Trauma Therapy vs. Trauma-Informed Care with Sarah O’Brien LCSW-S

Written By Katie Kurtz
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When it comes to trauma there is a big difference between trauma therapy and trauma-informed care.  There are so many different types of treatment and healing modalities but what are they exactly? In today's episode of A Trauma-Informed Future Podcast, host Katie Kurtz is in conversation with trauma therapist Sarah O'Brien LCSW-S who helps us better understand the key difference between trauma trained and trauma-informed and how essential it is that trauma therapists are trauma-informed. Sarah also helps us understand the difference between what a therapy modality is and how it's delivered.  

Learn more about Sarah:

Sarah F. O’Brien (she/her) is a dynamic and innovative trauma-informed professional. She is a Licensed Clinical Social Worker (LCSW, LCSW-C), and has been a practicing psychotherapist specializing in Anxiety Disorders, Substance Use Disorders, and Relational/Betrayal Trauma reactions & responses for over 15 years. She has had many diverse and enriching experiences as a therapist that inform her work as a Trauma-Informed Coach and Consultant. She has been finding ways to pivot her clinical skills into other areas to reach wider audiences for impacting social change. Sarah also writes, speaks, and creates audio & video media content in efforts to reduce the stigma around mental health disorders & treatment, and to increase understanding of and accessibility to trauma-informed practices for all people and all businesses. (Trauma-informed future, FTW!)

Not only is Sarah the Founder/CEO of both her psychotherapy practice and coaching/consulting business, she is the creator of the groundbreaking tool: the Trauma-Informed Crisis Response Guide. This step-by-step guide can be easily used and followed by any person, in any setting, to navigate the steps to address a mental health crisis in action. She has been featured in numerous media outlets to include Today and PsychReg. She has been a guest speaker on the Circle Back to You Podcast several times, as their in-house Mental Health and Trauma Consultant, as well as guest speaker/Subject Matter Expert for LIVE discussions and panels on LinkedIn. She strives to help folks wrap their minds around trauma-informed care in both clinical and non-clinical settings and work through their barriers to access transformational change, in life, in business, in self.

Sarah lives out her beliefs in every aspect of her work, as she employs TI principles to her business practices, marketing, design, content-creation, collaboration with other professionals or companies, and her work with clients. She has a contagious energy and uses it to empower every individual she works with to be their authentic selves…and wear it proudly. Her collaborative approach creates a synergy between herself and others that provides hype for motivation, follow-through on goals, and recognizable change.  Neuroscience and evidenced-based practices are the driving forces behind Sarah’s approach to understanding how people create lasting and transformational change for themselves.

Sarah holds several roles and titles in addition to Founder, CEO, clinician, consultant, and coach. These include: Social Impact Catalyst and Subject Matter Expert at Integrate Trauma-Informed Network and Circle of Friends Club. Ambassadorship for Belongly, Circle of Friends Club & Freedom Fight Expo, and Ace Med Assist, as well as, products for Own Your Stigma, CalmiGo, and Loop earplugs. Membership Chair of her local chapter of the Virginia Society for Clinical Social Work.

She's also a proud dog mom, loyal friend, faithful spouse, reggae music lover, travel enthusiast, changemaker, and trauma survivor.

Connect with Sarah:

Show Transcript:

Katie Kurtz (she/her): Hi, everyone, and welcome back to a Trauma Informed Future podcast. I am excited to be in conversation today with my colleague and friend, Sarah O'Brien. Sarah, hi. Welcome.

Sarah O’Brien (she/her): Hi, Katie. I'm so happy to be here.

Katie Kurtz (she/her):Yeah. So how are you arriving today in our shared space? Because I know we have so much to talk about. I'm already super fired up and excited.

Sarah O’Brien (she/her): I know, me too. I'm arriving also very excited and well rested. I actually got a really good night. Of sleep last night. So that's good. The one thing I didn't get to do was walk my dog this morning, but that was fine. Cause it was 34 degrees and I'm ready for spring to hit.

So I am here. I have my coffee. I am ready to go.

Katie Kurtz (she/her): Love it. Love it. Ready for spring too. So before we hit record, Sarah and I were already getting all fired up about what we're talking about today. And I was like, wait a minute. We have to hit record. Cause this is too good. So I really have been thinking a lot about, I'm always thinking about it.

So we know that my background's in [00:01:00] social work, mental health professional, mental health advocate for a very, very long time, and also within trauma. And there's a lot of misconceptions. And ironically, these misconceptions, I find, are most intensely housed within the mental health profession around the difference between mental health, mental illness trauma informed care.

And so I was like, who can I be in conversation with? And I thought of you, Sarah. And I was like let's just start with where I always like to begin with is shared language and understanding. And I'm curious, cause you were starting to say this. I was like, wait, let's say record. Let's talk about.

the difference between mental health and mental illness? If we could just start there.

Sarah O’Brien (she/her):Yeah, so what I was just saying was, these are two separate things that inform one another, right? Mental health is one thing and mental illness is another thing. And we can think about it like physical health is one thing and physical illness is another thing.

And the example I was giving was, somebody could have overall good [00:02:00] Physical health and still have a physical illness, like a thyroid condition or diabetes or whatever you could have a physical illness, medical illness, whatever you want to say about it, and then maybe it's well managed with some sort of treatment.

