The Community Acupuncture Setting and Trauma Informed Care
Acupuncture will not be an effective treatment for everyone with PTSD or everyone with a trauma history, because no one treatment works for every person. The community acupuncture setting will not necessarily be reassuring for everyone with PTSD or everyone with a trauma history, because everyone’s triggers are different. The purpose of the setting, therefore, is not to try to meet the needs of every individual, but to decrease the possibility for re-traumatizing encounters across the board.
Becoming trauma informed is not easy, and it’s an ongoing process. Particularly in healthcare settings, it can be both countercultural and daunting. There is always a learning curve. And for practitioners, that curve can be uncomfortable because everyone who tries inevitably becomes painfully aware of people they’ve failed. Most of us who work in healthcare have probably re-traumatized someone at some point, either because we didn’t know any better at the time or because structures we had no control over made it unavoidable. In the process of becoming trauma informed, everyone needs whatever help they can get. The community acupuncture setting is intended to help by taking some of the burden off of the individual practitioner.
Acupuncturists are not trained as mental health therapists, and yet we can readily slip into that role. Diet and lifestyle counseling can easily become counseling, period. New practitioners who feel uncertain about their needling skills can try to make up for it by being a supportive listener. Sometimes this works out OK, and sometimes it doesn’t. Considering what the ACE study suggests about the prevalence of trauma, it’s risky for everyone involved when acupuncture treatment crosses the line and becomes something resembling mental health therapy without either the patient or the practitioner fully realizing and clearly consenting to it. The community acupuncture setting, in general, makes it harder for this to happen.
From this perspective, the fact that there is limited time to talk in a community acupuncture setting is a good thing. If acupuncturists aren’t talking, we can’t say anything inadvertently hurtful, judgmental, or coercive to our patients. Many micro aggressions are verbal, and so a mostly nonverbal interaction can steer clear of them; a clinic with less room for micro aggressions is potentially more inclusive to more people. If we don’t have an opportunity to give lifestyle advice or to ask potentially invasive questions, the odds of us disempowering or embarrassing our patients go way down.
As an acupuncturist, if you are alone in a room with a patient who is lying face down on a table and partially or wholly undressed, talking about sensitive topics at the same time you are inserting needles into their skin, there are a thousand ways for you to screw up if that patient happens to have a trauma history. There are egregious ways and subtle ways, there are sins of omission and sins of commission, and all of them are not only available to you in that setting, they are amplified by it. And even if you don’t screw up, acupuncture itself can trigger a PTSD reaction for the patient while they are in an acutely vulnerable position relative to you. In short, the one on one setting puts a lot of pressure on the individual practitioner.
On the other hand, if you are a practitioner with a trauma history of your own, being alone in a room with a patient who is partially or wholly undressed can be challenging. There are widely reported anecdotes of male patients in acupuncture school clinics seeking out female student interns for the purpose of exposing themselves. Beyond such flagrant episodes, the setting can simply be confusing for patients with respect to interpersonal boundaries. This ambiguity can create a lot of anxiety for a practitioner with a trauma history, in addition to the pressure that the setting puts on every practitioner.
It is undoubtedly possible to provide trauma informed acupuncture in a one on one, non-community setting. It would require a lot of work, and it would of course look different from how trauma informed acupuncture looks in a community setting. Community acupuncture is uniquely suited to providing trauma informed care because the clinical environment itself both protects the practitioner and does much of the work of creating “social safety”.