Post-traumatic stress disorder (PTSD) has become one of the most pressing mental health issues among military veterans, particularly in the wake of modern conflicts in Iraq and Afghanistan. Years of exposure to intense combat, guerrilla warfare, and constant danger have left many veterans struggling with lasting psychological trauma. Despite increased public awareness and advances in treatment, PTSD continues to impose severe emotional, social, and economic burdens, both on individuals and on the healthcare system (Reisman, 2016).
PTSD among veterans is not a new phenomenon – it is a modern understanding of a condition that has existed as long as warfare itself. Historical records describe symptoms akin to PTSD as far back as ancient Greece, and over the centuries it has been labeled by many names, from “shell shock” during World War I to “battle fatigue” in World War II. The diagnosis of PTSD became formalized only in 1980, after the Vietnam War made clear the long-term psychological cost of combat. Contemporary studies estimate that between 13% and 30% of Iraq and Afghanistan veterans have experienced PTSD, with as many as half a million diagnosed cases over the past two decades (Reisman, 2016).
The condition rarely exists in isolation. Many veterans with PTSD also suffer from depression, anxiety, substance use disorders, and chronic pain, which together complicate both diagnosis and treatment. Depression is the most common comorbidity, and substance use is widespread among those attempting to cope with symptoms of trauma. Such overlapping conditions lead to higher rates of suicide, social isolation, and medical complications, making recovery a complex process requiring integrated care. Women veterans are particularly vulnerable, not only because of combat exposure but also due to the high prevalence of military sexual trauma, which can heighten the risk of developing PTSD (Reisman, 2016).
Diagnosis of PTSD involves both clinical interviews and self-report tools. Instruments such as the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5) help determine symptom severity and functional impairment. The DSM-5 defines PTSD through four main symptom clusters—intrusion, avoidance, negative mood and cognition, and arousal—which reflect the range of ways trauma manifests in the mind and body. These diagnostic criteria guide clinicians toward evidence-based treatment approaches.
Cognitive-behavioral therapy (CBT) remains the most effective psychological treatment for PTSD. In particular, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy are strongly supported by clinical evidence and widely used in veteran care. CPT focuses on identifying and restructuring distorted thoughts about the traumatic event, while PE encourages controlled and repeated engagement with trauma memories to reduce fear responses. Another therapy, eye-movement desensitization and reprocessing (EMDR), once met with skepticism, is now recognized internationally as an effective intervention that helps patients process trauma through guided eye movements and attention refocusing (Reisman, 2016).
While psychotherapy is the preferred first-line approach, pharmacological treatments are also important, particularly for those who do not respond fully to therapy. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are the only FDA-approved drugs for PTSD, although others like fluoxetine and venlafaxine are used off-label. These medications help regulate mood and anxiety symptoms but rarely lead to full remission. Researchers are increasingly investigating alternative pharmacological pathways, such as those involving GABA and glutamate neurotransmission. New drugs like vortioxetine, vilazodone, and even certain anticonvulsants such as topiramate are under study for their potential to modulate fear and memory processes. Some veterans also report relief from cannabis use, though its medical application remains controversial and tightly regulated (Reisman, 2016).
Combined treatment approaches – using both medication and psychotherapy – are often the most effective, particularly for veterans with severe or treatment-resistant PTSD. However, benzodiazepines, once commonly prescribed to manage anxiety, are now discouraged due to their limited efficacy and potential for dependency. The Veterans Affairs (VA) system has begun implementing education and shared decision-making programs to reduce benzodiazepine use and encourage evidence-based alternatives.
Beyond treatment, systemic and social barriers continue to hinder recovery. Many veterans face long wait times at VA facilities, limited access to mental health providers- especially in rural areas – and the persistent stigma associated with seeking psychological help. Cultural attitudes within the military often equate mental illness with weakness, deterring individuals from pursuing care. The VA has responded through public awareness campaigns like “About Face,” which normalizes PTSD treatment, and through telehealth services that provide remote therapy options. Studies indicate that telemedicine not only increases accessibility but also improves engagement and treatment adherence among veterans living far from urban centers (Reisman, 2016).
As more veterans seek care outside the VA system, the preparedness of community-based mental health providers has become a growing concern. Many civilian clinicians lack the training to address combat-related trauma effectively. To bridge this gap, the VA established the PTSD Consultation Program for Community Providers and partnered with organizations such as the Center for Deployment Psychology and Star Behavioral Health Providers, which train professionals in veteran-specific mental health care.
