Download Life journeys and trauma: the difference being trauma

Life journeys and trauma:
the difference being trauma-informed could make
Dr Cathy Kezelman, President
Adults Surviving Child Abuse (ASCA)
Let’s great real about trauma
Getting real about trauma
Trauma is:
• highly prevalent all communities
• substantial public health issue
• often intergenerational
Complex trauma - child abuse all forms,
witnessing/experiencing domestic/community violence,
living with parent with mental illness, who abuses
substances, whose parent is imprisoned, compounded
grief, loss, separation, marginalisation, entrenched
disadvantage, poverty
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Responses to trauma
Understanding trauma dynamics
Individuals and communities often
•
respond to trauma with fear and hyperarousal
• cope by using emotional and psychological numbing,
avoidance and withdrawal
Consequences of trauma for individuals and communities
include loss of memory (personal and collective history) ->
loss of connectedness, meaning making and integration of
experience (body, mind, emotions)
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Trauma and recovery
Key messages
• The `social brain’ is built over time. Neural growth and change
can take place across the lifespan (neuroplasticity).
Trauma can be resolved-recovery is possible
• When trauma not resolved-> impaired attachment and
difficulties in relating to self, others and world
Resolution of parental trauma breaks intergenerational
transmission – children do better
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What do we need to do - individuals?
Acknowledging impacts of trauma – individuals
We need to work with people, families and communities
•
truly collaborate with lived experience of individuals and
families
• strengths-based model
• break the cycle
• re-build/establish enduring trusting relationships at all levels
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What do we need to do – services?
Acknowledging impacts of trauma – services
Embrace paradigm cultural shift of trauma informed policy
reform, embed into systems, services and practice
‘Incorporating knowledge about the traumatic experiences
that underlie most of child and adult psychopathology is
terribly threatening to the existing worldview and the mental
models upon which human service-delivery is built’ (Bloom,
2011:126)
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What do we need to do – communities?
Acknowledging trauma – communities
• Overcome secrecy, silence – justice, accountability
• Tackle stigma, taboo, myths - speaking out, stories of recovery,
testimonies
• Overcome denial, disbelief – community education and information
• Minimise discrediting, ostracism – human rights, acceptance,
understanding
• Raise awareness, change attitudes - promoting healthy connections/
relationships, campaigns
`
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Community Resilience and Wellbeing (1)
Building healthy communities – healthy relationships
• People are harmed in interpersonal relationships; all abusive acts of
commission or omission involve breaches of this principle
• Most important paradigm shift is a move to what happens between
people. Healing occurs in healthy interpersonal relationships
Babies, children and adults all need to be listened to, understood,
respected and valued – community and care responses all embody the
principles of listening, understanding, respecting and valuing – Trauma
informed principles
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Community Resilience and Wellbeing (2)
Intergenerational patterns of trauma
Often, violence transmitted from generation to generation in cyclical
manner. Witnessing/ experiencing violence in childhood significantly
increases the risk of becoming a perpetrator or victim in later life.
•
DV /interpersonal violence
• Child protection
• ATSI; refugee communities
Naming the trauma underscores the “…difficulty for people to recover
from the effects of individual trauma when the community on which they
have depended has become fragmented and disconnected.” (Krieg, A.
Australasian Psychiatry 2009)
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What is the best start? What isn’t? (1)
Building healthy relationships with care-givers
• When child experiences trauma, secure parent or caregiver ->,
helps restore sense of safety and control.
• When parent cannot manage own reactions, is distressed and
overwhelmed-> overwhelmed child.
•
If repeated or if parent/ caregiver source of distress -> child does
not learn how to manage emotions, emotional arousal and/or
process what is happening.
‘The child’s first relationship, the one with the mother, acts as a
template, as it permanently moulds the individual’s capacities to enter
into all later relationships’
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What is the best start? What isn’t? (2)
Need for consistent attuned caregivers
Babies and children learn best when they feel safe, calm,
protected, and nurtured by their caregivers.
When loved well-treated children are becoming acquainted with
self – celebrating a developing sense of discovery, autonomy,
and fledging impressions of self-efficacy – abuse victim is
focussed on psychological survival (Briere, 1992: 45-46)
`Emotional abuse, loss of caregivers, inconsistency, & chronic
misattunement showed up as the principal contributors to a
large variety of psychiatric problems’ (Dozier, Stovall, & Albus, 1999; Pianta,
Egeland, & Adam, 1996; van der Kolk, ibid)
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Understanding Troubled kids (1)
Trauma dynamics
Troubled kids have trouble relying on others, utilise childhood defences
to manage extreme emotions
• excessive anxiety/ rage + intense desire to be taken care of <->
push people away.
Attempting to take control of what they believe is the inevitable return of
chaos, they appear to `provoke’ it in order to make things
feel...predictable’ (Perry, 2006:55)
• easily triggered by reminders of trauma -> trauma, as if in present.
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Understanding Troubled kids (2)
Being trauma informed
Troubled kids:
• struggle with relationships - caregivers, peers, intimate partners.
• struggle to regulate emotions, control impulses, maintain attention,
reason when under stress
•
prone to re-victimisation - repeated interpersonal trauma
`Response to trauma causes serious problems when
misunderstood by caretakers’
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Understanding Troubled kids (3)
When not trauma –informed
• -> Labelled e.g. “oppositional”, ‘rebellious”, “unmotivated”,
“antisocial” + punitive rather than supportive responses.
