Medical and procedural trauma:
when care is still needed.
I don’t need to forget the last time. I need March to be different.
How necessary medical care can still be traumatic, how several truths can stand together, and how to make the next appointment more manageable.
What this is: a guide to medical trauma when further care is needed.
Why it matters: many disabled people must keep returning to the settings that frightened them.
The sharpest reframe: the aim may be the next appointment, not only the last one.
One thing to take away: write the plan with the person, and review what actually happened.
Content note: this page discusses medical procedures, including painful and intimate ones, without graphic detail.
The short version
Medical care can save lives and still be experienced as traumatic: pain, frightening uncertainty, exposure, being restrained or held still, separation, not being told what is happening, being talked about instead of to, being disbelieved. Several things can be true together: the treatment helped, people meant well, the person was frightened or violated, there were few alternatives, and better explanation, consent or pain relief might have made a difference. For many disabled people, the hardest part is that more care is still needed. Therapy may aim at making the next appointment more manageable, not only at processing the last one. This page sits alongside the site’s main Medical Trauma page.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Several truths at once
Our frameworkThe treatment helped
It may have been necessary, even life-saving.
People meant well
Staff may have been doing their best under pressure.
It was frightening or violating
The person’s experience is real, whatever anyone intended.
There were few alternatives
Some procedures can’t be avoided or made painless.
It could have been different
Better explanation, consent, pain management or support might have changed the experience.
Nobody should have to describe healthcare as wholly harmful, or wholly good, to have their experience taken seriously.
Experiences that often come up
Our framework- Childhood procedures, especially when a child was held still or separated from parents. See Medical Separation and Attachment.
- Intimate examinations, and being examined in front of students or others.
- Repeated bodily handling: turning, positioning, lifting.
- Being spoken about rather than addressed.
- Reminders tied to particular rooms, smells, equipment or phrases (“just a sharp scratch”).
- Fear of future care that is still necessary.
Saorla is 31, uses a wheelchair, and has had many painful procedures since childhood. She has a cystoscopy booked in two months. She tells her therapist she wants help to get through the appointment. The therapist begins with breathing-based grounding. Saorla becomes more uncomfortable: focusing on her body makes her feel trapped.
Saorla is a fictional teaching example, not a real person.
What the work involved
Illustrative sequenceI can see that made it worse. I think I offered the wrong thing. What did I miss?
Focusing on my body is the problem. The worst part of appointments isn’t pain. It’s being positioned and examined without knowing what comes next.
Then maybe what would help is information and control during the appointment, more than something to do with your body. What would you want?
Someone to tell me each step before it happens. A word that means stop. And for them to talk to me, not over me.
Together they:
- separate earlier memories from what she fears about this appointment;
- agree what she wants help with: getting through this cystoscopy with as much control as possible;
- explore her current symptoms without asking for detailed accounts of past procedures;
- write a one-page appointment communication plan;
- consider, with her, whether trauma-focused treatment might help later (she decides: maybe, after this appointment);
- plan how to review both her symptoms and how the appointment actually went.
An appointment communication plan
PracticeSaorla’s plan (example)
- Please talk to me, not to my PA or about me.
- Tell me each step before you do it, including positioning and touch.
- My stop word is “pause”. If I say it, please stop and check with me.
- What helps: knowing how long each part lasts; my headphones in between steps; one person speaking.
- What doesn’t help: “just relax”; being turned without warning; students watching without my agreement.
- Pain relief: I’d like to discuss options before we start.
The plan was sent to the clinic in advance, with her consent, and she brought a copy.
Practical questions for the plan
The therapist can help prepare these; the clinical team must say what is feasible.
- Who has received the plan, and has anyone acknowledged it?
- What does “pause” mean during this particular procedure? Are there steps that can’t be interrupted immediately, and has that been explained in advance?
- Who will communicate for her, or with her, if she can’t use her usual method?
- What happens if the plan is ignored, and who can she tell?
- How will she decide whether, and with whom, to follow up afterwards?
Preparing a plan doesn’t make the disabled person responsible for preventing the next failure. The team is responsible for how she is treated.
Afterwards: a mixed result
Illustrative sequenceThe nurse read the plan and told Saorla each step. The consultant didn’t, and turned her without warning once. She said “pause”, and he stopped, apologised, and explained. Saorla says it was “the least awful one I’ve had, and still awful in places”.
The formulation changes: the core of her distress is loss of control and information, more than pain or bodily sensation. Future work focuses on that, including writing to the consultant’s team about what helped. She decides to wait before considering trauma-focused treatment.
One possible formulation, developed with Saorla
Our frameworkSituation
An intimate medical procedure is approaching.
Main concern
Being positioned and examined without information.
Response
Fear, and a sense of being trapped.
Earlier therapeutic assumption
Body-focused calming would help.
What changed that assumption
Saorla explained that attention to her body increased her distress.
Chosen focus
Information, step-by-step communication, a pain-relief discussion and an agreed pause word.
Review
Both her distress and what staff actually did.
This stays open to revision. After the appointment, the main concern was confirmed and one new one was added: the consultant, not only the procedure.
What needs attention here?
A necessary procedure is coming
Possible focus: making it more controllable, with the person
Watch for: processing the past only
A body-focused technique increases distress
Possible focus: stopping, and asking what was missed
Watch for: persisting
The person describes care as both helpful and harmful
Possible focus: holding both
Watch for: pushing them to choose
The appointment goes partly badly
Possible focus: revising the formulation from what happened
Watch for: treating it as failure
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The person feels more control in the next appointment, even if it is still hard.
- Their experience is taken seriously without having to call healthcare all bad.
- The formulation changes in light of what actually happened.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Am I aiming at the past only, when the person needs help with the next appointment?
- Did I check whether a body-focused technique suits this person?
- Have I let several truths about their care stand together?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Resisting re-traumatisation, and empowerment, voice and choice: SAMHSA (2014), SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.
The several truths, the appointment communication plan and the reading of the case are this site’s synthesis. See also Medical Trauma.
Saorla, the dialogue and the plan are constructed for learning. She is not a real person.
We have not located research on appointment communication plans for disabled adults with medical trauma.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Medical and Procedural Trauma: When Care Is Still Needed. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/medical-and-procedural-trauma/ (Accessed: [date]).