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The Relationship Between Attachment and Addictions

May 15, 2013

TLC Guest Blogger: Lori Gill, M.A.

We know we are born primed for connection, with the most significant relationship in a child’s life being his or her primary caregiver – but what happens when this does not occur? These relationships help us learn to self-regulate, develop a sense of self-worth and act as an emotional template for future relationships, shaping our view of people and the world around us. When these relationships are conflict-ridden, the outcome may lead to challenges with forming and maintaining future relationships (Perry, 2001).

Mate (2008) suggests that individuals with addictions are constantly seeking something outside of themselves to alleviate their insatiable need for relief and fulfillment. It is as a result of this longing and emptiness that individuals pursue substances or other self-harming/self-soothing behaviors, with the hope that it will provide some relief. Andrews (2010) further supports that it is through this fight to regulate and ultimately survive that the litany of behaviors begin, behaviors that will temporarily give relief from fear and the pain they suffer.

Mate (2008) indicates that addictions — regardless of the form they take — always result from pain, conscious or unconscious, with the addiction serving as an “emotional anesthetic.” It is human nature to want to be seen, to feel worth, and to have the connection. When this does not occur, we feel the void and seek desperately to fill this in any way we can. However, without intervention and support, individuals will remain in a state of despair, constantly seeking something to fill the void, potentially shifting from one addiction to another in attempt to find some relief.

parentsI have used TLC’s “Adults and Parents in Trauma” program to very effectively target underlying issues at a deeper sensory level. I remain humbled and amazed by my clients’ experiences and have observed that many, in spite of some unfathomable and violent traumas, identify their most significant trauma as something relating back to early childhood experiences of disrupted attachment. This supports the notion that at our core, we all just truly want and need to be loved. It is not the addiction that is the problem; this is just the bandage used in attempt to cope with the underlying problem. As clinician’s we need to help our clients find alternate options to heal their hurts.

How to help:

Compassionate Care: Trauma-informed treatment includes shifting to a place of compassion and awareness rather than blaming or questioning, asking instead “What happened to you?” This helps to understand what function the addiction serves and determine the underlying issue.

Education and Awareness: Becoming trauma informed and being able to share this information with clients in a compassionate manner is essential. Helping clients understand the automatic and subconscious processes of the brain and the automatic brain response patterns that develop. The brain seeks to find meaning from our experiences when we have previously used substances as a form of coping. The brain acts for us: “I know this feeling. When I feel this way I do this. This helps me feel better.” When we provide education and awareness to our clients, it leads to permission for compassion for self and awareness.

Empowerment and Nurture: We need to help individuals learn to nurture themselves and become empowered through new resources and increased awareness. Although addiction behavior is not ideal and not helpful in the long run, it is what is holding them at this time, perhaps even keeping them alive. It is an attempt to cope rather than just succumb to the pain. Our role as clinicians is to help expand their toolkit with items and strategies that nurture them. Yoga, sensory distraction, mindfulness and affirmation statements are all excellent tools.

Connection and Opportunity: The significance of attachment is that we are born primed for attachment.  If we don’t experience this, learn how to self-regulate, learn self-worth and learn how to form healthy relationships, this can impact us throughout life. Insight into the impact our early life experiences have had and providing opportunities to develop self-worth and inner awareness can shift this blueprint. Helping clients to experience authenticity, while tuning into their needs and wants, can be incredibly empowering. Working through what a healthy relationship looks like, with one’s self and others, and providing opportunities for connection can help reconstruct this blueprint.

Lori will be presenting on addictions, The Secret World of Substance Abuse, at this year’s TLC summer assembly.  This is a fantastic learning and networking opportunity.  To register or learn more, visit


Andrews, E. (2010). Being trauma informed [power point slides]. St. Catharines, Ontario, Canada: Art Therapy Services.

Perry, B. (2001). Bonding and attachment in maltreated children: Consequences of emotional neglect in childhood. Retrieved (July 15, 2011) from:

Mate, G. (2008). In the realm of the hungry ghost: Close encounters with addiction.  Toronto, Ontario, Canada: Random House.

Celebrating Loved Ones Who Are Gone

May 7, 2013

Bwoman looking at photosy TLC Guest Blogger: Robin A. Edgar

As Mother’s Day and Father’s Day approach, families look for ways to let our loved ones know how much they appreciate them. For those who are separated from or have lost a parent or a child due to death or illness, this can be a time of sadness.

Reminiscing about a meaningful time with that loved one is a wonderful way to ease the pain and celebrate the time you had together. The question is, how do you recall those significant memories?