Despite ongoing research and program development, PTSD remains one of the most significant public health challenges facing veterans. Its economic cost exceeds billions of dollars annually, and its human cost is measured in the thousands of suicides that occur each year among former service members. Continued investment in both psychological and pharmacological research, alongside improved access to culturally competent care, is essential. Addressing PTSD requires not only medical intervention but also systemic reform and societal understanding to ensure that those who have endured the traumas of war receive the comprehensive care and dignity they deserve (Reisman, 2016).
PACE is a therapeutic approach developed by Dr. Dan Hughes more than two decades ago, designed to help adults build safe, meaningful, and trusting relationships with children and young people who have experienced trauma. Rooted in attachment-focused family therapy, PACE encourages adults to think, feel, communicate, and behave in ways that help children feel secure. It is not a rigid, step-by-step procedure, but rather a flexible mindset that integrates four essential qualities: Playfulness, Acceptance, Curiosity, and Empathy.
Children who have lived through traumatic experiences often struggle with trust, connection, and emotional regulation. Their interactions with adults may be shaped by fear, defensiveness, or shame, making it difficult to form stable attachments. PACE aims to create an environment where these children feel safe enough to explore emotions, express themselves, and build resilience. By adopting PACE, adults can slow down their own responses, regulate their emotions, and remain engaged even during challenging moments. This emotional regulation is essential: when adults stay calm and supportive, children are more likely to mirror that stability, gradually learning to manage their own intense emotions.
Ultimately, PACE offers both children and adults a pathway toward understanding, connection, and healing. Instead of focusing primarily on correcting behaviours, it emphasises relationship-building and emotional safety. In this way, it equips caregivers, teachers, and social workers with strategies to guide children through difficult emotions and behaviours, without compromising their sense of self-worth.
Playfulness
Playfulness is the first element of PACE and serves as an important bridge to closeness without fear. Many children affected by trauma may withdraw from joyful experiences, having lost hope in the possibility of fun or shared enjoyment. For some, affection feels threatening, and hugs or overt displays of love may be rejected. A playful stance provides a gentler alternative, allowing warmth and closeness without overwhelming the child.
Playfulness reassures children that conflicts or separations in a relationship are temporary and not damaging to the connection. In tense situations, a light tone of voice, animated facial expressions, or humour can defuse defensiveness and create opportunities for reconnection. This is not about minimising serious misbehaviour but about keeping minor incidents in perspective. For instance, when a child resists transitioning between activities, introducing a playful game or role-play can reduce resistance and maintain cooperation.
Practical strategies for playfulness include storytelling tones rather than lecturing, softening facial expressions, lowering body posture to avoid intimidating presence, or transforming routine tasks into small games. These subtle adjustments communicate warmth and safety while maintaining the adult’s authority.
Importantly, playfulness is not about distracting from difficulties or denying a child’s struggles. Instead, it signals to the child that relationships can contain joy, even in the presence of challenges. For children who expect rejection or punishment, playfulness can be a powerful reassurance that their presence is valued. Over time, playful interactions rebuild a child’s belief in positive connection and create space for emotional growth.
Acceptance
Acceptance in PACE communicates to a child that their inner world—thoughts, feelings, and intentions—is safe from judgment. For many children, especially those shaped by trauma, the fear of being criticised or rejected for their feelings can prevent honest expression. Acceptance means separating the child’s identity and intentions from their behaviours. Adults can challenge unsafe behaviours while still affirming the child’s worth and humanity.
For example, when a child declares, “You hate me,” a typical adult instinct may be to deny or correct the statement. However, PACE encourages an accepting response such as, “I’m sorry it feels that way to you. That must be really painful.” This communicates understanding without dismissal, showing the child that their perspective matters, even if it is painful or inaccurate.
Through acceptance, children learn that conflict does not equal rejection. They discover that behaviours can be addressed and limited without threatening their relationship or self-worth. Adults may say, “I’m disappointed by what you did, but I know you were upset. It doesn’t change how much I care about you.” Such statements reinforce the difference between disapproving of behaviour and rejecting the child as a person.
This practice strengthens children’s confidence in relationships, making them more willing to share vulnerabilities. Acceptance fosters resilience by teaching children that they can be loved despite their mistakes, and that their feelings—whether anger, fear, or sadness—are valid and worthy of attention.
Examples or how to express acceptance:
“I can see how you feel this is unfair. You wanted to play longer” “You probably think that I don’t care about what you want” “You were letting me know that you were really scared when you ran away from me” “I can hear you saying that you hate me and you’re feeling really cross. I’ll still be here for you after you calm down”. “I’m disappointed by what you did, but I know you were really upset. It doesn’t change how much I care about you”.
