This is the blog post that correlates with the webinar I hosted on 5 October. You can see the video on my YouTube channel. The benefit to participating live is that you will get to ask me questions (about anything) after the talk. In the previous webinar and blog, I discussed resilience and recovery: what makes someone resilient and how can one develop resilience? While preparing for that talk I came across related material that I’d like to continue discussing today.

Remember that every encounter with someone – a patient, a trauma survivor, or someone suffering an illness – is an opportunity towards healing. It is especially important during an intake interview, a psychological assessment, or a medical history in which the clinician and beneficiary/patient are still getting to know each other. How can health professionals, social workers, case managers and others make the most of these introductory visits and ensure that these encounters are steps to building trust, resilience and healing. I have learned so much about taking a history and interviewing patients over the last 20 years. I’ve definitely made mistakes. I’ve also seen the power of making a connection, even if it occurs only once.

Please note that this is not a discussion about interviews in which we are trying to determine whether someone is trafficked or a victim of exploitation. Identification of victims is another topic for a later segment.

Strengths-based assessment and inquiry

An assessment or history interview has several core elements such as building rapport in which safety, trust and honesty between interviewer and interviewee are solidified. Another vital component is informed consent. Not just consent but a fully informed consent and consent that can be withdrawn. This is worth another webinar segment in the future. Next, we must assess the individual’s safety level. We are not going to accomplish much in moving forward with a plan if the person is still in danger, or perceives that he or she is, including from others or him/herself (suicidal/homicidal thoughts). After we have established basic safety, we can start to address basic needs such as clothing, housing and food. We can start to also address emotional needs and then move to goal setting for the short-, med-, and long-term. Underlying all these components is empowerment whereby we build resiliency through identifying their strengths and developing new ones. We can do this through designing our questions, body language, and interview atmosphere.

One of the criticisms of the trauma informed care approach is that there can be too much emphasis on the trauma and negative side of an individual’s situation and not enough attention on the strength and resiliency that he/she already has.

Originally, the ACE (Adverse Childhood Experiences) Study did not collect data on resilience factors. The designers of the study probably could not have foreseen what profound results the study would generate or its impact on addressing trauma. Studies are now starting to incorporate a strengths-based approach in their trauma inquiry – incorporating both past traumatic experiences as well as positive strength factors. This approach can help identify root causes as well as current resources. Interventions can then be better tailored to the individual which hopefully increases their effectiveness. Not every survivor of multiple ACEs ends up with a horrible life and not everyone who experiences the same trauma shares the same outcomes. We need to find out why. Several scales evaluate resilience factors such as the Resilience Scale Assessment (RSA), the Brief Resilience Scale (BRS), and the Connor–Davidson Resilience Scale (CD-RISC).

One does not have to use these resilience scales as/is unless you want to do some research. The questions and/or approaches in these scales may be included in your intake interviews, assessments and medical/social histories in order to incorporate a strengths-based approach. Lewis-O’Connor states: “Education about the impact of trauma is fundamental to inquiry. Patients may gain an understanding of how their experiences have a direct relationship to their health and well-being and be able to identify strengths and factors that enable posttraumatic growth.”(1) That is one form of psychoeducation. Furthermore, focusing only on the trauma can be triggering or destabilizing and lead to an increase in reactivity and hyperarousal throughout the interview. During an interview we of course do address the negative issues but shifting the focus of the conversation from negative to positive can help bring someone back into a perspective of strength and hope and help them better emotionally regulate through the troubling bits of the conversation.

The process of inquiry about resilience and strengths can benefit the interviewer as well as the trauma survivor. The overall relationship is improved with this approach.
Another author (2) states similar reasons for using strength-based questions:

  1. It allows a patent to feel known in more ways than just the negative events of life and the corresponding problems;
  2. it provides a fuller picture to staff so that the likelihood of “armoring,” the hard shell that workers can develop when faced with client problems that seem insurmountable, is diminished and a sense of manageability increases;
  3. it increases the likelihood that the strengths can be used during the delivery of health care services;
  4. in research, it provides richer understanding of the relationship between the independent and dependent research variables.

When a clinician, case manager, or care giver is faced only with the negative aspects of a client’s/patient’s life, the situation can seem overwhelming and it can be easy to get stuck on the negatives. Seeing the positive and the strengths helps the client as well as the clinician to have a more balanced view of the person’s circumstances as well as distill some next steps.

Examples of Strength-Based Questions
The interviewer may follow up a discussion of trauma exposures with questions or comments such as “Tell me about how you managed to get through this experience” or “You really showed a lot of strength being able to keep going through a situation like that – can you tell me more about that?”(3) In this way you can help the person reflect on their own strength and resiliency that got them through the trauma and to the point where they are having a conversation with you that day.

Assessments involve determining what physical needs someone has, but we can highlight the things that the individual already has as strengths. Resiliency factors include external and internal things. External factors include items such as housing, job/study, transportation, and financial security. Internal factors include things like faith, family, social relationships, hopes and dreams. Think of ways you can illuminate these to your client, who might not be able to see them as strengths. One interesting question I read was “If your good friend was here with us today and I asked him/her what they like best about you, what would she say?” (4) It may be that they don’t currently participate in the above activities but used to and perhaps you can explore ways with them to help re-incorporate one.

