Enhancing Professional Skills: Trauma-Informed Care for Mental Health Practitioners
The mental health field stands at a critical crossroads. As practitioners increasingly encounter clients who have experienced profound trauma from natural disasters, systemic marginalization, war, or interpersonal violence, the need for culturally responsive approaches and trauma-informed care has never been more urgent.
This article provides an exploration of trauma-informed care led by a panel of mental health practitioners and educators:
- Victoria Liou-Johnson, PhD - Clinical Psychologist and Neuropsychologist; Adjunct Professor at Notre Dame de Namur University (NDNU); Founding Executive Director of the Hawai’i Behavioral Health Connection.
- Shira Maguen, PhD – Clinical Psychologist at the San Francisco VA Health Care System (SFVAHCS); Professor at the University of California, San Francisco (UCSF) School of Medicine.
- Reika Faust, LMFT, LPCC – Licensed Marriage and Family Therapist; Licensed Professional Clinical Counselor; California State-Certified Sexual Assault Counselor specializing in sexual assault survivors, formerly incarcerated individuals, and LGBTQ+ populations.
Through their groundbreaking research and fieldwork, these experts share the core principles of trauma-informed care and practical ways to integrate this approach into therapeutic practices.
To experience the full, in-depth conversation, watch our webinar, Trauma-Informed Care for Marriage and Family Therapists (MFTs) and Professional Clinical Counselors (PCCs).
What Is Trauma-Informed Care?
Trauma-informed care is a clinical approach that recognizes how trauma resulting from natural disasters, assault, dysfunctional relationships, and war impacts individuals, communities, and generations. And larger systemic patterns of trauma can also repeat across marginalized populations.
Why Is Trauma-Informed Care Important?
For mental health practitioners, understanding the complexity of trauma is foundational to effective care. This includes grasping its impact on interpersonal relationships, identity, and well-being, as well as intervention methodologies.
This holistic framework of trauma and evidence-based treatments and approaches positions practitioners to work with communities that have experienced historical and ongoing trauma, such as Indigenous communities, LGBTQ+ individuals, sexual assault survivors, or veterans.
Additionally, when MFTs, PCCs, and other mental health professionals have a firm grasp of what providing trauma-informed care looks like, it lessens the likelihood of inadvertently retraumatizing clients and improves overall patient outcomes.
Three Practical Use Cases of Trauma-Informed Care
Providing trauma-informed care is not a one-size-fits-all approach. Instead, it’s a framework that must remain adaptable and responsive to whomever it serves.
The panelists share three distinct use cases of how they practice trauma-informed care across settings and tailor it to meet individual and communal needs, demonstrating compassion and care at every level.
1. The Framework of Decolonizing Psychology
Liou-Johnson’s work with communities impacted by the 2023 Maui wildfires illustrates the importance of trauma-informed care for those who are affected by natural disasters and for Indigenous groups that have been historically marginalized.
When over 12,000 people lost their homes in one of the deadliest wildfires in modern history, the trauma extended far beyond the physical danger. Many of those most harmed by the fires were Native Hawaiian families who had lived on ancestral land for generations. Being displaced from their homes, along with the mistreatment and discrimination they received from aid organizations, added another layer of trauma on top of centuries of exclusion and disempowerment.
Liou-Johnson explains how this situation requires trauma-informed care and a decolonization of psychology—a reexamination of how Western or Eurocentric standards have pathologized normal responses in collectivist societies and Indigenous populations.
How to Decolonize Trauma-Informed Care
Mental health professionals can decolonize their practice and impart a trauma-informed approach through four key ways:
- Center Client Voice and Experience: Mental health practitioners must remain open to listening to and understanding each client’s unique experience, especially when it differs dramatically from their own.
- Recognize Systemic Violence: Trauma often stems from systems of oppression, not only individual failings. Helping clients understand that their struggles may reflect broader structural issues can be profoundly healing.
- Honor Community Connection: For clients within marginalized populations, healing happens in community rather than as an individual journey. Western psychology often emphasizes individual therapy and may miss crucial opportunities for collective healing.
- Acknowledge Relationship with Land: Many Indigenous groups see the earth not simply as a resource but as a living relative that contributes to their own health and well-being. When working with Indigenous populations, practitioners should use this understanding to guide their treatment approaches.
Along with these strategic, culturally responsive measures, mental health professionals should refrain from assigning strict healing timelines to their clients and communities. As Liou-Johnson notes:
“Development and progress are not linear. This is true for any client we are working with who has experienced trauma. There are many times when we may feel like we are progressing and regressing—and that is okay.”
2. Moral Injury: Beyond Traditional PTSD
For decades, Post-Traumatic Stress Disorder (PTSD) has dominated trauma discussions. However, emerging research on moral injury offers a more nuanced understanding of the unique trauma that veterans, healthcare workers, and first responders often face.
Maguen defines moral injury as “when you do something, fail to do something, or witness something that goes against your moral beliefs and expectations. There must be a crossing of a line that happens for the individual, where they feel like they have transgressed in some way."
Moral injury often stems from exposure to a potentially morally injurious event (PMIE)—such as a police officer failing to intervene when colleagues use excessive force, or a healthcare worker removing life support from a patient—and the psychological symptoms that follow.
