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Q&A with a Therapist: Ashley Anthony on Trauma-Informed Care

Ashley Anthony, MA, has been a therapist at Eagleville Hospital for nearly five years. She works in an all-women co-occurring disorders unit, where, in her experience, the majority of her patients have undergone some form of trauma.

In an effort to better respond to their needs, Ashley uses an approach called trauma-informed care. Here, she describes what that looks like in her practice.

What is trauma-informed care?

In a nutshell: instead of asking someone what’s wrong with them, you’re asking them what they’ve been through. It’s about recognizing the impact of trauma in a validating and respectful way and putting the patient’s needs at the center of their treatment.

What we’ve come to understand is that the impact from trauma is widespread, so we incorporate trauma-informed care into every aspect of our process.

How do you introduce trauma-informed care with your patients?

One of my first meetings with my patients is at their personal history evaluation, or assessment. A portion of that assessment asks about abuse—physical, sexual, emotional. So we’ll start to set the boundaries during that session. I make it clear that if they’re comfortable enough and willing to share, I will listen. But there’s no pressure. If they prefer not to talk, I’ll respect that. From that moment on, the patients are guiding their treatment, which gives them agency over what they want to work on.

How do you approach someone who’s reluctant to share?

I’ve found that one of the best avenues is through our psychoeducational seminars. No one’s forced to share—it’s purely educational. A notable study found that the more adverse experiences someone has in childhood, the more likely they are to develop a substance use disorder. I use that study as the basis for one of my psychoeducational lectures, which plants the seed.

Group therapy can also be effective. If one person shares openly, others are more likely to follow suit and share. And that’s how healing begins. Once a week during group therapy, I use the Seeking Safety treatment manual, which describes an integrated approach to treating PTSD and substance use. It doesn’t require patients to get into the details of their trauma. In fact, it encourages them not to. It focuses instead on how past trauma impacts them in the present moment. From there, we get into skill-building.

In an individual setting, I’ll have them select the topics they’re interested in discussing in group therapy from the manual’s table of contents, which, again, reinforces their agency over their treatment.

Is coping with trauma a lifelong process?

I wouldn’t say it’s a lifelong process, but it can be a long-term one. As with any other change, you’ll take steps forward and backward in that process. No one’s going to completely recover from trauma or substance abuse when they’re with us. Our goal is to introduce them to the coping skills that will enable them to begin to live their lives in nondestructive ways. We provide a foundation for their healing.

The prospects of recovery can feel daunting on their own. How do you frame it so that the addition of another long-term process doesn’t feel overwhelming?

Every week in our Seeking Safety group therapy, we make a commitment to each other. It can be anything from informing our families of our crisis plans to asking for help in a particular way.

Making and committing to plans can improve our sense of self-efficacy. That can help life feel a little less overwhelming because we’re better prepared for a potential crisis and more aware of our support network. When we’re able to prove to ourselves that we can accomplish our goals—and see the benefits of it—that’s motivating.

You’ve also mentioned regaining a sense of gratitude—how is that integral to recovery?

The fundamental idea behind AA and NA is people in recovery helping one another. You’re only able to help someone once you’re grateful for your own recovery.

Coming from a trauma-informed care approach, I don’t want to use gratitude in the “everything happens for a reason” sense. That could minimize or invalidate their experience. Instead, I’ll use gratitude to help them reframe their perspective.

One thing I try to do is end our group sessions by having everyone name something they’re grateful for that day. It can be something as small as having a toothbrush and toothpaste or as large as having the support of their family. It’s about getting them into the practice of reshaping their perspectives. When patients practice gratitude, they tend to be more receptive to treatment.

And if someone can’t identify something to be grateful for, we’ll normalize that by acknowledging that we’ve all been there, so let’s reflect on what helped us to improve our own sense of gratitude.