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Collaboration and Mutuality When Working with Clients with Substance Use and Traumatic Stress Disorders

Published:
September 11, 2024

This post discusses Principle 4: Collaboration & Mutuality of SAMHSA's six key principles of a trauma-informed approach.

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Collaboration and mutuality are one of SAMHSA's six key principles of trauma-informed care (TIC). Organizations that emphasize collaboration and mutuality as part of a TIC approach practice shared decision-making, view clients as experts of their own lives, and provide person-centered services. Through a case study review, this post outlines how to implement collaboration strategies with clients experiencing substance use disorder (SUD) and traumatic stress disorders.

Case Study:

Eva, a 25-year-old Latina, has a history of childhood trauma and has been struggling with SUD and PTSD for several years. Eva experienced 4 out of 10 Adverse Childhood Experiences (ACEs), including being raised by a parent with untreated alcohol use disorder. She has recently re-started therapy to address both her trauma and substance use issues. She minimized alcohol use and reported experiencing difficulties trusting previous therapists. When exploring her main support network, client reported, “I don’t trust anyone.” Eva’s therapist is trained in TIC and believes in the power of collaboration and mutuality in the therapeutic process.

Initial Sessions:

  • Therapist focuses on creating a safe and trusting environment by introducing herself as Latina and disclosing her experience with other Latina clients. She listens actively to Eva’s story without judgment, acknowledging her strengths and resilience.
  • Therapist explains the principles of TIC and ensures Eva understands that her safety and autonomy are priorities.
  • Therapist explores client’s cultural values and traditions and how they impact Eva’s view of substance use and mental health.
  • Therapist explores if there are uncovered basic needs and connects Eva with community support for her and her family.

Collaborative Goal Setting:

  • Therapist invites Eva to identify her therapy goals. Together, they discuss her desire to manage her trauma symptoms, reduce substance use, and improve her quality of life.
  • Therapist proceeded to brainstorm treatment barriers with Eva and develop strategies to reduce them.
  • They co-create a treatment plan that includes both short-term and long-term goals, ensuring that Eva’s voice is central in deciding the therapeutic direction.
  • Therapist acknowledges power dynamics and reminds client that therapy is about her, that there are no wrong questions or answers, and that therapy is a growing process for both the client and clinician.

Jointly Exploring Coping Strategies:

  • Therapist uses analogies and Latino TV novelas to share information about trauma, its effects, and various coping strategies. She encourages Eva to share her insights and coping mechanisms that have worked for her in the past.
  • They engage in a mutual learning process where Eva feels empowered to contribute to her healing journey in which her lived experiences are a vital part of therapy.
  • Eva and therapist explore different coping strategies for managing trauma triggers and cravings related to substance use. They also experiment with techniques such as mindfulness, grounding exercises, deep breathing, dancing, and cognitive-behavioral techniques.
Reviewing Progress Together:
  • Therapist has open conversations about scheduling therapy sessions in a date, time, and modality (i.e., in-person or virtual) that works with Eva’s work schedule.
  • Eva and therapist review her progress toward her goals. They celebrate successes and openly discuss challenges, making necessary adjustments to the treatment plan.
  • Therapist ensures Eva feels her progress is a joint effort, emphasizing the partnership in their therapeutic relationship.
Outcome:

Through the collaborative and mutual approach of TIC, Eva feels more empowered and engaged in her therapy. She reports a reduction in trauma symptoms and substance use and an increased sense of control over her life. The mutual respect and shared power between Eva and therapist have created a supportive and effective healing environment.

This case example illustrates how collaboration and mutuality in trauma-informed care can enhance the therapeutic process, leading to meaningful and sustained recovery for individuals with complex needs.

Reference

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014).  SAMHSA’s Concept of Trauma and Guidance for a Trauma-informed Approach. https://www.ncbi.nlm.nih.gov/books/NBK207204/#part2_ch1.s11


Read the other posts in this series on SAMHSA's six guiding principles of TIC!

Author(s)
Isa Velez Echevarria, PsyD and Mark Sanders, LCSW, CADC
Contributing Center(s):
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