Curiosity
Curiosity is the element of PACE that invites children to explore and reflect on the reasons behind their behaviours. Many children, especially those living with trauma, may recognise that their actions are inappropriate but lack the words or awareness to explain why. Instead of asking “Why did you do that?” in a demanding or accusatory way, curiosity involves gentle wondering, aimed at understanding rather than interrogating.
For instance, rather than scolding a child for breaking a toy, an adult might say, “I’m wondering if you broke the toy because you were feeling angry.” Such open-ended reflections give children the opportunity to recognise and articulate their emotions without fear of judgment. The tone is vital: curiosity must be communicated lightly, with compassion rather than frustration.
Curiosity helps children distinguish between their behaviours and their identities. When adults show genuine interest in the underlying feelings—such as sadness, fear, or confusion—children begin to understand that their behaviours are expressions of unmet needs rather than evidence of being “bad.” This reduces shame and defensiveness, replacing them with healthier emotions such as guilt, which can motivate positive change.
Examples of curiosity include phrases like, “I wonder if…,” “Could it be…?,” or “Tell me if I’m getting this wrong.” These sentence starters signal openness and a desire to understand, not to correct. Over time, curiosity builds children’s capacity for self-reflection and strengthens trust in their caregivers.
Examples of curiosity:
“I’m wondering if you broke the toy because you were feeling angry.” “I’m thinking you’re a little nervous about going back to school today, and that’s why you don’t want to get ready this morning”. “I’ve noticed that you’ve been using a really loud voice, and if you’re trying to tell me that you’re angry with me.” “I’m a little confused. Usually you love going for a walk, but today you don’t want to go. I’m wondering what’s different about today”. “When she couldn’t play with you today, I’m wondering if you thought that meant she doesn’t like you.”
Empathy
Empathy is the heart of PACE, ensuring children feel that they do not face struggles alone. Empathy involves actively recognising and validating a child’s distress, demonstrating compassion and solidarity. For traumatised children, empathy communicates that their emotions are not too overwhelming or burdensome for the adult to handle.
Showing empathy requires both words and actions. Adults might say, “That must have been so painful,” or “You are really upset right now, and that’s so hard.” Such statements acknowledge the child’s feelings without minimising them. Non-verbal cues, such as calm body language, gentle tone, and attentive presence, reinforce the message.
Importantly, empathy is not about pity or indulgence. It is about recognising that behaviours often stem from deeper struggles and showing willingness to share in those struggles. By doing so, adults demonstrate resilience and commitment, reassuring the child that the relationship remains intact even during difficult moments.
For example, when a child lashes out after feeling excluded, empathy might sound like: “It hurt so much when she didn’t ask you to play. That must have felt confusing.” This helps the child name their emotions and feel understood. Over time, empathy helps children build trust in relationships, knowing that their vulnerabilities will be met with care rather than criticism.
Examples of empathy: “You are SO upset about this right now. That must be really hard!” “It hurt so much when she didn’t ask you to play. You were probably thinking ‘Why did she do that?’ It was a real shock for you.” “You wanted to have another turn so badly. You were so excited about it and it’s so unfair that we ran out of time”. “It seems to you like he hates you. That must be really hard. I know you like him a lot, so this is pretty confusing”. “I know it’s hard for you to hear what I’m saying.” “Me saying ‘No’ has made you angry with me. I get why you don’t want to talk to me right now”
PACE in Practice
While PACE is simple in principle, applying it consistently in real-life situations can be challenging. Adults often feel the urge to correct or discipline, especially when confronted with disrespect or aggression. Yet practice shows that PACE-oriented responses defuse conflict and build stronger relationships.
Take, for instance, Emily, who becomes angry when denied a turn on the swings, yelling “I hate you!” A typical response might involve correcting her rudeness. A PACE-ful approach, however, acknowledges her anger with playfulness and empathy: “Wow, you’re really angry! It feels rubbish when you can’t do what you want.” Such responses validate her feelings while keeping the relationship intact.
Similarly, when Tom swears at his dad after school, a typical response might be punishment. But with PACE, his dad could say, “I can see you’re really angry. I’m wondering if something happened at school.” This curiosity and empathy create space for Tom to share his feelings rather than escalating conflict.
These examples illustrate how PACE transforms discipline into connection. Instead of viewing behaviours as personal attacks or defiance, adults see them as expressions of inner struggles. By responding with playfulness, acceptance, curiosity, and empathy, adults guide children toward emotional regulation, resilience, and trust.