The treatment is not necessarily medication, but it could be something else. That doesn't mean you don't have the illness. It just means you're not struggling with the symptoms of the illness because it's being treated and also, to piggyback on that, if you have a physical illness that's being treated where the symptoms aren't causing dysfunction in your life, then overall your health and functioning is better , your illness is well managed. Therefore, it's not interfering with the way that you want to function in life. Okay. Mental health is the same. It's separate from illness. Somebody could have. Overall, good mental health and still have a mental illness, like major depressive disorder

This is classified in the [00:03:00] same way that you would go through criteria for a thyroid disorder there's a medical component to that. Now, the dysfunction that comes with the illness, major depressive disorder would vary based on treatment or wellness or coping or managing that illness.

So, some ways to manage major depressive disorders with medication, among another of other kinds of treatments. If you are undergoing treatment. For your major depressive disorder, just like undergoing treatment for your thyroid disorder, then you might be functioning really well and you're not, in dysfunction or struggling to function the way you want to as a result of your illness symptoms.

Whether physical or mental getting in the way. Now, if you have a physical or a mental illness and it's not treated or well managed, then it could be causing dysfunction in your everyday life in your day to day. Illness is a disorder. It's a medical condition, [00:04:00] medical issue, something that.

May or may not be helped by treatment. We can't treat all medical conditions. We can't cure all medical conditions. Guess what? It's the same for mental illness. They're not all easily or well treated and. They're not all able to be cured and not exist anymore in somebody, but they can be well managed.

So when we talk about mental health it's overall, like, how are you doing? In the grand scheme of things, not a pinpointed. Illness that has specific criteria to meet to get the diagnosis, mental health is not a diagnosis. Physical health is not a diagnosis. It's like a way of. Of being, are you well, or not well, in this area I guess we could say the same thing about emotional health. Are you well, or not well, in that area. There's a difference between just the overall [00:05:00] health. Good, bad, somewhere in the middle, and then a specific illness that we're talking about.

Katie Kurtz (she/her):Yeah, thank you for that. I think it's always so important to remember that distinction, and then when we're thinking about trauma, and as folks know, I talk about this a lot, and again, a reminder that there's no universal agreed upon definition of trauma or there's many definitions, and for the sake of this podcast and how when I talk about trauma, I'm talking about our response to events and experiences, not specifically certain types of events or experiences, because we know we all have different responses.

And when we do that, we can eradicate certain people's individual felt senses of safety and their lived experiences. And we don't want to exclude the wide array of responses. So when it comes to trauma I do this right away when I train is like trauma is not a mental illness, but it can manifest into it .. This [00:06:00] might be a hot take. I'm curious what you think. I think trauma is always going to impact our mental health as our physical health because it's our response, right? It's our human response. It's a neurobiological response. However, it's not always going to manifest into a mental illness. And I would love to hear because of your role as a trauma therapist and a trauma informed trauma therapist, which we're going to talk about what that really means.

I would love to hear you speak a little bit about this distinction.

Sarah O’Brien (she/her):Yeah, I'm on board with you. Trauma is the body's response or reaction to abnormal circumstances, either in a single event or ongoing,? So yeah, we don't make a distinction between this or that. It's could be something that happened to them once.

It could be something that happens all the time. Many times or twice or every day, like it depends trauma really what we're talking about is responses trauma equal responses. That's what it is. We could say trauma [00:07:00] is the same as reaction to. And it's a involuntary reaction to it's kind of, like, if you go to the doctor, and they used to do the test and hit your knee with the thing and it bounces.

 That's trauma. It's a reaction to something happening to you in the environment that's involuntary and a lot of times automatic. And so my thought with that is, yes. Trauma is really a response, and it is the result of living through an abnormal, intense particularly maybe unhealthy experience, something that is abnormal for the human experience or abnormal for the neurobiology of the human being to experience, like, not adapted to manage that. Therefore, it comes out and maladaptive responses and patterns. The biggest thing that I like to focus on with this here is that without some sort of, [00:08:00] action, thing, behavioral, and or body experience or internal mental experience, which ultimately results in a body experience somewhere that if without having this experience that is abnormal, trauma would not develop. We don't have it without this. It doesn't come out of nowhere. It's not something people are necessarily born with but then it also has to show itself, which also depends a lot on your environment. Just because you have a predisposition for it doesn't mean that it's going to pop out. It depends on your circumstances, right? And if you live through a circumstance that is abnormal, intense and basically too much for your neurobiological system to manage, we develop like compensations also go back to the physical and I go back to this a lot because I've had chronic pain for over 10 years and I have spent seven years in physical therapy trying to address my chronic pain and I learned so much about my body in that [00:09:00] process and one is like If you're dealing with something abnormal, like a pain or a pain in a specific area, your body compensates.

So it learns how to adjust for that pain. So my pain is a lot in the right hip. So ironically, how that is manifested for me is a pulling on my left shoulder. And the ribs back here and it actually pops this rib out of place. So the way my body is compensating has caused another issue that makes it difficult for me to function and move in the ways that I want to. That's how I would describe trauma,. It's an abnormal experience that happened and your response to it is the compensation your neurobiology is making to deal with that thing that is off. That's not right, not settled, not at equilibrium in your body, in your mind, in yourself.

So this is where we get those responses, like my shoulder responding in a way that's not healthy, not normal, not natural and causing dysfunction [00:10:00] for me. More pain is the same. We end up in these responses, these compensations to the trauma that's already adjusted or changed our system.

