I am writing today about my favourite topics: Post Traumatic Stress Disorder (PTSD), and why more of us medical professionals need to learn about trauma informed practice.
Trauma is an event in which you or a loved one is in significant danger. Think rape, robbery, war, earthquakes and serious motor vehicle accidents.
PTSD is a reaction to trauma. It typically includes flashbacks to the moment of horror, where you feel like the horror is happening again and again in the present. It also includes graphic nightmares with themes associated with the trauma (running, crying screaming). Alongside this, people with PTSD also experience high levels of day-to-day anxiety, hypervigilance and dissociation (spacing out or numbing).
PTSD gets a lot of airtime in the field of psychology, and is now very well understood in therapy circles. Therapists offer trauma therapy in the form of EMDR, CBT, AEDP and other modalities for the common symptoms of PTSD.
However, individuals with more prolonged or repeated trauma may require specialised approaches that address deeper emotional patterns and relational wounds. In these cases, complex PTSD therapy can support long-term healing by focusing on both trauma recovery and emotional regulation.
The Deep Need for Trauma Informed Practice
However, trauma needs to be far better understood outside of these circles, particularly amongst professionals who deal every day with vulnerable people
In my 15 years as a therapist, one story about the need for trauma informed practice stands out:
The client was a young woman in her early twenties who had been sexually assaulted while inebriated in a bar. A man much bigger than her forced himself on her after following her to the bathroom. Wanting to deny the experience, she turned down her flatmate’s offer to contact the police, preferring to sleep it off and forget it ever happened. A few months later, she experienced another incident of assault when a man grabbed her breasts and then her bottom on a crowded dance floor.
This time, the post-traumatic reactions hit hard. While she managed to function before, she now struggled to sleep at night for fear of the nightmares. She struggled to stay focused at work because of flashbacks and a tendency to dissociate. She became forgetful and fearful at work and at home, and eventually suicidal.
Like so many victims of sexual assault, she felt intensely embarrassed and thinking that maybe she “asked for it” because of the way she dressed, or how much she drank. As I got to know her, it became more and more clear that she had done nothing wrong.
One day, a few weeks before we first me, she finished a whole bottle of wine by herself, wanting to block out the feelings of shame and “dirtiness” that each flashback brought.
Still distressed, she cut herself badly, first as a way of changing the way she was feeling. Cutting is often about converting seemingly intolerable emotional pain into more focused physical pain.
But then, she cut herself more deeply. She had initially hoped to die, but got scared by the bleeding, and realised just how much damage she had done.
She called the ambulance to get help. Seeing that she had attempted suicide, the paramedics put her into the ambulance and brought her to hospital to check her wounds and consider psychiatric care.
While this was all routine, my client recalled tearfully that not once did either of the two seemingly nice, highly competent paramedics look her in the eye, or acknowledge her presence. Doing their job professionally, they dressed her wound mechanically, and asked her simply to follow them into the ambulance.
In the 20 minutes ride, the client described feeling worse than she had ever felt. She received similar treatment in the emergency room – quiet efficient care, but no eye contact, and no acknowledgement of her pain.
She felt shame, like a red-hot spear through her heart.
In the weeks that followed, she started to feel more and more unworthy and deserving of contempt. First for putting herself in the position of being sexually assaulted, and then self-harming, and needing medical help.
These feelings continued, and she came to see me after a second unsuccessful suicide attempt.
While we worked through her trauma, and the magnitude of misplaced blame and shame she felt, what stood out for me was the fact that the treatment she got from the paramedics cut deeper than the actual assaults.
Their inability to connect with her empathically felt like blame, and this reinforced her feelings of unworthiness and shame.
Experiences like hers are part of why I focus so much of my practice on the sexual abuse therapy Singapore survivors can turn to — care that is specifically trauma-informed, rather than well-meaning but disconnected.
Emotional Overwhelm in Helping Professionals
Curious about my client’s experience, I asked a few people in the helping professions about this, and they all gave me knowing nods.
One experienced social worker explained, that if my client had been an old person or a child, the paramedics would most likely have been more kind, cheerful and upbeat, sympathetic to her despair.
But because this was self-harm and suicide, they themselves became emotionally overwhelmed, and perhaps had to block her out to stay focused on the task.
Another explanation was that they were afraid of saying the wrong thing and upsetting a vulnerable patient further.
But as my client’s experience shows, not saying anything at all is far worse.
Contact me for Trauma Training for Trauma Informed Practice
For the sake of our helping professionals who see and hear so much in the course of their work, and for their clients, I’m advocating for trauma training and trauma infomed practice to become routine
Trauma is not just the domain of us mental health professionals. In the next blog, I’ll talk more about how trauma presents in schools, and how teachers and educators often miss the first principals of learning – the need for attachment and emotional safety. https://dramrit.org/trauma-informed-practice/
Frequently Asked Questions About Trauma-Informed Care
What is trauma-informed care?
Trauma-informed care is an approach where professionals – whether therapists, paramedics, doctors, teachers or social workers – are trained to recognise the signs of trauma and respond in ways that avoid causing further harm. It centres on safety, trust, and treating the person with dignity, rather than focusing only on the immediate task at hand.
How do I support someone who has experienced trauma?
Simple things matter more than people expect: making eye contact, acknowledging what happened without judgement, letting them set the pace, and avoiding language that implies blame. You don’t need to have the right words – being present and non-judgemental is often more healing than advice.
What is vicarious or secondary trauma?
Vicarious trauma is the emotional toll that helping professionals can experience from repeated exposure to other people’s traumatic experiences. Left unaddressed, it can lead to compassion fatigue, burnout, and – as the story above shows – unintentionally distant or clinical behaviour toward the people they’re trying to help.
Get in Touch
If you or someone you know has been impacted by trauma, or if you’d like to bring trauma-informed training to your team, I’d love to help.
You can also reach out directly at dramrit.sg@gmail.com.
(Please note that personalities and places are modified or amalgamated in these stories to protect the privacy of clients)
