What You Can Do Series – What Therapists Can Do

What Therapists Can Do: Healing Trauma,

Restoring Hope, and Transforming Futures

Introduction: Therapists as Healers and Advocates

Therapists—whether working in schools, clinics, community settings, private practices, or as part of multidisciplinary teams—are often the first, sometimes the only, professionals capable of translating the science of trauma into lasting recovery. In a nation where millions of children endure violence, neglect, or abandonment each year, therapists’ roles are both lifesaving and system-transforming. Yet, too often, therapists are under-resourced, unsupported by the systems surrounding children, or pressured to provide quick fixes where long-term healing is needed. Drawing on urgent lessons from the book and the latest research, this section details what therapists can do to make a difference—and why their sustained commitment is both a catalyst for individual recovery and wider societal change.

1. See the Whole Child: Going Beyond Diagnoses

• Start With Empathy, Not Labels: Before ever assigning a diagnosis or treatment plan, therapists should recognize the impact of trauma as the origin of many “symptoms” presented by children. Behaviors such as aggression, anxiety, withdrawal, or inattention are often normal responses to abnormal circumstances, not evidence of innate pathology.
• Conduct Trauma-Informed Assessments: Use tools such as the ACEs questionnaire and narrative histories, paired with clinical interviews. Prioritize rapport and safety, especially with children who may never have experienced a reliable adult relationship before.
• Value Narratives Over Checklists: Allow the child’s story—and their nonverbal cues—to guide assessment. Therapeutic presence, patience, and listening for what is not said are as critical as standard inventories.

2. Deliver Evidence-Based, Trauma-Informed Care…

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• Understand and Use Best-Practice Therapeutic Modalities:
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): The gold standard for children exposed to complex trauma or abuse. Combines coping, skill-building, gradual exposure, and joint sessions with caregivers.
  • EMDR (Eye Movement Desensitization and Reprocessing): For children struggling with persistent traumatic memories, EMDR can rapidly reduce symptoms.
  • Play Therapy & Expressive Arts Therapies: For young children, nonverbal methods are central. Play, art, music, and storytelling allow safe exploration of trauma and build trust.
  • Attachment-Based Therapies (e.g., Dyadic Developmental Psychotherapy, Theraplay): Especially effective for foster/adopted children and families disrupted by trauma.
• Do No Harm: Avoid treatment approaches that risk re-traumatization—such as coercive “tough love” programs, overemphasis on behavioral compliance, or unstructured group therapy (especially with sexual trauma survivors).
• Integrate Family and Caregiver Work: Healing accelerates when the caregiving environment is part of the process. Collaborate with biological, foster, or kin caregivers—educating them on trauma responses, coaching effective support, and modeling regulation.

3. Establish Safety and Trust as the Foundation for Healing

• Build a Sanctuary: Therapists must offer spaces (physical and psychological) where children feel unconditionally safe. This means consistent boundaries, predictability, confidentiality, and clear limits on sessions and content.
• Practice Relationship Repair: Many traumatized children distrust adults. Therapists can expect ruptures—missed appointments, testing boundaries, angry outbursts—and must respond with patience, self-regulation, and willingness to begin again.
• Promote Psychoeducation: Teach children (and caregivers) about the body’s trauma responses: explain the amygdala, hyperarousal, dissociation, and why “bad” behaviors are survival strategies.

4. Identify and Triage Risk: Suicide, Self-Harm, and Safety

• Screen Aggressively for Risk: Suicidality, self-harm, and violence are prevalent among traumatized youth—especially those in foster care or known to CPS. Standardize screening at intake and at regular intervals. Use clinical judgment alongside standardized tools.
• Create Crisis/Safety Plans: Develop concrete, actionable plans for moments of escalation or crisis. Involve child, caregivers, and, where needed, schools or residential staff in safety planning.
• Respond Rapidly to Disclosures: When children report active abuse, follow all mandated reporting laws. Provide immediate stabilization, document disclosures, and connect to protection authorities. Do not “hold secrets” that threaten safety.

5. Empower, Don’t Pathologize: Focus on Strengths and Skill-Building

• Identify Resilience and Agency: Use strengths-based language. Help children see times they survived, overcame, or acted wisely even in dangerous situations.
• Teach Emotion Regulation and Coping: Equip youth with mindfulness, grounding, self-calming, and distress tolerance skills tailored to age and development.
• Normalize Responses: Frame hypervigilance, numbing, anger, or distrust as adaptive responses to real danger rather than shameful flaws.

6. Coordinate, Collaborate, and Advocate

• Be a System Connector: The most effective therapists operate beyond the therapy room—liaising with schools, doctors, social workers, and, where possible, legal advocates or CASA volunteers.
• Support Trauma-Informed Teams: Participate in multidisciplinary case reviews. Share insights (with consent), suggest interventions across contexts, and help other professionals understand “challenging” behaviors through a trauma lens.
• Challenge Overmedication: Therapists have a duty to question the overuse of psychotropic medications for behavioral control. Pair therapy with regular medication reviews, document side effects, and track functional progress.
• Push for Resources: Help families obtain access to specialized services: occupational or speech therapy, mentorship, recreational outlets, and family support. Write letters, attend IEP meetings, and testify in court as needed.

7. Fight Isolation: Group Work and Community Connection

• Cautiously Facilitate Peer Groups: For some, group therapy or support with peers (e.g., in foster care, LGBTQ+ youth, or survivors) aids normalization and healing. Safeguards, skilled facilitation, and screening for appropriateness are essential.
• Empower Through Advocacy Training: Teach children (especially teens) self-advocacy, “speaking up” scripts, and how to recognize/report unsafe adults or environments.
• Promote Belonging: Guide youth toward safe community embeddedness—sports, arts, leadership. Community support is a buffer against relapse and risk.

