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.
If you found this helpful, here are a few more resources you might be interested in:
This is helpful with the response of opening up the avenues of freedom not to trust. When client and counsellor talk about trust, it helps to break it down into bits, which I learned from The Thin Book of Trust by Charles Feltman. When inquiring and exploring with the client about where trust went off the rails, leaving them with low trust, it helps to dissect it within the areas that Feltman indicates. I have had clients wake up to aspects of trust that were met, while certain aspects were not. It helps to remove the global sense of trust and see where the impacts are with each client.
Respected Sir/Madam: I am interested in joining the program.I was really amazed to hear and update my practical experience and the unique way for treatment and other models of treatment techniques and it’s uniqueness . I have completed the Master’s degree in counseling and psychotherapy from Tamil Nadu Open University during June –2021.And the results were published by the end of July 29th 2021.I have received the provisional degree certificate by August 11 2021 with I st class distinction.I need the practical training and intensive training with certificate from your esteemed institution.Awaiting the reply at the earliest.Thanking You; Yours faithfully;. (SUDARSHAN SHRIKANTH.)
Hi Sudarshan, you can sign up for this program using this link: Advanced Master Program on the Treatment of Trauma. Hope this helps!
Janina is very wise.
I worked under supervision providing therapy for over five years and it was only a mis-communication that kept me from being licensed in 1990. I had an MEd and all of the supervisors were MSW’s. As it turned out, memories from my childhood were blocked and only surfaced through further trauma in the decades since. In recent years I’ve begun to mentor others through my non-profit. I find they tend to trust me. But I am very clear. “I am not a licensed therapist, I’m a peer. I’ve been to hell and back and so I may have experiences that can help you. But you will have your own path to recovery based on your needs and your experiences. If anything I say provides an insight that helps you, I’ll be happy for you. But my job is only to provide encouragement while you continue to search for a licensed professional.” My organization has a lending library and for the most part, I suggest reading and exercises in various workbooks. I am only a stop-gap measure until the person that came to me can find a licensed therapist to work with them.
Right now we are all temporarily following health rules just as in any other time in history when we were plagued by a deadly disease. For example, there is no more (or not much of it anyway) Small Pox because we are all vaccinated against that deadly disease so it’s basically gone. This is basically the same thing. Eventually we will be able to go back to more comfortable social practices. If presented that way to your clients they will understand. The delivery of the message is everything.
This is a marvelous “session.” All sessions have been good and informative, but this one BUILDS TRUST and there can be no healing until we give the client the ability to be in charge of their healing. [Builds their lagging ego, NOT OURS] AND that is our job, to build their health.
Thank you. Thank you.
What an amazing and in-depth few weeks learning!
For me, as a Integrative crisis practitioner and CPTSD survivor this has been such an important self-educational course, it was simple and easy to listen too, understand and absorb (retain) the new learning.
I have been qualified a Health-Care Natural medicine for over 13 years and have trained in Trauma Informed studies before, this was the clearest and helpful of those I have engaged in.
I had many practical skills and tools, and after watching your course, I have a full tool box of quick, practical and most importantly, the right methodology to offer to my clients.
I am so pleased and grateful that I took the time out of my very busy week to attend it.
And, all I have learned here I will be using in my own Trauma & Chaos for women courses, and then referring others to your body of Trauma informative works.
Thank you everyone here at NICABAM
Sorry I added my maiden name🤣
Dawn Stemmer
Thank you Janine. I really enjoyed your ideas on trust. It has been how I have always approached trust in the therapeutic setting.
We in NZ are in the middle of an outbreak of COVID and mask wearing and distancing necessary while we try to contain the spread for now. Online videoing is second best to face to face but it does work and I and my clients are grateful for this technology in these times of COVID
I am really enjoying the whole course and using it in my practice.
Suzanne
Psychotherapist
When clients comes into therapy with me and have a trauma history, I assume that they are not going to trust me at first because their trust was broken on a deep level, especially if they were abused by their main caretakers. It was interesting and helpful to hear some of the actual words that Janina Fisher uses when a client brings up not trusting her.
Thank you!
Yip agree Gertrude the media is toxic, it amplifies unconsciousness, I feel it should be avoided especially if one is feeling lost in or taken over by thoughts and emotions. It is the media that sets up divisive memes (such as as the injected vs non injected) that suits political agendas.
What I see from msm is the collective hive mind of humanity appears to be clinically insane.
Spend time in nature, meditate , do things you enjoy, practice self compassion,and just focus on your in and out breath.
I am a big advocate for positive changes in psychology a move away from the power imbalance in client and therapist to truly listening openly with love( aka ” Carl Rogers”) and the labeling that holds an imbalance in place when clients make it part of their ego( self identity ) sometimes for life.
Blessings and Love
This approach is so liberating–for both therapist and client. It reminds me of the Chinese proverb: Much that I sought I could not find, much that I found I could not bind, much that I bound I could not free, much that I freed returned to me.
Thank you for your additional supplementary info about when a client doesn’t trust the therapist. I have especially liked y the NICAMB course on Trauma, not just the new knowledge about trauma i have gained but especially for the examples of what to ask and say to clients when working with clients on a specific application . This is the practical part that many other courses leave out, when in fact it is extremely helpful. I think these others think that students are not astute enough to not mimic exactly rather than finding their own expressions of the applications. I have enjoyed the ‘bottom up’ approach of the whole course tremendously and gained a lot new material about trauma. I look forward to the final module (No, 5). Thanks again. Jackie Gillies
I love the idea of making “trusting me as the therapist” NOT an issue in the therapy – thank you Dr Fisher. And I also love (and often teach about) the concept and reality that not everyone is trustworthy – discerning what is “healthy trust” – this is a position to be earned over time. And that there are different levels of trust – I might trust one person to show up on time, but not necessarily “trust them with my life”. Trust is a continuum and is built/earned/granted over time and experience with another. Thank you, as always, for very insightful, applicable and real examples of improving our capacity as effective therapists.
What you highlight is so important — the need to discern healthy trust, the different levels of trust, and that trust is a continuum to be built and earned over time. Trust is not something automatically given, especially in situations where abuse by caretakers has occurred. The client/patient is right to be hesitant about trusting. This has been an incredibly helpful series.
It is always energizing to me to hear you speak your “outside the box” ways of addressing such problems. Thank you for listening to your creative self (or the Holy Spirit?). Thank you for being unafraid to step out of a “well, you must trust me if you expect me to help you,” frame of mind and being willing to deal with people as they come to you. You help them learn to trust themselves again — I think that is a critical first step on the road to healthy relationships.
Thank you, Dr. Fisher!
Yes, we cannot EXPECT someone who has experienced abuse to trust us immediately. And, yes, we need to move our ego out of the way in order to be of assistance to these fragile, yet resilient and strong patients/clients. They need to be able to learn to trust and these methods can do just that.
Thank you. This makes a lot of sense.
Zethu Memela (Clinical Psychologist, South Africa)
Very interesting. I like how Dr. Fisher stated “healthy versus unhealthy trust.” I am often sharing with my clients about healthy versus unhealthy fear, anger, guilt. Never thought to apply this to trust. Good stuff!! Thank you, Lillian
Beautifully explained thank you
Thank you for sharing this information. It makes it much more easy to not taken it to much personal.
This sounds great. As a client I was told that I’d I don’t trust then there is no point in our work as this is the basis. I was also asked “do you trust your mom?” In a very sarcastic and mean way…so NO I do not trust therapists and I might never do again….so sad that one or two horrible heart breaking experiences have prevented me from seeking help.