The best way to start is to follow your nose, since the senses are proven to help trigger significant long-term memories. You can also round up some old photos or objects to help you recall significant events from the past.

As you share your memory with others, even a sentence or two can grow into a story. Here are some prompts to get you started:

  • Is there a certain aroma, such as a particular perfume, bread baking in the oven or fresh mowed grass, which reminds you of a special time in your life?
  • Do sounds, like grating and chopping in the kitchen, a certain song or the slamming of the back porch screen door, trigger any memories?
  • Perhaps a piece of jewelry, an article of clothing or furniture reminds you of your loved one.

Once you’ve found them, you can develop a simple ritual or family tradition from these memories such as baking your loved one’s favorite recipe, planting a tree or going fishing. This allows you to celebrate them in your own personal way.

Adapted from In My Mother’s Kitchen: An Introduction to the Healing Power of Reminiscence (copyright Robin A. Edgar, 2002).

Healing with Words, Rhythm and Voice

April 17, 2013


April is National Poetry Month in North America. It is a time to celebrate poetry and increase awareness and appreciation for the gift of this art form. Poetry therapy is a form of bibliotherapy, which uses a wide range of literature/books for healing and personal growth. Poetry is one of many expressive arts modalities used therapeutically for a wide range of clinical issues, including the treatment of trauma (Levine & Kline, 2006, Loue, 2012, Nicholas, 2003). Like many art forms, it may often be dismissed as a therapeutic resource if we, as therapists, feel we lack the propensity to write poems. Yet poetry can be used within a solid therapeutic framework in a variety of ways.

I see these interventions as invitations to our clients, whether it is bringing created poems, lyrics or rhymes to the session or writing poetry. The following section outlines only some of the ways poetry may be incorporated in the therapy session:

1. Invitations: Use already created or well-known poems/stories. I have a folder with many poems, lyrics and quotes that I personally have loved or ones that clients have brought to me to use in their therapeutic work.

Poem Ideas:

  • “Autobiography in Five Short Chapters” – Portia Nelson
  • “Summer Day” – Mary Oliver
  • “The Journey” – Mary Oliver
  • “She Danced” – Shilo Sophia
  • “Prelude” – Oriah Mountain Dreamer
  • “Rhymes and Stories to Prevent and Heal Trauma” – Peter Levine and Maggie Kline

Book ideas:

  • “The Fall of Freddie the Leaf” – Leo Buscaglia
  • “The Giving Tree” – Shel Silverstein
  • “My Many Colored Days” – Dr. Suess
  • “The Velveteen Rabbit” – Margery Williams

As therapists, we may have a sense, in terms of right timing, to share a poem or story that may have meaning for our clients. I also invite my clients to bring a special poem, quote or story that is important to them. We then use that writing in our work. How has this poem or story been important to them? Is there a particular line that stands out? What if they took that line and used it as a starting point to their own poem or story?

Another intervention is to invite our client to read the poem. It is sometimes in the reading of the poem in their own voice that the connection to the meaning and essence of the writing becomes clearer. We can really slow down this process and stay with whatever emotion arises.

 2. Use poem prompts. Using prompts can be a nice springboard to the inner world of our clients. Some prompt ideas include:

  • My hurt is like…My body is…I feel most alive when…The “me” nobody knows…The inside “me”…The outside “me”…
  • Write a poem with the title: “No One Heard Me” or “The Feelings I Hide”
  • Or write a poem in the voice of a young girl or boy or in the voice of a hero or superstar.

3. Intermodal use of poetry. In a session, if we have started with creating a visual image (i.e. a painting), we may then move to writing one-word responses to the image. I will write out all the words that come to them as they observe their piece. If it is hard to get started, I may offer up some words to begin with. I hand them the words and invite them to create a written response to their piece. Having the one-word responses offers a framework that may be easier to write from than just from the imagination.

On a more personal note, poetry saved my life as a teen. There were certainly no formal resources readily available, and “talking” about problems wasn’t encouraged. I turned to writing poems. My own suffering found a home in words strung together to make sense of untouchable hurts. It was like the poem provided the container for an event or an intense emotion and helped to move it outside of the body and hold it safely, which provided distance, relief and inner calm. Poems came again to my assistance through the grief of my mom dying of cancer and the long process of her illness. The poems seemed to document what I was witnessing and needed to be witnessed through the sharing of my poems with a trusted friend. Still, to this day, I tend to turn toward the arts, in particular to creative writing, as a way to sift through the “stuff of life,” including both the sorrows and the joys.

