Trauma-Informed Practice in Speech Therapy

As speech pathologists, we work with individuals who experience a range of communication needs and difficulties. Many of our clients have also had traumatic experiences, which can impact communication skills and overall well-being. As such, it is essential that we have a deep understanding of trauma-informed practice and its principles.

What is Trauma-Informed Practice?

Trauma-informed practice is an approach to care that recognises the widespread impact of trauma. It is not a specific treatment or therapy, but rather a way of providing care that emphasises safety, trustworthiness, choice, collaboration, empowerment and respect for diversity.

Trauma can have a profound impact on an individual’s communication. Trauma can cause changes in the brain and body that can lead to difficulties with language, attention, memory, and emotion regulation. Trauma can also affect social skills, such as the reading and interpreting of facial expressions. As such, trauma-informed practice is highly relevant in the field of speech pathology.

The Principles of Trauma-Informed Practice

There are six commonly accepted principles of trauma-informed practice. Below you will find a brief explanation of what each principle is and examples of how we can be putting them into practice within speech therapy.

It’s also important to acknowledge that practicing in a trauma-informed way first requires being trauma-informed with ourselves. It is also very difficult to be trauma-informed if the organisation you work within isn’t trauma-informed. Before reading the below, consider how you’re currently feeling within your body and if you might benefit from some regulating such as by stretching or taking a few deep and slow breaths. You don’t need to be implementing every single one of the below dot points, start small 🙂

1. Safety – the physical and emotional safety of the client comes first. This includes:
   • Creating a regulating, private and predictable environment for therapy
   • Using language and behaviours that are non-threatening and non-judgmental
   • Incorporating grounding and regulating strategies to help clients feel more present and connected
   • Providing trigger warnings and avoiding unnecessary detail
   • Remaining aware of our own triggers and need for self-regulation
2. Trustworthiness – it is important to be transparent and honest with clients about the therapy process. This helps to build trust and create a sense of safety and security. Trustworthiness can also include:
   • Following through on promises and commitments
   • Remaining aware of and respecting physical and emotional boundaries and autonomy
   • Showing up for sessions consistently and starting on time
   • Respecting client confidentiality and privacy – this may include asking for permission to discuss certain topics (e.g., medical or family history and asking for reports) the client may find intrusive and personal (it can help to explain why you’d like to know and wait till more safety and trust has been established before asking)
3. Choice – wherever possible, clients should be given choice and control over their care. This can include:
   • Supporting clients to choose their therapy goals and the methods used to achieve them
   • Offering a range of communication strategies for clients to choose from
   • Respecting the clients’ decision to decline certain therapeutic approaches or speech therapy itself
   • Giving clients the opportunity to choose which topics they’d like to discuss in each therapy session
   • Offering different communication options even when speaking is possible (e.g., texting)
   • Giving clients plenty of opportunities to express their needs and preferences
4. Collaboration – collaboration between the client and therapist (and team) is essential to the success of therapy.
   • Clients should be:
     • At the centre of decision-making (if they feel safe to do so) such as regarding therapy goals, plans and overall care
     • Given opportunities to provide feedback on the progress of speech therapy or share their concerns to guide future service delivery
     • Given the support required to ensure they can be an active participant in the decision-making process
   • The team should:
     • Work together respectfully, such as through joint goals and regular communication (which should include the client and family)
5. Empowerment – clients should be supported to develop the skills needed to succeed outside of therapy. They should be supported in:
   • Developing their strengths and interests
   • Learning the skills required for autonomous decision-making
   • Learning the skills required for safe self-advocacy, such as:
     • Advocating for communication needs in school and workplace settings
     • For boundary setting, communication rejection and expressing anger
   • The functional implementation of their strengths and skills
   • Celebrating their strengths and accomplishments
6. Respect for Diversity – it is important to be sensitive to the diversity issues that may impact a client’s experience of trauma, engagement in the service and communication. Diversity affirming practice involves:
   • Using respectful and affirming language as you become aware of it
   • Intentionally creating and maintaining an inclusive and equitable environment that values and respects the differences of all individuals
   • Recognising and honouring clients’ cultural backgrounds and identities
   • Becoming aware of beliefs we hold that may actually be assumptions and stereotypes that will influence our interactions and clinical decision making
   • Listening to and learning from lived experience voices (including the clients’) to become more aware of our unconscious biases and barriers that may be preventing clients from fully participating in therapy
   • Being aware of the impact of social and cultural factors on clients’ experiences and adapting therapy approaches accordingly

As a quick side note, another crucial element of trauma-informed speech therapy is about understanding what trauma actually is and how it impacts the brain, development, communication and functioning. You can learn more about this in a post I’ve written here.

Why is Trauma-Informed Practice Important in Speech Pathology?

Trauma-informed practice is essential in speech pathology for several reasons:

1. Trauma can impact communication: Trauma can cause changes in the brain and body that can impact on communication development and accessing communication skills. Trauma-informed practice helps speech pathologists understand and address these challenges.
2. Speech therapy can be distressing: When clients have experienced distressing communication-related events like bullying, social isolation, frequent communication breakdowns, and difficulty connecting with others, discussing speech therapy goals can be distressing; however, trauma-informed practice can help minimize the risk of re-traumatization and support successful engagement in the service.
3. Trauma is common: More than two-thirds of the US population have experienced at least one Adverse Childhood Experience (ACE), such as physical, emotional, or sexual abuse. ACEs have been linked to a range of negative outcomes, including difficulties with communication, socialisation, and emotional regulation. By considering the potential impact of past trauma on a client’s current communication difficulties and engagement, speech pathologists can provide care that is sensitive to the client’s needs and experiences.

Mental Health & Trauma Therapy vs Trauma-Informed Speech Therapy

The field of mental health and trauma involves providing clinical support to individuals who have a history of mental health concerns and/or trauma, with mental health professionals such as psychologists, psychiatrists, social workers, and counsellors offering direct clinical services to address these issues. On the other hand, trauma-informed practice is an approach to care that acknowledges the widespread impact of trauma, creates a safe and supportive environment, and uses trauma-informed principles to guide all interactions and decision-making. As a speech pathologist, adopting a trauma-informed approach means understanding the potential impact of trauma on communication and developing strategies that are sensitive to each client’s needs, regardless of whether they have a mental health diagnosis or reported history of trauma.

Conclusion

By embracing the principles of trauma-informed practice, speech pathologists can ensure that they create a safe and supportive environment for all clients, even when they are unsure if the client has been impacted by trauma. A trauma-informed approach involves recognizing the potential impact of trauma on communication, acknowledging clients’ strengths and resilience, and empowering them to take an active role in their care. This approach also emphasizes the importance of creating a collaborative and non-judgmental therapeutic relationship that supports clients’ recovery and well-being. By adopting a trauma-informed approach, speech pathologists can enhance the quality of care they provide, promote positive outcomes for clients, and make a meaningful difference in their lives.

Want to learn more?

Sign up for a course on trauma-informed practice for speech pathologists