Example: Emily asks Mum if she can play on the swings. Mum says she can’t as they need to be home soon. Emily gets very upset and angry and starts yelling “that’s so unfair, I hate you. You’re horrible!!!!” Typical response: “Emily, don’t be so rude!” “Life’s unfair!” “I am not horrible and you don’t hate me.” PACE-ful response: “OH WOW [in an animated voice], you’re feeling REALLY ANGRY [with a concerned expression]….you think I’m being mean by not letting you go on the swings when you really want to go…I’m saying no and you really want to go and that feels rubbish…it’s so frustrating when someone says we can’t do something that we want to do!” “I’m really sorry you feel that I hate you Emily that must feel awful – no wonder you’re so angry and upset if you think I hate you! I’d want to scream and shout too…” “It’s rubbish that we can’t do the things we enjoy right now…I’m missing the swings too…maybe we could all have a think about what other games we could on our way home…”
The 4 R’s of Responding with PACE
To support practical application, PACE can be aligned with the “4 R’s of Responding”: Regulate, Relate, Reason, and Repair. These steps provide a framework for managing challenging behaviours while maintaining emotional safety.
Regulate involves calming both the child and the adult. Adults must notice their own emotional state, ensuring they remain calm, compassionate, and engaged. They also help the child regulate by addressing immediate safety concerns and using soothing, light-hearted approaches.
Relate comes next, where adults seek to understand the meaning behind the child’s behaviour. Using curiosity and empathy, they explore the child’s motives, fears, or frustrations, showing genuine interest in their experience.
Reason follows, when the adult and child can discuss the behaviour rationally. Logical consequences may be introduced here, but always in a way that separates the behaviour from the child’s worth.
Repair is the final step, ensuring the relationship remains strong. This might include offering a hug, doing something enjoyable together, or using words and actions to affirm ongoing love and connection.
For example, if a child breaks a jar in a supermarket, a PACE-ful process would involve regulating emotions first, then relating by wondering what feelings triggered the act. Once calm, the child can reason about consequences, such as writing a letter of apology. Finally, repairing the relationship reassures the child that the incident does not damage their bond with the adult.
This structured yet compassionate approach ensures that discipline is balanced with emotional safety, turning difficult incidents into opportunities for growth.
Conclusion
PACE offers a trauma-informed, attachment-based framework for supporting children and young people. By integrating Playfulness, Acceptance, Curiosity, and Empathy into everyday interactions, adults can build stronger, safer, and more trusting relationships. The approach recognises that behind every challenging behaviour is an unmet need, an unspoken emotion, or a legacy of trauma. Instead of focusing narrowly on behaviour management, PACE invites adults to engage with the whole child, affirming their worth and supporting their healing journey.
Through consistent practice, PACE not only helps children regulate emotions but also strengthens the resilience of caregivers, teachers, and social workers. The “4 R’s of Responding” provide a practical framework for applying these principles, ensuring that discipline and connection go hand in hand. Ultimately, PACE reminds us that children are not problems to be fixed but individuals to be understood, supported, and valued.
In a world where modern medicine often focuses on treating symptoms with pills and procedures, Dr. Gabor Maté, a renowned Canadian physician and psychotherapist, offers a radically different perspective. In his international bestseller When the Body Says No: The Cost of Hidden Stress, Maté argues that the root cause of many chronic illnesses—such as cancer, addiction, and depression—lies not in genetics or biology alone, but in suppressed emotions and unhealed trauma. Drawing from decades of clinical experience and scientific studies, Maté’s work challenges the conventional separation of mind and body in Western medicine, urging us to address the emotional wounds that silently shape our health.
1. The Mind-Body Connection: Chronic Illness Starts with Emotional Repression
Maté asserts that the roots of most chronic illnesses are psychological and emotional, a perspective that starkly contrasts with mainstream medical practice. He points out a troubling statistic: 70% of adults in the United States are on medication, yet chronic diseases, obesity, addiction, and mental illness continue to rise. Why are we struggling despite advancements in science? Maté argues that modern medicine’s fatal flaw is its failure to integrate the mind and body. “The repression of anger leads to the chronic secretion of stress hormones, such as cortisol, that suppress the immune system,” Maté explains, citing research from his website (drgabormate.com). This suppression, he notes, has been linked to a wide range of conditions, from cancer and rheumatoid arthritis to migraines and fibromyalgia.
