Engaging an Adult Who Has Experienced Trauma: Questions, Psychoeducation and Cognitive Processing Therapy (Social Work Discussion)

Discussion: Engaging an adult who has experienced trauma

While trauma is most commonly associated with posttraumatic stress disorder, it can manifest in adulthood in many different ways. Consider those who have experienced poverty, racism, or grief, for example. These clients may be significantly affected by their trauma but may not necessarily receive a diagnosis of PTSD.

Social workers intervene directly with trauma when working in veteran’s services, domestic violence/sexual assault response programs, and child protective services. Social workers intervene with trauma indirectly when working in mental health, substance abuse clinics, schools, refugee resettlements, and other forms of social service. Whether or not you are directly or indirectly treating it, trauma will be present in the practice space.

In this Discussion, you take on the role of a social worker engaging with an adult who has experienced trauma. Describe how you would engage with an adult who has experienced trauma. Specifically:

• Consider the questions you would ask to elicit information about the client’s trauma experience.
• Explain how you would educate the client on the effects of trauma.
• Explain what advanced-level clinical modality you would recommend and why.

Original example for study purposes, using a fictional client (about 620 words).

The client. Denise, a 41-year-old Black woman, is referred to an outpatient clinic for insomnia, irritability and “shutting down” at work. She grew up in poverty, witnessed violence in her neighborhood, recently lost her mother and describes repeated racist treatment at her workplace. She does not describe a single traumatic event and has never been diagnosed with PTSD, yet her symptoms suggest that cumulative trauma is shaping her daily life.

Engagement and questions to elicit the trauma experience

I would begin by applying SAMHSA’s (2014) six principles of trauma-informed care: safety, trustworthiness and transparency, peer support, collaboration, empowerment and choice, and attention to cultural, historical and gender issues. I would explain confidentiality and its limits, tell Denise she controls how much she shares and invite her to pause at any time. Rather than asking her to describe traumatic events in detail at the first session, which can cause overwhelming distress, I would ask open, strengths-based questions:

• “What brings you in now, and what would you like to be different?”
• “Some people have experienced events that were frightening, painful or unfair. Have you had experiences like that you would be comfortable telling me about, in general terms?”
• “How do those experiences show up in your life today, in your sleep, body, relationships or work?”
• “What has helped you get through hard times? Who do you turn to?”
• “How have racism, money stress or your mother’s death affected you?”
• “Is there anything about your culture, faith or family that is important for me to understand?”
• “Are you safe now? Have you had thoughts of harming yourself?”

With her consent, I would use standardized screens such as the Life Events Checklist (LEC-5) and the PTSD Checklist for DSM-5 (PCL-5), along with depression and substance use screening, while recognizing that racial and poverty-related trauma may not fit neatly into these tools.

Educating the client on the effects of trauma

Psychoeducation helps clients understand that their reactions are normal responses to abnormal experiences, not personal failures. I would explain how the brain’s alarm system responds to threat with fight, flight or freeze, and how ongoing danger, including chronic racism and financial insecurity, can keep the nervous system on high alert. This can cause insomnia, irritability, difficulty concentrating, numbness and “shutting down.” Using the idea of a window of tolerance, I would help Denise notice when she is hyperaroused (anxious, angry) or hypoaroused (numb, disconnected) and teach grounding and breathing skills to return to balance. I would also discuss how grief and trauma can overlap, and emphasize resilience: the coping skills that helped her survive deserve respect, even if some now cost more than they help. I would offer handouts, check her understanding with teach-back and frame the message as “What happened to you?” rather than “What is wrong with you?”

Recommended advanced clinical modality

I would recommend Cognitive Processing Therapy (CPT), a 12-session, manualized, trauma-focused therapy that helps clients identify and challenge “stuck points,” beliefs about the trauma, themselves and the world in the areas of safety, trust, power and control, esteem and intimacy (Resick et al., 2017). The 2023 VA/DoD clinical practice guideline recommends CPT, Prolonged Exposure and EMDR as first-line treatments for PTSD, preferring them over medication (Schnurr et al., 2024). CPT fits Denise well because her distress involves beliefs shaped by injustice, such as “I can’t trust anyone at work” or “It’s my fault I couldn’t protect my mother.” CPT can be delivered without a detailed written trauma account, which respects her choice, and its structure suits clients who prefer practical, skills-based work. I would culturally adapt CPT by validating that some beliefs about danger reflect real racism rather than distortion, distinguishing accurate appraisals from overgeneralized ones and incorporating her faith and community supports. If Denise’s symptoms do not meet PTSD criteria, I would still use trauma-informed CBT skills, grief-focused work and advocacy around workplace discrimination. Throughout, I would monitor progress with the PCL-5 and attend to my own self-care to prevent vicarious trauma.

References

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Press.

Schnurr, P. P., Shiner, B., Kelly, U. A., Lang, A. J., Petrakis, I. L., Norman, S. B., Wiechers, I. R., Hamblen, J. L., Morganstein, J. C., Sall, J. L., Riggs, D. S., Holtzheimer, P. E., Wolf, J., Coller, R., Collie, C., Fuller, M. A., McGraw, K., Papke, K., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine, 177(3), 363–374. https://doi.org/10.7326/M23-2757

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884).