As practitioners, we know how important it is to build trust with clients.
But when a patient has a trauma history, trust may not come easy – and rightfully so. So, how can we go about building healthy trust in the therapeutic relationship with these clients?
In the video below, Janina Fisher, PhD, shares how she works with trauma survivors when they tell her that they don’t trust her – and possibly never will.
She’ll get into the specific language she uses that can actually help a patient regain their capacity to trust.
Take a look.
For the most part, when I tell clients, “It’s your mistrust and you earned it. Don’t think that I’m asking you to give it up.” Usually I can see the relief.
“I don’t have to trust you?”
“Oh, you don’t have to trust me. You don’t have to trust anybody.”
When there’s no requirement to trust, then actually the therapy goes so much more smoothly.
If a client has had negative experiences in previous therapies, and the mistrust has come out of those experiences, one of the most important questions that I always ask is, “What were the things that happened that left you feeling betrayed, sabotaged, undermined, kicked to the curb?” I want to know the answers for two reasons. I want to make sure that I don’t make the same mistakes.
Also, I want to evaluate the degree to which those mistakes were simply triggering for the client, versus the degree to which those mistakes were severe enough empathic failures, or even ethical violations.
If my client is a trauma survivor, what tends to happen is that that trust grows. Or what I see often in trauma is a part of the client has unconditional trust in me, and part of the client has unconditional mistrust in me. Over time, what I hope for is that the unconditional trust, that part will become more realistic. The unconditional mistrust part can relax a little bit.
But it’s not up to me. I don’t ask the client to explore it unless it’s an issue that is of immediate interest to the client.
This goes to the issue of trust in a more general way or trust in other relationships. I say often to clients, “The goal is for all of us – me too – to have healthy trust. Because you don’t want to just trust everybody and anybody. You want to have healthy mistrust and healthy trust.”
They say, “Well, what’s that?”
I say, “Healthy trust is when we know I can trust someone in these ways. I can trust someone this much, but I can’t trust them this much. Healthy mistrust is gathering evidence. You meet your new neighbor, your new colleague, and you say, ‘Well, I don’t know this person yet. So I have to gather data. I have to see all of the subtle and not so subtle signs that this person is trustworthy or not trustworthy.'”
To me, the key is that we’re comfortable being mistrusted. That’s the hardest thing for a therapist. It’s so painful for us when we’re mistrusted. I try to relax around it, and to give clients lots of room for their mistrust, because I know that if you have lots of room to mistrust, it creates a situation in which trust can grow.
When a person experiences trauma, it doesn’t just impact them – it can also affect their families, friends, and communities, too.
In the Advanced Master Program on the Treatment of Trauma, we take an in-depth look at how to work with patients whose trauma history triggers problems in their current relationships – take a look here.
You’ll hear from Bessel van der Kolk, MD; Peter Levine, PhD; Stephen Porges, PhD; Pat Ogden, PhD; Thema Bryant-Davis, PhD; and Janina Fisher, PhD, among other leading experts in the field.
Now we’d like to hear from you. How do you work with clients when trauma keeps them from trusting in their relationships? Please let us know by leaving a comment below.
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