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74 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 2 • Know grounding techniques: When clients or patients have an unexpected emotional reaction to some trigger that takes them out of the present, it is important to be able to reorient them to their surroundings in a safe and compassionate way. • Work with patients, rather than on them. The therapeutic alliance in TIC is a partnership, not a one-way hierarchy. It is a collaboration with mutual goals, rather than a provider only giving something—instructions, a prescription, a referral—to the receiving patient. I hope readers will resonate with these practical applications of TIC, because many of them are built into the ways we learn to interact with clients from the very beginnings of massage therapy education. But to be skilled in the field of TIC, these practices and the attitudes behind them must be conscientiously developed and nurtured. WHAT DOES HEALING LOOK LIKE? Traumatization is not the result of an event; it is the result of a person's responses to adverse or threatening situations. Those initial reactions to dangerous situations were probably appropriate and protective—there's nothing wrong with them. But when those effects linger and interfere with being able to live a life of meaning and purpose, then more functional responses must be developed. Healing from trauma is not a matter of fixing anything—those initial sympathetic reactions were necessary. Rather, it's a long road toward learning new ways of dealing with the repercussions of the initial event. The trek can be lengthy, and may involve many helpers: family and intimate, trusted friends, talk therapists, medical doctors, and sometimes bodywork practitioners who can help trauma survivors reconnect with their resilient, miraculous, physical selves. [People living with trauma] ". . . cannot recover until they become familiar with and befriend the sensations in their bodies. . . . In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self- awareness is the first step in releasing the tyranny of the past." 6 Healing from trauma isn't about flipping a neurochemical switch, or correcting misaligned perception, and then being done. A traumatized person may never wake up someday and say, "Wow, I'm glad I don't have to deal with that anymore." Healing from trauma is a process, an ongoing project, a journey through what can look like scary, uncharted territory. Progress isn't always smooth, and momentum can stall. The path forward can seem to disappear, or the person can get mired Resources A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Sciences. 2014. https:// store.samhsa.gov/sites/default/files/d7/priv/sma14- 4816.pdf. Bruce, Marta M. et al. "Trauma Providers' Knowledge, Views, and Practice of Trauma-Informed Care." Journal of Trauma Nursing 25, no. 2 (Mar/Apr 2018): 131–38. https://doi.org/10.1097/ JTN.0000000000000356. Dawson, S. et al. "Trauma-Informed Approaches to Primary and Community Mental Health Care: Protocol for a Mixed-Methods Systematic Review." BMJ Open 11, no. 2 (2021): e042112. https://doi.org/10.1136/ bmjopen-2020-042112. Felitti, V. J. et al. "Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study." American Journal of Preventive Medicine 14, no. 4 (1998): 245–58. https:// doi.org/10.1016/S0749-3797(98)00017-8. Fitch, Pamela. Talking Body, Listening Hands: A Guide to Professionalism, Communication, and the Therapeutic Relationship. Pearson, 2015. Grossman, S. et al. "Trauma-Informed Care: Recognizing and Resisting Re-Traumatization in Health Care." Trauma Surgery & Acute Care Open 6, no. 1 (2021): e000815. https://doi.org/10.1136/tsaco-2021-000815. Gundacker, C. et al. "A Scoping Review of Trauma- Informed Curricula for Primary Care Providers." Family Medicine 53, no. 10 (2021): 843–56. https://doi. org/10.22454/FamMed.2021.500263. Levy, R. "Beyond the Buzzwords: What Does Trauma- Informed Care Truly Mean?" Mad in America. May 20, 2020. www.madinamerica.com/2020/05/beyond- buzzwords-trauma-informed-care. McFarlane, A. C. "The Long-Term Costs of Traumatic Stress: Intertwined Physical and Psychological Consequences." World Psychiatry 9, no. 1 (2010): 3–10. Ravi, A. and V. Little. "Providing Trauma-Informed Care." American Family Physician 95, no. 10 (2017): 655–57. Rosenow, M. and N. Munk. "Massage for Combat Injuries in Veteran with Undisclosed PTSD: A Retrospective Case Report." International Journal of Therapeutic Massage & Bodywork 14, no. 1 (2021): 4–11. National Institute for the Clinical Application of Behavioral Medicine. n.d. "The Neurobiology of Trauma." Accessed May 2022. www.nicabm.com/ program/a3-brain-trauma-fb. Van der Kolk, B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Publishing Group, 2018. Trauma-Informed Care Implementation Resource Center. n.d. "What is Trauma-Informed Care?" Accessed May 2022. www.traumainformedcare.chcs. org/what-is-trauma-informed-care.