8. Educate and Empower Caregivers and Systems

• Family Psychoeducation: Deliver workshops, one-to-one consults, and written materials to parents/foster parents about trauma, attachment, behavior, and healing.
• Model Healthy Boundaries: Many traumatized children and families have experienced blurred or abusive relationships. Therapists teach, not just tell, about respectful boundaries.
• Support Systemic Change: Agencies, schools, and courts benefit from therapist input. Therapists should collaborate on policy development, lead training, and provide expert testimony to shape trauma-informed procedures.

9. Be a Mandated Reporter and a Child’s Ally in the System

• Never Look the Other Way: Therapists are obligated to report suspected abuse, neglect, or endangerment. Beyond compliance, believe and validate children’s experiences—even those that seem “unbelievable.”
• Support the Child Through Reporting: Prepare children for next steps, explain the process, and buffer the fear and guilt that often follow disclosures.
• Document Meticulously: Keep clear, accurate records—not just for legal liability, but to ensure follow-through, continuity of care, and advocacy with other professionals.

10. Care for Themselves to Sustain the Work

• Guard Against Vicarious Trauma: Exposure to children’s stories, pain, and system failures can bring burnout, compassion fatigue, or secondary trauma. Therapists must build personal resilience—regular supervision, consultation, therapy, and personal wellness routines.
• Avoid Moral Injury: The system often fails children in devastating ways. Therapists must guard against internalizing rage or helplessness, and seek collective action or advocacy when systemic injury recurs.

11. Champion Policy Reform and Innovation

• Advocate for Systemic Change: Therapists, especially those in leadership, have the power to amplify children’s voices to lawmakers, administrators, and funders. Participate in advisory committees, join advocacy organizations, and push for:
  • Trauma-informed training standards
  • Mental health funding reform (Medicaid, CHIP, school-based billing)
  • Data-driven child outcome measurement and public reporting
  • Responsible oversight for psychotropic medication use
• Pioneer New Models: Innovate with tele-therapy, community-based programming, integrated care, peer mentorship models, and new forms of restorative and relational healing appropriate to diverse populations.

12. Amplify Survivor Voice and Lived Experience

• Support Survivor Narratives: When children are ready, therapists empower them to tell their stories—whether privately, in support groups, or publicly as advocates and mentors. Survivor voice reduces stigma, builds hope, and informs systems change.
• Protect Youth From “Rescuing” Narratives: Center healing in agency and skill-building—not in adult “saviors.” Collaborate with survivors to shape messaging, policy, and practice.

13. Navigate System Barriers and Persist Amid Adversity

• Push Through Gatekeeping: When agencies or insurance block needed care, therapists must persist: appealing decisions, finding grants, or collaborating creatively with other providers.
• Educate and Challenge Institutional Misunderstandings: Advocate within your organization and professional circles to replace punitive, one-size-fits-all approaches with healing, skill-based, and relational models.
• Discuss and Destigmatize Suicide, Self-Harm, and Abuse: Help children and families confront these realities head-on. Teach communities that talking about hard things saves lives and reduces suffering.

14. Success Stories: Therapists as Catalysts for Change

• Healing After Years of Silence: A therapist working in a community clinic supported a seven-year-old, mute since entering foster care, using play therapy and trauma narrative work. Within a year, the child was talking, attending school, and making friends for the first time.
• Averting Criminalization: A school-based therapist, after a violent outburst from a traumatized child, formed a care team, advocated with administrators, and arranged for intensive family therapy—avoiding expulsion and breaking the cycle of exclusion.
• Systemic Advocacy: In multiple cases, persistent therapists organized peer support networks for youth aging out of foster care, resulting in higher school completion rates and healthier transitions to adulthood.

15. Ongoing Learning and Professional Development

• Keep Current With Science: Trauma research is evolving. Therapists must stay up-to-date on best practices in neurobiology, psychopharmacology, cultural competence, and new interventions.
• Seek Cross-Disciplinary Learning: Collaborate with law enforcement, court-appointed advocates (CASA), school personnel, and survivor organizations to broaden perspectives and sharpen tools for healing.

Conclusion: Therapists as Champions for Children

Therapists are not just clinicians—they are advocates, educators, connectors, and system disruptors. By working at the intersection of individual healing and systemic change, therapists have the power to unlock recovery for traumatized children, transform broken services, and give society a road map out of the epidemic of childhood trauma. Their courage, expertise, and commitment are indispensable in turning the tide from punishment to healing, from crisis to resilience, and from silence to agency and hope.

References

1. CDC/Kaiser Permanente ACE Study
2. National Child Traumatic Stress Network – TF-CBT guidelines
3. The Deepest Well (Burke Harris); The Body Keeps the Score (van der Kolk)
4. Harvard Center on the Developing Child
5. U.S. Department of Health & Human Services, “Psychotropic Medication Use by Children in Child Welfare”
6. National CASA/GAL Association Impact Report
7. Annie E. Casey Foundation, “Thriving Families, Safer Children”
8. Pew Charitable Trusts, “Evidence-Based Treatment in Child Welfare”
9. Safe Passage for Children of MN, survivor voices and youth leadership
10. American Psychological Association, “Trauma-Informed Care in Behavioral Health Services”

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This article submitted by former CASA volunteer Mike Tikkanen