In his over two decades of family medicine, including seven years in palliative care, Maté observed a consistent pattern: patients with chronic illnesses often exhibited emotional shutdowns, particularly an inability to express anger. They were driven by a compulsive sense of responsibility for others, often at the expense of their own needs, and struggled to say “no.” This emotional repression, Maté argues, creates a physiological environment ripe for disease, a theory supported by studies showing that individuals who suppress emotions are at a 30% higher risk of developing depressive symptoms (Journal of Personality and Social Psychology, 2003).
2. Trauma Begins in the Womb: The Lasting Impact of Early Stress
One of Maté’s most profound insights is that trauma can begin even before birth. He explains that a stressed mother’s emotional state directly affects the fetus, shaping its brain development and physiology. “A stressed mother affects the physiology and brain development of the fetus,” Maté notes. “The impacts of that stress can be seen decades later by how they respond to stress as adults.” In Western societies, where many pregnant women work well into late pregnancy, this stress can imprint on the baby, influencing its future mental and emotional health.
Maté’s own life story as the Budapest-born son of Holocaust survivors underscores this point. As an infant, his mother left him in the care of strangers for weeks to save his life during the Holocaust, an experience he believes left him with lifelong themes of abandonment, loss, and rage (theconversation.com, 2025). This early trauma, he argues, is not an isolated case but a universal phenomenon that shapes who we become, often manifesting as chronic illness or mental health struggles later in life.
3. Addiction as a Coping Mechanism: Reframing the Problem
Maté’s perspective on addiction is both compassionate and revolutionary. “Addiction isn’t the problem, it’s the solution,” he states. He views addiction—whether to substances, behaviors, or even work—as a coping mechanism for unhealed emotional trauma. “We turn to substances or behaviors to soothe wounds,” Maté explains, a theory backed by a study in the American Journal of Preventive Medicine, which found that 70% of individuals in drug treatment programs report having experienced trauma.
Rather than asking “Why the addiction?” Maté urges us to ask “Why the pain?” This shift in perspective encourages self-compassion and a deeper understanding of the emotional wounds driving addictive behaviors. For Maté, healing addiction requires addressing these underlying emotions, a process that goes beyond the surface-level interventions of most treatment programs. His own struggles with addiction and ADHD, which he has openly discussed, lend a personal authenticity to his approach, making his insights resonate with those who feel misunderstood by traditional medical frameworks.
4. Depression and the Weight of Suppressed Emotions
Maté challenges the conventional view of depression as a chemical imbalance, such as low serotonin levels. Instead, he identifies suppressed emotions as the true root cause. “When you bury your pain, sadness, or anger, it doesn’t disappear,” he warns in the thread. “It lives in your body, silently shaping your thoughts.” This emotional repression leads to feelings of hopelessness, emptiness, and depression, a connection supported by the 2003 study mentioned earlier, which linked emotional suppression to a higher risk of depressive symptoms.
Healing, according to Maté, requires reconnecting with these buried emotions and feeling them without judgment. This process can be daunting, as it involves confronting pain that has been avoided for years, if not decades. However, Maté emphasizes that this emotional reconnection is essential for recovery, offering a path to liberation from the cycle of depression.
5. People-Pleasing as a Sign of Deeper Wounds
At first glance, people-pleasing might seem like a harmless trait, but Maté sees it as a symptom of deeper emotional wounds, often rooted in childhood. “Those raised in emotionally unstable environments learn to prioritize others’ needs before their own as a survival tactic,” he explains. This behavior, while adaptive in childhood, leads to a loss of connection with one’s own needs in adulthood, perpetuating a cycle of emotional suppression.
To break free, Maté recommends a three-step process: learning to identify your own needs, setting healthy boundaries, and reclaiming your sense of self. This journey requires processing suppressed emotions, which can be facilitated through therapeutic methods like Internal Family Systems, Somatic Experiencing, EMDR, Psychedelic-Assisted Therapy, and Maté’s own approach, Compassionate Inquiry. These methods, he notes, help individuals reconnect with their bodies and emotions, paving the way for true healing.
A Path to Healing: Reconnecting with the Body
Maté’s work is a powerful reminder that healing is not just about treating the body—it’s about addressing the mind and emotions as well. His insights challenge us to look beyond the surface of our struggles and confront the emotional wounds that shape our health. Fortunately, as Maté points out, healing is more accessible than ever before. The first step, he suggests, is free: reconnecting with your body and sensations. From there, therapeutic methods can provide the tools to process suppressed emotions and reclaim your well-being.
For those feeling stuck, Maté’s message is one of hope. Various resources available that can help individuals change their habits, routines, and mindset, fostering strength and discipline. Maté’s work, combined with such tools, offers a roadmap to break free from the hidden costs of suppressed emotions and live a healthier, more authentic life.
