Trauma Processing Contraindications Checklist: Essential Assessment for Trauma-Focused Therapy

This clinical assessment tool provides therapists with a structured framework to determine when trauma processing work may be contraindicated and stabilization should take precedence. The checklist helps clinicians make informed decisions about treatment timing and approach based on client readiness and safety.

Purpose and Application

The checklist evaluates five critical domains that may indicate a need to delay trauma processing:

1. Severe Dissociative Symptoms - Including depersonalization/derealization, unexplained memory gaps, identity fragmentation, and uncontrolled shifts between self-states

2. Insufficient Stabilization & Coping Skills - Assessing present awareness capacity, distress management strategies, dissociation recognition, and emotional regulation

3. Unstable Emotional or Psychological State - Evaluating self-harm behaviors, suicidal ideation, hospitalization risk, substance abuse, and psychotic symptoms

4. Unresolved Safety Concerns - Identifying current unsafe living situations, ongoing perpetrator contact, lack of support systems, and environmental stressors

5. Poor Ego Strength & Limited Dual Awareness - Measuring ability to differentiate past from present, maintain boundaries, manage recall distress, and address negative self-beliefs

The tool provides clear guidance: when two or more indicators are present in any category, clinicians should focus on stabilization work before proceeding with trauma processing.

This resource empowers therapists to:

• Make evidence-informed decisions about treatment sequencing

• Reduce risks of retraumatization or decompensation

• Prioritize client safety and stabilization

• Document clinical reasoning for treatment planning

• Engage clients collaboratively in assessing their readiness for trauma work

The checklist includes sections for therapist notes and client self-reflection, promoting a collaborative approach to treatment planning while maintaining clinical rigor. It serves as both a decision-making tool and documentation for clinical practice, ensuring trauma treatment proceeds at a pace that supports healing rather than overwhelming a client's current capacities.