Most therapists have encountered trauma-informed practice as a framework. Fewer have considered what it means when the client is a violinist who can no longer hold a bow, or a golfer whose putting stroke has become unrecognisable to them.
The translation is not obvious, and getting it wrong in this population is easy — in both directions. This article is an attempt to set out what the framework actually asks of us here.
Sign up here to receive future blogs, insights, and updates from us.
The framework, briefly
The widely used definition sets out four assumptions: realising the prevalence and impact of trauma, recognising its signs, responding by integrating that knowledge into practice, and actively resisting re-traumatisation (SAMHSA, 2014). Six principles follow: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and attention to cultural, historical and gender issues.
Note what this is and is not. It is a stance, not a modality. It does not require that you deliver trauma therapy, or that trauma be discussed at all. It asks that your practice be organised so that it does not replicate the dynamics of the experiences your clients are carrying.
Why performers specifically
Three features of this population make the framework unusually relevant.
Early specialisation. Elite musicians and athletes typically begin serious training in childhood, during the years when the nervous system is still forming its basic regulatory patterns. Whatever the emotional conditions of that training were, they were laid down in developmentally significant time. The brain is not fully mature until the mid-to-late twenties, and much of what it needs during that long window is appropriate attunement from the adults present.
Identity fusion. For most people, work is something they do. For performers, the skill is generally experienced as constitutive of the self. Losing it is therefore not an occupational setback but something closer to annihilation — which is why the distress accompanying performance difficulties is so frequently underestimated by clinicians who have not worked with this group.
The pedagogical culture. This is the one I want to name directly, because it is rarely acknowledged in the literature and it is doing a great deal of work.
A large proportion of high-level training operates on what I call the Oppression Model: large goals accompanied by the message that you have little merit until you reach them; focus on outcome rather than process; the confusion of technical ability with self-worth; criticism, comparison and competition as standard method; practice driven by willpower and control rather than curiosity; long forced repetition that overrides fatigue and pain; and no safety for exploration or mistakes. There is an external measure of right and wrong that systematically invalidates the person’s own inner experience.
Read that list against the six principles above. It is close to a point-by-point inversion of them. Many of the clients you will see spent their formative years inside it, and — this is the part that matters clinically — they generally do not experience it as adverse. It is simply how learning felt. The undercurrent is invisible from the surface, and many people have swum with it for so long that they no longer notice the pull.
Attunement is the mechanism, not the atmosphere
Trauma-informed practice can be taught as a set of procedural adjustments — clear contracting, predictable structure, choice about pacing. These matter. But the active ingredient is relational, and it is physiological rather than attitudinal.
Children develop the capacity to regulate their own emotional states through repeated experience of being regulated by an attuned adult. Very small children cannot soothe themselves; they need someone calm and internally quiet enough to sense what they are feeling and respond to it (Schore, 1994). Lewis, Amini and Lannon (2000) named the mechanism in three parts: limbic resonance, in which nervous systems measurably affect one another; limbic regulation, in which they synchronise over time to establish lasting emotional tone; and limbic revision, in which patterns not established early can be modified later through relationship. Coan and colleagues (2006) demonstrated the effect directly — the neural threat response measurably reduces when a trusted other is holding your hand.
This is why your own regulation is a clinical variable and not merely good self-care. In this work, the primary instrument is your nervous system. A practitioner who is subtly activated — by the client’s distress, by the pressure to produce results, by their own performance history — is offering a system that cannot be safely referenced.
Working within the window
The practical discipline that follows is pacing. Siegel’s (1999) window of tolerance remains the most useful frame: the band of activation within which a person can process experience without tipping into hyperarousal or shutdown.
With performers there is a particular trap. They are exceptionally good at tolerating discomfort — that capacity is precisely what made them successful — and will therefore push far past their actual limits while reporting that they are fine. The presentation is compliant and the system is overwhelmed. You cannot rely on self-report here; you have to read the body.