In my therapy office, I keep a journal that is waiting for me to fill the pages with my responses to what I witness as therapist. These responses reflect the stories and sufferings of many children, teens and adults I see on a daily basis. This journal is my companion. It is reliable, ever ready, even encouraging me, and, at times, begging me to take the time to spill open onto the pages with words and images that surface in my own inner world as a therapist.

Recently I asked a 15-year-old girl with a significant trauma history how poetry or writing has helped her on her life’s journey. Almost immediately she exclaimed, “Get me a paper, get me a pen!” I did, and these are the words that tumbled out within a few minutes:

The steady beat of my heart,
Sounding like the drums of war.
Blood pumping through my veins
coursing like a fire.
As the voice of reason whispers,
“Write it down on this page.”

What is it Our Brains Need Most?

March 8, 2013

GrandparentTLC GUEST BLOGGER: Barb Dorrington, MEd

What is it our brains need most? Much of brain science talks about safety, predictability and nurturing as key ingredients to help the brain thrive. As a school social worker, many of the principals at my school board have developed these same concepts into more user-friendly words for teachers. The simple questions asked by an administrator for a suspendable consequence were: “Was your action fair? Was it kind? Was it respectful?” One particular principal expelled a student for assaulting a teacher and used these questions. The end result was that same expelled student shook hands with the administrator while leaving the school with a police officer, returning a few days later to pay money for previously unpaid school fees. It leaves one to ponder what took place to cause such a responsible result from a particularly troubled student?

The Adverse Childhood Experience (ACE) Studies investigates connections between child maltreatment and later-in-life health difficulties. All the small daily traumas of life create our attitudes and shape our personalities. What can help? History has shown that we continue to feel closest to those people who provide us with a consistently safe and nurturing haven. Likely that student felt protected and safe in the school environment and with that caring principal, even though he was being expelled for an assault.

According to Mark Brady, a neurocscience editor, grandparents have a special place in the hearts of children and stave off the isolation, loneliness and disconnection of hard daily living. He suggests that it is not the number of positive interactions but rather the quality, timeliness and rhythm of these positive interactions. His big brain question to each grandparent is, “Are you there for me?” If that answer is a resounding yes, then that child is acknowledged and feels validated. Brain science supports this need for such affirming repetition to change those dusty ruts in our brains into new strong neural superhighways.

While for some it may be the unconditional love of a grandparent, I had a wonderful Aunt Helen who told my parents I had a lazy eye at the age of two and they needed to attend to it. Some years later, she told them that I needed help with braces on my teeth. My parents loved me but they were busy and led rather chaotic lives, not necessarily vigilant about certain practical matters. Aunt Helen watched over me until her own death. She validated my existence. I always knew my Aunt Helen would be there for me, and I still ask myself, “What would Aunt Helen say?” In turn, I now ask clients about the adult that made the difference for them as children. It is a natural, safe place for us—and people of all ages—to share their stories of the person who made the difference.

The programs at TLC are solidly research-based and designed to validate the experiences of each survivor we help. TLC Founder Dr. William Steele talks about shifting victims to survivors and ultimately thrivers. While TLC offers many programs that honor the work we do with survivors, the website is full of personal stories and articles that are free to read. Do consider attending a workshop at one of the TLC assemblies, as the connection with other like-minded people is well worth the effort.

Barb Dorrington

About Trauma, Trauma Intervention and the Brain

January 30, 2013

iStock_000022148880XSmallTLC Guest Blogger: Lori Gill, M.A.

I recently had a client mention they were told—by a therapist—that they were not stable enough for therapy. This really shocked me and caused me to wonder: If we can’t stabilize in therapy, where can we stabilize? This paired with a psychiatrist telling a client she was not stable enough for trauma therapy really got me thinking there is still a considerable lack of awareness regarding what trauma therapy is and how it works. As a result, I thought I would focus on a few areas where there seems to be some confusion. Trauma therapy by a qualified and Certified Trauma Specialist ensures that the therapist has an understanding of trauma—how it impacts the body, the mind and behavior—and knows how to work in a safe and ethical manner to create stability.

