Not repeating harm
in services.
I’ve told my story to forty professionals. Why does every new one need it?
How services, including therapy, can repeat experiences of harm, and what choice and information by default look like.
What this is: a practical guide to resisting re-traumatisation.
Why it matters: for many disabled people, services have been a source of harm.
The sharpest reframe: the room and the routine can repeat harm, not just the conversation.
One thing to take away: give information and choice by default.
Content note: this page mentions restraint in services, without detail.
The short version
SAMHSA’s fourth R is resisting re-traumatisation. For many disabled people, services themselves have been a source of harm: being restrained, handled without consent, examined in front of others, disbelieved, made to retell painful histories, or left without information about what will happen. Therapy can repeat these patterns in small ways: a closed door, a fixed chair, a sudden reach, an unexplained silence, a referral letter shared without asking. Resisting re-traumatisation means looking at the service’s own routines, giving information and choice by default, and agreeing in advance what will happen if someone becomes distressed.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Resisting re-traumatisation
Established theorySAMHSA’s framework names resisting re-traumatisation as one of the four Rs of a trauma-informed approach: services should recognise how their own practices, often unintentionally, can repeat the experience of harm, and change them.
Fintan is 30, autistic, and has a mild learning disability. In his early twenties he spent two years in a residential unit, where he was restrained several times. He now lives in supported housing and has been referred for counselling because of anger and sleep problems. At his first session, the counsellor closes the door, sits between him and it, and asks him to “tell me a bit about your history”. Fintan stands up and leaves.
Fintan is a fictional teaching example, not a real person.
Routines that can repeat harm
Our frameworkThe room
A closed door, the therapist between the client and the exit, a chair that can’t be moved, no way to adjust light or noise.
The body
Unexpected touch, standing over someone, reaching towards them, physical checks without explanation.
Information
Not knowing how long a session lasts, what will be asked, what is written down, or who sees it.
Retelling
Being asked for a full history at the start, or again by every new professional.
Disbelief
Accounts of harm doubted, softened or attributed to the person’s disability.
Responses to distress
Restraint, raised voices, crowding, or calling for help without telling the person what is happening.
Choice and information, by default
Practice- Let the person choose where to sit, and whether the door is open.
- Explain the session before it starts: how long, what might be asked, how to stop, what will be written down, who can see records in this service, and the limits of confidentiality, in accessible form.
- Don’t require history. Ask what the person wants to share today. Use existing records only with consent.
- Agree a distress plan in advance: what helps, what doesn’t, who should be called, and what nobody should do.
- Ask before any touch, and accept no. See Touch & Consent.
- Offer accessible information: easy-read, visual timetables, a written summary afterwards.
- Look at the service’s own policies, including on restraint and information-sharing, not only at individual sessions.
See also Power, Access and the Therapy Frame and Medical Trauma & Body Ownership.
What it might sound like
(at a second attempt, with Fintan’s support worker present) Fintan, last time I got things wrong. I closed the door and sat in front of it. This time, you choose where to sit and whether the door is open.
Open. I sit there.
Okay. Today is thirty minutes. I won’t ask about your history. You can stop any time by saying stop or showing this red card.
What do you write down?
Just a few words about what we talk about, and I’ll show you. The notes are kept on the service’s secure system. My supervisor and some colleagues here can see them. There are a few situations, like a serious risk to you or someone else, where I’d have to share information; where I can, I’d tell you first. Here’s an easy-read sheet about how it works in this service.
The repair, and what it changes: the counsellor names her mistake and changes the room, the information and the pace. Fintan comes to all six sessions. In the fourth, he chooses to mention the residential unit, briefly. He says the red card was the most important thing, though he never used it. Not everything settles: by the fifth session, thirty minutes feels too short some weeks and too much on others, so they agree he will choose the length at the start of each session.
What needs attention here?
Someone leaves or refuses at the start
Possible focus: what in the room or routine might be repeating harm
Watch for: reading it as non-engagement
The service asks for full histories
Possible focus: whether that is needed, and asking consent
Watch for: requiring retelling
Distress escalates
Possible focus: the agreed plan, information and space
Watch for: crowding or restraint
A person has been harmed by services
Possible focus: how this service’s own routines could repeat it
Watch for: focusing only on their reactions
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The person knows what will happen, and can stop it.
- The room and routines are adjusted, not only the conversation.
- The person doesn’t have to explain why they need choice.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- What in my room or routine might repeat someone’s experience of harm?
- Do I ask for history because I need it, or out of habit?
- Do I have an agreed plan for distress, made with the person?
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 as part of a trauma-informed approach: SAMHSA (2014), SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.
The routines that can repeat harm and the default practices are this site’s synthesis.
Fintan and the dialogue are constructed for learning. He is not a real person.
We have not located research on re-traumatisation in psychological therapy for disabled people who have experienced restraint.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Not Repeating Harm in Services. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/not-repeating-harm-in-services/ (Accessed: [date]).