The corollary is that the work happens at the edge of the window rather than inside it or beyond it. Too far in and nothing changes. Too far out and you are reinforcing the very pattern of override that brought them to you.
What trauma-informed practice does not mean here
Three cautions, because the framework is easy to over-apply.
It does not mean assuming a trauma history. Not every performer has one. Adverse early experience is associated with lasting physiological effects (Felitti et al., 1998), and attachment disruption appears frequently in this population — but frequency is not universality, and arriving with the assumption is its own kind of imposition.
It does not mean treating the performance difficulty as a symptom of trauma. Focal dystonia is a neurological condition with measurable cortical reorganisation. Reframing it as an expression of unprocessed trauma is inaccurate and, for the client, often insulting.
It does not mean avoiding challenge. Safety is not the absence of difficulty. A practice so cautious that nothing is ever approached leaves people stuck, and performers in particular will read excessive gentleness as an assessment of their fragility.
The reframe that does the most work
If I had to reduce trauma-informed practice with this population to a single move, it would be this: the nervous system is not malfunctioning.
Whatever the presentation — the collapsing embouchure, the frozen hand, the vanished putting stroke — the system is running a protective adaptation. Those adaptations were intelligent responses to the conditions the person was actually in, frequently laid down long before any instrument was picked up. They are not evidence of weakness, and they are not the client failing to try hard enough.
Delivering that reframe credibly requires that you believe it. Clients in this population detect performed warmth immediately; they were trained for decades to detect exactly that. Which returns us to the same point: the work rests on your own nervous system, and there is no route to that except doing your own.
The Focal Dystonia Method and Free to Perform Certification is the only professional training of its kind for therapists wanting to work at this level. Find full details at ruthslchiles.com/certification.
Frequently Asked Questions
What is trauma-informed practice?
Trauma-informed practice is a stance rather than a modality, built on realising the prevalence of trauma, recognising its signs, responding by integrating that knowledge into practice, and resisting re-traumatisation. Its principles include safety, trustworthiness, collaboration, and attention to voice and choice.
Why does trauma-informed practice matter for performers?
Three features make it particularly relevant: elite training typically begins in childhood during formative developmental years; identity is usually fused with the skill, so losing it is experienced as losing the self; and much high-level pedagogy operates on principles close to the inverse of trauma-informed ones.
Does working with performers mean assuming they are traumatised?
No. Adverse early experience and attachment disruption appear frequently in this population but are not universal. Arriving with the assumption is itself an imposition. The framework asks that your practice not replicate harmful dynamics, not that you presume a history.
Is focal dystonia caused by trauma?
No. Focal dystonia is a neurological condition with measurable cortical reorganisation. Reframing it as an expression of unprocessed trauma is inaccurate. Nervous system state and early experience shape the conditions in which it develops, which is a different claim.
What is the window of tolerance and why does it matter with performers?
The window of tolerance is the band of activation within which a person can process experience without tipping into hyperarousal or shutdown. Performers are exceptionally good at tolerating discomfort and will often push far beyond their limits while reporting that they are fine, so self-report is unreliable and the body must be read directly.
Why does the therapist’s own regulation matter?
Because the mechanism is physiological. Nervous systems measurably affect one another through limbic resonance, and clients regulate in part by referencing the practitioner’s state. A practitioner who is subtly activated is offering a system that cannot be safely referenced.
Enjoyed this article? Sign up here to receive future blogs, insights, and updates from us.
References
Coan, J. A., Schaefer, H. S., & Davidson, R. J. (2006). Lending a hand: Social regulation of the neural response to threat. Psychological Science, 17(12), 1032–1039. https://doi.org/10.1111/j.1467-9280.2006.01832.x
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Lewis, T., Amini, F., & Lannon, R. (2000). A general theory of love. Random House.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton.
Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Lawrence Erlbaum.
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). U.S. Department of Health and Human Services.
van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.