Assessments may also be opportunities to build the regulatory capacity of the individual (Hopper), which also develops strength and resiliency. For example, the interviewer can inquire about what he/she does to help feel better when upset, such as breathing exercises, or thinking about her children, or praying. What potentially problematic coping mechanisms, such as substance abuse or self-harm, are currently being employed? These kinds of questions can also lead to brain-storming ideas about more positive ways the individual can handle difficult situations.

Inquiring about biorhythms is another way to address regulatory capacity and gain insight into an individual’s mental health state. It is also a tangible way that survivors can understand themselves as well as providing concrete ways for them to improve their health and strength. Hopper states that “It may be easier for survivors to answer questions such as, ‘how have you been sleeping?’, ‘what is your energy level like?’, or ‘how is your appetite?’ rather than a more ambiguous question such as, ‘how are you feeling emotionally?’ Promotion of health behaviors can also be concrete, such as offering information on sleep hygiene, nutrition, and physical activity.” (3)

Emphasizing the positive without discounting the negative
Everyone has strengths and dreams and is capable of recovery. When we focus only on the negative impacts of trauma, it is easy to overlook what the survivor brings to the table for their own recovery. Assessments should take in the entire spectrum of circumstances from the trauma and health impacts, the current negative situations, to the resiliency factors the individual already possesses.
Although they do need help, they are also a lot stronger than sometimes we give them credit for. By focusing only on the trauma of what has been done to them and the current negative circumstances (and yes sometimes they are VERY serious), a lot of care givers tend to see them as weak and can sometimes get caught up in over-helping. The survivor can also be affected by this by perpetuating a negative perception of him/herself encouraging an attitude of passivity and victim-mode, allowing the staff or care team to do most everything for them instead of building Empowerment, strength and resiliency. We need to emphasize personhood over victimhood. Positive encounters can help change that when you see in them more than they see in themselves. Reflect on times when someone has seen more in you than you did in yourself.

Interviewing Pearls
In conclusion I’ll share some interviewing pearls I’ve learned along the way:

  • Know the stated purpose of the interview and ask only the questions that you need – the ones that are essential to the purpose. Don’t ask questions to satisfy your curiosity, although it can be difficult to know where that line is. I’ve gotten into trouble with this one before.
  • Informed consent and open opt-out of the interview. The person can always refuse to answer a question or terminate the interview
  • Ask open-ended questions. Good follow up questions include, “tell me more about that”, or can you describe that with a bit more detail?”
  • HOW you ask things or say things is as, if not more, important than what you ask. Good questions are important but asked in the wrong way may hurt more than help.
  • The client/patient is the expert and owner of his/her story
  • Memories of traumatic times can be fragmented, and the patient/client is not always able to recall certain things in the correct time sequence and may have other inconsistencies. Be patient. The client/patient may also be aware that the memories sound jumbled – don’t contribute to the frustration. Just try to ask clarifying questions realizing that there may be a limit to the clarity that day. Don’t belabor a point.
  • Be aware of the pitfall of “unloading” People may want to share all their story to “get it all out”. Some may think that when they do this, they will be free of the burden that they’ve been carrying around – they can finally relieve themselves. However, sometimes this backfires and they become flooded with traumatic memories and other triggers. There is a balance between listening and letting the person get into a deregulated state.
  • Sometimes clients can derail an interview or avoid difficult points (which may be unconscious) by perseverating on a particular story. This can also get them whipped up into hyperarousal. Be prepared to draw appropriate boundaries on the interview process and purpose and gently re-direct the interviewee. At this point it may be a good time to take a break.
  • Give frequent breaks – and offer one if you see signs of dysregulation such as hyper- or hypo-arousal. These conversations can be hard and fatiguing.
  • Be yourself and be fully grounded and present to the person. Don’t react.

I always find it amazing how “well” or “ok” or “stable” someone can appear when they have had to appear that way for a very long time. It also takes a lot of energy – if you have ever had to “put up a good front” in difficult times you know what I’m talking about.

I hope that this provides a good introduction on incorporating a strengths-based approach to your interviews and assessments. There are many more points about interviewing that arise from here to discuss, but I’ll leave those for future segments.


  1. Lewis-O’Connor A, Warren A, Lee JV, Levy-Carrick N, Grossman S, Chadwick M, Stoklosa H, Eve Rittenberg E. The state of the science on trauma inquiry Women’s Health Vol. 15: 1–17
  2. Kimberg L. Trauma and trauma-informed care. In: King TE and Wheller MB (eds) The medical management of vulnerable and underserved patients: principles, practice and populations. Upper Saddle River, NJ: McGraw-Hill Professional, 2016.)
  3. Hopper EK. Trauma-Informed Psychological Assessment of Human Trafficking Survivors.
    Women and Therapy 3 Oct, 2016, accepted manuscript available online:
  4. Leitch L. Action steps using ACEs and trauma informed care: a resilience model. Health and Justice. (2017) 5:5 DOI 10.1186/s40352-017-0050-5.

Resilience Assessment Scales (not exhaustive list):
• Resilience Scale Assessment (RSA)
• Brief Resilience Scale (BRS)
• Connor–Davidson Resilience Scale (CD-RISC)