Safety & Structure:

A qualified trauma therapist understands the key features of trauma are a sense of terror and powerlessness, occurring primarily at a sensory level. As a result, the primary focus of intervention is to instill a sense of safety, beginning with sensory interventions. A trauma therapist should be willing to slow down treatment to focus on addressing and resolving the underlying issues in a safe and secure manner to allow for externalizing, containment and reconstruction. The programs provided by TLC provide an excellent framework for safe, structured sensory interventions. I have used TLC’s various programs with children as young as two and with adults up to 65 years of age and have consistently observed great success including the reduction of trauma-related symptoms. You can review the various evidence-based trauma intervention programs at TLC’s online bookstore.

brain001_thumbThe Brain as the Master Conductor:

A trauma therapist also understands how the brain becomes hardwired and associations are formed that cause us to respond in rigid, automatic ways, rather than how we would want to respond. They understand that it is not that the brain is “not working” properly during a trauma state, rather it is actually working quite effectively, but it is operating from a place of survival due to an actual or perceived threat. This means that while we may observe behaviors that seem unusual or disproportionate, we must keep in mind that although the behaviors may not make sense to us, they are functional for the individual at some level. This may be represented through hyperarousal or dissociative continuums, which are actually protective mechanisms.

Differential Diagnosis:

Behaviors exhibited following trauma may commonly be misinterpreted by those lacking an awareness of trauma and its impact. For example when in a heightened state of arousal reactions may seem unusual to others, prompting inaccurate diagnosis, these behaviors make sense to the individual acting from a state of survival:

  • Fight – We may see verbal or physical aggression or excessive reactions, which may be misinterpreted as behavioral or attention seeking. This may also be perceived as oppositional behavior, ADHD, anxious/aggressive-type behavior and may be representative of traumatized youth in conflict with the law.
  • Flight – We may see individuals trying to escape or avoid circumstances, people, places and things (avoidance, kids running away, etc.) difficulty with isolation and social skills.
  • Freeze – When unable to fight back or flee, we may see psychological protective responses such as trying to escape through numbing or dissociation. This may present as daydreaming behavior, inattention, inability to focus and concentrate, disorganization, etc., resulting in a diagnosis of ADD. The frozen stare of an individual immobilized by fear may also be interpreted as oppositional or passive-aggressiveness (freeze-fight).
  • Surrender response – We may also observe compliance. This can be misinterpreted as agreement, when in reality it may be that they do not feel they will be heard or have expressed their feelings only to have them be ignored.

*It is crucial that we allow children to express how they feel and be heard!

*It is important to note that fight-flight-freeze behaviors are not mutually exclusive and may occur simultaneously as well.

TLC offers training providing foundational information about trauma and its impact, leading to certification as a Trauma Specialist. To learn more visit  One of the online courses TLC offers focuses on the differential diagnosis between ADHD and PTSD.

therapyAutomatic Responses are not Willful:

A trauma therapist understands it is not that we “don’t” but rather sometimes we “can’t.” The behaviors and experiences that result are not contrived but are automatic processes governed by need for survival in the moment. During this time, higher-order brain functions not deemed necessary for survival are placed on hold to optimize those perceived vital to survival. Therefore those higher-order cognitive functions and executive control functions may not be accessible. When presenting brain function to clients, we need to do so from a space of genuineness and compassion, normalizing the way their brain and body is responding and associated symptoms as being common to trauma. Many already experience guilt and self-blame. Helping them understand these symptoms are normal and occur at an automatic and largely subconscious level helps reduce some of the associated guilt, blame and magical thinking.  TLC’s book “Brave Bart” is an excellent tool for identifying and normalizing common trauma reactions.

Compassion, education and empowerment are so important for those who have experienced trauma. TLC Certified Trauma Consultant – Supervisor Cherie Spehar nicely summarizes the needs of those who are wounded by trauma and how we can help them heal: notice me, understand me, soothe me. If we can provide this, we can help create a sense of safety, empowerment and healing.

The Magic of Mentoring: January is National Mentoring Month

January 9, 2013

mentor2TLC GUEST BLOGGER:  Carmen Richardson, MSW, RSW, RCAT, REAT

A mentoring relationship is one in which one person offers wisdom and expertise to another. These relationships are believed to be life changing.

Magic is defined as having the power to influence by using mysterious powers. Perhaps it really isn’t so much that these relationships are magic. Yet, what is it then, that this kind of relationship offers a young person?

I began asking young people I knew or worked with and older people about the mentors in their lives. I asked what it was that made that person a mentor and how that relationship influenced their lives. The following are some of the gifts they reportedly received in the mentoring relationship:

  • Comfort/caring
  • Inspiration
  • Hope
  • Belief in self
  • Encouragement
  • Wisdom
  • Fun/play
  • Practical support

How did this relationship influence their life?

“I started to believe in myself and really wanted to help others.”

“I went to university. I never dreamed I had it in me!”

“His passion for learning lit a fire in me. I became a teacher.”

