the practitioner offers support and guidance, but the client does the hard work of learning to understand why they have reoccurring traumatic experiences, and how to manage them in a way that promotes their health and well-being. PRACTICAL STEPS While the idea of TIC is widely accepted in the medical community, many health- care providers are unsure whether they can provide it skillfully. This is often attributed to the assumption that TIC takes more time than the clinician can offer, or to a lack of education, confusing information about TIC, or fears of inadvertently retraumatizing patients. 5 When clinicians write about the practical differences between a trauma- informed encounter and one that is less sensitive, some interesting suggestions arise: • Be prepared: Have the room ready for whatever activities are planned, so the patient doesn't have to be there while a doctor or nurse searches for the correct equipment or unpacks the right tools. • Make eye contact with your patient and try to keep your eyes on the same level as theirs—that is, avoid standing over your patient while you are having a conversation. • Be transparent and get consent: Tell the patient what is going to happen and get their agreement as you go through each step together. If something is happening that the patient can't see, inform the patient about what is going on. • Offer suggestions rather than directions: "Some people find it easier to take a deep breath at this point" is better than "take a deep breath" when a patient is in obvious discomfort.