Our NHS People

Talking about trauma

Fallot and Harris 5 guiding principles for Trauma-informed care

A useful framework to have in mind when planning and conducting a conversation about painful past occurrences is offered by Fallot and Harris.

The following guidelines are based on this framework.

  • Safety applies to physical, geographical space (e.g. the building and room; the ‘place’ in which you are speaking) and emotional space i.e. atmosphere and comfort levels, your own and those of the person to whom you are speaking.
  • Consider the nature of your relationship to the person you are concerned about and its possible implications for your conversation.

How might the nature of your relationship affect…

a) Their perceived and actual physical and emotional safety? 

b) Your sense of safety in speaking with them? 

c) Your and their comfort levels? 

  • Ask yourself “In light of my relationship, or lack of relationship, with this what steps can I take to help the conversation go well?”
  • Choose your moment carefully if you are initiating the contact – respect the staff member’s preferences regarding the time, location for the conversation, etc. if you can.
  • Your approach and style should be empathetic at all times.
  • Tune in to their verbal and non-verbal communication.
  • Consider what may have happened to the person rather than what is ‘wrong’ with them, (but remember, don’t make the person dwell on anything – let them lead with what they wish to talk about).
  • Recognise that where a person’s displays challenging behaviours and responses, this may be their attempt to protect themselves and to cope with stress.
  • Listen to and validate the person (don’t talk over them or contradict them).
  • Not knowing what to say can be a positive. Sometimes words don’t help when responding to deep distress. It’s okay to say; “I don’t know what to say”.
  • When you listen compassionately, tune in, you are present and express your support through your non-verbal communication, you will help the person feel safe. 
  • Recognise signs of stress (which may take the form of visible agitation, such as accelerated pace, raised voice OR silence, glazed expression and ‘shut down’). If you can – often by allowing a pause or break – gently help them restore equilibrium if their stress levels become high.
  • If the person initially says they are “okay”, but you are still concerned, you can gently ask a second time as the first response may be automatic. Do not persist if the person is reluctant or insistent.
  • Don’t give advice unless you are asked for it (e.g. avoid saying “Have you tried…?”)
  • Inquire about who the person might call upon for the kind of support they need, and be prepared to signpost relevant services such as Occupational Health or Psychological Support where appropriate.
  • Try to ensure the person does not leave the conversation in a distressed state.
  • Remember that the way in which you interact with the person (and not just what you say/do) is important for their safety. Being able to recognise the signs of stress and being able to help them to reduce their distress builds confidence and is mutually protective).

Often, the most reassuring support you can offer is to simply be with the person. Don’t try to fill the space with words, which often falls flat. Words imply that you know what the person is experiencing when you don’t. This can make them feel less safe. 

A reminder. You are not expected to diagnose or treat trauma. Your role as a leader is to create compassionate confidential spaces for people to talk to you when they wish to, and to help people seek more specialised help should you both agree it might help. If the person you are leading refuses help, but you are very worried about them, your Occupational Health team and/or Human Resource team can advise you.