Is EFT Trauma-Informed?

The phrase ‘trauma-informed’ has become a bit of a buzz-word in recent years. People have begun to search for ‘trauma-informed’ therapists and ‘trauma-informed therapies’. It has become a marker of safety in therapy, as well as good practice in the workplace and public services. However, what does it actually mean? How can you know if a particular therapeutic approach or a particular practitioner is trauma-informed?

What is trauma? – The Three E’s of Trauma

First of all, let’s begin by understanding what trauma is. The Oxford Dictionary defines trauma as:

Trauma happens when you go through something that you feel is harmful or life-threatening. Trauma is also an individual emotional response to an event. One person might experience an event as a trauma, while others might go through the same thing and not develop trauma.

A person experiences trauma when two key aspects are in place:

·       They feel isolated (even if seemingly surrounded by helpful people)

·       They feel powerless (even if they actually could have done something).

If someone goes through a terrible shock but they feel they can tell someone about it, feel heard and seen and sympathized with, they are much less likely to develop trauma. If someone experiences an awful event but they are able to take some sort of action about it, either at the time or soon after, they are less likely to feel traumatized.

Here’s another definition from the US-based Substance Abuse and Mental Health Services Administration (SAMHSA)[1]:

These are the ‘Three E’s of Trauma’ – Events, Experience of events, and Effects.

The Effects of Trauma

The third key point is that the trauma lies in the effects of the shock. The event itself is not the trauma, but the damaging after-effects constitute the trauma. The effects may occur immediately or have a delayed onset. They may be short or long-term. They may be continual or may come and go. These effects include physical, mental, emotional and behavioural symptoms[2] such as:

·       Flashbacks

·       Nightmares

·       Physical symptoms (e.g. pain, sweating, feeling sick, trembling, headaches, dizziness, chest pains, stomach aches)

·       Constantly thinking about the event

·       Avoidance of situations which remind the person of the event

·       Emotional numbing, inability to relate to loved ones

·       Hyperarousal (feeling jumpy)

·       Irritability

·       Angry outbursts

·       Sleeping problems

·       Difficulty concentrating

·       Depression

·       Anxiety

·       Phobias

·       Substance abuse or self-harming

To summarise, trauma is when something happens to you that you feel is harmful or life-threatening, you feel isolated and powerless, and experience adverse effects.

What does trauma-informed mean?

Trauma-informed care refers to the organisational climate and conditions in which services are provided, rather than to the interventions themselves. It is the general approach, not the method itself. According to SAMHSA[3]:

When considering EFT, most practitioners operate alone rather than within an organisational framework such as the UK’s National Health Service. Therefore, when deciding if EFT or a particular practitioner is trauma-informed, it is more about the individual’s skills, knowledge and delivery of EFT, rather than a systemic policy as with a public service or large corporation.

Therefore, while it is clear that EFT can be a very effective treatment for trauma[4], it is in the approach to the practice of EFT where trauma-informed practices are relevant. “Individuals can be re-traumatised by the very people whose intent is to be helpful.”[5] It is the way in which the practitioner helps the client rather than the EFT itself which can be trauma-informed or not.

For example, a practitioner may not spot the signs of trauma, and allow a client to fall headlong into sudden re-traumatising memories, where they re-experience the original trauma. Alternatively a practitioner may spot the signs of trauma but be too insistent in leading the client to memories that they are not yet ready to deal with. They may be able to use EFT effectively but not be good at helping the client to feel safe while doing so. They may go too far, too fast and result in re-traumatising the client (although EFT itself is a very gentle and helpful way to balance this re-traumatising, it is unnecessary and potentially harmful to push a client too far and too fast).

What does a trauma-informed approach look like?

SAMHSA identifies a number of assumptions, principles and implementation domains in a trauma-informed approach. I have picked out for discussion below the points which I feel are most relevant when considering if an EFT practitioner is trauma-informed.

1. Understand trauma

Practitioners should understand what trauma is and how it may show up in a client, recognise its signs and symptoms and understand the potential impact of trauma and how to help a person recover from trauma. Where possible, clients should also be informed about the effects of trauma, and that the symptoms they may be experiencing are typical of trauma, as this can minimise any shame, fear about the symptoms, or a feeling that there is something ‘wrong’ with them.