• Diagnoses without capturing lived experiences/reactions to trauma
e.g. PTSD often inappropriate; multiple co-morbidities - Depression,
ADHD, ODD, Conduct Disorder, GAD, Separation Anxiety Disorder,
Reactive Attachment Disorder.
Each diagnosis cherry-picks aspect of child’s experience
or behaviours rather than looking holistically in the context
of their trauma, their attempts to manage their traumatic
stress and impacts
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Trauma - making healthy transitions (1)
Understanding trauma dynamics
Adolescents abused or neglected were often maltreated when younger
-> cumulative effects of abuse and neglect.
•
Most teenagers act impulsively at times, make poor decisions or
take risks - more prevalent and extreme in abused adolescents.
• Traumatised adolescents focus on survival -> delays in school and
in social skills -> take risks e.g. experiment with drugs and crime.
Can’t model healthy adult relationships and/or for becoming good
parents.
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Trauma – making healthy transitions (2)
Being trauma informed helps us understand:
• That “acting out,” “self-destructive,” “borderline,” or “conductdisordered ” presentations/diagnoses are strategies to cope
• That suicidality, self harm, substance abuse, eating disorders,
excessive risk-taking, physical altercations - are behaviours
that help adolescent to distract, soothe, avoid, reduce ongoing
or triggered trauma-related dysphoria (Perry, 2006:90).
Consistent care is required `Just because a child is older does
not mean a punitive approach is more appropriate or effective’
(Perry, 2006:244)
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Trauma – making healthy transitions (3)
Trauma informed practice : supporting healthy transitions
• establish safety in environment - home, school, and
community
• help develop skills in emotional regulation and
interpersonal functioning
• help to make meaning about trauma/ find more
constructive self perceptions
• establish hope
• enhance resiliency and social integration
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Trauma – Contributing life (1)
Trauma dynamics
• Can create lifetime patterns of fear/ mistrust, sensitivity to
criticism
• Impact identity, self-esteem, relationships, ability to regulate
emotions, self-soothe, self-care; manage stress
• Cause body symptoms and sense of hopelessness
• Create difficulty feeling and being safe, being self-protective
• Contribute to withdrawing/isolation - > often don’t seek help,
engage in/or sustain treatment, and/or participate in community.
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Trauma - Contributing life (2)
Being trauma-informed
When mental illness +/- drug/ alcohol use +/- criminal behaviour ->
rejection by community; difficulty seeking or finding care, housing,
regular employment.
• self-harm, suicidality, risk-taking behaviours; criminal justice issues
• mental health, substance abuse; physical health
• relationship challenges -> isolation, disconnection
Adult survivors often little experience of core trauma informed
principles - safety, trustworthiness, choice, collaboration, empowerment
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Trauma – Body and soul (1)
Adverse Childhood Experiences Study has established:
• (1) Adverse childhood experiences are `vastly more
common than recognized or acknowledged’
•
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(2) They powerfully impact both mental and physical
health `a half-century later’ (Felitti, 2002:45).
Trauma - Body and soul (2)
Understanding intersection of physical and mental health
ACE Study established:
•
conversion, over time, of childhood coping mechanisms into
risk factors for adult physical and mental health problems (Felitti,
Anda et.al., 1998)
• highly significant relationship between adverse childhood
events and alcohol/drug abuse, sexual promiscuity/sexually
transmitted diseases, cigarette smoking, obesity, physical
inactivity.
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Trauma - Breaking the cycle (1)
Changing the paradigm:
Medical model <-something is wrong with a person.
Symptoms, signs, diagnosis -> treatment plan.
In the context of trauma most important factor is an
understanding of what happened to the person. What was
the impact of their traumatic stress? How did that person
manage and how are they managing now?
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Trauma - Breaking the cycle (2)
Understanding trauma dynamics
Psychiatric patients subjected to childhood sexual and physical abuse
•
•
•
•
•
earlier first admissions; longer/ more frequent hospitalisations
longer in seclusion; more medication
more likely to self-mutilate
high symptom severity
more likely to attempt suicide
Fink Read et al cited ACE’ing trauma Informed Care “Breaking the Silence”, National Council of Community
Behavioural Healthcare 2001, issue 2
“When we pathologise a survivor’s coping mechanisms or
unintentionally recreate the abuse by use of forced medication,
seclusion or restraint we can also do more harm. We must offer
trauma-informed services and supports.”
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Trauma - living long and strong (1)
Compounded trauma
Elderly
• vulnerable, increased frailty
• power imbalance enables abuse + reduced ability to respond
• dependency, isolation
• social disadvantages -> particular risk of abuse/ victimisation.
Many elderly are abused in homes, relatives’ homes, and/or in care
facilities.
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Trauma - living long and strong (2)
Re-traumatisation
• Traumatic events often compounded ; impacts, cumulative; elderly
at particular risk of re-traumatisation.
• Triggers of past trauma-> memories flood present
• Old age - realities of mortality; unprocessed grief and loss
compounded by multiple losses
• Many high prevalence disorders e.g. depression and anxiety are
underpinned by undiagnosed/ untreated trauma
Medication - heightened sensitivities to side effects, polypharmacy and
challenges of compliance with dosage schedules.
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ASCA contact details
Support
Professional Support Line: 1300 657 380
Counsellor: [email protected]
Website: www.asca.org.au
Professional Development and Training Inquiries
[email protected] ; 02 8920 3611
Guidelines www.asca.org.au/guidelines
Dr. Cathy Kezelman, ASCA President
[email protected] ; 0425 812 197
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