What the Walls Are Doing While You Heal

We talk a lot in this field about what happens inside the room: the relationship, the intervention, the work. But what about the room itself? The walls, the lighting, the chair you're sitting in, the hallway you walked down to get here. What if the space itself was either helping you heal or quietly working against you the whole time?

That's the question trauma-informed design exists to answer.

Trauma-informed design, or TID, starts from the same place trauma-informed care does. SAMHSA describes a trauma-informed program as one that realizes the widespread impact of trauma, recognizes the signs of it in the people moving through a space, responds by weaving that understanding into every policy and practice, and actively resists doing further harm (Substance Abuse and Mental Health Services Administration, 2014). TID simply asks what happens when we apply that same lens to the physical environment itself. Not just how we treat people, but how the building treats them too.

There are six principles underneath all of this, according to SAMHSA (2014): safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and attention to cultural, historical, and gender context. Every hallway, every waiting room, every intake office either lives up to those six things or it doesn't, whether anyone designing it ever thought about trauma at all.

Shopworks Architecture, alongside the University of Denver's Center for Housing and Homelessness Research, built out an actual process for doing this well, and it breaks into four phases (Shopworks Architecture et al., 2021).

Phase one is vision setting. Before a single wall gets drawn, the whole team, architects, developers, service providers, has to actually sit with what trauma-informed care means and commit to it together (Shopworks Architecture et al., 2021). This is the only phase that comes with homework, and for good reason. You cannot design around something you don't understand yet.

Phase two is where it gets interesting: pre-occupancy research. This is where the team goes and actually talks to the people who will live in or use the space, along with the front-line staff who will work in it every day (Shopworks Architecture et al., 2021). Not a survey. Focus groups, building tours, real conversations. Questions like where do you feel unsafe here, what spaces do people avoid, what gives you hope right now. The people with lived experience become the ones informing the blueprint, not an afterthought consulted once the drawings are basically done.

Phase three is design, collaborate, refine, and this is where the actual architecture starts responding to everything learned in phase two (Shopworks Architecture et al., 2021). It isn't one draft and done. The design gets shown back to the same residents and staff who were interviewed, adjusted based on their feedback, shown again, adjusted again. Iterative, on purpose, because no one gets it perfectly right on the first pass, and pretending otherwise is how you end up with a building that looks thoughtful but doesn't actually function that way for the people inside it.

Phase four is post occupancy research, and it's the phase most projects skip entirely. Twelve to eighteen months after people have moved in, the team goes back and asks what worked, what didn't, what needs to change for the next building (Shopworks Architecture et al., 2021). Projects that have gone through this full cycle consistently report the same throughline in what residents and staff describe: spaces that feel calmer, more predictable, and more dignified than the institutional environments many of them had lived in before. That's not a small thing. That's the entire point.

Now, all of that research was built around physical buildings, permanent supportive housing specifically. But trauma doesn't stay in the physical world, and neither should the design principles meant to protect people from it.

A 2023 study out of Rutgers, Michigan, and Cornell Tech looked at trauma-informed design online, specifically in communities where trauma narratives are commonplace (Randazzo et al., 2023). The researchers interviewed 29 trauma survivors and used something they called a spinning top metaphor to describe how these online spaces actually function, spinning steadily when they're well supported, wobbling and falling when they're not (Randazzo et al., 2023). The goal, according to the authors, is building online spaces that are more compassionate and ethical, prioritizing user safety, well being, and healing (Randazzo et al., 2023). If a physical waiting room can retraumatize someone through bad lighting and a lack of privacy, a poorly moderated online support group can do the same thing through public comment sections, unexpected triggering content, or a complete lack of control over who sees what you share. The principles transfer. Safety, trust, choice, collaboration, empowerment, they matter just as much in a Facebook group as they do in a hospital hallway.

And then there's the piece that made all of this feel less academic and a lot more real to me. Debbie Gregory, a nurse and healthcare designer, wrote about her own son's experience in a trauma unit after a severe accident, an open bay environment where he could hear every other patient's crisis unfolding around him while unable to move or speak (Gregory & Zborowsky, 2025). What he described afterward was, understandably, its own trauma layered on top of the physical one. Reading it, you realize trauma-informed design was never really an abstract architectural theory. It's the difference between a space that lets someone heal and a space that adds a second wound on top of the first.

Terri Zborowsky, writing alongside Gregory, points to six goals that should sit underneath any trauma-informed space: a sense of safety, privacy, and personal space, empowerment and personal control, dignity and self esteem, stress management, a sense of community, and beauty and meaning (Gregory & Zborowsky, 2025). And there's a set of questions, adapted from the Creating Cultures of Trauma Informed Care framework, that apply to both the people using a space and the staff working in it (Gregory & Zborowsky, 2025). Do people have choice and control here. Is there consistency and clarity in how this place operates. Is power actually shared, or does it just look that way. Are people, patients and staff both, given room to build skills and feel capable, not just managed.

That last part matters more than it gets credit for. Vicarious trauma is real for the people who work in these spaces every day, and a building that only protects the people passing through while ignoring the people who staff it isn't actually trauma informed. It's half of the job.

If there's one line that captures the whole philosophy, it's this: do no harm (Gregory & Zborowsky, 2025). That's the floor, not the ceiling, of trauma-informed design. At minimum, resist retraumatizing someone. At best, build something that actively helps them heal.

This matters to me beyond just being an interesting concept, because the same questions apply to therapy spaces themselves, whether that's a physical office or, in my case, the virtual space someone logs into from their own living room. Does this feel safe. Does this person have choice and control here. Does this space reflect dignity, not just function. Those aren't just design questions. They're the same questions I'm asking every time I meet with a client, just asked of a room instead of a conversation.

If you're in design, healthcare, or housing work and this is new to you, it's worth sitting with. The people occupying the spaces you build already know what feels safe and what doesn't. The work is simply learning to ask them, and then actually listening to the answer.

References

Gregory, D., & Zborowsky, T. (2025). Trauma-informed design: Lessons through a life-altering lens. HERD: Health Environments Research & Design Journal, 18(1), 14 to 20.

Randazzo, C., Scott, C. F., Bellini, R., Ammari, T., Devito, M. A., Semaan, B., & Andalibi, N. (2023). Trauma-informed design: A collaborative approach to building safer online spaces. In Companion Publication of the 2023 Conference on Computer Supported Cooperative Work and Social Computing (pp. 470 to 475).

Shopworks Architecture, Group14 Engineering, & University of Denver Center for Housing and Homelessness Research. (2021). Implementing a four-phased trauma-informed design process.

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).