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A Healthcare Practitioner’s Guide to Trauma-Informed Language
The words we choose and the manner in which we communicate with our patients can have a profound impact on their experience. For trauma-exposed individuals specifically, certain phrases, tones, touch, settings, or images can inadvertently activate distressing memories or emotional responses.
The words we choose and the manner in which we communicate with our patients can have a profound impact on their experience. For trauma-exposed individuals specifically, certain phrases, tones, touch, settings, or images can inadvertently activate distressing memories or emotional responses. As healthcare professionals, using trauma-informed language helps us avoid re-traumatization by creating a safe, respectful, and supportive environment for all patients. This guide aims to provide practical tips and examples to help you integrate this language into your practice.
Practical Tips for Trauma-Informed Communication
1. Address the Person First: A key component of offering person-centered care is placing the individual before their condition. This applies both in conversation with a patient and when speaking about a patient with colleagues/other practitioners. For example:
Avoid
“A diabetic”
“Mr. Thompson is a 48-year-old homeless man with a history of medical noncompliance and alcoholism who is here with poorly controlled diabetes.”
Replace With
“A person with diabetes”
“Mr. Thompson is a 48-year-old man with a history of housing instability, alcohol use disorder, and diabetes with an A1c of 15.”
2. Use Simple Language: A trauma-informed approach to communication supports transparency and collaboration. To ensure patients understand their conditions and treatments, it’s important to remember your audience and avoid using medical jargon. In addition to speaking in accessible terms, keep your words clear, your speed slow, and your volume appropriate, while paying attention to cues from the patient that show understanding — you can and should pause if there are any signs of distress or confusion.
Avoid
“Palpate”
“Auscultate”
“Percuss”
“Myocardial infarction”
“Can you tell me your past surgical history?”
Replace With
“Press”
“Listen”
“Tap”
“Heart attack”
“Have you had any surgeries?”
3. Be Mindful of Non-Verbal Cues: Remember that non-verbal communication is as important as spoken words. The undivided attention you provide and the pleasant and calm demeanor you maintain will help to instill trust and provide comfort to your patients, reinforcing that their health is a priority to you. This is true whether you are seeing them once in the ER or longitudinally in primary care. Maintaining open body language, making appropriate eye contact, and sitting/standing at eye level with the patient are also ways to demonstrate non-verbal support.
4. Adopt a Professional Over Personal Approach: While the care we deliver is person-centered, the language used — especially during an exam — should remain somewhat neutral and formal. Some examples of this include:
Avoid
“Your breast”
“Butt”
“Bed”, “Sheets”
“Put up your arms like you’re going to fight”
“Don’t let me do this”
“Feel”, “Touch”
Replace With
“The breast”
“Bottom”, “Buttocks”
“Exam table”, “Drape”
“Bend the elbows”
“Keep the arms up”
“Examine”, “Evaluate”, “Check”
Remember, we cannot make assumptions around where, when and how someone’s past negative experiences took place. Even something as seemingly calming as “pretend you’re at the beach” can be presumptive (even triggering). This example can be easily replaced with something like “some find it helpful to take a relaxing breath.”
During an exam, provide information in advance of your actions (“I’m going to listen to the lungs”), what they will expect (“The speculum/stethoscope may feel cold”), and why you’re doing it (“This is important, because we need to see if you have pneumonia, which is an infection of the lungs.") And of course, always ask for permission before physical contact, even during routine procedures. This respects personal boundaries and reduces the risk of causing a trauma response.
5. Provide Choice: Whenever possible, give the patient options. This can be as simple as asking, "Would you like to discuss your test results now, or after you’ve had some time to think?" If you’re conducting an exam that’s more sensitive in nature (ex. breast, genital, or rectal) offer the individual an option to include a chaperone, loved one, or other support person. If providing choice seems overwhelming for the patient, ask them something more open-ended, such as “How can I support you today?"
6. Practice Inclusivity: Be mindful of language that respects diverse identities and experiences, including those related to race, gender, sexuality, and ability. In some instances, it may be necessary to make accommodations for patients (ex. those who speak other languages, have large body sizes, or those facing challenges with social determinants of health). Find some examples of inclusive language below:
Avoid
“Mr. Jackson! Nice to meet you. I’m Dr. Elisseou.”
“Are you married? Do you have a husband/wife?”
“Do you understand?”
“Everything on your exam looks normal.”
Replace With
“Nice to meet you! I’m Dr. Elisseou. How would you like to be addressed?”
“Are you in a relationship? Do you have a partner?”
"Would you like an interpreter to help us communicate?"
“Everything appears healthy.”
Adopting trauma-informed language in healthcare extends beyond what I’ve shared here. For a deeper dive into best practices, check out this presentation I gave during the 2022 Gold Executive Session of the Planetree International Conference, entitled “Trauma-Informed Care as Person-Centered Care.”
By educating ourselves and being mindful and deliberate with our communication, we can better support the healing journey of individuals who have experienced trauma, ultimately enhancing their quality of care and promoting engagement for better health outcomes.