Conclusion: A Call to Emotional Awarenes
Gabor Maté’s insights into the mind-body connection are a wake-up call for a society grappling with rising rates of chronic illness and mental health struggles. By linking conditions like cancer, addiction, and depression to suppressed emotions and unhealed trauma, Maté challenges us to rethink our approach to health. His five key insights—ranging from the psychological roots of illness to the origins of people-pleasing—reveal the profound impact of emotional repression on our lives. But more importantly, they offer a path forward: by reconnecting with our emotions, setting boundaries, and seeking therapeutic support, we can break free from the cycles of pain that hold us back. In a world that often prioritizes quick fixes, Maté’s work reminds us that true healing begins with listening to what the body—and the heart—have to say.
Social workers often encounter individuals whose lives have been deeply impacted by trauma. These experiences, whether occurring in childhood or adulthood, shape fundamental beliefs about safety, trust, and personal worth. Trauma-informed care (TIC) is a revolutionary approach that integrates an understanding of trauma’s effects into all aspects of service delivery. Rather than treating symptoms in isolation, TIC acknowledges that behaviors often emerge as coping mechanisms in response to adverse experiences. This holistic approach not only strengthens the therapeutic alliance between social workers and clients but also fosters posttraumatic growth. It allows clients to feel understood and validated in ways that traditional methods might overlook, recognizing that many issues stem from deeply ingrained patterns developed in response to past distress. By shifting the focus from pathology to resilience, TIC empowers individuals to see themselves as survivors rather than victims, reinforcing their ability to heal and build meaningful, supportive relationships.
Understanding Trauma and Its Prevalence
Trauma is broadly defined as exposure to extraordinary experiences that create physical or psychological threats, inducing feelings of helplessness and fear. It can stem from a variety of sources, including criminal victimization, accidents, natural disasters, war, community violence, and familial dysfunction. Research underscores that early childhood trauma, often categorized under Adverse Childhood Experiences (ACEs), carries particularly profound and lasting consequences. A large-scale study conducted by the Kaiser Permanente Health System found that nearly two-thirds of adults had encountered at least one form of childhood maltreatment or household dysfunction. Among clinical and disadvantaged populations, the prevalence of ACEs is even higher, contributing to significant medical, mental health, and behavioral challenges later in life. These challenges manifest in myriad ways, including chronic illness, anxiety disorders, substance abuse, and an inability to maintain stable employment or relationships. Individuals who experience multiple ACEs often struggle with a heightened stress response, making it difficult for them to regulate emotions, trust others, or engage in healthy coping mechanisms. Over time, these unaddressed traumas can lead to a cycle of dysfunction that spans generations, emphasizing the need for early intervention and trauma-sensitive approaches in all areas of social work practice.
The neurological implications of trauma are extensive. Chronic stress leads to hyperarousal, increased production of stress-related neurochemicals, and inhibited neural connectivity. Over time, this alters emotional regulation, social attachment, impulse control, and cognitive processing. The fight-flight-freeze response, which is biologically adaptive in immediate survival situations, becomes maladaptive when chronically activated. These long-term effects help explain why trauma survivors often struggle with impulse control, addiction, mental health disorders, and unstable relationships. Understanding these biological responses is crucial for social workers, as it allows them to approach clients with empathy and insight into their behaviors rather than judgment. By recognizing that many clients are not deliberately engaging in self-destructive patterns but are instead responding to deeply wired survival instincts, practitioners can implement strategies that support healing rather than reinforce negative cycles. Additionally, the ability of the brain to rewire itself through neuroplasticity offers hope that, with the right interventions, individuals can rebuild healthier coping mechanisms and regain a sense of control over their lives.
The Core Principles of Trauma-Informed Care
Trauma-informed care is not a specific therapeutic technique but rather an overarching framework that guides service delivery. The goal is to create environments that foster healing rather than inadvertently retraumatizing clients. This approach is rooted in five core principles: safety, trust, choice, collaboration, and empowerment. These principles provide a foundation for ensuring that clients feel respected, heard, and supported throughout their healing journey. By embedding these values into all interactions, social workers can create an atmosphere where individuals feel safe enough to explore their past traumas without fear of judgment or further harm. This approach recognizes that healing is not linear and that individuals need time and consistent support to unlearn deeply ingrained patterns of fear, avoidance, and self-doubt. Through patience and understanding, practitioners can help clients gradually rebuild their sense of self and navigate their way toward healthier, more fulfilling lives.
