Most professionals are not receiving trauma training.
Trauma training is rarely implemented into the core curriculum of graduate training in psychology and other related fields [9] [10] [14]. This lack of trauma training means that many mental health professionals are not skilled in working with traumatized individuals [9] [10] [11] [12] [13].
- If trauma survivors are not given trauma-informed care, clients may not respond optimally or may even be re-traumatized by the mental health system, and clinicians may experience vicarious traumatization [10].
Research has found:
- 56% to 70% of mental health professional had received no training in childhood sexual abuse [6] [7].
- Only 30% of those who had received training felt sufficiently trained to be able to inquire about abuse [6] [15].
Because clinicians are not receiving sufficient trauma training, many patients are not receiving trauma-informed treatment:
- 2/3 of patients reported sexual, physical, or emotional abuse, but only 20% had been asked about abuse by mental health clinicians [1].
- 69% of patients who reported abuse believed there was a connection between the abuse and their mental health symptom(s), but only 17% of clinicians recognized this connection [1].
- The medical records of 51% of patients did not indicate whether or not they had been traumatized [1].
- However, 41% of the above patients had documented evidence of trauma.
- Another study found that only 32% of patients were asked abuse-related questions, even when admission forms included a section for abuse history [2].
- The pattern is consistent: Clinicians typically do not directly ask about trauma [1] [2] [3] [4] [5] [6].
Barriers to assessing trauma
Mental health professionals avoid taking assessing for trauma because “they do not feel sufficiently competent to do so, or they feel unable to follow-up with appropriate management if they uncover a history of trauma” [1, p. 5]. Some professionals also feel “too uncomfortable” to ask [6] [8] or do not think abuse is important [8].
- Time pressures, feeling the need to develop adequate rapport, and fear of distressing the patient are common barriers to assessing for trauma [2].
- Other barriers include: fear of vicarious traumatization (i.e., the clinician being overwhelmed by hearing about the client’s trauma); concern about client embarrassment; lack of training and confidence about trauma; fear of exacerbating clients’ distress; clinicians’ beliefs regarding the reliability of clients’ accounts; concern about contributing to “false memories “; uncertainty about how to respond appropriately if the client discloses abuse; discomfort with discussing such personal topics; and belief that the client may prefer to be asked by a clinician of the same gender, culture or a different clinician [2].
Clinicians have not been trained to assess for trauma:
- 24% of clinicians had received no training on how to ask about abuse [2].
- Clinicians thought they needed more training in the following areas:
- What questions to ask,
- When to ask,
- How to ask specific clients (e.g., older, or dissociative, or psychotic clients),
- The effects of child abuse, and
- How to avoid encouraging false memories and inaccurate allegations of trauma [2].
By failing to take trauma history, “clinicians may unwittingly confirm any belief that the service user may have that there is a need to deny the reality of their experience” [6].
- Clients wish clinicians would approach them about trauma: 12 studies found that mental health consumers who experienced domestic violence wished for more direct inquiry about abuse and recommended that staff receive training to improve their ability to be compassionate and ask about trauma [5].
Trauma training is helpful
Donohue (2010) found that a one-day training course led to 93% of participants believing they had developed enough skill to inquire about abuse and handle disclosures of abuse [7]. Additionally:
- 77% of participants thought the course had changed their practice, and
- 44% of participants said they inquired about abuse with most patients after the training [7].
Professional resources:
Where can I receive professional trauma training?
1. Division 56 (Trauma Psychology) of the American Psychological Association (APA) was established in 2006 by researchers, clinicians, educators, and public policy experts with an interest in the psychological effects of trauma. They provide scientific research, professional and public education and training, and support for professional activities related to traumatic stress.
- Training: Division 56 provides a webinar series focused on issues relevant to researchers, teachers, and practitioners in the field of trauma psychology. Example topics include PTSD in the DSM-5, Treating Adult Traumatic Bereavement, and Multi-Systemic Psychosocial Support Model for Responding to Disasters and Mass Violence.
- Conferences: Division 56 also provides opportunities for professional development. Researchers present the most up to date material on research, policy, theory, and practice at the annual convention of the American Psychological Association. You may view valuable past convention talks here.
- Higher Education: Please see here for Division 56’s comprehensive list of doctoral and internship training programs with a trauma focus.
2. The International Society for the Study of Trauma and Dissociation (ISSTD) is a non-profit professional association organized to develop and promote clinically effective and empirically based resources and responses to trauma and dissociation. One of their primary goals is to educate the public through training programs, conferences, and the Journal of Trauma & Dissociation.
- Training: The ISSTD provides various levels of training to those who are interested in the trauma field. Trainings include literature discussion, lecture, discussion of real life applications, and more. Training is available at all levels for therapists who are novices at treating complex trauma and dissociative disorders to advanced therapists as well as specific training in treating children and adolescents. The calendar for training courses is available here.
- Conferences: The ISSTD also holds a bi-annual conference that addresses topics related to complex trauma in children, adolescents, adults, families, and society. Valuable past conference talks are available here.
- Higher Education: Please see here for ISSTD’s comprehensive list of academic supervisors with a trauma focus for undergraduate to doctoral level programs.
3. The International Society for Traumatic Stress Studies (ISTSS) shares information about the effects of trauma and the discovery and dissemination of knowledge about policy, program, and service initiatives that seek to reduce traumatic stressors and their consequences. Their mission is to promote advancement and exchange of knowledge about traumatic stress.
- Training: The ISTSS disseminates professional knowledge to the public in numerous ways. ISTSS provides both live webinars engaging in trauma topics as well as an online learning library that houses previous recordings and other informative training materials. Example topics include A United Transdiagnostic Treatment for Emotional Disorders Applied to Combat Related PTSD, An Introduction to the Neurobiology of Traumatic Stress, and Applications of Dialectical Behavior Therapy to the Treatment of Dissociative Behavior and Other Complex Trauma Related Problems.
- Conferences: The ISSTD holds an annual conference dedicated to trauma treatment, education, research and prevention. Symposia, workshops, panel discussions, cases and media presentations are presented on a wide variety of topics related to traumatic stress. Past conference talks are available here.
For additional information regarding training, please see APA’s Education and Training Resource Documents page that includes a document on guidelines on trauma competencies for education and training.