Recently I gave a training to a large group of primary care physicians and nurse practitioners in Florida. As I walked them through the “red flags” they are likely to see when treating a patient who is a survivor of trauma or abuse, I realized, through no fault of their own, that their mental health training was fairly limited. In addition, many of them worked in rural areas where access to seasoned trauma specialists didn’t even exist. As a result, they were somewhat in the dark about how to care for these patients. Many of them bemoaned the fact that within their communities, there were no viable referral sources available to their patients.
Although this was distressing, what I also saw was a room full of medical professionals who were genuinely interested in wanting to better understand and help their patients. After my talk, they lined up for over an hour to ask questions, and they shared poignant stories of patients who had been somatically struggling for years. These were professionals who cared deeply about their patients. They also expressed legitimate anxiety when they said, “Ok, if I start asking about trauma and neglect, and I find it- then what do I do? And how do I do it in a 15 minute brief office exam?” It reminded me that doctors often need very basic information about how to respond when a patient discloses a history of abuse and trauma, and that maybe mental health professionals need to be reminded of that “next step” response as well. So, here is the advice I gave to this very eager group of doctors in Florida. It’s not meant to be formulaic, but I think the steps make sense and seem to provide clients with an immediate feeling of relief and comfort after they have disclosed to us. The following sentences provide some ideas of how to respond. The exact wording should always be genuine and come from the medical or mental health provider in an authentic way.
“Thank you for trusting me enough to share such a personal and difficult story.”
“I appreciate the courage it took to share that with me.”
“I want you to know that what happened wasn’t your fault. You did whatever you had to do to survive.”
“I am so sorry that you were hurt/mistreated/harmed.”
“You deserve support. You deserve a witness for your pain. You deserve to learn strategies that can help you to heal.”
“You are not alone. You don’t have to be alone in your healing.”
“You’ve just taken the first step. Now let me help you take the next one.”
I think these responses are helpful because they are non-judgmental, compassionate, and can reduce shame. They offer words of comfort and apology that the victim has probably never heard before. Instead of saying “you need help” which can be misinterpreted as “there is something wrong with you,” saying, “you deserve support,” is an idea that provides ego-strengthening and empowerment. Hopefully, taking the next step includes a referral to a well-trained trauma specialist, a free 12-step meeting, a de-pathologizing self-help book, or a well trained spiritual advisor.
How would you respond to someone who has just disclosed a trauma? Please share your thoughts as a comment.