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How can you integrate trauma-informed care with MI to build trust?

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Trauma-informed care (TIC) is a framework that recognizes the impact of trauma on people's lives and aims to create a safe, respectful, and empowering environment for them. Motivational interviewing (MI) is a collaborative, goal-oriented, and person-centered approach that helps people explore and resolve their ambivalence about change. How can you integrate TIC with MI to build trust with your clients or patients who have experienced trauma? Here are some tips and strategies to consider.

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Dr. Arushi Gangaher, Psy.D.

Psychotherapist | Professional Member CCPA | Trauma-Informed | Shame-Informed | CBT & Trauma Specialist
Vanessa Funmi Ullam

1 Understand trauma and its effects

Trauma can be defined as any event or situation that overwhelms a person's ability to cope and causes lasting physical, emotional, or psychological harm. Trauma can affect how people think, feel, behave, and relate to themselves and others. Some common signs of trauma include anxiety, depression, anger, guilt, shame, isolation, hypervigilance, flashbacks, nightmares, and substance use. To integrate TIC with MI, you need to understand how trauma affects your clients or patients and how it may interfere with their readiness, willingness, or ability to change.

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Hamid Karim Shor Muluk

Counselor @ Médecins Sans Frontières (MSF) | Counselling, Psychiatric care
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Understand trauma event and history but must be skills of active listening and reflecting. If go deeper can be traumatise again. The beginning listening and reflecting able to build the trust with trauma clients.

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2 Create a safe and supportive space

Safety is the foundation of TIC and MI. You need to create a safe and supportive space for your clients or patients to share their stories, feelings, and goals without fear of judgment, criticism, or harm. You can do this by establishing clear and consistent boundaries, rules, and expectations; by using respectful and empathic language and tone; by validating their experiences and emotions; by offering choices and options; and by respecting their autonomy and self-determination. You can also use physical cues, such as lighting, seating, and distance, to enhance the sense of safety and comfort.

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3 Use the principles and skills of MI

The principles and skills of MI are compatible with TIC and can help you build trust with your clients or patients. The principles of MI are: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. The skills of MI are: open-ended questions, affirmations, reflections, and summaries. You can use these principles and skills to elicit and reinforce your clients' or patients' own reasons and motivations for change; to explore and resolve their ambivalence; to acknowledge and address their barriers and challenges; and to enhance their confidence and competence in achieving their goals.

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Dr. Arushi Gangaher, Psy.D.

Psychotherapist | Professional Member CCPA | Trauma-Informed | Shame-Informed | CBT & Trauma Specialist
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MI can work beautifully within the context of TIC, provided the client has attained a certain level of safety and trust with the therapist. The timing of applying this eclectic mix is very critical and only a seasoned well trained clinician should attempt to do so. A major proponent of MI - reflecting listening - can help in establishing trust in the therapeutic process and alliance, as well as create a safe space for feeling heard and understood. Expressing empathy, rolling with resistance, building discrepancy, etc. can help bring healthier change, and encourage client’s self autonomy via active decision-making (which MI primarily promotes), as trauma clients can find it difficult to let go of maladaptive coping/ cognitions.

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Vanessa Funmi Ullam
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Empathy: Demonstrate genuine understanding and empathy towards clients' experiences and feelings. This builds trust and rapport, foundational elements of MI. Collaboration: Engage clients as partners in their care. This egalitarian approach empowers clients, making them more likely to engage in the therapeutic process. Personal Experience: Share a moment when employing MI principles, like expressing empathy or supporting autonomy, led to a breakthrough with a client. How did this reinforce the value of MI in building trust?

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4 Be trauma-sensitive and responsive

Being trauma-sensitive and responsive means being aware of the potential triggers and reactions that your clients or patients may have during the MI process and being prepared to respond appropriately. You can do this by asking for permission before exploring sensitive topics; by checking in regularly on their comfort level and emotional state; by pacing the conversation according to their needs and preferences; by offering breaks and coping strategies when needed; and by debriefing and following up after the session. You can also use trauma-specific interventions, such as grounding techniques, relaxation exercises, or cognitive-behavioral strategies, to help them manage their trauma symptoms and cope with stress.

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Vanessa Funmi Ullam
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Recognize Triggers: Be aware of potential triggers for clients with trauma histories. This awareness allows you to navigate conversations more carefully and avoid retraumatization. Adapt Your Approach: Modify your communication and strategies based on the individual's trauma responses and needs. Being flexible and responsive shows that you prioritize their comfort and safety.

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5 Collaborate and coordinate with other providers

Integrating TIC with MI may require collaborating and coordinating with other providers who are involved in your clients' or patients' care. This can help you ensure that your clients or patients receive comprehensive and consistent support and services that address their trauma-related needs and goals. You can do this by communicating and sharing information with other providers, with your clients' or patients' consent; by making appropriate referrals and follow-ups; by participating in multidisciplinary meetings or case conferences; and by seeking consultation or supervision when needed.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Faezeh Elahi

Social worker
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Trauma-Informed Care is an approach in human service field that assumes that traumatized patients don’t like to have history of trauma and healing naturally and promote environmentally recovery is better than intervention and give services because it may effect on re-traumatize.Trauma-informed motivational interviewing is a tool for building connection with client, understanding their way of thinking,build non-judgmental space for problem-solving.MI approach is client-centered and a method for enhancing intrinsic motivation to change by exploring and resolving ambivalence as the individual progresses toward recovery, MI and TIC emphasis on client centered and evidence based, skills of MI lead TIC reach to goals.

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How can you integrate trauma-informed care with MI to build trust?

1

2

3

4

5

6

1 Understand trauma and its effects

2 Create a safe and supportive space

3 Use the principles and skills of MI

4 Be trauma-sensitive and responsive

5 Collaborate and coordinate with other providers

6 Here’s what else to consider

Motivational Interviewing

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How can you integrate trauma-informed care with MI to build trust?

1

2

3

4

5

6

1 Understand trauma and its effects

2 Create a safe and supportive space

3 Use the principles and skills of MI

4 Be trauma-sensitive and responsive

5 Collaborate and coordinate with other providers

6 Here’s what else to consider

Motivational Interviewing

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