"Trauma-informed care begins with a fundamental shift in perspective: from 'What is wrong with you?' to 'What happened to you?' This reframing is not merely semantic—it transforms the therapeutic relationship from one of pathologizing symptoms to understanding adaptations, from treating dysfunction to witnessing survival."
What is Trauma-Informed Care?
Trauma-informed care (TIC) is an approach to service delivery—in healthcare, mental health, education, social services, and beyond—that:
- Realizes the widespread impact of trauma
- Recognizes the signs and symptoms of trauma in clients, staff, and others
- Responds by integrating knowledge about trauma into policies, procedures, and practices
- Resists Re-traumatization by actively avoiding practices that could trigger trauma responses
At its core, trauma-informed care shifts the question from “What is wrong with you?” to “What happened to you?”—recognizing that symptoms and behaviors often make sense as adaptations to overwhelming experiences.
The Six Principles
The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six key principles of trauma-informed care:
1. Safety
Physical and emotional safety is the foundation. This includes:
- Safe physical environments
- Transparent, predictable interactions
- Clear boundaries
- Creating felt sense of safety, not just objective safety
2. Trustworthiness and Transparency
Building trust through:
- Clear, honest communication
- Consistent follow-through
- Explaining decisions and processes
- Maintaining appropriate boundaries
3. Peer Support
Recognizing the value of:
- Shared experience
- Mutual self-help
- Connection with others who understand
- Building communities of recovery
4. Collaboration and Mutuality
Leveling power differences:
- Shared decision-making
- Recognizing that everyone has a role in healing
- Valuing client expertise about their own experience
- Partnership rather than hierarchy
5. Empowerment, Voice, and Choice
Supporting self-efficacy:
- Prioritizing client choice
- Strengthening skills and autonomy
- Supporting self-advocacy
- Recognizing that survivors are experts on their own lives
6. Cultural, Historical, and Gender Issues
Acknowledging:
- Cultural differences in trauma and healing
- Historical and generational trauma
- Gender-related trauma patterns
- The need for culturally responsive services
Why It Matters for Narcissistic Abuse Survivors
Survivors of narcissistic abuse face specific challenges in seeking help:
The Risk of Re-traumatization
Without trauma awareness, providers may:
- Minimize the abuse (“That doesn’t sound that bad”)
- Blame the victim (“Why didn’t you leave?”)
- Recreate power dynamics (authoritarian, dismissive treatment)
- Push too fast into trauma processing
- Fail to recognize the abuse as abuse
The Unique Nature of Narcissistic Abuse
Narcissistic abuse involves:
- Chronic invalidation (making trauma-informed validation particularly important)
- Gaslighting (making belief and validation crucial)
- Attachment wounds (making the therapeutic relationship especially significant)
- Covert manipulation (requiring provider understanding of these dynamics)
What Survivors Need
Trauma-informed care for narcissistic abuse survivors includes:
- Believing the survivor’s experience
- Understanding the dynamics of narcissistic abuse specifically
- Validating that the abuse was real and harmful
- Avoiding replicating controlling or dismissive dynamics
- Supporting autonomy and self-trust
- Going at the survivor’s pace
Trauma-Informed vs. Trauma Therapy
Trauma-Informed Care
- A framework for any service
- Assumes trauma may be present
- Avoids re-traumatization
- Creates conditions for healing
- Can apply to schools, hospitals, legal systems
Trauma Therapy
- Specifically processes trauma
- Uses specialized techniques (EMDR, SE, IFS, etc.)
- Directly addresses traumatic memories
- A form of treatment, not just an approach
- Always should be trauma-informed
You can receive trauma-informed medical care, trauma-informed education, or trauma-informed legal services without them being “therapy.” Trauma therapy is a specific treatment that should always be trauma-informed.
Finding Trauma-Informed Treatment
Questions to Ask Potential Providers
- “What is your training in trauma?”
- “How do you approach working with trauma survivors?”
- “What does safety look like in your practice?”
- “How do you handle pacing—going too fast or too slow?”
- “What do you know about narcissistic abuse specifically?”
Green Flags
- Provider asks about trauma history
- Explains what therapy will involve
- Emphasizes your control over pacing
- Validates your experience without you having to convince them
- Respects your boundaries
- Welcomes questions
Red Flags
- Minimizes or dismisses your experience
- Pushes you into trauma processing before you’re ready
- Doesn’t ask about or acknowledge trauma history
- Breaks confidentiality or boundaries
- Makes you feel blamed or shamed
- Creates power dynamics that feel controlling
Beyond Individual Therapy
Trauma-informed principles can apply anywhere:
Healthcare
- Explaining procedures before performing them
- Asking permission before touching
- Providing choice where possible
- Understanding that medical settings can be triggering
Education
- Understanding behavior as communication
- Creating safe classroom environments
- Avoiding punitive responses to trauma-driven behavior
- Supporting rather than punishing struggling students
Workplace
- Understanding that trauma affects work performance
- Providing accommodations
- Creating psychologically safe environments
- Training management in trauma awareness
Legal System
- Understanding trauma responses during testimony
- Avoiding re-traumatizing questioning
- Providing support services
- Recognizing that trauma affects memory and presentation
The Healing Context
Trauma-informed care creates the conditions in which healing can occur. It doesn’t do the healing—the survivor does that, often with therapeutic support. But without a trauma-informed context, healing is much harder, and well-meaning services can actually cause harm.
For survivors of narcissistic abuse, finding providers and systems that are trauma-informed is especially important. You’ve spent enough time being invalidated, blamed, and controlled. Your healing environment should be different.
You deserve care that believes you, respects you, and works with you—not care that recreates the dynamics you’re trying to heal from.
Frequently Asked Questions
Trauma-informed care is an approach that assumes many people seeking services have experienced trauma, and designs systems and interactions to avoid re-traumatization. It shifts the focus from 'what's wrong with you' to 'what happened to you,' recognizing symptoms as adaptations to overwhelming experiences.
Research shows trauma is extremely common (over 70% of adults have experienced at least one traumatic event). Without trauma awareness, well-meaning services can inadvertently re-traumatize. Trauma-informed approaches improve outcomes and reduce harm across healthcare, mental health, education, and social services.
Key principles include: (1) Safety - physical and emotional; (2) Trustworthiness and Transparency; (3) Peer Support; (4) Collaboration and Mutuality; (5) Empowerment and Choice; (6) Cultural, Historical, and Gender Issues awareness. These principles guide all interactions.
No. Trauma therapy specifically processes traumatic experiences. Trauma-informed care is a broader framework that can apply to any service—medical, educational, legal—ensuring services don't re-traumatize and support recovery. Trauma therapy is trauma-informed, but not all trauma-informed care is therapy.
Look for: therapists specifically trained in trauma (EMDR, Somatic Experiencing, DBT, etc.); providers who ask about your history of trauma; those who prioritize safety and give you control; practitioners who explain what they're doing and why; those who believe you and don't minimize your experience.
Narcissistic abuse creates specific trauma patterns: chronic invalidation, gaslighting, attachment wounds. Non-trauma-informed providers may minimize the abuse, blame the victim, or inadvertently recreate abusive dynamics. Trauma-informed care validates the survivor's reality and avoids replicating harmful patterns.
