TLC 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.
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.
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 www.starrtraining.org/trauma-certification. One of the online courses TLC offers focuses on the differential diagnosis between ADHD and PTSD.
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.
TLC 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:
- Belief in self
- 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.”
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.
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:
- Academic Achievement: better attendance, more likely to graduate, better attitudes toward school, more likely to go on to higher education
- Health and Safety: prevent substance abuse, lowers engaging in negative, delinquent behaviors
- 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!
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:
- Find local mentoring resources and begin utilizing them.
- Learn about National Mentoring Month.
- Consider becoming a mentor yourself.
- Find ways to partner with local mentoring programs.
- Thank your mentor.
- Make a donation to a local mentoring organization.
- Research and learn about the amazing impact that mentoring can have on the lives and future of youth.
- Jan. 10 is “I am a mentor” day. Do something!
- Jan. 21 – Join Martin Luther King Day of Service. Use this day to highlight the importance of mentoring.
- Learn about the many and varied mentoring relationships – academic, social, etc. – with children and teens.
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: http://www.pediatrics.org/cgi/content/full/peds.2007-0508v1
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: http://www.srcd.org/documents/publications/spr/ spr20-3.pdf
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.
So 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.
TLC 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.”
Shame – 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.
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.
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.
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
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.
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.
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!
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:
- Children having a history of sexual or emotional abuse
- Children with physical disabilities and emotional or behavioral problems
- Each additional year of age increased the likelihood of disruption, which went up by 6 percent
- Children who entered the child welfare system due to lack of supervision or environmental neglect
- Adoptive parents feeling they had a lack of information on where to go for appropriate services as well as the cost of services
- 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 core certification courses, such as Children of Trauma and Structured Sensory Intervention, provide basic information needed to understand how traumatic experiences effect children from a sensory perspective, as well as offering information on how to provide trauma-informed care for these children
- Numerous online courses to choose from that provide information for working with specific populations (i.e. Zero to Three and Domestic Violence)
- Level-1 and Level-2 Trauma and Loss eCertification. All courses are offered online so you can receive full certification right from your own home
- Attendance at TLC’s Childhood Trauma Practitioners’ Assembly, then completing certification online from home
- TLC will come and train in your agency
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.
- Booklets: What Parents Need to Know, A Trauma is Like No Other Experience and After a Traumatic Loss
- Programs: Trauma Intervention Program and What Color is Your Hurt
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!