Utilizing Trauma-Informed Approaches for Collaborative and Empowering Care

Lydia Anne M. Bartholow, DNP, PMHNP, CARN-AP, medical director, Central City Concern, UCSF, Portland, Oregon, believes that the adage "nothing about us without us" is the key to understanding the peer support and self-help necessary for success when implementing trauma-informed care. Psych Congress Network sat down with Bartholow following her Psych Congress Elevate 2023 session "Beyond PTSD - Incorporating Trauma-Informed Care into your Mental Health Practice" to learn about misconceptions, primary challenges, and what clinical pearls she wanted attendees to take home.

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Evi Arthur, Associate Digital Editor, Psych Congress Network (PCN): What were the main takeaways from your session “Beyond PTSD - Incorporating Trauma-Informed Care into your Mental Health Practice”?

Lydia Anne M. Bartholow, DNP, PMHNP, CARN-AP: This brief workshop did 3 things for new clinicians: First and foremost, this workshop introduced the idea of trauma-informed care in an accessible and non-academic way. Embedded in this idea is that any and all clinicians can bring trauma-informed care into their practices even if the larger system of care is not fully trauma-informed; to this end, this workshop distilled how to operationalize trauma-informed care into psychiatric practice. We also highlighted how and why trauma-informed care is not the same as trauma-specific care, which is often useful for new providers as they make sense of the various care paradigms they are being introduced to.

PCN: What are the primary challenges for clinicians working with patients while practicing trauma-informed care?

Bartholow: The biggest barrier to implementing trauma-informed care is often the very training we've been given. Many of us were trained in best practices and yet those best practices didn't always ensure that our care was non-hierarchical and collaborative, or that we didn't harm patients in the process of care. For example, my training focused heavily on prescribing practices and therapy modalities. However, I was never trained in how to not harm a patient when I requested a urine drug screen, though we know that patients often experience those as traumatic and/or stigmatizing. 

PCN: Why are peer support and mutual self-help important in this care approach?

Bartholow: Peer support and mutual self-help are at the center of the trauma-informed paradigm because they are the essence of collaborative and empowering care. People with lived experience of trauma, adversity, and behavioral health diagnoses are the true experts in healing and recovery. This principle harkens back to the adage "nothing about us without us" and takes very seriously the idea that those with lived experience should be at the center of decisions and designs regarding behavioral health services.

PCN: In your session, you say “one does not have to be a therapist to be therapeutic.” Can you elaborate on what you mean by that? How can clinicians use this principle or be aware of it in their daily practice?

Bartholow: It is common practice for clinicians today to be expert psychopharmacologists; many of us do not consider ourselves therapists. And yet, our meetings with patients can be therapeutic. When we utilize the key principles of trauma-informed care, we improve the experience of care for our patients and offer them gifts beyond pharmacology. The key principles of TIC are safety, trustworthiness and transparency, peer support, collaboration and mutuality, voice and choice and, as I call it, tending to structural violence. When we utilize these principles (as much as we can in our clinical roles) we both decrease the possibility that we will retraumatize someone and increase the potential for being therapeutic. For example, if we need to decline a request for a benzodiazepine, we can focus on the trauma-informed principle of safety and ensure that the patients understand that we won't prescribe for them because we don't think it's safe for them, not simply because of clinic policy or because these medicines can be addictive. 

PCN: What are the practical implications for clinicians discussed in your session?

Bartholow: The practical implications of trauma-informed care are sometimes hard to see clearly. And yet, if you tend carefully to the 6 principles of trauma-informed care and learn to use them in your clinical practice, trauma-informed care can become quite practical as a roadmap of prevention for harming patients when they are in our care. We can use the 6 principles of trauma-informed care to guide care systems and individual practice decisions in a practical and useful way.  

PCN: What misconceptions on this topic would you like to clear up?

Bartholow: There are 2 misconceptions that I hear about trauma-informed care regularly. And they are worth clearing up and being very clear about. First, I often hear a belief that trauma-informed care is nebulous and solely about how we connect to patients, colleagues, and ourselves. Of course, the relational connection is imperative in this care paradigm, but trauma-informed care has a fairly clear road map to improving care for patients. Trauma-Informed care utilizes its key principles to help guide clinicians in making care decisions that are less likely to re-traumatize patients and improve their experience of care. 

The second misconception about trauma-informed care is that it is the same as trauma-specific care. In other words, clinicians often think that trauma-informed care is about tending to people with a diagnosis of PTSD or a specific history of trauma. In some ways, trauma-informed care is the opposite of trauma-specific care: trauma-informed care says that we assume that people who come into behavioral health systems have likely experienced trauma and adversity and we should change the way we provide care to everyone regardless of their trauma history. So, for example, we might rearrange the seating in the lobby differently if we think about preventing retraumatization, but this doesn't mean that we diagnose everyone with PTSD and give them all a prazosin script (that would be trauma-specific care).

Lydia Anne M. Bartholow, DNP, PMHNP, CARN-AP, is a doctorally prepared psychiatric nurse practitioner with a specialty in addiction medicine and trauma-informed care. She is a medical director at a large FQHC that focuses on houseless health care and is on faculty at UCSF where she teaches in the psychiatric nurse practitioner program. She speaks nationally on topics such as co-occuring disorders, harm reduction, and substance use disorder care system improvement. She focuses all parts of her practice on radical public health, harm reduction, and anti-oppression work. Bartholow lives in Portland, Oregon, on Chinook, Kathlamet, Clackamas, and Kalapuya land.