2. Safety of the client - avoid re-traumatisation

Practitioners should create a safe environment within the therapy space (the physical or online space, as well as the non-judgmental and compassionate  holding of the therapeutic relationship). The client feels physically and psychologically safe. A properly trained EFT practitioner will always use various techniques within a session to ensure client safety at all times. These include gentle methods, for example using a code word instead of immediately delving into the details of a difficult memory, distancing techniques, and keeping clients grounded in the here and now. Appropriate boundaries must be maintained by the practitioner, for example, exploitative financial, sexual or romantic relationships are not acceptable.

3. Trustworthiness and Transparency

The practitioner must work to build and maintain the client’s trust. The sessions are confidential and the client’s personal details and session notes are kept securely. The practitioner should be transparent about pricing, what is involved in the therapy, how long the therapy can be expected to last, what can be expected during a session, what kind of results can realistically be expected, and be transparent about the methods used within a session and why they are being used. The opportunity to fill out a feedback form and time at the end of a session to ask questions or raise further issues can be helpful ways to increase trust and transparency.

4. Collaboration, empowerment and choice

“Healing happens in relationships and in the meaningful sharing of power and decision-making.”[6] Within a practitioner-client relationship, this can translate into allowing each session and each overall course of sessions to be client-led, with the practitioner guiding, suggesting, and watching out for red flag areas where it may be unsafe for the client to go just yet. The practitioner should not impose their ideas, words, or judgements on the client. Rather, the practitioner accompanies the client along their journey, keeping them safe and suggesting where they may wish to go next. The client can expect their feelings and experiences to be heard and validated by the practitioner. “Staff [Practitioners] are facilitators of recovery rather than controllers of recovery.”[7]

5. Cultural, historical and gender issues

The practitioner should make every effort to be aware of potential historical or cultural trauma, and their practice should be open to all, regardless of race, gender, religion, etc. However, practitioners also need to keep themselves safe by not taking on clients who are outside of their experiences and capabilities. Many practitioners choose to specialize in working with a certain population, for example, women, but they need to be careful to not exclude potential clients based only on such criteria, but to assess each person on an individual basis as a suitable fit for working together.

6. Other support for the client

SAMHSA emphasises the importance of utilizing peer support among trauma survivors. This is outside the scope of a normal EFT practice, although practitioners could explore the possibilities of facilitating group sessions of people involved in similar life experiences, for example, those undergoing cancer treatment, those with addictions, or the recently bereaved. It is also a good idea to try to ensure the client with trauma has a support system within their family and wider community. They could be encouraged to join other groups such as Alcoholics Anonymous or a domestic abuse support group. If a practitioner refers a client on to another organization or individual, for example, a 12-step program, a dietician, or a psychiatrist, they should ensure that this new person or organization is also trauma-informed.

7. Safety of the practitioner

A trauma-informed work environment includes the practitioner’s needs. The practitioner may become triggered or re-traumatised themselves by something the client says, and there is also a risk of secondary trauma to the practitioner from hearing disturbing stories. Therefore practitioners need to be vigilant and have their own support network in place including peers, colleagues and therapists, and must work on their own reactions and their own traumas as and when they arise. The practitioner may refer a client on to another therapist if they feel unsafe or out of their depth working with a particular person.

8. Membership of a respected organization

The practitioner should be a member of EFT International (or potentially another widely recognized certifying body for EFT). EFTi supports the implementation and maintenance of a trauma-informed approach. It has rigorous training requirements incorporating knowledge about trauma, as well as a skill set for working with trauma. It also employs a compulsory support system of mentoring and supervision for practitioners. All practitioners must adhere to EFTi’s Code of Ethics[8] which reflects trauma-informed principles. There is a formal complaints procedure. All EFTi-registered practitioners must also undertake continuing professional development each year which can include training about trauma as well as specific EFT techniques to help people with trauma.

It is clear that a trauma-informed approach is wide-ranging and involves far more than the therapy itself. If you have experienced trauma and are looking for an EFT practitioner, choose carefully. Make sure the practitioner is registered with EFTi and talk to them in detail about their approach before you undertake sessions.

If you'd like to chat with me about how I approach EFT and find out how I could help you, please contact me to set it up!

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