The 'trauma' of trauma-informed care: perspectives on implementation and the psychological formulation of trauma

Section A
Background: Trauma-informed care (TIC) is a relatively new construct that has seen widespread uptake within mental health services over recent year, reflecting a burgeoning understanding of the potential for iatrogenic trauma. Despite this, there is a scarcity of research into the perspectives of mental health professionals on its implementation.

Aim: This literature review aims to understand mental health providers’ perspectives on trauma-informed care in the UK and Ireland, including barriers to implementation across service contexts and the impact of TIC on professionals.

Method: A systematic literature search was conducted. The literature was scrutinised using a structured critical appraisal tool (CASP checklist for qualitative research). Papers were analysed using a three-stage approach to coding and synthesising themes. A thematic synthesis methodology was utilised to draw together themes and perspectives from diverse research papers.

Findings: Twelve studies were appraised using the CASP checklist scored out of 10). Most were high quality, with nine scoring 8 or above. One lower-quality study was retained for its relevance to the research question. Four superordinate themes emerged from the data: Emotional Demands and Professional Identity, Conceptual Challenges, Systemic and Organisational Barriers, and Leadership and Support. Each contained several subthemes.

Implications: The findings show the importance of supporting professional emotional wellbeing by mirroring the trauma-informed practices implemented for service-users. Leadership plays an important role in ensuring supportive cultures are developed, including cultivating a shared understanding of and responsibility towards TIC. Wider considerations should focus on the incompatibility of existing service structures with TIC.

Section B
Background: Trauma-informed care is central to psychological practice, yet discussions on trauma beyond PTSD remain limited. There is limited research on the content and development of trauma formulations beyond PTSD in clinical practice. Understanding how trauma is conceptualised is key to improving trauma-informed care.

Aim: This study explores what Clinical Psychologists include in their trauma formulations and the key influences shaping this process. It examines the trauma conceptualisation beyond PTSD and in the absence of a formal definition, aiming to support greater consistency in trauma-informed care and understanding across professionals.

Methodology: Using constructivist grounded theory (Charmaz, 2014), 12 Clinical Psychologists from private, third sector, and NHS settings participated in semi-structured interviews. Trauma-specialist services were excluded.

Findings: Participants struggled with defining trauma, favouring a process-oriented view over rigid event-based models. Four key themes emerged: trauma as disruption to ways of being; an adaptive survival response; shaped by and shaping wider contexts; and meaning-making. Trauma was seen as universal across diagnoses, with diverse trajectories fitting under the umbrella. Systemic influences including dominant diagnostic frameworks shaped formulations, leaving participants the role of advocating for alternative understandings and creative approaches. Conceptualisations evolved over time, informed by both professional and personal experiences.