Kind of like with my hip pain and then the automatic involuntary, I didn't ask for this shoulder to be off and this rib to pop out. That's an automatic thing that just happened as a result of my body compensating for this other thing that happened, which by the way is also result Kind of the physical trauma is because I had a fall.

I fell and I injured myself. So we could also think about that. Trauma is an injury. It's an injury to the neurobiology. It's a cognitive. emotional neurobiological hit to your system, and it's injured. And if you don't heal it well, you will compensate for that injury.

It's hard enough for people to understand they need to heal a physical injury , and go to physical therapy and do all the things, right? It's hard for people to follow through with that. And physical therapy and mental health [00:11:00] therapy are closely related because for physical therapy to work, you have to do your at home program.

For mental therapy to work. You got to do stuff outside the session. That's the only way you're really going to see change. It's the only way you're going to see lasting change. For me, it was 7 years of physical therapy before I could say Okay, I can do this on my own. I don't need to go back and get readjusted by my physical therapist.

Sort of the same in mental health therapy. We're helping you get readjusted to move away from those compensations to get back to your normal functioning. So hopefully that you learn enough in a place like you don't need me anymore. You don't need the mental therapist unless you need like a tune up, or you re injure it.

Or it gets re injured. So if I get re injured and my hip starts hurting again, and my own program is not working, I got to go back to my physical therapist and get adjusted and start again. I might need to get some new home program stuff, some stretches and some other exercises that help based on this new injury to get things back. To me, it really works just the same way with that. It's a compensation that's involuntary that your [00:12:00] neurobiology makes as a result of this injury. But the injury is internal.

Katie Kurtz (she/her):And it all takes time. I love how you talked about like this involuntary response and use such poignant examples, because examples or metaphors or comparisons are really helpful for folks. But we might have a very involuntary response immediately, or it may manifest over time, we can't assume, and this is where culturally, we're just programmed to think, okay, not just with trauma healing, but mental health healing and physical health healing that we need this quick fix and that, you need to have a hip injury and that's seven years like yeah. That's frustrating and annoying. And I'm always like, can't we get there faster, but also if you were injured. You go too quick, you're not going to heal. And so it's a great comparison and I'm curious if you can then talk to us, because we [00:13:00] know our mental health and physical health are impacted by trauma. Everything's interconnected. But when does it begin to manifest into potential mental illness? Specifically like post-traumatic stress Complex, PTSD.

Sarah O’Brien (she/her):So if I stick with my example, it would be the compensation is going on longer and longer before you get treatment. So that's basically like same as a physical injury. The longer you go without getting proper treatment. I spent three years not getting proper treatment before I spent seven years getting proper treatment with my physical therapist that actually helped. So there's that piece, but getting treatment that actually is helpful.

Or getting to that place of stepping into that for people is that the problem gets so big. The dysfunction gets so big. For me, it's the longer you go before you recognize that you've been injured and you start the healing, the more your body, your neurobiology [00:14:00] is going to compensate for that injury, which is likely the more dysfunction you're going to have.

And if you think of a physical injury, that's exactly what happened. The more my body was trying to compensate for this injury, the more other things started to hurt and basically just like my whole body is breaking down. And there's just pain everywhere. And instead of just like the concentrated area that I had the injury, it's now basically spread to my whole body. If we think about that with trauma and specifically how it affects emotional cognitive functioning, which then translates into behaviors and actions informed by how we feel and what we think a lot of the time, that gets warped, but let's say the compensation, right?

Basically, in my body for the physical stuff is warped. It's not working normally. I'm not moving in natural ways that my body is meant to it's the same with that. When you have. This ongoing injury that you don't have healing for that your neurobiological system is compensating for the more and more dysfunction you're going to have.

It's not [00:15:00] the thing that you need to be doing. It's just the thing that your internal body automatically does to try to compensate for the injury. It's not thought out. It's like the stuff that's hurting on me. It just. does something so that I can keep walking.

Like my hip hurts, but it makes a compensation so that I can keep walking and standing as I need to. Well, guess what? For trauma, it's the same. You're going to compensate for that injury so that you can walk ahead. That means wake up the next day, be a parent, go to work, be a spouse, be a friend a sibling, a child, whatever your role is it's going to adjust the way that you then walk forward.

So it's going to compensate the way you think about things, the way you view things, the way you view others how you get your needs met, how we adjust for this injury that we're not healing, that, we're not getting proper treatment and healing for. And. [00:16:00] Honestly, even with physical injury, like over time, I could notice, but it took a while to notice what the compensation was doing to the rest of my body and physical is something people notice usually a lot more than anything mental or emotional. So then we're probably talking about even longer, sometimes in a few years period of time that you recognize you've been compensating based on a traumatic injury.

And sometimes you don't get there, and sometimes it's a long time. And in my case, I'll just take me as personal example. I have lots of trauma, I have complex PTSD. And I've been in treatment, I've been in therapy, I've had many therapists, I've done EMDR for 15 years or more. Not doing the right treatment and realizing, in my mid thirties, there's a bunch of stuff that's compensated because I actually haven't healed the original injury.

I've tried to do a bunch of healing that compensated [00:17:00] pain, but not really at the and all the therapy I've been in also hasn't gotten to what that injury was and what I really needed to heal, which I'll just tell you straight up after all the therapists and all the things and the therapist I have now it's the trauma informed piece.

It's not because I didn't feel a connection with my therapist. The EMDR worked for my brain some, but that was the modality not the care provided. So we know that EMDR modality works really well for complex PTSD with what it does in the brain and what we know about neuroscience, but in terms of, okay, so that may be targeted, potentially part of the original injury, but not all the compensated problems.

