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Trauma-informed responses in relationship-based practice

04 June 2018

Danny TaggartDanny Taggart

I once worked with a young mum who had been referred to a mother and baby assessment unit. The unit was nicely decorated to make it family friendly and homely. As we sat together talking about her baby, I remembered that this mum had been in care.

I asked her what it was like to be back in the system, this time as a mother. She told me about how she had been sexually and physically abused by a member of care staff and that she had managed this by being a ‘bad little girl’ who was always naughty and loud. We talked about how clever a strategy this was to protect herself as a child, but how this way of managing might not serve her as well now.

After we had spoken I couldn’t help noticing the things about the assessment unit that gave it away as not being a proper home. The fire extinguisher on the wall, the heavy doors, the staff office at the front of the building with a latch on the door. It occurred to me that this might have been very like the building that this mum had been housed in as a child. A place that looked like a home, but wasn’t. I wondered if she might be subtly triggered by these physical reminders of her childhood abuse and if she was in a state of reliving her trauma while trying to look after her baby. Surrounded by people who seemed to mean well, but also reminded her of her abuser. Sadly, the assessment unit stay did not go well. However, I think that this mum and I were able to think together about the impact her traumatic past was having on her life now. Also how important it was to separate out the past from the present in order for her to have a different future with her baby.

This story can help us to be in touch with what it is like to live with trauma. Sensing that no matter where we turn, there are reminders all around us of terrible things that may have happened. That often the strongest reminders of trauma are not outside at all, but inside our minds and bodies, like unwanted guests who refuse to leave us in peace (Fraiberg et al, 1975). It speaks to the fact that for many traumatised young people, the behaviors they display, which we consider challenging, are actually ways they have learnt to try and protect themselves (Ford and Blaustein, 2013). This young mother’s story also helps us to understand how difficult it is for survivors of trauma to trust that help offered by authority figures, such as professionals, is genuine and that the intimacy offered by a therapeutic relationship is different from the forced intimacy and abuse that characterise physically and sexually abusive relationships. It helps us remember the uncomfortable truth – that many of the young people in our social care, mental health and justice systems are victims of abuse and neglect (Young Minds, 2018) and that sometimes rather than helping them, service provision can inadvertently lead to retraumatisation (Ho et al, 2008).

Trauma-informed approaches

One way to work with traumatised young people is to build upon social work’s commitment to relationship-based practice and develop services that adhere to the principles of trauma-informed approaches. The core components of this approach, and some suggestions for how they might be enacted by practitioners and then experienced by young people, are detailed below (Sweeney et al, 2016):

 

What this means for services

What this feels like to young people

Recognition of trauma

Finding a way to check out if anything has happened to a young person in our care.

‘I am being seen and believed.’

Avoidance of re-traumatisation

Trying to minimise taking control away from the young person, being transparent and talking about it if we have to do this.

‘They are not like the people that hurt me.’

Cultural, historical and gender context

Being sensitive in selection of key workers and treatment to the young person’s specific identity.

‘They thought about me as a unique person. Me as a whole person.’

Trustworthiness and transparency

Being explicit at all times what services are doing and why.

‘When they say they will do something, they do it.’

Collaboration and mutuality

Understanding power imbalances and working to ‘flatten the hierarchy’.

‘We are working through this difficult stuff together.’

Empowerment, choice and control

Enable the development of agency through access to resources.

‘I am taking control of my life now.’

Safety

Developing safe systems- from admin processes through the entire organisation to be trauma informed.

‘I feel like I can finally begin to trust people again.’

‘It might be worth seeing if they’re trustworthy.’

Survivor partnerships

Peer mentor, peer support and young people led social action groups.

‘Meeting other people like me makes me feel less alone.’

Pathways to specialist trauma treatment

Development of links to specialist, evidence based psychological therapies and medication.

‘I go somewhere safe to talk through what happened to me.’

 

Conclusion

For professionals working in a trauma-informed way – listening to young people carefully, helping them recognise how past experiences influence their ways of relating to the world today and offering a trustworthy relationship where they can try to build a safer life for themselves – might be the most important service we can offer them (Knight, 2015). It is through this re-forging of social bonds and the development of different types of relationships that young people can learn to live with the legacy that trauma leaves and where the hope for a different type of life can be fostered.


About the author

Danny Taggart is a clinical psychologist at the University of Essex. He works clinically and conducts research in the field of edge of care interventions – parent infant mental health and recurrent care services. Today, Danny is writing a Research in Practice Frontline Briefing for social care staff on the importance of trauma-informed approaches with young people.


Research in Practice Webinar

Danny Taggart is the presenter of the Research in Practice Webinar 'Trauma informed responses in relationship-based practice'. The webinar explains how recognition of adolescents' past experience can play a critical role in supporting the safety, permanency and wellbeing of adolescents and young adults. 


Related resources

Resources relating to trauma research and trauma informed approaches:

SAMHSA - Trauma-Informed Approach and Trauma-Specific Interventions

ACEs Connection

An example of how trauma research is being used in the UK:

Adverse Childhood Experiences and their association with chronic disease and health service use in the Welsh adult population

A social work piece on re-traumatisation:

Preventing Retraumatization: A Macro Social Work Approach to Trauma-Informed Practice and Policies


References 

Ford J and Blaustein M (2013) ‘Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs’. Journal of Family Violence 28 (7) 665–677.

Fraiberg, Selma, Adelson, Edna and Shapiro, Vivian (1975) Ghosts in the Nursery: A Psychoanalytic Approach to the Problems of Impaired Infant-Mother Relationships. Available online: http://infantmassage.org.au/wp-content/uploads/2014/11/Fraiberg-Ghosts-in-Nursery.pdf  

Ho et al (2008) Creating Trauma-Informed Systems: Child Welfare, Education, First Responders, Health Care, Juvenile Justice. Available online: https://pdfs.semanticscholar.org/642b/2b0ae392ccd12d2c8c1c006a80238a98d099.pdf

Knight (2015) Trauma-Informed Social Work Practice: Practice Considerations and Challenges. Available online: https://www.researchgate.net/publication/271773782_Trauma-Informed_Social_Work_Practice_Practice_Considerations_and_Challenges

Sweeney et al (2016) Trauma-informed mental healthcare in the UK: what is it and how can we further its development? Available online: https://www.emeraldinsight.com/doi/full/10.1108/MHRJ-01-2015-0006

Young Minds (2018) Addressing Adversity – Prioritising adversity and trauma-informed care for children and young people in England. Available online: https://youngminds.org.uk/media/2142/ym-addressing-adversity-book-web.pdf  

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