Safety
Both physical and psychological safety are paramount in trauma-informed practice. Social workers must create environments that feel secure and welcoming. Simple adjustments, such as warm interactions with office staff, adequate lighting, and clear boundaries, contribute to a sense of stability. Clients who have experienced trauma often struggle with hypervigilance, perceiving potential threats even in benign situations. Ensuring predictability and consistency in interactions helps counteract these fears. Establishing respectful language and professional boundaries further reinforces the message that the social worker’s role is to support, not to exert coercive control. Creating safety also involves understanding the unique needs of each client, recognizing triggers that may cause distress, and working collaboratively to establish coping strategies. This may include offering private meeting spaces, ensuring culturally sensitive practices, and providing opportunities for clients to set their own pace in therapeutic discussions. The goal is to foster a sense of empowerment, where individuals feel secure enough to explore their experiences without fear of retraumatization or dismissal.
Trust
Trust is the foundation of all therapeutic relationships, yet it is often compromised in trauma survivors due to past experiences of betrayal and manipulation. Building trust requires transparency, reliability, and genuine engagement. Social workers should clearly communicate expectations, policies, and confidentiality guidelines to reduce anxiety stemming from unpredictability. Trust is cultivated over time through small, consistent acts of reliability and validation. A simple demonstration of understanding—such as recognizing when a client is struggling without forcing immediate disclosure—can significantly strengthen the therapeutic alliance. When clients feel that their experiences are acknowledged and that they are not being rushed or judged, they are more likely to engage in the process and develop a sense of security within the therapeutic space.
Choice
Choice is a fundamental principle of trauma-informed care, as it seeks to restore a sense of agency that trauma survivors may have lost due to past adverse experiences. Many individuals with trauma histories have faced environments where they had little control over their circumstances, which can lead to feelings of powerlessness and anxiety when making decisions. By incorporating choice into service delivery, social workers enable clients to have a voice in their own healing process. This can include allowing them to decide which therapeutic approaches they prefer, selecting appointment times that suit their needs, or choosing the pace at which they share their experiences. Providing opportunities for informed decision-making helps clients build confidence, reduce resistance, and enhance engagement in their treatment. Social workers can further support choice by validating client preferences, respecting boundaries, and encouraging autonomy, all of which contribute to increased self-efficacy and long-term well-being.
Collaboration
Collaboration is a key component of trauma-informed care, ensuring that the therapeutic process is a partnership rather than a hierarchical dynamic. Many trauma survivors have experienced relationships where power was wielded against them, leading to deep-seated distrust of authority figures. By working collaboratively, social workers reinforce a sense of mutual respect, shared decision-making, and empowerment. Clients should feel actively involved in setting goals, developing strategies, and determining the direction of their care. Encouraging open dialogue, seeking client input, and respecting their insights foster a sense of agency and investment in their healing journey. Collaboration extends beyond the client-worker relationship, often involving coordination with other professionals, family members, and support networks to create a holistic and sustainable healing environment. When social workers emphasize collaboration, they help clients regain control over their lives and build meaningful connections that support long-term recovery.
Empowerment
Empowerment is an essential component of trauma-informed care, as it helps clients reclaim their sense of self and control over their lives. Many trauma survivors experience a profound sense of helplessness, feeling that they lack the ability to influence their circumstances. Social workers play a vital role in reversing this narrative by recognizing and reinforcing clients’ inherent strengths. By providing opportunities for individuals to develop self-efficacy and resilience, social workers help clients rebuild their confidence and assert control over their own healing process. Encouraging self-advocacy, offering skill-building exercises, and celebrating progress—no matter how small—can make a significant difference in a client’s ability to move forward.
Applying Trauma-Informed Principles to Social Work Practice
Integrating trauma-informed principles into social work practice requires a commitment to understanding and responding to the lasting impact of trauma. This means adopting a client-centered approach that prioritizes safety, empowerment, and collaboration. Social workers must continually educate themselves on best practices for working with trauma survivors, ensuring that they offer services that are culturally responsive and attuned to individual needs. It is also critical to advocate for systemic changes that promote trauma-informed policies within organizations, ensuring that all aspects of service delivery align with these principles. By implementing TIC across all levels of practice, social workers can help clients break cycles of trauma and build pathways toward recovery and stability.
Honour-based violence (HBV) represents a pervasive form of gendered oppression rooted in cultural traditions and patriarchal systems. It seeks to control and suppress individual agency, particularly for women and girls, in the name of preserving family or community “honour.” This article explores the narratives of young women in Sweden who have endured HBV, shedding light on their vulnerabilities, the systemic challenges they face, and the role of Swedish social services in providing support and relief.