“I chose to live.”

iStock_000012915316XSmallYour mentors….

Think back over your own life. Who made a difference in your world? A teacher, coach, friend, parent, sibling? There were no mentoring programs back in my day growing up in a small prairie town, however, I can certainly think of a few people who changed my life. There was Jackie, the woman I babysat for as a teenager. When she would come home, more often than not, we sat together talking into the night. There were many things that stood out for me about that relationship. One was that she listened. Even back then I knew that this was no small gift. She asked me questions. She cared. She had a strong faith. She was a lifeline through a stormy adolescence. The other relationship that stood out for me was with Sr. Doreen. Still, to this day, I call her my first “emotional mother figure.” She had similar qualities as I described in Jackie. Sr. Doreen supported me in a way I had never experienced. She believed in me, celebrated small day-to-day life experiences, and she was a role model that I longed to be. For the first time in my life, I felt really “seen and heard,” truly an essential ingredient to becoming “real,” as the Velveteen Rabbit would say. And yes, there was a certain “magic” in those life-changing influences that both of these relationships had on my future.

Mentoring works…

Research shows that mentoring works (Ahrens, DuBois, Richardson, Fan, & Lozano, 2008; Cavell, DuBois, Karcher,Keller, & Rhodes, 2009; Rhodes, & DuBois, 2006). In fact, some studies show that mentoring can help in the following ways:

  1. Academic Achievement:  better attendance, more likely to graduate, better attitudes toward school, more likely to go on to higher education
  2. Health and Safety:  prevent substance abuse, lowers engaging in negative, delinquent behaviors
  3. Social and Emotional Development:  better relationships with peers and parents, overall better communication skills, increased self-esteem

Trauma practitioners are mentors, too…

In the spirit of the mentoring relationship, there are many elements of that connection that are similar in the relationships trauma practitioners develop with their clients. I look at the list of gifts that people I talked with said they received from the mentoring relationship. I believe these are gifts that we, as trauma practitioners, cultivate and offer those who experience trauma. We offer hope, inspiration, encouragement, belief in self, comfort/caring, practical support and wisdom. There are certainly similarities between the role of mentor and trauma practitioners. The beauty in all of these relationships is that there is reciprocity in the experience of being mentor and/or clinician. It is in giving that we receive such important ingredients for life, such as a sense of aliveness, contentment, satisfaction, hope and so much more!

Get Involved…

Whether it is acknowledging the mentoring work we are already doing or getting further involved in our communities in other mentoring capacities, The National Mentoring Month website identifies many ways to get involved:

  1. Find local mentoring resources and begin utilizing them.
  2. Learn about National Mentoring Month.
  3. Consider becoming a mentor yourself.
  4. Find ways to partner with local mentoring programs.
  5. Thank your mentor.
  6. Make a donation to a local mentoring organization.
  7. Research and learn about the amazing impact that mentoring can have on the lives    and future of youth.
  8. Jan. 10 is “I am a mentor” day. Do something!
  9. Jan. 21 – Join Martin Luther King Day of Service. Use this day to highlight the importance of mentoring.
  10. Learn about the many and varied mentoring relationships – academic, social, etc. – with children and teens.

A Toast….

In honor of National Mentoring Month, I toast and hold up the Jackies and Sr. Doreens of the world who offer themselves and truly make a difference in the lives of others. As I write this, I wonder if they knew how important they were in my life. Perhaps you might be inspired to get involved in your own community, or maybe you will pick up the phone and call someone who made a difference in your life and let them know. Whatever it may be, may we remember, as this year progresses, that whatever we do, we do it with a grateful heart.

“Do stuff, be clenched, curious. Not waiting for inspiration’s shove or society’s kiss on our forehead. Pay attention. It‘s all about paying attention. Attention is vitality. It connects you with others. It makes you eager. Stay eager.”

S. Sontag

Carmen Richardson MSW, RSW, RCAT, REAT

Ahrens, K.R., DuBois, D.L., Richardson, L.P., Fan, M.Y., & Lozano, P. (2008).  Youth in foster care with adult mentors during adolescence have improved adult outcomes.  The online version of this article, along with updated information and services, is located on the World Wide Web at:

Cavell, T., DuBois, D., Karcher, M., Keller, T., & Rhodes, J. (2009).  Strengthening mentoring opportunities for at-risk youth.  Policy Brief.

Rhodes, J. E., & DuBois, D. L. (2006). Understanding and facilitating the youth mentoring movement. Social Policy Report, 20(3). Available online at: spr20-3.pdf

Putting the “New” in New Year. When in Doubt, Sing!

