Trauma - SWEET INSTITUTE - Continuing Education for Mental Health Professionals

Engagement and Trauma: Building Safety and Trust in Populations with High-Acuity Needs

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Sat, 24 Jan 2026 12:28:34 +0000

Authors Frederick Shack, LMSW1,4 Mardoche Sidor, MD1,2,3 Gary Jenkins, MPA1 Jose Cotto, LCSW1,5 Karen Dubin, PhD, LCSW2,4 Lesmore Willis Jr, MPA, MHA1 Affiliations 1Urban Pathways, New York, NY 2SWEET Institute, New York, NY 3Columbia University Center for Psychoanalytic Study and Research, New York, NY 4Columbia University, School of Social Work, New York, NY 5New York University, Department of Social Work, New York, NY Correspondence concerning this article should be addressed to Mardoche Sidor, MD, Urban Pathways, at msidor@urbanpathways.org Abstract Trauma profoundly shapes how individuals perceive safety, relationships, and systems of care. In supportive housing and community mental health, residents with trauma histories often present with mistrust, withdrawal, or conflict that can be misinterpreted as “non-engagement.” This article examines how the Four-Stage Engagement Model—Sitting, Listening, Empathizing, Collaborating—creates safety and trust for populations with high-acuity needs. Drawing on trauma theory, polyvagal science, and recovery research, we highlight how engagement restores relational security, counters retraumatization, and promotes healing. Composite case studies from Urban Pathways illustrate trauma-informed engagement in practice. Keywords Engagement, Trauma, Safety, Trust, Populations with High-Acuity Needs, Trauma-Informed Care, Polyvagal Theory, Supportive Housing Introduction Populations with high-acuity needs, including individuals experiencing homelessness, serious mental illness, and substance use disorders, are disproportionately impacted by trauma (Hopper et al., 2010). Trauma alters stress regulation, fosters hypervigilance, and erodes trust in relationships and systems (van der Kolk, 2014). Staff often misinterpret trauma-related behaviors as resistance or disinterest. The Four-Stage Engagement Model reframes these behaviors as protective adaptations and provides a relational framework for rebuilding safety and trust. Theoretical Framework Engagement and trauma-informed care intersect through: Polyvagal Theory: Safety and co-regulation restore autonomic balance (Porges, 2011). Trauma Theory: Trauma fragments trust and requires corrective relational experiences for repair (van der Kolk, 2014). SAMHSA’s Trauma-Informed Principles: Safety, trustworthiness, empowerment, and collaboration guide systemic care (SAMHSA, 2014). Attachment Theory: Consistent relational presence repairs disrupted attachment patterns (Siegel, 2012). Application/Analysis At Urban Pathways, staff are applying trauma-informed engagement by: Sitting: Learning to provide calm, non-demanding presence that reduces hyperarousal. Listening: Learning to validate traumatic narratives without rushing to problem-solving. Empathizing: Learning to offer unconditional positive regard to counter internalized stigma. Collaborating: Learning to co-create goals that respect trauma history and current level of preparedness. Composite Case Example: A resident with repeated violent outbursts was initially labeled “non-compliant.” Staff reframed the behavior as trauma-related hypervigilance. Through consistent sitting and empathic presence, the resident began to trust staff; and this is expected to be followed by reduced crises and increased participation in collaborative planning. Implications Practice: Engagement strategies are to be trauma-informed to avoid retraumatization. Supervision: Reflective supervision is to support staff in managing countertransference with trauma-affected residents. Policy: Programs ought to mandate trauma-informed engagement as a standard of care. Research: Studies need to measure the impact of engagement on trauma recovery outcomes. Systems: Trauma-informed engagement needs to extend across all staff roles, not only clinicians. Conclusion Trauma is not only a clinical diagnosis but a relational reality. The Four-Stage Engagement Model provides a roadmap for restoring safety and trust in populations with high-acuity needs, transforming engagement into a trauma-informed healing practice. References Hopper, Elizabeth K., et al. “Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings.” The Open Health Services and Policy Journal, vol. 3, no. 2, 2010, pp. 80–100. Porges, Stephen W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. Norton, 2011. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication, 2014. Siegel, Daniel J. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. 2nd ed., Guilford Press, 2012. van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014. This article is part of a collaboration between SWEET Institute and Urban Pathways. Read the full scientific version HERE

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How to Escape from Trauma

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Wed, 24 Mar 2021 14:00:00 +0000