I had a result of that, which were interpersonal, which were relational, which were shame, [00:18:00] loneliness, isolation, non acceptance exclusion. And that is what my current therapist has been able to address a lot more in a way that resonates and helps me feel seen and heard. And he's not doing EMDR. He's not using any drama modality, really, as far as I know, he's just able to relate and empathize and, say those things out loud and the way that they resonate with me, if that makes sense. And I'm just using myself as a personal example here. It's like been through the gamut, like a physical mental trauma, this EMDR, that therapist, people want to know, it's a process. I've been doing this a long time trying to even just heal myself.

And I know more than most because I study this both academically and professionally to be able to help my clients better and I'm still in the dark sometimes it's helpful then to have my therapist who uses trauma informed skills. [00:19:00] In a way, I didn't know I needed, that actually then produces the healing that I'm looking for.

So the longer you go, the more it's going to manifest in other things. And for me, that manifested in many things. I have sensory issues with sound and touch. I have generalized anxiety. That, ramps up, does this based on different things, especially if I've been re injured you can just expect my anxiety to go sky high.

And so all the things that come with my anxiety, it's going to look like I had more dysfunction and my anxiety disorder. . I'm more hyper vigilant. I have more trouble focusing. I have even more trouble sleeping, like I noticed when that ramps up and it's the same. I have less tolerance, like for my sensory things.

If I'm more stressed, if I've been re injured, if I'm compensating it some way, if I don't have capacity, that's where it all shows up. So if you have any sort of past trauma and it's untreated and unhealed, I [00:20:00] would, this is what I say to my clients. There's not many things that I'm like A guarantee on right?

Because there's a lot of room for nuance and that kind of thing. But this is 1 of those things that if you have. unhealed trauma, I would bet all my money that you will end up with a mental health disorder meeting criteria for something because of the compensation your whole system is trying to do as a result of that injury that's not being addressed and is not being healed.

And the way I say that to my clients is if I feel that at a hundred percent or almost a hundred percent, you can take it to the bank and cash it. I've seen it enough. I've worked with Hundreds and hundreds of clients and individual psychotherapy treatment and group therapy treatment spaces and know this is what I've seen 100 percent of the time.

Katie Kurtz (she/her): I think for anyone listening, again, using terminology like warped, it's not that you are warped or you're broken or you're dysfunctional or abnormal. I [00:21:00] think sometimes we hear those words and we have a visceral feeling.

Trauma is our body's response. Of course, our bodies are here to keep us alive and going and moving through the world in a way to be safe. And I would say that compensation is also a safety. How can we safely move about as safe as possible when we're never feeling safe or around people that we don't feel safe around.

And I think that, These responses, these reactions we have, these neurobiological, fight, fight, freeze, when we really break those down, that flight hypervigilant response, hyperarousal can often look like intensified anxiety. And on the opposite, that hypo arousal, that freeze response chronically over time can look like depression.

And I think, there's a whole other episode around diagnostics, but like , diagnoses are important. And also we have to be mindful about [00:22:00] pathologizing everything and pathologizing trauma when it's our natural response, like of course we're going to respond to that. Your body is brilliant and your body is brilliantly compensating to get you through life as safe as possible.

And so diagnoses can be empowering and helpful and supportive and also not the end all be all. And when it comes to PTSD, complex PTSD it's important to recognize not all experiences of trauma manifest into that. I have childhood trauma. It took me 23 years to name and identify. And I don't believe we're ever healed. I think healing, it's just an active practice, but Sometimes many of us aren't even there yet of naming and acknowledging our trauma and it took me a very long time to do that because it wasn't that intense, that very concrete thing we think of, and it was minimized .

 It's [00:23:00] chronic, very levels, multiple things, not just acute. Levels of single events, but also chronic over time that manifested into this thing that was able to be named and acknowledged early on. But because there's so much complexity there existing in the world and that injury being constantly poked at it, there needs to be more tailored support to function and reestablish safety rather than constantly compensating, which can come out as a variety of things. Those trauma responses can look like behaviors. It can look like cognitive, emotional, social, relational, physical, all the things. And it's just going to be very different. My trauma did not manifest into PTSD or see PTSD, but I still have, heightened hypervigilance, heightened anxiety, all these different, physical ailments that are all tied to it. And so that's why. [00:24:00] understanding trauma and not getting stuck in these very rigid beliefs. And also not gatekeeping that only trauma should be known by mental health professionals or health care providers and why we should have kind of this universal trauma awareness and trauma informed care is so key, which leads me to my next conversation, because I get real fired up about this.

Something I see all the time. As someone who sits at the intersection of multiple industries, as a mental health professional, licensed social worker, but also mainly in my role as a trauma informed trainer, is that people assume that all social workers, all counselors, all therapists, and sometimes, although I definitely see people give me the confused face when I say this, but even some people still assume healthcare providers are all trauma trained and trauma informed.

So let's first start with the difference between trauma training, [00:25:00] being trauma trained versus being trauma informed, because these are not the same thing. If you are trauma trained, you better be trauma informed. I feel 110 percent confident that is an absolute, and sadly, I don't know how many people I've worked with who are trained in trauma modalities, trauma healing modalities, who are teaching about trauma, who are not trauma informed.