January 2, 2013

TLC GUEST BLOGGER: Barb Dorrington, MEd

Almost everyone chooses to come up with a New Year’s resolution. For myself, I’ve identified two goals, one for work and one for my personal life. My work resolution is to once again examine all the resources TLC has to offer. There are some new books, online courses and podcasts. Two exciting new resources that come to mind include “Brave Bart and the Bully,” which speaks to the issue of bullying with a focus on communication and skill building, and the Life Events Checklist, a screening tool that helps identify potentially traumatizing life events. Podcasts are also available like TLC Founder Bill Steele presenting on the role of private logic. This podcast will help us make sense of a child’s choices, especially when they do not make sense to us.

And how am I putting the “new” in new year personally? For me, “new” stands for notice, experiment and wonder. My personal resolution is to show more compassion for myself, especially when I forget things or when things drop out of my hands from growing arthritis. Is this a self-centered resolution? Not really. Brain research is showing that if we can be compassionate with self, we open the door to compassion for others. Compassion is about being connected to others with an inclination toward action. Relationships are essential to feeling safe, calm, useful and hopeful about the upcoming new year.

Empathy also has a lot more to do with the emotions and thoughts of others. Noticing others without judgment and seeing a situation with a “beginner’s mind,” as Jon Kabat-Zinn, founding director of the Center for Mindfulness in Medicine, would say, allows one to be positively curious. And curiosity fosters hope. Experimenting has to be with allowing oneself to make mistakes. By definition, an experiment is designed to determine an outcome, so there is no right or wrong here. My experiment this year is to demonstrate being more loving toward others. Not only do they benefit, but it is like putting on my own oxygen mask and loving myself. Finally, showing wonderment in a mindful way also allows me to be curious and imaginative in a non-judgmental way. Ultimately it is all about compassion for myself and others. This is exactly the recipe for the positive attachment and support we want to promote when working with children with traumatized histories.

iStock_000000556191XSmallSo where does singing come in? Well it is kind of like a social experiment. When we sing, we trigger our brain to hear calming and self-regulating sounds. As Stephen Porges, a professor of biological psychology and psychiatry at the University of Chicago, notes, in singing, we do everything right for our social engagement system. We connect, especially if we sing in a group, we listen, we breathe in and exhale in a controlled way, and we are using our all important mouth muscles. Porges referred to this as “yoga for our social engagement system.” More ideas like this are interwoven in the many courses and resources TLC offers.

Barb Dorrington

Secondary Wounding – A Family Healing Approach

December 21, 2012

iStock_000016267513SmallTLC GUEST BLOGGER: Cherie L. Spehar, LCSW, RPT-S, CTS, CTC

In earlier articles, we’ve discussed the impacts of secondary wounding and self-secondary wounding.  We covered some important interventive strategies for healing from this aspect of the trauma experience and how an individual can work within his or her own recovery process to overcome the effects of secondary wounding. Now, we take this a step further by examining how secondary wounding affects healing families.

Family systems are already disrupted and shaken by trauma. It is a time when families search for meaning, context and reason. Well intentioned people in the victim’s circle will say things that meaning to themselves, while inadvertently creating an atmosphere of blame for the victim (e.g., “Well, that makes sense because she was walking home alone in the dark”). To the victim, it implies that people think she did something wrong, and in the context of a traumatic event, that point no longer matters.

Often, effective psychoeducational guidance and support can relieve a family of the pain and guilt associated with this dynamic. At other times, it complicates the healing journey in unexpected ways, and additional supports may need to be considered. Let’s explore the sensitive issue of the traumatized family system, how trauma recovery can be supported or compromised, and some ideas to help.

How Secondary Wounding Impacts Families

When secondary wounding happens in a recovering family system, it can further destabilize it and cause issues with guilt, shame, anger and more.

Guilt – Most secondary wounding that occurs is not intentional. Yet, when family and friends learn about this aspect of trauma and the potential role they had in re-wounding, they are often faced with immense guilt at contributing to the victim’s experience and may berate themselves and blame themselves for “hurting someone I love so much.”

Young Woman ThinkingShame – Like guilt, once a family is introduced to the idea of secondary wounding, it can create a profound sense of shame. With shame, many people, understandably, may not have considered that their words of support could have hurt, and they shame themselves by starting to believe there is something wrong with them to not have known how to support the victim. A person can begin to think they are an unfit parent or friend for doing something that further hurt their child or friend.

