- Carolyn Knight
- Clinical Social Work 45, (2015)
The majority of individuals seeking or required to seek services in addiction, mental health and child welfare settings are adult survivors of childhood trauma. The focus in these settings is generally on the present-day difficulties that the survivor is struggling with, while underlying past trauma and its impact on current functioning is often overlooked.
Similar traumatic childhood events are experienced differently by individuals as a result of a number of factors (for example, social, individual, intra-familial). Childhood trauma, particularly when it involves interpersonal victimisation, is associated with a range of difficulties in adult life including depression, low self-esteem, anxiety, substance abuse and eating disorders. These experiences also colour the way survivors think about their social world, potentially leading to isolation and difficulties forming positive relationships of trust.
At the core of trauma-informed practice is a practitioner's sensitivity to the ways in which the client's current problems can be understood in the context of past victimisation. Also important is the need for practitioners to recognise that, because of negative past experiences (including negative experiences of professional intervention) survivors may be unable or unwilling to enter into a working alliance with them.
Gold (2001) concluded that trauma-informed practice helps survivors "develop their capacities for managing distress and for engaging in more effective daily functioning". It recognises that the working alliance between survivor and professional can provide a corrective emotional experience for them. This is achieved through the development of a relationship that can challenge distortions in the client's thinking about the self and others. The therapeutic potential of the relationship depends upon workers being knowledgeable about childhood trauma and its relationship to current difficulties.
There are four principles of trauma-informed practice:
- Normalising and validating clients' feelings and experiences
- Assisting them in understanding the past and its emotional impact
- Empowering survivors to better manage their current lives
- Helping them to understand current challenges in light of past victimisation.
The ability to convey empathy and understanding serves to affirm and validate a survivor's feelings and experiences, thereby reducing isolation and feelings of being alone and different. Solution-focused techniques are also important in strengthening the client's self-capacities by helping them identify positive ways they have coped in the past. Techniques such as writing, art and other physical activities allow survivors to express feelings non-verbally.
Several studies have reported that survivors find professional input unhelpful if they:
- Avoid addressing the trauma
- Ask for too much detail
- Encourage expression of feelings when it is not appropriate
- Minimise the significance of the trauma in the client's current life.
Potential challenges in using trauma-informed practice when working with clients with a history of childhood trauma include:
- The client not reporting the childhood trauma because of the shame and guilt this engenders
- The client having little or no memory of past trauma, often as a result of repression as a coping mechanism
- The impact on professionals of working with highly distressed clients, which can lead to secondary traumatic stress, vicarious trauma and/or compassion fatigue.
Implications for practice
- Practitioners should be sensitive to the ways in which clients' histories affect their present-day challenges. They should aim to validate clients' experiences to empower them to manage their lives more effectively.
- Developing a working alliance is key to addressing the long-term effects of childhood trauma. Practitioner skills required include empathy, working in partnership and helping clients either express or contain feelings.
- The author notes the importance of not directly addressing the trauma before the client is psychologically and emotionally ready to do so as it may re-traumatise them and affirm their sense of powerlessness.
- Practitioners should employ self-care strategies to minimise the impact of indirect trauma and counter-transference. The organisational culture is crucial in engendering a climate that encourages practitioners to talk about and manage their feelings.
The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice part of the Dartington Hall Trust.
This article is part of CYP Now's special report on Children's Mental Health. Click here for more