Trauma informed care is crucial in a culture that sees mental illness as a character defect.
If you feel like you’re belittled every time you dare open your mouth about how you’re feeling, you’re not crazy. You’re being gaslit in a culture that laughs at your “weakness,” institutionalized and indoctrinated behavior passed from generation to generation.
This is why trauma informed care is crucial, arguably now more than ever. I previously wrote about trauma informed therapy and why all therapists aren’t trauma informed. Today, I want to talk about the broader concept of trauma informed care and the barriers to accessing it. It’s also important to bring up how the American view of mental illness as a character defect kneecaps that care.
Trauma informed care is really about an entire environment of care. It recognizes the impact of trauma (including abuse, neglect, violence, racism, etc.) and acknowledges its signs and symptoms. This kind of care integrates trauma knowledge into policies, procedures, and practices, and – crucially – avoids re-traumatization by emphasizing emotional and physical safety.
In other words, it points to a system of care that is mindful of trauma’s impact, not just a list of therapy techniques. A U.S. study of trauma center providers (trauma nurses, therapists, physicians) found that 89% were positive to trauma informed care, but only 19% rated themselves as “somewhat competent” or better in actual practice. This suggests that many providers who consider themselves trauma informed are not applying structured, evidence-based trauma frameworks (like EMDR, TF-CBT, or CPT) in practice.
On top of that, a 2023 survey of 193 APA-accredited doctoral programs in clinical psychology (which you need to be what we call a therapist) found only 9 programs (5%) required a course on trauma-informed theory and intervention. That equates to about 8% of students receiving formal trauma informed care coursework.
So considering that’s under 10% of therapists receiving and pursuing trauma coursework, the answer is no, it’s not common to find trauma informed care providers. Which blows my mind.
Good question. Let’s break this down (because I like to stay organized).
We’ve just established that most therapists lack formal trauma-centered education, be it certification, coursework, continuing education, or other. But let’s not be too quick to blame those who train in a system not built for trauma informed care. Burnout for medical professionals is real and high caseloads reduce capacity to apply trauma informed care consistently.
If you’re overworked and underresourced then yeah, you might not be consistent in applying these principles. You might find yourself in a work environment that amounts to assembly line therapy. From what I’ve read, this kind of work method also requires ongoing supervision and organizational support, not just a one-time training.
Trauma-focused therapies like EMDR or prolonged exposure often require specialized training. This is costly for therapists and employers and multiple long sessions are costly for patients. Those that are specialized in trauma therapy are often out-of-network, meaning sessions can cost $150–$250+ out of pocket. Insurance companies also provide fragmented coverage, with some plans covering trauma-focused CBT or EMDR while others exclude them as “experimental.”
If it makes you feel better, trauma informed therapy is also rare over here in Sweden. Most therapists are trained in CBT and those that are trauma focused are only in Stockholm. From what I’ve gathered, there are basically no trauma-focused therapists in the public health system. Without private insurance, this means private sessions are incredibly costly.
The ballpark cost of a 45min session with this kind of therapist is 1,300kr. That has the same effect on a Swedish wallet that $400 might have on a US wallet. Not exactly accessible care.
If it’s difficult to access trauma informed care in a big city, then it’s twice as difficult in rural or underserved areas. You may only find generalist care or short-term crisis stabilization without long-term trauma care. You might struggle to find someone culturally sensitive or multilingual. Add to that the fact that everyone knows everyone in smaller communities, or that you may have to drive for hours to get to your provider, and you have a recipe for personal (and ultimately community) disaster.
BIPOC, LGBTQ+, those with disabilities, and immigrant communities also often face providers who lack cultural competence. They may pathologize cultural expressions of trauma, and medical racism and dismissal of pain or experiences is real. Trauma informed care requires institutional humility and systems-level changes. This is near impossible in underfunded, under-resourced, and overworked staff on the county and township levels.
And let’s be honest: a bachelor’s, master’s, and PhD are not cheap and you can charge more in big cities. No judgement – we all have to provide for ourselves and our families – but that’s a part of the rural access equation too.
Many trauma survivors don’t recognize their symptoms as trauma-related. We might know that we’re depressed and a therapist may agree, but neither consider that our depression is not a pathology in itself but rather a result of trauma. Not always, mind you, but often enough where this needs to be a common line of inquiry.
Sometimes we’re at rope’s end after years of misdiagnosis or patchwork medical care. As women, we’re so often medically gaslit that we’re forced to Google our way through our symptoms (which this blog tries to reduce the need for). What really bothers me is when non-trauma-informed providers (who should be the experts in mental health care??) may inadvertently blame, gaslight or retraumatize patients by, for example, pushing for disclosure too early.
So the one suffering is sometimes not aware that trauma is at play (again, not always), but the therapist who is supposed to provide holistic mental health care is not trauma informed. This means that you, the patient, must know to vet a potential therapist for this upfront. Unfortunately, it’s not safe to assume all therapists are trauma informed.
None of this is happening in a vacuum. The American view that mental illness is more or less a character defect underpins the entire environment of healthcare. Now I want to be incredibly clear here: I am sure this is not just a US problem and I am not saying that all medical professionals subscribe to this mentality. If you’re a medical professional, then you probably don’t.
With that said, we grow up in a “pull yourself up by your bootstraps” culture where the quality and access to care varies by state and township and where insurance companies rule the roost. The idea that mental illness is a moral failing, personal weakness, or lack of willpower – especially when compared to physical illness – is horsesh*t.
It does, however, influence what lawmakers think is important to champion and fund, what private employers and managers view as worthy of accommodation to do one’s job properly, and so on.
Those of us who need trauma informed care the most might fear being seen as “crazy,” “unstable,” or “lazy.” Moreover, internalized shame and stigma means we often put off seeking help. In an international study across 11 countries, authors of the study found that 60% of members of mental health advocacy groups waited on average 8 years before first seeking treatment for anxiety or a mood disorder.
It doesn’t help that families and communities often minimize or dismiss symptoms.
In short, scaling trauma informed care as a systematic way of working will require major investment in piquing interest among students and professionals, workforce training, reimbursement reform, culturally competent care, and awareness of trauma’s role in our lives. We’re never going to change the bootstraps culture, but we can work on everything else. Never stop advocating for yourself, as impossible and maddening as it feels sometimes.
P.S. I outlined this post months ago, before the egregious actions of the current administration, but the need for trauma informed care has now reached a critical point. I urge any medical professional reading this – from psychologist to cardiologist to oncologist and beyond – to invest in trauma informed care for their patients.
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