Sarah O’Brien (she/her):Yep. I'm glad that you use the word modality because that's what I was thinking about. A trauma treatment modality training is not the same as trauma informed care, trauma treatment modalities or medical procedures, so to say they're medical interventions for the trauma injury.

Like that we were talking about.

Katie Kurtz (she/her): Like a comparison.

Sarah O’Brien (she/her): Yeah. Like in thinking about that. And I get it. Social work in general, hates the medical model, but there is a distinction here, a little bit with how you treat something or how you pinpoint it.

Whether it fits the criteria or not. [00:26:00] So again, the trauma treatment modality addresses the symptoms or responses like we're talking about to the trauma, the things that are coming out that are causing you to not function the way that you would like to in the world. So trauma treatment modalities are things like EMDR, EFT and tapping, psychodrama, etc.

Those are the same as like anxiety treatment modalities, like CBT, exposure therapy, acceptance and commitment therapy, etc. They address the maladaptive behaviors and thoughts that are the result of trauma or anxiety as we're talking about here with that. So a trauma modality training is what you do not how you do it. Trauma informed is how you conduct the treatment modality with the patient or client. So it's how you engage the client or patient while using whatever modality you're [00:27:00] trained in. To treat the dysfunction that's showing up in them symptoms or behaviors or things that are causing enough of a concern for the person that they want to get help for it.

That they don't want to be like this anymore. They don't want to have these behaviors, these thoughts, these things. And so they seek out, right? So you're treating that dysfunction that they're coming in for. And that's the what. So that's Using like one of those special, like laparoscopic machines to do an appendectomy.

That's a modality. That's what you're going to use to remove the appendix. How then you would treat the patient in that process is basically how the doctor talks to me. It's how the nurse talks to me when I wake up afterwards, it's what they explain to me, it's how they explain it, it's how they address my fear of having to go into emergency surgery that's a trauma informed how, not a what, so the what is the , the how is the approach, so I to say it like this, trauma informed is an approach to relationships, working, , professional. Intimate or otherwise an attempt to reduce causing more harm. That's how I [00:28:00] think about it. It's absolutely not the same as a trauma trained modality. Let me just touch on that real quick. Let's say something else about it. 16 years ago, when I'm in my masters of social work program, there are no classes on trauma that were required. There was one elective on trauma, which I opted to take because it was military and PTSD trauma. And that's it. one of the main things in social work school is the biopsychosocial spiritual assessment. This is how we assess for dysfunction. Basically we assess for the problems that somebody's experiencing.

We don't just look at the physical health. The thing I was talking about in the beginning, We look at The mental, the behavioral, the emotional, the social, the spiritual, societal, everything that this person is involved in, because all of those things also affect their function or dysfunction, as it may be and Everything I've learned about it has come after school, like having to set out to learn it on my own because this is not what they teach.

They don't teach it in assessment. Honestly, we didn't even take a class to be able to recognize it so [00:29:00] much. Hopefully it's changing it needs to, right? . It's almost like what you're going to do in the first semester in your first class when they talk to you about assessment.

It's how you ask the question. to gather the information. That's trauma informed. So let me just piggyback off that. If we don't get that in our curriculum, in our collegiate and graduate programs, when we go into, gosh, we're just talking about like social work, like all the other mental health professions, all the health professions.

It's amazing to me that doctors and nurses don't get any training on trauma. It's Whoa, I don't know what's happening there, but it's even more amazing that we're not getting training on trauma, right? And so you have to seek it out on your own. I would hope that it would change and we get it in curriculum, but someplace else we could add it, probably wouldn't even be that hard to add.

Let's talk about those certification trainings, EMDR. Can we not do the [00:30:00] whole very first thing before we get into how to do EMDR in terms of the actions. All the things and understanding that. Let's add a piece on trauma informed principles and communication skills to the EMDR training, right?

Learn the modality and how to do it in a trauma informed way. Anybody doing any certification training in mental health could add this piece as part of the modality that you are then learning.

Katie Kurtz (she/her):Absolutely. Yes. I love the comparison that you're using and again to reiterate to folks that, we're not equating mental health and trauma healing modalities to surgical medical procedures, but you're really beautifully using this is an example of comparison. And I loved how you made this distinction that we have these specific modalities. There's a lot of mental health, psychological modalities within mental health, right? Like tons. There's a, lots of [00:31:00] letters and acronyms and things that are confusing. When we say like CBT, we're talking about cognitive behavioral therapy, but there's I don't know, 10 different types of CBT, mindful, trauma focused, all these things. And then you have based on population, so if you're working with children or early childhood or adolescents or, older adults. Substance use, but whatever. So there's so many different modalities, and when it comes to trauma, we know that cognitive behavioral therapy is probably the most commonly utilized modality for any type of therapy. Which is typically delivered in short term, dictated by insurance, which is a whole other conversation. But we know that we cannot just look at cognitive shifts when it comes to trauma healing. It's neurobiological. That's why we lean on and we learn from evidence based modalities that look at somatic, soma meaning body, which we have some great episodes of folks who've [00:32:00] already been on this podcast to talk about somatic integration.