While PTSD is a formal diagnosis with clear symptoms and treatments grounded in fear-based theory, moral injury is not a diagnosis. Instead, it centers on guilt, shame, and the inability to forgive oneself. It can include hallmark symptoms, such as:
- Withdrawal from relationships due to feeling unworthy
- Self-sabotaging behaviors stemming from a belief that one doesn't deserve happiness
- Loss of spiritual connection or faith
How do we treat moral injury? Clinical care is important, but Maguen emphasizes that moral injury is not just treated in a therapy room.
"We want to know the communities in which the person is embedded. So, cultural communities, spiritual communities, and we have to build bridges to really treat the whole person. So this is really important in treating moral injury. Therapy is going to be one part of the picture, but we have to connect people with a much larger community in order to heal.”
3. Working With Sexual Assault and LGBTQ+ Populations
As Reika Faust explains, every 74 seconds, someone in the United States experiences sexual assault. For mental health practitioners, this means sexual assault survivors will regularly seek care for a broad range of clinical presentations, including complex PTSD symptoms, depression, substance abuse, profound shame, and more.
To provide the help needed, practitioners must be fully equipped and well-versed in trauma-informed care, as well as its intersectionality with marginalized sexual and gender identities. Faust reiterates that LGBTQ+ individuals face compounded risks and are affected by victimization at four times the rate of cisgender heterosexual people.
Along with supporting them through the assault-related trauma, mental health professionals assist LGBTQ+ clients in navigating additional stressors like:
- Expectations of rejection, particularly from family
- Identity concealment and the exhausting work of hiding one’s authentic self
- Negative healthcare experiences that require constant justification and defense
Faust emphasizes the importance of grounding trauma-informed care in an understanding of the demographics you're working with and the different cultural norms.
“If you're in a heterosexual paradigm, you're going to come into a therapy session with a particular lens of what you're working with, and it’s not going to be quite effective or accurate because you don't know what that other queer experience is, and sometimes that can cause some harm within the relationship.”
This risk of accidental retraumatization highlights exactly why a trauma-informed lens is essential. MFTs and PCCs have the unique responsibility of creating a safe space for healing, which requires them to set aside their default assumptions to validate a client’s lived reality and deliver transformative therapeutic care.
How Can Mental Health Professionals Improve the Future of Trauma-Informed Care?
Build Trauma-Informed Systems
Many organizations now label themselves "trauma-informed," but implementation often stops at awareness training. Applied trauma-informed care requires systemic change:
- Policies that account for the realities of marginalized populations
- Staff training that goes beyond surface-level understanding
- Recognition of how organizational structures can retraumatize
For individual practitioners, this means going beyond a two-hour training on trauma and seeking out supervised clinical or consultative experiences to gain practical trauma-informed skills. Taking the time to build expertise under the guidance of a more seasoned practitioner ensures you meet client needs without inadvertently causing additional harm.
Remain Curious and Embrace Lifelong Learning
One of the most important clinical tools when delivering trauma-informed care is curiosity. Mental health professionals have the responsibility to understand their clients' experience with an open mind, rather than fitting them into predetermined frameworks.
Practitioners improve therapeutic relationships and elevate client outcomes by:
- Working across diverse cultural contexts with respect and understanding that your personal worldview will not align with every client’s lived experience.
- Addressing personal biases and assumptions you bring into every clinical session.
- Educating yourself on systemic trauma and how institutional barriers and historical marginalization leave a lasting impact on community and individual well-being.
- Recognizing the limits of your own lived understanding and embracing the idea that clinical knowledge is an evolving process rather than a destination.
Take Preventive Measures to Lessen Vicarious Trauma
Due to the intensive nature of their work, mental health professionals can experience vicarious trauma, which can lead to increased anxiety and hypervigilance, compassion fatigue, and professional burnout.
Faust, Maguen, and Liou-Johnson encourage intentional self-care that helps safeguard practitioners from taking on trauma from their clients. These practices include:
- Doing Your Own Work: Every therapist needs their own therapist. If you haven't processed your own trauma and triggers, you risk being activated in session, making the work about you rather than your client.
- Establishing Clear Boundaries: Know your limitations. Understand what types of cases or content are particularly difficult for you. It’s a strength, not a weakness, to refer clients to other practitioners who are better suited to help them.
- Somatic Practices: Trauma lives in the body. Use somatic work, whether through movement or time in nature, to help process what is absorbed from clients.
- Strategic Scheduling: When seeing particularly difficult cases, build in time between sessions. Create space to breathe and transition rather than moving immediately from one client to the next.
- Consultation and Community: Working in isolation intensifies vicarious trauma. Regular consultation with trusted colleagues provides essential support and perspective.
Intentionally implementing these habits into your professional practice ensures you remain focused on your clients and deliver the best possible care.
Become a Leader in Trauma-Informed Care at NDNU
At NDNU, we prepare the next generation of marriage and family therapists and licensed professional clinical counselors to serve diverse communities with deep expertise, compassion, and an enduring commitment to social justice.
Our MS in Marriage and Family Therapy (MFT) and MS in Clinical Psychology (MFT/LPCC) programs integrate practitioner-led instruction with a holistic curriculum. You’ll gain advanced training in specialized trauma-informed care, cross-cultural issues, wellness and spirituality, and more, preparing you to deliver evidence-based care to a broad spectrum of clients.
Take the next step toward a fulfilling mental health career.