supporting survivors of trauma: how to avoid re-traumatization

when somebody experiences a traumatic event, they’re often supported by people in social work, legal and clinical contexts who ask them repeatedly to recount their personal stories.

this retelling of these events can exacerbate symptoms of post-traumatic stress disorder (ptsd) and potentially re-traumatize the person. how can people avoid contributing to re-traumatization during conversations inside and outside of clinical settings? 

damir s. utrzan, phd, ms, lmft, says it just depends on a person’s individual experience and journey through the healing process.

utrzan, the treatment director of an intensive residential treatment services facility operated by the minnesota department of human services, explained how anyone can use a social worker’s mindset to be mindful of re-traumatization when interacting with others.

re-traumatization occurs when a person re-experiences a previously traumatic event, either consciously or unconsciously. this can be caused by stressors that are similar to the environment or circumstance of the original trauma, such as smell, physical space, lighting, imagery, memory, or even a new relationship that mimics a previously traumatic one.

“the more people get away from their experience, the less they may think about it regularly,” utrzan said. “but they might be triggered by certain events, like visiting a primary health care provider, which can thrust them fully back into the experience.”

re-traumatization can happen to anyone who has experienced a traumatic event. this includes people who may have developed or been at risk of developing ptsd, including:

• refugees and asylum seekers.
• people who have experienced sexual abuse, domestic violence or human trafficking.
• students who have experienced mass shootings.
• people who have been incarcerated.
• veterans or active-duty military service members who have survived combat.
• people who have witnessed other forms of interpersonal or mass violence.

even if it’s been years since the traumatic event occurred, symptoms can resurface suddenly or periodically if the person is exposed to reminders of the original event. according to the substance abuse and mental health administration, symptoms of re-traumatization (pdf, 2.3 mb) may vary from person to person but generally include one or more of the following:

symptoms of trauma or re-traumatization

• flashbacks and nightmares
• anxiousness or fear
• difficulty concentrating
• trouble sleeping
• fatigue
• social isolation and avoidance
• overall intense negative emotions
• inability to control emotions
• strong physical reactions to triggers

“the government will use inconsistencies in narratives as proof that it didn’t happen,” utrzan said. “but clinicians know that it’s a clear symptom of re-traumatization.”

re-traumatization may also manifest differently across the lifespan. children who are exposed to traumatic experiences may be affected by re-traumatization for the rest of their lives, explained utrzan.

“trauma physiologically changes your brain structure,” utrzan said. “it makes changes that are difficult to undo. so, if you spend the majority of childhood living in fear, that leads to generalized anxiety, which is difficult to manage without medication.”

symptoms of re-traumatization can arise whenever someone is thinking about the event, even if they haven’t been prompted to think about it, so avoiding the conversation won’t necessarily prevent re-traumatization. however, there are a few situations that can set off stressors (pdf, 81 kb), according to the anna institute:

• evaluations from clinicians or providers in which they ask a client to retell a story about a traumatic experience.
• interviews with reporters or journalists who are covering traumatic events.
• conversations with friends and family members who want to provide support in the aftermath of a traumatic event.
• discussions in which emotional boundaries are not respected or people are made to feel like they aren’t being believed.
• situations in which people are asked to undress or change clothes in front of other people
• situations where physical restraints or isolation are used as a means of control during a conversation.
• anniversaries of traumatic events.
• retelling of similar traumatic stories, either in the news or entertainment media.

“it’s a paradox,” utrzan said, “because most people who have experienced a trauma are thinking about it all the time.”

when talking to a trauma survivor, he said it’s important to remember the purpose of the conversation or evaluation; try not to deviate from that purpose if possible. utrzan said that two places where re-traumatization can occur are clinical and forensic evaluations.

clinical evaluation

• purpose is to better understand a person’s physiological needs while providing care with a nurturing bedside manner. 
• may expose the person to triggers, such physical contact during exams.

forensic evaluation

• purpose is usually to gather evidence or triangulate information that can be used to support evidence in a legal proceeding.
• less likely to include bedside manner or nurturing care.

“in a forensic setting, i’m not there to heal them,” utrzan said. “but i have to be careful to not put [them] back into the physiological realm of their traumatic experience. i’m still responsible for making sure they’re safe.”

a holistic mindset can benefit professionals during all types of evaluations, as well as in more casual conversations about a person’s day-to-day life.

a holistic assessment is a comprehensive evaluation that acknowledges the relationship of a person to their physical and social environment. the following components contribute to a person’s overall well-being:

• personal: a person’s recollection of their own life, in their own words, without interruption.
• physiological: biological and physical needs, chronic conditions, sexual activity and history, substance use.
• sociological: family history, demographic information.
• psychological: mental health, emotional well-being, clinical personality or mood disorders.
• cultural: values and customs based on nationality, ethnicity or race.
• spiritual: religious and other faith-based practices, values and customs.
• legal: criminal, civil and immigration files.

while every provider may not have time to ask questions about each of these aspects in a one-on-one conversation, it’s important to recognize that these variables may contribute to a person’s overall nature and needs.

“social workers have unique skills,” utrzan said. “they address a client’s physical needs [and] mental health needs, but also their basic needs.”

building a network of resources to help people meet their basic needs is a crucial part of holistic care.

people in all professions can pull from the ecological model of social work to address a person’s relationship with their environment, which values the physical and social environment of a person’s life in addition to their inner processes, family life and role within their environment.

utrzan said building trust with a client starts with having a conversation, “genuinely learning and wanting to understand who they are.”

in conversations within and beyond clinical walls, it’s important to be mindful of behaviors or questions that could exacerbate re-traumatization and know where to find additional help if needed.

eight tips for mitigating re-traumatization

avoid scheduling extensive interviews

asking questions may take several hours, but once an interviewee has felt re-traumatized, they need time to recover and heal before proceeding. try scheduling shorter conversations that take place over several days.

establish routine

for recurring conversations about the same topic or in the same physical space, create a routine to provide safety and familiarity.

identify potential triggers

have the other person describe or write out things that make them feel safe and unsafe.

prioritize consent

when possible, let the other person know they don’t have to answer questions that make them feel uncomfortable or upset.

keep an open mind

avoid making assumptions or skipping through questions you may think you know the answer to. understand that this may be the first time the other person is sharing their story.

make space to relax

try using breathing or mindfulness exercises to calm symptoms of trauma when they arise. let others know how to use these exercises on their own when they feel unsafe at other times in their lives.

be transparent

some evaluations require physical examinations or contact between both parties. ask for permission before touching another person and explain every action before performing it.

have resources available

be familiar with hotlines or text lines that trauma survivors can easily contact, such as the crisis text line. find out what organizations exist within your community, or see below for a list of national and international groups. 

utrzan said that two of the most important things to remember during this process is to make sure people feel believed and to ask them how they want to be helped. they know themselves best.

“make the effort to understand yourself,” he said. “you want to avoid secondary trauma and establish a day-to-day practice of conscientiousness.”

many national organizations exist for survivors of various traumas and have resources for people in social work and clinical-, legal- and advocacy-related professions.

additional sources:

are you interested in working with survivors of trauma? learn more about how to become a licensed clinical social worker or review online clinical social work programs.

this article is for informational purposes. if you or somebody you know may be experiencing the effects of re-traumatization, please consult a medical provider or mental health practitioner.