Q&A: Trauma and Occupational Therapy with Heather Gilbert, OTD ‘23

Lecturer Heather Gilbert, OTD ‘23, describes trauma-informed care and how OTs can support those who have experienced trauma.
Heather Gilbert portrait

Heather Gilbert is a new lecturer and Tufts alum, specializing in mental health, acquired brain injury, and management. She has worked in a variety of settings, including as the director of rehabilitation at an inpatient forensic psychiatric facility for men who were detained or incarcerated, operated by the Massachusetts Department of Corrections.

  1. What is trauma? 

There has been so much interest and research into the topic of trauma in recent years, and there are different definitions of it. A prevalent definition is that trauma is an emotional response to an event or circumstance that was (or was perceived by) the mind and/or body to be life-threatening.

Trauma can result from a lot of different things. The big ones people usually think about are psychological, emotional, physical, or sexual abuse. Trauma can also include witnessing domestic violence or school violence. It can result from experiencing serious accidents, life-threatening illnesses, war, and national disasters. It can also stem from neglect, which is a little bit subtler in that it’s not a singular event that happened to you. It can be a life circumstance where your caregivers were absent or emotionally unavailable  and you’re not getting the support you need to be healthy and develop effectively. The key thing is that research is demonstrating that there are real changes in the brain that occur from trauma, especially repeated trauma.

It’s very likely that most people will experience a major trauma in their lifetimes. There’s research that shows ⅔ of children will experience at least one trauma by the time they’re sixteen. What I find interesting is how differently individuals process and recover from trauma. You might know some people who have endured multiple, big heavy traumas in their lifetime and are doing okay. You might know someone else who experienced one major trauma and they’re experiencing multiple effects of that trauma. Maybe they don’t sleep well or they have trouble holding down a job or their social relationships are strained.  

There’s fascinating research into why some people recover or adapt more quickly from trauma. People with strong social support networks tend to fare better as well as people with greater resiliency, which involves the ability to adapt, cope, and move forward from hard times. As a society, we should be asking questions like: How do we build resilience in people? How do we foster strong social networks? How do we create a world that produces less trauma for everyone?

  1. What is trauma-informed care?

Trauma-informed care is a framework that allows healthcare and other professionals to deliver services in a way that both supports the recovery process and also minimizes the likelihood of inadvertently retraumatizing someone while they’re receiving services. This approach to care is a common thread in all Tufts OT coursework. 

Trauma-informed care is about promoting a sense of physical and psychological safety for clients. It’s putting clients in the driver’s seat and empowering them to make their own decisions regarding the care they’re receiving. It’s being very intentional and clear in explaining who you are and what you’re going to be doing for the day, so the client has a good idea of what to expect and the agency to end the session at any time. Depending on the care setting, it’s letting the client choose where to meet or if they want another staff person present. It’s asking permission to touch them. It’s all those little moments of gaining trust and making the client feel like they have the right to make decisions. 

When you think about it, trauma-informed care is just good human being etiquette. It’s probably what we all appreciate in another person and it’s the approach I use universally with my clients.

  1. How do OTs approach supporting clients who have experienced trauma? What unique training do OTs have in this area?

Occupational therapists are really well positioned to support people living with trauma. Research shows that some of the most important components of recovery from trauma are things like improving your health status, establishing a safe home, being connected to your community, and having a sense of autonomy and purpose. These are all areas that OTs have expertise in supporting. We are trained as generalists, meaning that OTs have a solid understanding of general body systems and can support people who are experiencing illness or injury in a holistic way.

We’re well trained in helping clients with health management and working with people who have multiple diagnoses. We can support clients to create healthy routines and manage their medications; develop better self-regulation strategies to manage anxiety; enhance their social skills; and improve their relationships. OTs really want to know what makes our clients tick. What gives them a reason to get up in the morning and participate in life. We can help our clients to explore their interests as well as volunteer opportunities, employment, and leisure activities.

OTs are also uniquely trained in the areas of “functional cognition” and “sensory processing,” which can be vital in recovering from trauma. Functional cognition encompasses how a person uses their thinking to participate in everyday activities. We know from research that trauma negatively impacts the brain’s ability to think, make decisions, and take action in the moment. OTs are trained to help our clients develop strategies to improve those processes, so they can make better decisions and participate in activities that are meaningful to them. People who have experienced trauma can also have issues with sensory processing, so that is being overly or under sensitive to things like sound, touch, and smell. OTs can help people build their self-awareness and understanding of their triggers and overcome them, so they can get back to, or in some cases, begin to live full lives.

In the Tufts Occupational Therapy Department, we talk a lot about “cultural humility,” which involves self-reflection of our own experiences, relationships, and biases as well as being sensitive to the unique needs of other people. It’s being respectful and curious about other traditions and customs. Different cultures may think of trauma and healing in very different ways and we need to be open to understanding that perspective in order to best support the individual in front of us. I love occupational therapy, but just because I think it’s phenomenal and could be a good fit for everyone, doesn’t mean it is the right choice for everyone – and that’s okay. 

  1. For people interested in these topics, could you recommend any books or other resources on trauma?

For anyone interested in understanding trauma, I always recommend The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk. It’s one of the most popular books on how trauma impacts different bodily systems and pathways towards healing. Tina Champagne is an expert occupational therapist on this topic, so reading her work or attending one of her training sessions would be valuable. I would also recommend the Substance Abuse and Mental Health Services Administration (SAMHSA) website, which includes a host of information on substance abuse, trauma, mental health, and ways to support those in crisis.

Read more about Heather Gilbert, OTD ‘23, here.