Cultivating Trust: A Trauma-Informed Approach to the Therapeutic Alliance

Prairie Doc Perspective Week of March 1st, 2026
Cultivating Trust: A Trauma-Informed Approach to the Therapeutic Alliance
By Patti Berg-Poppe, MPT, Ph.D. and Shana Cerny, OTD, OTR/L, BCP


Health care professionals enter every patient encounter with the goal of helping individuals heal, yet many don’t realize how often past adversity shapes the way a person experiences care. Trauma, whether from childhood experiences, medical procedures, accidents, interpersonal harm or environmental conditions, doesn’t remain a distant memory. It becomes embedded in the body through biobehavioral adaptations that influence posture, muscle tension, breathing patterns, nervous system sensitivity and low body safety. When we understand that trauma lives not only in stories but also in tissues and reflexes, we begin to see why a trauma-informed approach is essential for building trust.


Trauma and adverse experiences are more common than we may realize. More than two-thirds of the patients that health care providers encounter in practice are likely to have experienced trauma in some form. Trauma‑informed care should be a universal precaution, guiding providers to assume that any patient may have a history of adversity, even if it is never disclosed. This mindset shifts the focus from “What’s wrong with you?” to “What’s happened to you, and how is it affecting your health today?” For clinicians who rely on touch, such as physical and occupational therapists, physicians, nurses and primary care professionals, this awareness is especially important. Touch can be grounding and healing, but it can also activate the sympathetic nervous system, triggering a stress response before a patient has words to explain why.


Trust becomes the foundation of the therapeutic alliance, and trust is built through safety, predictability and respect. Trauma‑informed practice encourages providers to slow down, explain what they are doing and invite patients into shared decision‑making. Simple actions, such as asking permission before touching, checking in about comfort, offering choices and being transparent about what comes next, signal to the nervous system that the environment is safe. These small shifts can reduce physiological stress responses and create space for true healing.


Research on trauma‑informed health care highlights how past adversity can influence patient engagement, adherence and outcomes. When patients feel overwhelmed, misunderstood or rushed, they may appear “non‑compliant,” when in reality their nervous system is doing its best to protect them. A trauma‑informed lens helps clinicians interpret these reactions not as resistance but as communication. It encourages us to look beyond the symptom in front of us and consider the whole person, including their history, their stress load, their strengths and their goals.


Holistic care means recognizing that physical symptoms rarely exist in isolation. Pain, fatigue, dizziness and muscle tension often have emotional and neurological components. When providers acknowledge this mind‑body connection, patients feel seen rather than dismissed. They’re more likely to share concerns, ask questions and participate actively in their care. This collaboration strengthens the therapeutic alliance, which research consistently links to better health outcomes across disciplines.


Trauma‑informed practice is not a specialty; it’s a skillset. It requires curiosity, humility and a willingness to adapt. It asks clinicians to be mindful of their tone, body language and pace. It reminds us that healing happens in relationships, and that every interaction, every moment of touch, every explanation, and every pause can either reinforce safety or erode it.


When we approach patients with the assumption that their bodies carry stories we cannot see, we create conditions where trust can grow. And when trust grows, so does the capacity for healing.


Patti Berg-Poppe, MPT, Ph.D., is a physical therapist, professor, and Chair of the Department of Physical Therapy at the University of South Dakota. She has published on trauma‑informed care, including work examining how adverse childhood experiences influence patient engagement and how trauma‑aware practices can strengthen therapeutic relationships. Her writing and teaching emphasize the importance of trust, safety and respectful communication in all health care interactions. Shana Cerny, OTD, OTR/L, BCP, is an occupational therapist and associate professor in the Department of Occupational Therapy at the University of South Dakota. Her research, service and teaching interests revolve around trauma-informed care, including publication of practice guidelines for trauma-informed occupational therapy, interventions for individuals after exploitation, and the effectiveness of a trauma-informed care curriculum for multi-disciplinary care providers. She is a Trust-Based Relational Intervention® Educator and co-creator of the Child & Adult Advocacy Studies graduate certificate at the University of South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

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