Trauma is characterized by fear, and by terror. And the way out of fear is by giving up our attack thoughts. Other than that, nothing else will work. If this sounds absolute, it is because it is. For our response to trauma is thought. Our reexperiencing of trauma is also thought. And whatever we may try to do to escape from our trauma is always thought-based. Yet, we are using the actual cause of the problem to solve the problem, without addressing the actual cause. In other words, the cause of anything that takes place in trauma is “thought,” the solution to anything related to, or that takes place in trauma must be thought and thought alone. Everything else is meaningless. And whoever has any doubt on this can go ahead and continue to do whatever they’ve been doing for the past 10 years and see if there will ever be any result different from what they have gotten so far. It will not be any different until the real problem is addressed. And the real problem is in our thought [1]. Everything else is meaningless, regardless of how much meaning we’ve been assigning. The Reality is that every thought we generate makes up some segment of everything we perceive in ourselves, others, our surroundings, our life, and in the world [2]. Can you see how we cannot pretend to escape from trauma if we don’t give up our attack thoughts? It matters little how much people around us rearrange things to make us more comfortable and accommodated. It matters little how many techniques we have to deal with our intrusive thoughts, our nightmares, our flashbacks, or with our hypervigilance. It does not matter how good these techniques are. They only work short term, and partially, and we know that [3]. We have experienced that with our patients. Short-term relief to their symptoms of trauma. This is so because everything on the outside is merely the effect of our thoughts. This is so because everything we experience in our life is the result of our thoughts. Now, if this piece of insight makes anyone of us lament, we ought to understand that this again would be our thought in the making. When we pay attention to what’s going on around us, to our surroundings, our triggers, our circumstances or our situation, we are also paying attention to ourselves; the maker of all these images we are see in the world. It is all Projection. Things do not come from the outside-in, rather, they go from the inside-out. Things originate in our thoughts, and while we may have spent all our life believing the contrary, it is now time for us to make the shift. If we are truly want to escape from “trauma,” we do this by giving up our attack thoughts. End of story. When we are ready to give up our attack thoughts, we first do so by putting an end to judging or criticizing ourselves, others, situations, or the world. We give up our attack thoughts by putting an end to hating or condemning ourselves, others, situations, or the world. We give up our attack thoughts by putting an end to resenting ourselves, others, circumstances, or the world. We are not trapped in our “trauma.” The cause of our “trauma” was never in any event, situation, or circumstance, to start with. The cause has always been our own thought before the event, during the event and after the event. And the cause can be changed, and we can learn how to do this. If you are a clinician would like to learn how to best help your patients escape from trauma, then join us on Friday, April 9th, for our 6 CEU full-day webinar on Trauma. Click here to register, and We will see you then,Karen and Mardoche [1] Eva Keiffenheim, MSc. “To Transform Your Life, Start Changing Your Thoughts.” Medium, Change Your Mind Change Your Life, 24 May 2020, medium.com/change-your-mind/to-transform-your-life-start-changing-your-thoughts-fc0efc423b69. [2] Morin, Amy. “This Is How Your Thoughts Become Your Reality.” Forbes, Forbes Magazine, 15 June 2016, www.forbes.com/sites/amymorin/2016/06/15/this-is-how-your-thoughts-become-your-reality/?sh=420c561528a0. [3]Foa, Edna B et al. “Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD.” Psychological science in the public interest : a journal of the American Psychological Society vol. 14,2 (2013): 65-111. doi:10.1177/1529100612468841

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Trauma and Education

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Wed, 17 Mar 2021 14:00:00 +0000