Anger – The victim, once learning about secondary wounding, may also feel a temporary sense of anger at his or her perception of having been blamed or at fault. While this calms with continued, gentle psychoeducation, a sting may persist for some time as all family members integrate their understanding of this aspect of trauma.

How It Affects Trauma Recovery

Estrangement – I have worked with families who, because the secondary wounding was so severe, became emotionally, mentally and even physically estranged from one another. This is one of the most serious effects and takes a long time to heal. Victims will focus so heavily on this aspect of their trauma experience that they become stuck and are less able to work through the traumatic experience itself.

Distrust – Trauma already causes a disruption in a person’s ability to trust the world and the people in it. With secondary wounding, this can become exacerbated because by perception, the people they trusted to help them feel better inadvertently created shame, blame and minimization of their pain. Because a person’s view of the world is distorted after a trauma, regaining this trust can be a delicate process.

Extended recovery time – When secondary wounding is very prominent in a family system, or if it is perceived by the victim as particularly hurtful, this will certainly impact the time spent in trauma recovery. Family members may need to learn and relearn more helpful responses, and they in turn will also need their own level of support for their own healing, and to be as present for the victim as possible. Other supportive healing measures must accompany and integrate with the TLC Trauma Intervention Programs.

Integral part of trauma narrative – Because secondary wounding becomes part of the trauma experience, it also becomes part of the healing trauma narrative. It can be used in a positive way to make meaning of the event and how the family attempted to heal.

Intervention Suggestions

Psychoeducation – One of the most helpful measures a clinician can take to ease the perceptions that come about from secondary wounding is to share the following information:

  • What secondary wounding is
  • It is rarely intentional
  • It is not irreparable
  • Help to normalize and relieve guilt the family may be experiencing by indicating that they didn’t know what they didn’t know

Family Therapy – When secondary wounding is of particular prominence, it can impact a victim’s experience of the trauma themes and create a sense of being “stuck.” Family therapy specific to this issue can be most helpful. Sometimes, this can be as minimal as incorporating supportive adjunct family sessions to review secondary wounding as a family unit and facilitate a communicative process that allows for apologies, forgiveness and understanding. At other times, moving temporarily to a family therapy—Contextual Family Therapy is often my intervention of choice—that integrates well with other forms of family therapy to address deeper issues becomes necessary. Be sure to seek consultation about when each is most appropriate with any given case.

Mitigating Factors

Secondary wounding in families, while presenting additional obstacles, can also make space for opportunities of bonding, closeness and healing.  Families who navigate this situation well are noted to have a wide range of system resiliency factors such as fairly healthy existing interpersonal relationships with each other, a method of overall respectful communication, and a desire to remain close, connected, interested and engaged with one another.


It is important to note some dynamics that are especially difficult when healing from secondary wounding. There are some situations in which the process of secondary wounding is actually abusive, controlling or even intentional. There may be verbal or emotional abuse already occurring in the family system, and secondary wounding may be “standard practice” in the family’s interactions.

Also, with some of the victim’s supports, it may be quite difficult to generate an awareness or understanding of how and why secondary wounding is detrimental to a victim’s experience and healing.  Victims may feel unheard and unsupported when family members have trouble with this insight and continue to engage in secondary wounding during their interactions.

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As we have shared together in this series of articles, it is easy to see that secondary wounding is faceted, potentially complex, and in need of specialized attention. In my work, assessing and exploring secondary wounding is an integral part of trauma healing, not only in its acknowledgement, but in incorporating and addressing it as a treatment issue. Watch for new changes in the “Adults in Trauma Intervention Program,” which will specifically offer a process for doing this that weaves seamlessly into the familiar structured sensory interventions!

Cherie L. Spehar, LCSW, CTC-S, RPT-S
Founder and Director at Smiling Spirit Pathways

How Do We Know When Trauma Survivors are Ready to Fly on Their Own?

December 3, 2012

TLC Guest Blogger: Jean West, LCSW, CTC-S, CT

In working with survivors of trauma, there has always been one difficult question: How do we know when they are ready to fly on their own? I have used the SITCAP® program with over 100 children within the last four years with extraordinary results. One adolescent boy sticks out in my mind. I met with him about a month ago for our debriefing session. His father had been very abusive to him and his brothers when he was little, leading to his incarceration. After our session, with tears in his eyes, he said, “You know, I have never really told my story like that ever before.” This boy has had at least five years of counseling from professionals, and in our first session, he gained a new sense of relief from being able to truly tell his story because I was a safe, curious witness to what he had gone through.