Offering Trauma-Informed Support to Loved Ones
Supporting a loved one through trauma can be a delicate and challenging endeavor. Acknowledge that you have already taken a first step by finding yourself on this page. Educating yourself on what trauma is and how to best offer support is integral to being able responding more effectively to your loved one’s needs.
Supporting a loved one through trauma can be a delicate and challenging endeavor. Acknowledge that you have already taken a first step by finding yourself on this page. Educating yourself on what trauma is and how to best offer support is integral to being able responding more effectively to your loved one’s needs. You can help to create a safe, supportive environment that facilitates their healing. In the following sections, we’ll explore practical strategies and insights to help you navigate this challenging, yet profoundly important role.
Understanding Trauma
You don’t have to have endured the same adverse experiences as someone else to understand or offer support, but it is important to know what trauma is. The Substance Abuse and Mental Health Services Association (SAMHSA) describes trauma as “an event or circumstance resulting in: physical harm; emotional harm; and/or life-threatening harm.” It can stem from various experiences, such as abuse, accidents, war, natural disasters, medical illness, or loss, and can be acute (a single incident), chronic (repeated and prolonged), or complex (the result of multiple stressors, particularly early in life). Symptoms may include anxiety, depression, flashbacks, and difficulty trusting others, though there can be a wide range of effects depending on the person and the nature of the trauma.
While it is true that human responses to stress are well studied, biological, and generally predictable, an individual’s interpretation of an event as traumatic is quite personal. What might be traumatic for one person might not be for another. In other words, it’s not so much what happened that matters—it’s how it impacts us.
Every instance of trauma impacts individuals uniquely, affecting their emotional, physical, and psychological well-being, and can alter how individuals perceive the world, their relationships, and themselves. Offering trauma-informed support means approaching your loved one with sensitivity, understanding, and empathy. Here are some practical steps to provide effective trauma-informed support that align with SAMHSA’s 6 guiding principles of a trauma-informed approach.
Principles of Trauma-Informed Support
1. Safety: Create an environment where your loved one feels physically and emotionally safe.
2. Trustworthiness and Transparency: Be reliable and consistent in your actions. Building trust is crucial for someone who may feel vulnerable or betrayed.
3. Peer Support: Peer support can offer validation, empathy, and understanding from those who have shared similar experiences.
4. Collaboration and Mutuality: Work together with your loved one in their healing process.
5. Empowerment, Voice, and Choice: Empower your loved one by respecting their autonomy, highlighting their strengths, and validating their feelings.
6. Cultural, Historical, and Gender Issues: Be aware of your loved one’s intersectional identities (ex. age, gender, race, ethnicity, occupation), which may shape their trauma and healing process. Listen rather than assuming, and remain humble in your desire to learn.
Practical Steps for Providing Support to a Trauma-Impacted Individual
1. Educate Yourself: This cannot be overstated--Understanding trauma and its effects can help you respond more effectively. Read about trauma and consider seeking guidance from professionals or support groups, whether in your area or virtually.
2. Listen Actively: When they are ready and/or ask to talk, offer a non-judgmental, empathetic ear. Let them share their story at their own pace without pressing for details. Oftentimes, just being there and listening can be profoundly healing. If it makes sense, you can acknowledge their emotions without minimizing or dismissing them. Phrases like “It’s okay to feel this way” or “Your feelings are valid” can provide comfort.
3. Be Patient: Healing from trauma is a long and non-linear process. Be patient with your loved one and understand that progress may come in small steps, with ups and downs along the way. Understand that your loved one’s behaviors are coping mechanisms they’ve developed and are not aimed to hurt, offend, or push you away. Trauma survivors often need to establish and maintain boundaries to feel safe. Respect these boundaries, even if you don’t fully understand them.
4. Encourage Professional Help: Gently suggest professional help if they are open to it. Therapists and other professionals specializing in trauma can provide tools and strategies that friends and family are likely not equipped to offer. If 1:1 support doesn’t appeal to them, peer support groups are an alternative that can offer a sense of belonging and community and help reduce feelings of isolation and shame.
5. Promote Self-Care: Self-care is crucial in the healing process and can consist of physical, mental, emotional, social, and spiritual well-being practices. Encourage your loved one to start/restart/continue activities they enjoy, such as exercise, mindfulness, journaling, playing music, or other positive hobbies. Eating nutritious foods and prioritizing a healthy amount of sleep are also important for overall wellness and help to establish a routine.
6. Take Care of Yourself: Supporting someone through trauma can be emotionally taxing, but remember, you are not alone in this process; professional resources and support networks are available for both you and your loved one. Ensure you’re also taking care of your own mental and emotional health and seek support for yourself if needed. As the saying goes, ‘you can’t pour from an empty cup.’
Above all, compassion is the cornerstone of trauma-informed support, and being there for someone you love is a profound act of empathy and care. Your continued presence and unwavering understanding can make a significant difference in their path to recovery.