Life journeys and trauma: the difference being trauma-informed could make. Dr Cathy Kezelman, President Adults Surviving Child Abuse (ASCA)

Transcription

1 Life journeys and trauma: the difference being trauma-informed could make Dr Cathy Kezelman, President Adults Surviving Child Abuse (ASCA)

2 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 102

3 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) 103

4 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 104

5 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 105

6 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) 106

7 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 ` 107

8 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 108

9 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) 109

10 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 110

11 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) 111

12 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. 112

13 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 113

14 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 114

15 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. 115

16 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) 116

17 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 117

18 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. 118

19 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 119

20 Trauma Body and soul (1) Adverse Childhood Experiences Study has established: (1) Adverse childhood experiences are `vastly more common than recognized or acknowledged (2) They powerfully impact both mental and physical health `a half-century later (Felitti, 2002:45). 120

21 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. 121

22 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? 122

23 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. 123

24 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. 124

25 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. 125

26 ASCA contact details Support Professional Support Line: Counsellor: Website: Professional Development and Training Inquiries ; Guidelines Dr. Cathy Kezelman, ASCA President ;