And so many of the somatic healing is derived from cultural practices that have been utilized for centuries. So we look at EMDR and somatic experiencing, that modality is to help treat and help the healing process of trauma. What I want you to closely hear, and I'm going to reiterate what Sarah said is you're not necessarily learning how to deliver that modality in a trauma informed way. Say it again, Kate. When you receive trauma healing modalities, the person delivering it may not necessarily be trained in trauma informed care. So the delivery of that modality may contradict the actual modality because the person is not actually using trauma informed communications, trauma informed relationship building skills, [00:33:00] trauma informed decision making consent and choice, all of these things, can contradict the actual modality. And I've heard from countless people. I myself have experienced working with therapists who identify as being trauma trained, so trained in trauma extensively and trauma modalities that I had to leave that relationship quite quickly because they were not trauma informed, and I could feel it. And I was like, ooh, this doesn't feel right. And this was like early on in my social work career, but I too graduated 15, 16 years ago. I was not trained in trauma or trauma informed care.

Now, mind you, the SAMHSA model was just being published. So I literally learn from SAMHSA trauma informed care like we all did we all took the classes and things like that and now teaching at Universities at a graduate school level It's still not baked in as it should be and I guest lecture at a lot of universities [00:34:00] for mental health providers, but also I do a lot of work in healthcare and we're getting there.

I'm not going to dismiss. It's a slow trudge. We're definitely seeing more and more conversations. I'm delighted to be invited into more and more medical education programs. But I agree with you. It just doesn't make sense to me anymore. Especially with social work. We're always looking at the biopsychosocial holistic, the full humanity of people.

 That is a deeply rooted social work thing. And strengths based approach. That is like a quintessential social work thing. The essence of social work is looking at not the, what's wrong with you. It's looking at what happened to you. That is what I learned as a social worker. And I can't speak for counseling programs or marriage family therapist programs, but I know having friends and colleagues in those programs, it's different. , they still lean on those things, but social work, that is like a thing.

 That's what we do. And so it just doesn't [00:35:00] make sense that trauma informed care is just not the standard of care approach that we're all learning, like in orientation. Indeed, and also, , being applied within academics too, because social workers also need to receive this care, but that's like a whole other thing.

 All of this to say is, again, please do not assume that when we have letters after a name, and this is not just social workers or counselors or therapists, this is especially for psychologists and psychiatrists.

 Again, we're not coming at this to bash people or anything like that. This is just an awareness conversation that I always like to inform people.

Sarah O’Brien (she/her):And when there is a lack of this, it's terrible for folks. I have been subjected to it myself. Like you're saying, just feeling really uncomfortable and like an unsafe in the office of a psychologist or a psychiatrist or a therapist and thinking it's me because this should be the place that I'm getting help and like [00:36:00] really having to dive into that. So yes, we can't assume that they know the how that's going to reduce the harm.

Katie Kurtz (she/her):Oh, I love that. Yeah and so I hold the and both with us because even for us, Who, mid career, I guess we are. Trauma informed care has been around for a long time. It was officially published and formalized in 2014. 2012, 2014. There was documentation in the SAMHSA, TIP 57, all those things. Which isn't that long ago. Oh, gosh. Although trauma education, all of that, it's been around, but what we know, those principles the six principles, the four R's, the three E's, the SAMHSA model we look to, is still very, very young.

So you have to remember that although we should not assume people are trauma informed, even if they provide a trauma specific modality, we also have to pause with some, I just, I [00:37:00] have to pause with Grace. You can do what you want. Me, I have to remember because I get fired up about this. We don't know what we don't know until we know it. And most of us did not have that exposure in our professional studies. And so what I am hoping is that we do better now. It's been some time. We need to be calling in professional programs to be adding this, not as also, because this is where I want to go next, not as an added certification that you have to pay more money for.

I cannot tell you how many universities now have trauma specific or trauma informed certifications, master's level, that you can obtain for a lot of money because it's university level. And in addition to the program, which I understand that. And also, that should be the norm of the program.

And [00:38:00] this is where we wonder why we have high burnout rates in our fields when in order to learn all of this, like, I have a lot of therapist friends and you're one of them that has a lot of integrity when it comes to your knowledge, like seeking education, continuing education, not just the requirements we have, but furthering your development to better serve your clients.

I don't know how many certifications you have. I see a lot on your wall behind you. You had to pay for that out of pocket. And travel, I would assume. I have therapist friends who travel and take a lot of time. These trainings are very lengthy. They're very expensive. And if you live, especially in places that are rural, the Midwest, if you don't live in coastal areas where these are more readily available, and you work at an agency that doesn't have the funds to pay you,

Sarah O’Brien (she/her):That was me at my last job as a licensed clinical social worker, barely making 40, 45, 000 a year, and they didn't pay for licensure renewal. They didn't pay [00:39:00] for CEUs. Like you had to do extra CEUs if you wanted to move up their career ladder . Social workers make the least amount of money and nobody gives you any perks. And there are still things that you have to do to keep up with your job. So that's the re traumatizing. In the system, right? It's like you can't keep up with what they want.

Katie Kurtz (she/her): On top of student loans. And this is where we see. A lot of exclusion happening or lack of access is that we're seeing around just United States, especially a lot of groupings of more people, becoming or accessing these modalities, specifically trauma modalities. But they're centered in specific geographic areas, and we're seeing a lack of it in other areas because, to get, it's expensive, specific types of trauma modalities or multiple trauma modalities, because we didn't even touch upon how EMDR is not for everyone.

I feel like everyone now is like EMDR trained and offering it, which is great. Just within the [00:40:00] last four years, a huge surge, which is an excellent thing. But have to remember that trauma, just like trauma, healing comes in many pathways. And what may be healing for me may not be healing for you.

Sarah O’Brien (she/her): EMDR can't be the gateway, right? Like the gatekeeper that can't be the only one.