HBV is not confined to a single culture, religion, or region; it transcends borders and manifests in various forms worldwide. At its core, HBV hinges on the belief that the behavior of women is intrinsically tied to the reputation of their families or communities. For the women subjected to these rigid norms, life is often characterized by a lack of autonomy and agency. They are controlled through restrictions on movement, clothing, education, and social interactions, with severe consequences, including violence, when these norms are violated.
In Sweden, a country that prides itself on gender equality and human rights, the existence of HBV underscores the challenges of integrating diverse populations with varying cultural norms. Estimates suggest that tens of thousands of women and girls in Sweden live under the shadow of HBV, facing threats such as forced marriage, female genital mutilation, and honour-related restrictions. While these numbers highlight the urgency of the issue, they also reveal the limitations of current systems in addressing such deeply ingrained cultural practices.
The study at the center of this discussion focuses on young women aged 18 to 25 who sought help from Swedish social services to escape the grip of HBV. Their narratives provide a vivid picture of the oppressive environments they left behind, as well as the struggles they encountered in their pursuit of freedom. The women described their lives as being tightly controlled by family members, with some recounting experiences of constant surveillance. One woman revealed how her every movement was tracked using bus schedules or even GPS devices, leaving her with no personal space or independence.
The pressure to conform to honour norms extended beyond the immediate family, involving the wider community as enforcers of these standards. Women shared stories of being mocked, shamed, or harassed by neighbors or acquaintances for minor acts of defiance, such as not wearing a veil or attending public swimming pools. These acts of resistance, though small, were seen as affronts to the family’s reputation and often triggered severe backlash.
The decision to seek help from social services was, for many, an act of desperation—a choice made in moments of extreme crisis. For some, this decision came after years of emotional and physical abuse, while others were driven to act by the fear of forced marriage or even death. However, reaching out for help was not without its challenges. The women described the immense psychological burden of breaking family ties, knowing they risked permanent estrangement and even violent retribution. One participant recounted how contacting social services led to threats against her life, as her family viewed her decision as the ultimate betrayal.
Swedish social services play a pivotal role in supporting individuals fleeing HBV, yet their effectiveness is often limited by systemic and cultural gaps. While many women expressed gratitude for the support they received, they also shared stories of frustration and disillusionment. Some women experienced delays in accessing services or felt that their situations were misunderstood by social workers unfamiliar with the complexities of HBV. Language barriers further exacerbated these challenges, with one woman describing how her inability to communicate effectively delayed the assistance she desperately needed.
The quality of placements in sheltered housing or foster families also varied significantly. While some women found solace and security in these environments, others experienced isolation and alienation. One woman compared her foster home to a cold, unwelcoming space, where her emotional needs were overlooked in favor of fulfilling basic physical requirements. She poignantly stated that she would have preferred to live in a refugee camp surrounded by loved ones than to endure the loneliness of her placement.
Despite these challenges, social services also provided life-changing support for many of the women. Thoughtful interventions, such as connecting women with peer networks or providing trauma-informed care, made a significant difference. One participant described the profound relief she felt when a social worker took her fears seriously and acted decisively to ensure her safety. Another woman, who had fled a forced marriage, recounted how social services not only provided her with protection but also helped her rebuild her life, describing the social workers as “angels” who gave her a second chance.
The broader societal response to HBV in Sweden, however, remains inadequate in addressing the root causes of this violence. Prevention and education efforts are critical in challenging the patriarchal norms that underpin HBV. Public awareness campaigns, school-based programs, and community engagement initiatives are essential tools in promoting gender equality and empowering individuals to assert their rights. Yet, these efforts must be coupled with robust support systems that prioritize the needs of survivors.
The study also highlighted the importance of recognizing the psychological toll of HBV on survivors. Many women grappled with feelings of guilt, loss, and identity crises as they navigated their new lives. The emotional strain of severing family ties was compounded by the challenges of integrating into a new cultural context. Social services must take a holistic approach to support, addressing not only the immediate safety concerns of survivors but also their long-term psychological and social needs.
Ultimately, the narratives of these women serve as a powerful testament to their resilience and courage. Their stories reveal the immense strength required to break free from oppressive environments and build independent lives. At the same time, they underscore the urgent need for systemic reforms to ensure that social services are equipped to meet the unique challenges of HBV. By listening to the voices of survivors and incorporating their experiences into policy and practice, Sweden can take meaningful steps toward eradicating HBV and supporting the rights and dignity of all individuals.
Beyond Barriers 