It is not the trauma. It is not the traumatic event. It is not what happened. This may sound cruel and insensitive, especially given the collectively held belief that suggests that it is, but we know that this belief has been detrimental in our lives. If nothing that takes place in our life is a result outside our thoughts, and if noting that we experience is outside the effects of our thoughts, then how we respond to whatever takes place in our life cannot be the result of what happens in our life, rather, the result of our thoughts. [1] If we think about it, there is nothing more empowering, transformative, freeing, and more liberating than this single piece of insight and awareness. If you think about this, this piece of insight cuts through all the clutter and goes straight to the heart of the matter. Most people do not really know what arouses their anger, their fear, or their impulsive behaviors. Most people only try to make sense of them and often associate their emotions with something salient in their brain – a past “trauma,” a past “traumatic event,” a situation, or circumstance [2]. Yet this is because the essence of what really is, of how things really work, of who we really are, and of what it means to be a human being, lies outside of our awareness. We spend decades in school, either in formal college, university, or in trade school, then get a job, earn money, raise a family, accumulate things, retire and die. As a society, we have agreed that this is how things work, and we have all been working hard to maintain this way of being. However, this has been detrimental to most of us. For we have not truly been educated. We have not learned how to think, and the decades we spend in school are spent accumulating information, almost all of which has been part of our collective programming [3]. This has had a profound effect on: How we think about health, including physical and mental health How we understand life Our understanding of who we are What it means to be a human being What we think truly matters How Life truly works Our relationship with others and the rest of the world How all this has been playing out with our patients is that we have been supporting the belief that what happened to them in the past is the single most significant determinant of the rest of their life. In doing so, we have stripped them of their nature as human beings. We have made them believe that they are weak; that life is against them; that they are the victims of outside circumstances; and they’ll have to spend the rest of their life, “working out” something that happened to them 40 years ago, or when they were 10 years old, or 3 years old. We have given them a death sentence when we think we are helping them. Of course, because this has been part of the collective belief, it sounds “normal.” In fact, the opposite has been regarded as “abnormal.” In other words, we have been led to believe that it is abnormal to face a situation, and respond to it in a way that helps us grow. The concept of growth mindset is foreign to us when working with this patient population. Instead, we adopt a fixed mindset, and, as a result, they have come to understand that what is going on right now with them, their anger, their emotions, their intrusive thoughts, are because of a “traumatic event,” and this it will be for the rest of their life. We teach them to manage their symptoms rather than to live their lives fully and completely. Today, we are raising the bar, we are taking a stand to help cease suffering throughout the world, and it all starts with raising the awareness. It all starts with making sure that all of us clinicians and all patients we serve, know the following: Our perception of a situation and not the situation itself, determines the feelings and behaviors that follow, as it is well explained in CBT We are never upset for the reason we think we are Feelings come from our associated thoughts and not from “things,” people, events, situations, or circumstances The way we respond to anything has nothing to do with how “bad,” or how “good” such a thing is; rather, on the meaning we assign to such a thing Every thing, everyone, every situation, event, or circumstance is neutral, and we and only we, g assign meaning to it Once we change the meaning we assign to anything, we change how we focus on it, which changes our associated thoughts and therefore, our feelings The type of meaning we assign to things is determined by how we are perceiving them, which, is determined by our overall attitude and beliefs, which, in turn, are decided upon by our level of consciousness. What is needed then is to raise our level of consciousness, and help our patients do the same. Then and only then can we see a decrease in suffering in our current patient population affected by “trauma.” Would you like to learn how to best do so? Then join us on Friday, April 9th for our 6 CEU Full Day Webinar on Trauma. Click here to register, and We look forward to seeing youKaren and Mardoche [1] Morin, Amy. “This Is How Your Thoughts Become Your Reality.” Forbes, Forbes Magazine, 15 June 2016, www.forbes.com/sites/amymorin/2016/06/15/this-is-how-your-thoughts-become-your-reality/?sh=420c561528a0. [2] Harms, L., Talbot, M. The Aftermath of Road Trauma: Survivors’ Perceptions of Trauma and Growth, Health & Social Work, Volume 32, Issue 2, May 2007, Pages 129–137, https://doi.org/10.1093/hsw/32.2.129 [3] Hough, Lory. “What’s Worth Learning in School?” Harvard Graduate School of Education, www.gse.harvard.edu/news/ed/15/01/whats-worth-learning-school.

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Violence Risk Assessment: What it Really Entails

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Sun, 16 Jun 2019 11:00:00 +0000

While additional tools might help with the implementation of this decision making process, a multidisciplinary team-based discussion around making this decision is a crucial part of this approach. It is well known that the tools do not replace sound clinical judgment, but using these in combination—team discussion, sound clinical judgment and best tools—for immediate decision-making is…

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The Silence of Trauma

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Wed, 02 Jan 2019 11:00:00 +0000

Millions of individuals are affected by the sequelae of trauma, many of them, in silence. The effects of chronic trauma tend to be cumulative, because each event serves as a reminder of the prior trauma and reinforces its negative impact. A child or adolescent who has been exposed to a series of traumas may become increasingly inundated with each subsequent event and more convinced that the world is not a safe place.

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The Color Purple And The Patients And Clients We Serve: A Psychiatrist’s Perspective, Part IV

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 11 Oct 2018 10:00:00 +0000

“Love is all we need,” were the first five words Maya said to me, as she took her usual seat in my office. And as usual, my response to these kinds of doorknob comments was silence, as I waited for her to continue. I allowed the time for Maya to organize her thoughts and then she added, “I think I am Celie and I have found my Shug, and I now feel empowered and liberated.”

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The Color Purple And The Patients And Clients We Serve: A Psychiatrist’s Perspective, Part III

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Tue, 09 Oct 2018 10:00:00 +0000

In this third article, we will elaborate on two more essential points from the movie, The color purple, an epic drama I think every public and community health clinician, advocate, and social work service worker should see.

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The Color Purple And The Patients And Clients We Serve: A Psychiatrist’s Perspective, Part II

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 04 Oct 2018 10:00:00 +0000

The Color Purple illustrates the lives of so many patients I have had the privilege to serve in the public sector, in such a way that I felt compelled to write about it. We already described two salient points, child abuse and survival mode. In this current article, we are going to describe two additional ones.

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