Katie Kurtz (she/her): Lots of different modalities to find what works best for you.. And so that's why all of these different modalities exist. But, to access the training for them, I live in Ohio, I live in the Midwest.

To access some of these trainings, you'd have to travel to California, or Colorado, or New York, or wherever. There's a cost. The trainings take a long time. There's a lot of cost involved. And so, it makes it prohibitive to access some of these things and then to bring it back to and then you're not having access to some of these things.

Sarah O’Brien (she/her):There's an expectation that social workers in particular live in practice above reproach, but there is not support for us to do So and nobody's making enough money to, like you said, to not burn out, [00:41:00] in some way, which then affects the quality of the work and the treatment that you can provide, which then what happens in the system, it comes back to you're not a good worker.

I'm not doing a good job because I'm burned out because the whole system doesn't support me in doing this work. Also knowing that I could be a professional with a lived experience of trauma and that comes into play, like having to be well cared for in that space.

And then you talk about like these training, DBT training too. It's really long. It's really expensive. And so then we talk about people did finally get through graduate school and pay for that, that, that's it, they literally can't afford to get a certification or do anything else, and that should not be limiting to their practice necessarily, if they can practice well or do other things.

And the thing that you talk about is it shouldn't be that expensive to do these things.

Katie Kurtz (she/her): Yeah, there's just so many layers. And I'm in my healing era. I've been in my healing era since probably [00:42:00] my second year of grad school with social work. I have a lot of feelings I've experienced personally, a lot of trauma in this field. And I also hold the squishiness of the fact that we work within systems and social work, like it's problematic. There's a lot of problems and the systems we work in and upholding a lot of systems of harm. And so that's a whole other thing. But I think this kind of comes full circle back to again, why I want to have this conversation is to talk about another reason why it's so imperative that trauma informed care is the standard of care for mental health professionals. If we are working with people and directly responding to their trauma to support their healing, And it's not through a trauma informed lens, then we are opening, those pathways of harm are widening, becoming far wider and deeper than anything would if we were just applying this approach in any other field, because of the direct care [00:43:00] of someone coming to you for trauma healing.

I mean, they disclosed it. Exactly. And That's The purpose of them being there. Again, this isn't to, go after the therapy world. We love the therapy world. We are the therapy world. It's to name and acknowledge the realities, and invite in and call for the standard of care, and to remember to any therapist listening, just because you have, knowledge and awareness and understanding, you may have a deeper understanding of trauma than I do, that doesn't equate to trauma informed care.

That's not the approach, the how, which I love how you said it, Sarah. It's not the what, but the how. , that's what trauma informed care is. We teach you how to relate, to speak, to do, to care, to reduce harm.

Sarah O’Brien (she/her): I have two last things about that. Yeah, please do. One, when we were talking about like the certifications that you can get or through the universities of certifications and I would say, in some ways, this is true of my social work program, although they [00:44:00] try to add the practice applied piece, with an internship and field placement. And then you have a field supervisor is somewhat paying attention to how you practice. The how of what you learned in the classroom but we're still missing a big practice component of that. And so when you even talk about these certifications trainings, are they applied? Are they practicing? Do they do this in front of other people, like we do in our other network, like? There's communication circles. There's chats. There are places in which you have to show up either in person on camera, whatever, live and use these skills with other people. So if you're going to have a certification training, that is going to cost a lot of money, whatever, if you're going to be stuck on keeping that.

Well, then you better add a practice component where people are applying it and you're evaluating their application of these skills. Not that they just say they learned it. That's like a whole separate piece. This is why it's a how, not a what. Because we can learn the what all day [00:45:00] and not practice the how.

And so my final sentence on that is trauma informed is how you engage so that you can treat whatever is present using the modality that you're trained in.

Katie Kurtz (she/her): Yes. Yes, absolutely. Thank you so much, Sarah. Yeah.

Sarah O’Brien (she/her):Like you were saying with the EMDR, if you don't use the how, then what you're doing is definitely not going to be as effective and it could be totally ineffective or could totally be worse and have the opposite result.

Yeah. Not the how.

Katie Kurtz (she/her):Absolutely. That's so important. I think too. So it also deepens your ability to hold space as a therapist and mental health professional and health care provider. I agree. And again, we don't skimp on the bi directionality when we utilize and know how. The how of this approach also benefits us.

It benefits us as the person delivering this approach. It's bi directional [00:46:00] and so it impacts our experience is working with clients or patients depending on the mental health or healthcare setting. it's how we apply trauma informed self care. there's mutuality. Trauma informed care is about mutuality. And also the delivery of it, how we provide the approach is also, there's mutuality there. It includes us. And. It reduces burnout. Exactly. There's so many different things. And I love that you touched upon the application because we know that's a big that's what I'm all about.

How do we integrate? How do we apply? How do we evolve with this approach? And so I guess, Yeah, it takes time. It takes time.

Sarah O’Brien (she/her):That's the other thing. It's you can know the what maybe in fast time, but the how? And practicing communication, decision making behaviors takes time. It's yeah, it's like with treatment.

It's not a quick fix. You can't just do a one week long training program and be trauma informed. You have to be practicing it. You probably have to get feedback on it from other people. That part's [00:47:00] uncomfortable. Then you have to make adjustments, right? It takes time. You can't just be trauma informed because you took a class or a course or a certification.