Some of the Think-et game items available

I could write for days on children’s stories I have worked with, but what I want to focus on is how I pull it all together and know when I am through with my work. I use the SITCAP®  pre- and post-test (CAQ), which shows me how far their anxiety levels and PTSD symptoms have dropped. If they are still high in a specific area, such as anger, I will pull out more from the “One-Minute Interventions” material and dig further. I use play-based sensory interventions to go along with the program. For example, the Self Esteem Shop sells a tiny kit called “Think-ets Games,” which I use with families, individual sessions with children, and even in trainings. The kit consists of 15 tiny objects, ranging from an elephant to a wrench. There are several different activities you can do with this kit. The main activity I use is to take turns telling a story using the objects. One 13-year-old girl I am working with told the story of how lonely the elephant was and how much the elephant missed her brother and sister. This girl’s father had committed suicide over a year ago, and each of the three siblings have been separated, going from relative to relative, as mom is unable to care for them due to active substance abuse and homelessness. This activity helped me know where to go as a practitioner to further the healing process.

Left to Right: Caelan Kuban, Cherie Spehar and William Steele

This is an example of a play-based assessment, like those that will be presented at TLC’s Training and Certification Conference in San Antonio, TX, Feb. 21-24, 2013. Everything from “Sensory Interventions” with William Steele to “Advanced Structured Sensory Interventions” with Caelan Kuban and Sarah Slamer will be offered, so any level of practitioner will benefit from attending. I am especially excited about Cherie Spehar’s new training on “Putting it all Together: Trauma Assessment, Practice Points and Trauma Integration” because that is where I feel like I am at in my walk with SITCAP® . Learning more play-based assessment techniques, exploring secondary wounding and its effects on trauma recovery, and most of all learning trauma-focused closure interventions that support the new survivor as they fly on their own! I can’t wait to go and hope to see you there!

Adoption Awareness: Avoiding Adoption Disruption

November 7, 2012

TLC Guest Blogger: Annette Miner, CWY, CTC-S, CYC

“We have given our child everything; so much love, a great home, everything she could ever want, but it doesn’t seem to matter. We have done everything we can think of. We have read every book on child rearing, tried everything to get this behavior under control, and nothing has worked. We don’t know what else to do! We love her, but we don’t know how much longer we can do this.”

Sound familiar? There may be different families or different ways of expressing deep emotion, but basically the same story is told over and over again by parents who have adopted children with histories of trauma.

Various studies have been done on adoption disruption with statistics fluctuating on their findings. One publication, “Adoption Disruption and Dissolution,” Child Welfare Information Gateway, states that adoption disruption on average ranges from as low as 6–25 percent, depending on the population studied, and various other factors. It went on to break down results found in various populations studied. Although this was not a national study, the information gathered is worth reviewing from a trauma-informed perspective.

Adoption disruptions pointed to traumatic experiences being demonstrated through behavior. Here are some examples:

  1. Children having a history of sexual or emotional abuse
  2. Children with physical disabilities and emotional or behavioral problems
  3. Each additional year of age increased the likelihood of disruption, which went up by 6 percent
  4. Children who entered the child welfare system due to lack of supervision or environmental neglect
  5. Adoptive parents feeling they had a lack of information on where to go for appropriate services as well as the cost of services
  6. And many other factors

Often by the time an adoptive family comes for help, they are emotionally exhausted and feeling quite helpless and oftentimes hopeless. They may have sought help from books or other well-meaning support systems, but often resources given for dealing with behavioral issues in general are in the form of behavior modification. These approaches simply do not work. In fact, they often compound a child’s trauma experiences.

It must be a relief for adoptive families who are struggling when they are able to receive trauma-informed care for their families and education on trauma and trauma responses, as well as being given strategies and ways in which to help their child feel safe. Having a trauma specialist/consultant who understands what is happening at a deeper level within their child provides parents with the hope that their child will finally have the help he or she needs to find relief from and completion/resolve of their traumatic event(s).

TLC offers a number of excellent training options to practitioners on providing trauma-informed care to these children and their families.

TLC offers many tools and resources as well for practitioners to use with families when explaining trauma. TLC also offers exceptional trauma intervention tools to help children work through their traumatic experiences.

TLC offers tools for Foster/Adoption:  Foster Care Workbook and My Care: A Book for Transitions

I cannot help but believe statistics will change if adoptive parents are given education and tools on trauma and trauma response as part of their pre-placement training, as well as post-adoption, trauma-focused support once adoption has taken place. Adopted children and their new families deserve to have the best start they can as they begin their journey together!