square bulletImplementation Updates March/April 2020

From Stephanie Sundborg, PhD, Director of Research and Evaluation , Trauma Informed Oregon

This newsletter’s theme is about trust and transparency. These concepts are central to trauma informed care (TIC) during normal times, but during a challenging time like what we’ve been experiencing with COVID-19, they are critical. As I think about trust and transparency as it relates to TIC implementation, one of the common requests for technical assistance comes to mind . . . the request for scripts. People become nervous about being trauma informed (TI) in their communication, and often ask Trauma Informed Oregon (TIO) to help them think about the words to use. While I understand that most people are hoping for an actual script to use, you can imagine that it would be impossible to provide the exact words for every situation and circumstance. Not to mention, that the words wouldn’t feel genuine and authentic. The words really do need to come from you, but…maybe I can help by showing you the essential elements of a Trauma Informed (TI) script so that you can build your own.

I titled this blog the Anatomy of a Trauma Informed Script, because I believe there are some key ingredients that need to be included in order for it to meet the criteria of being TI. It reminds me of a toy many of us have played with in our past, Mr. Potato Head. Remember how you could pick from a variety of lips to use, or noses to use, or ears? TI scripts are a bit like that. There are certain elements that are important, but the exact words are really up to you—and depend on the circumstances. Before we go over the sections of a script, let’s pause for a minute and think about communication more broadly. To help, I reached out to Dr. Chris Wilson, a licensed psychologist in Portland, Oregon and an expert in trauma-informed communication.

Chris was happy to talk about the importance of communication and the qualities that make it TI, which include normalizing and validating, being transparent, offering an explanation or “why,” and providing choice. When the message being delivered is easy, communication isn’t as challenging. It’s during times when we need to deliver a difficult message, that we become less confident. Perhaps we need to set boundaries (which, by the way, is a TI practice), be clear about expectations, or deliver difficult news. These situations are no-doubt hard, and are the type of circumstances that really call for a TI approach. TI communication calls on us to be compassionate as well as able to be clear and direct—skills that Chris notes can vary depending on service sectors.

Before going into the break-down of a script; however, there are a few other important takeaways from my conversation with Chris. When talking about communication, Chris really emphasized the importance of nonverbal forms of communication including gestures and body language as well as tone of voice and prosody (the rhythm of your speech). When delivering a message to someone, especially someone who has been impacted by trauma, remember they will be watching for signals of threat—which can be threats to physical or emotional safety, or even threats to status, which Chris says provoke the same type of threat reaction. We need to convey safety when we communicate, and Chris notes that how we say something can be even more important than what we say. Quite frankly, he was a bit nervous about the idea that I would provide you with actual words to say. He prefers to give people principles to work from and then role-play various scenarios with them so that they can find their own words. Therefore, I will give you some overarching ideas and you can play around with the exact words you would use. We invite you to role-play if that helps, and please do remember the importance of the other aspects of communication (e.g., body language, facial expressions, tone of voice, etc.). If you keep in mind that the goal is to convey that you care, you won’t go wrong.

Parts to a trauma-informed script

Validating and normalizing

It’s important to convey that you understand someone’s perspective—why they might feel the way they do, or why they might be behaving in a particular way. As you likely remember, an important skill in being TI is to be able to reframe someone’s behavior. When you do this, you are able to think about the underlying cause of the behavior you are seeing in front of you—the answer to the question, “what else could be going on?” When you validate or normalize, this is your way to communicate that you understand what else could be going on. Here are a couple of example phrases that illustrate this idea, “I know during times of stress it’s difficult to stay focused” or “We know that social connection provides comfort in times of stress—and remaining separated can feel unnatural and hard.”

Being clear and direct

This section of a script may feel uncomfortable because many of us have been taught that being clear and direct means you are likely being harsh, possibly even rude. However, being clear and direct is important for everyone, and critical for trauma-impacted individuals. Stressed brains are on the lookout for threat, and will pay particular attention to novel or uncertain situations. Without complete information, a stressed brain is likely to misinterpret or fill in missing details. The other aspect to consider is the cognitive processing that happens when a brain is stressed. Attention is more narrowly focused on the details deemed most important to the person receiving the message. Clear and direct communication will ensure that the giver and receiver of the information will both be on the same page.

Providing the “Why”

Explaining the why is the most trauma informed part of a TI script.   Drawing once again on our foundational knowledge of TIC, predictability and knowing what to expect are important ways to prevent someone from initiating a stress response. Helping someone know “why” a decision has been made, or a boundary has been established, or a policy has been enacted will go a long way in helping establish a sense of consistency and predictability. When there is no reason “why,” decisions, policies, and practices can seem arbitrary and random. And remember, uncertainty can trigger a stress response. You will know that you are providing the “why” when your clear and direct statement is followed by the word “because.”

Providing options and choice

The final section of a TI script is to offer opportunity. This is part of focusing on the positive and creating hope. Often, the best way to do this is to talk about options and choice. Choice is a form of empowerment and gives someone the sense that they have some control. For a stressed brain, having control is crucial. We often suggest offering several acceptable choices, especially for a stressed brain that may have difficulty generating ideas.

OK, now that we’ve covered the TI elements of a script, let’s circle back and remember how this is related to trust and transparency. Validating and normalizing the situation, and offering options and choice are all ways to build trust. You are also being transparent by providing a clear and direct message with a reason of “why” attached. This too builds trust. With trust and transparency intact, you will be able to have any range of conversations, even the difficult ones.