Recommendations & sample scripts

Tip 1: Routine query about trauma history

• Provide brief psychoeducation to normalize prevalence and impact of trauma
• Inform the client that they are not required to disclose occurrences of trauma if they do not wish to
• Then, ask the client whether they have been exposed to trauma previously
• If they do not wish to disclose, ensure they understand they can bring it up at any time they wish
• Accept what the client is willing to share. Do not push

“Many people have had traumatic experiences in their life – situations in which they felt their safety and lives were threatened. We ask about our patients/clients’ trauma histories because we know trauma has a big impact of their health. You don’t have to answer the question if you don’t want to. Please know that we can talk about it at any time that you want to. Is there anything I should know about your history that will help us to work together in a way that makes you feel safe?”

Tip 2: Recognize signs and symptoms of trauma history

• Recognize that some health behaviours (frequent cancellations, non-adherence to treatment) may be indicative of history of trauma
• Avoid labelling language (“non-compliant,” “challenging,” “resistant to care”)
• Convey nonjudgment and compassion

“I notice that you haven’t picked up your diabetes medications in three months. Sometimes people have difficulty with their schedules and picking up medications. Is there any way I can be of help?”

Tip 3: Respond to signs and symptoms of current self-harm

• Determine intent
• Determine level of risk
• Maintain a respectful and compassionate attitude
• If it is appropriate in your practice setting, and if the client is willing to discuss further:
  • Validate that self-injury is a coping strategy
  • Determine the function of self—injury (e.g., “What does the self-injury do for you?”)
  • Gather a history of self-injury
  • In a non-judgmental way, discuss other options for coping and collaboratively brainstorm alternative coping strategies
  • Collaboratively work to create a safety plan and refer to counselling, if able

“I notice that you have several cuts on your hands. Can you tell me what happened?”

Tip 4: Recognize when someone is being triggered

• Use strategies to ground client in the present moment
• Orient them to a time and place:
  • State their name in a clear and calm voice and ask if they can hear you
  • If you do not get a response, repeat their name and ask again
  • Ask them to look around the room
  • Remind them where they are
  • Ask if they know who you are, remind them who you are
  • Let them know they are safe
• After the triggering situation has been managed, validate and normalize response:
  • After a triggering situation has been managed, feelings of shame may arise. Validating and normalizing the client’s response can be accomplished by conveying your understanding about how reminders of one’s trauma history can activate memories and the associated fearful response
  • Let the client know that this is not uncommon for clients who have histories of trauma
• Next, collaborate on how to proceed:
  • Given that the client has been triggered in the process of your session, it is important to discuss with the client how to proceed to reduce the likelihood of this happening again
  • Collaborate on solving the problem together. This shows your respect and caring, as well as empowers the client

“Susie, are you ok? Can you hear me? I notice you have become very quiet and seem distracted. I am right here and want to help. Can you look around the room?”

• Grounding techniques:
  • Ask the client to become aware of their physical body. For example, “Let’s help you get grounded. Can you feel your feet on the floor? Great. Just notice your feet. Maybe wiggle your toes. Can you feel that? Great. Can you feel your arms resting on the chair? Good. Notice your back against the chair. Wonderful. How about we stand up so that you can really feel yourself in your body. I’ll stand up with you. That’s good. Ok. So how are you? Are you here with me? Are you fully here with me? What percent?”Another grounding technique is diaphragmatic breathing. Ask the client to put a hand on their belly and to breathe into their diaphragm so that they feel the belly rise. This is important for someone who is hyperaroused. If the client is hypoaroused, the aim is to get the client more activated and so the breathing technique would be to have them breath fully into their chest

Tip 5: Responding to disclosures

• When a client discloses a history of trauma, your response should:
  • Validate: Do not challenge or ignore
  • Normalize: Normalize the client’s reaction to disclosing and to having this history
  • Convey compassion: Through tone of voice and body language.
  • Assure confidentiality: Ask about the immediate impact of having disclosed

“I am sorry that happened to you. It is okay to cry. I realize that it took courage for you to tell me this.”

(Ensure that client is comfortable with having this information added to their chart. Help the client plan how they will take care of themselves when they leave you, as disclosure can cause delayed or visceral reactions.)

Tip 6: Risk assessment and referral

• Determine risk
• Determine action to take
• If unsure, seek assistance from team
• Asking about suicidal intention does not increase the risk of suicide
• Additional considerations:
  • Child abuse: Mandatory duty to report
  • Domestic violence: Reporting is not mandatory. If client discloses, provide support and information

Suicide: “Do you have thoughts of suicide? Do you have a plan? What is it? Do you have the means to carry out your plan?”

Domestic violence: “Do you feel safe at home?”