Ethical guidelines for treating trauma survivors

Trauma survivors are a distinctive population with varying displays of resilience, posttraumatic growth, and resulting mental disorders. Mental health professionals who treat trauma survivors must incorporate specific ethical considerations when working with clients who have a history of trauma.

The importance of ethics

Within the field of psychology, ethics define the standards of professional conduct. The American Psychological Association (APA) describes their Ethics Code as a “common set of principles and standards upon which psychologists build their professional and scientific work” (p. 8). Ethics help clinicians to think through and critically analyze situations, while also serving as aspirations and virtues that clinicians should strive towards. When working with trauma survivors, often times client’s traumatic experiences can be so overwhelming for both the patient and the clinician that professional and ethical boundaries may become endangered. The following ethical guidelines should be considered when working with clients who have survived a traumatic experience:

Informed consent

The APA ethics code (2010) outlines many professional guidelines for clinicians including the maintenance of confidentiality, minimizing intrusions to privacy, and obtaining informed consent. Informed consent ensures the client has an adequate understanding of the techniques and procedures that will be used during therapy, expected timeline for treatment, and possible consequences for engaging in specific tasks and goals.

When clinicians work with trauma survivors their informed consent should emphasize diagnosis and treatment of trauma and include clear guidelines for maintaining secure and firm boundaries. Some research suggests that clients who have experienced complex trauma may deliberately or unconsciously test clinician’s boundaries by missing or arriving late for appointments, bringing the clinician gifts, attempting to photograph the therapist, calling during non-office hours, or trying to extend the session either in person or with a follow-up phone call. In addition, clinicians should also provide clear cancellation policies and numbers for local and national crisis hotlines in their informed consent. Finally, the clinician should include all training, education, and limitations they may have related to their competency to treat trauma survivors.

Risk management

Research indicates that suicide attempts are correlated with both childhood maltreatment and PTSD symptom severity. Further research suggests that trauma survivors are more likely than those without a history of trauma to report suicidal ideation and to engage in self-harming, non-suicidal behaviors. Clinicians who treat trauma survivors should continuously monitor their client’s suicidal ideation, means, and plans especially surrounding anniversary dates and triggering experiences.