Katie Kurtz (she/her): Exactly. And that's why I always say I honor the origins of this approach. I honor SAMHSA. I was, taught by SAMHSA this approach, but they do a really great job of telling you what it is, what trauma informed care is, what the principles are. But again, it lacks the how, and we're left to our own devices to figure out how and why.

I think we're going into the future of trauma informed care is really focusing on the how do we apply, how do we model, mirror, and then infuse it into everything we do, not just therapy, but like this is, oh, I didn't even touch upon the misunderstanding within the clinical space is that trauma informed care is only for trauma informed care clinicians, but as you see here, it's not because most people aren't trained in it, or they're just assuming they're trauma informed without actually [00:48:00] the due diligence of active application, community practice, peer support, etc.

Sarah O’Brien (she/her): And I would say, we didn't talk about in this space, but I've said in many other spaces, like trauma informed principles need to be for everybody that ever interfaces with other human beings, especially at work, like from front desk to C suite to whomever, like whoever you are.

If you interface with somebody coming in, a customer, a client, a patient, a whatever, you're providing the treatment, your ancillary staff, it doesn't matter. Everybody should know how to do this if you're going to interface with people in every industry. Cosine one hundred percent. Yeah. That's why it's not just for medical professionals, it's for people.

For people. For people in spaces where there are more than one person. So anytime there's an interaction of any kind.

Katie Kurtz (she/her):This goes back to we're not always able to see the injuries or illnesses we have. [00:49:00] They're not always visible. And we can live with chronic illness of any kind and it not be seen.

And so we need to not assume, but rather this is how we expand our empathy into action, is by utilizing this approach, which is available to us all. Thanks so much, Sarah. I would love to invite you into the gentle spritz or yes, soft spray of questions.

I love that your approach is like not a rapid fire. It's a gentle spritz, like a misting. Exactly because everyone gets these questions ahead of time. I would love to hear from you if you could describe trauma informed care in one word, or if you have more, that's fine too.

What would it be?

Sarah O’Brien (she/her): Oh, I really tried to get down to one word because that's what you said, and that was hard for me. But I came down to kindness. And I really looked up the definition for this and I looked up versus mercifulness and altruism.

And this one just seemed to make the most sense because it's all encompassing, Mercifulness [00:50:00] is for people who don't deserve it. Altruism is also qualified, like who that applies to. And kindness applies to everybody. And it's basically like a compassionate approach to people.

And that's what I think about with trauma informed care.

Katie Kurtz (she/her):Yes. Yeah. What is your current go to for nervous system care?

Sarah O’Brien (she/her):Oh, this is good. I broke them down into two. If I'm in extreme dysregulation, I use ice packs, deep breathing, intense physical movement for a little bit or a cold shower. And my clients hate these. . And there's a whole science behind cold and ice therapy and how it stimulates the vagus nerve, which is a whole other conversation for trauma healing.

So there is actually some empirical based evidence too cold when you're dysregulated and rebalancing your nervous system. And they happen to work for me. Less extreme dysregulation. So three to six, four to six range on the one to 10 scale, [00:51:00] listening to music that I like doing tasks or crafts that use my hands have to be doing something kinetic with my hands, take a walk.

Snuggle my dogs. Also deep breathing. Deep breathing. I use it because it works faster on your brain at turning off cortisol and calming your physiological system than Xanax hear that again. Folks, deep breathing practices work better at calming your system. And faster than Xanax.

Take that what you will., Those are mine.

Katie Kurtz (she/her): Love that. And what does a trauma informed future look like for you?

Sarah O’Brien (she/her): So if I get more down to the real Sarah Fargo O'Brien, the person in addition to the professional, in addition to the trauma advocate, in addition to being a trauma survivor and having to walk my own healing journey, a trauma informed future for me looks like All people are well cared for, loved, included, accepted, have a [00:52:00] community and can live the life they want to live in the best way possible, in all places and spaces.

Honestly, it probably just looks like a greater humanity than we have right now, and less division, more just, Like you said, not making an assumption, entering with kindness, assuming people need more love than they need judgment and criticism. And that's true across the board, and I think trauma informed care bridges that gap of separation between people of the division, people feeling excluded, not seen, not understood, left out, difficulty in relationships.

I see that. Less of a thing, less of a problem for people in a trauma informed future.

Katie Kurtz (she/her):Yeah. Thank you so much, Sarah. This was a really great conversation and I want to be sure folks know how to connect with you. all your information's in the show notes, but is there anything else you'd like to share before we close?

Sarah O’Brien (she/her): As we just talked about all of this and burnout, I [00:53:00] just finished all my compassionate self kits. They are for sale on my website. I have a setting boundaries kit, a self care kit, and a burnout awareness kit, or you can get the full burnout recovery, which includes all three kits and some extras.

So it really breaks down like, where are you in your self care? where are you in your burnout awareness. Are you aware of what leads you there and what does it? And, are you aware of how you set boundaries or setting boundaries at all or what those are? And if you have any questions about any of those things, then you probably want to pick up one of my kits because it's going to give you a lot of information that you can use for yourself.

And then if you're a clinician or a practicing provider of any kind, a lot of these principles will then work in The work with your patients and clients as I use it with mine as well. So check out my website and get your kit.

Katie Kurtz (she/her): Awesome. Those will all be linked in the show notes. , thanks so much, Sarah. This was so great. , appreciate you and this conversation.

Sarah O’Brien (she/her): I appreciate you too, Katie. Thanks for [00:54:00] bringing me in. I enjoyed this.

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